Purpose: to study the association of blood pressure (BP) visit-to-visit variability (VVV) with non-valvular atrial fibrillation (AF) in rural dwellers with arterial hypertension (HTN). Material and methods. The cross-sectional study retrospectively analyzed complex data from consecutive 160 males with primary HTN (mean age 50 ± 6 years). Patients with major HTN complication were excluded. We analyzed the office systolic BP (SBP) and diastolic BP (DBP) levels, obtained at four consecutive doctor`s visits. As a metric of BP VVV, we used standard deviation (SD) and coefficient of variation (CV) values. The criteria for high BP VVV were Patients were ascertained to have high BP VVV in case of SD (SBP) ≥15 mm Hg and/or SD (DBP) ≥14 mm Hg. Totally, high BP VVV status was in 82 (51,3 %) patients. Paroxysmal AF was detected in 29 (18,1 %) patients. Results. HTN with AF group (vs. HTN alone) was characterized by higher average values of BB VVV metrics (median, interquartile range): SD (SBP) (16,7 (15,9-17,5) vs. 8,7 (4,6-15,2) mm Hg, respectively); SD (DBP) (11,5 (8,9-14,6) vs. 5,7 (3,9-8,9) mm Hg, respectively); CV (SBP) (10,1 (9,6-10,7) vs. 5,6 (2,9-9,2) %, respectively); and CV (DBP) (12,9 (9,3-15,5) vs. 6,3 (4,1-9,7) %, respectively) (р<0,001 in all the comparisons). Additionally, HTN with AF group associated with worse kidney filtration function (estimated glomerular filtration rate (eGFR): 57 (53-59) vs. 67 (62-77) ml/mim/1,73 m2, respectively) and more pronounced albuminuria (urine albumin/creatinine ratio (A/Cu): 36,1 (32,3-40,6) vs. 10,3 (6,5-26,9) mg/mmol, respectively) (р<0,001 in both comparisons). While integral assessment of eGFR and A/Cu values, we determined higher frequency of patients with high and very high cardiovascular and renal adverse events risk (AER) in HTN with AF group. Moreover, patients with HTN and AF presented with higher left atrial antero-posterior dimension (LAD) (4,3 (4,2-4,6) сm vs. 3,9 (3,6-4,1) cm, respectively; р<0,001), as well as with more advanced left ventricular remodeling. At multivariable analysis, SD (SBP) ≥15 mm Hg and SD (DBP) ≥14 mm Hg, along with AER and LAD, were the most significant factors independently associated with AF. Conclusion. In rural males with HTN, the presence of high BP VVV is one of the factors associated with non-valvular AF risk increase. High BP VVV could be proposed as an additional modified AF risk factor in patients with HTN.
Purpose: to establish the possibilities of modifying blood pressure visit-to-visit variability (VVV) in rural males with arterial hypertension (HTN) by the use of antihypertensive therapy (AHT), considering also the correction of dyslipidemia and certain lifestyle aspects, as well as the changes in compliance with pharmacotherapy (CP). Material and methods. The prospective study enrolled 160 rural males with uncomplicated primary HTN (mean age 50 ± 6 years). Seventy three (45,6 %) patients were overweight; 85 (53,1 %) patients were active smokers. An alcohol consumption ≥1 time per week was pointed out by 77 (48,1 %) males. VVV (of systolic (SBP) and diastolic blood pressure (DBP)) was assessed by means of standard deviation (SD) and coefficient of variation (CV). We prescribed a fixed perindopril/amlodipine (P/A) combination, with indapamide (IND) addition as required. With the aim dyslipidemia correction, we prescribed atorvastatin (daily doses 10-40 mg). Optimal CP was pointed out by 37 (23,1 %) patients. Results. At 1yFU, all enrolled patients achieved SBP/DBP targets (<140/90 mm Hg), and strict SBP/DBP targets (<130/80 мм Hg) were achieved in 159 (99,4 %) cases. More than 90 % of patients achieved the following prespecified «target» BP VVV levels: SD (SBP) <4,8 mm Hg; CV (SBP) <3,9 %; SD (DBP) <3,7 mm Hg; CV (DBP) <5,1 %. Aimed to predict SD (SBP) reduce >9,7 mm Hg probability at 1yFU, we built the 6-factors logistic regression model: 1) improvement and maintenance of optimal CP (by MGLS) (β = 1,27; р<0,001); 2) body mass index reduce >1,3 kg/m2 (β = 0,57; p=0,035); 3) alcohol consumption modifying (0,72; p=0,007); 4) optimal compliance with atorvastatin daily doses 30-40 mg (1,25; p<0,001); 5) smoking status modifying (0,43; р=0,097); 6) SBP reduce >46,7 mm Hg (0,47; р=0,098). The probability of status «reduction of SD (SBP) >9,7 mm Hg at 1yFU» increase was associated with the higher sum of predictors` β-coefficients. Conclusions. In rural HTN males, at 1yFU, the AHT (based on P/A, with IND addition as required) favored the significant blood pressure VVV reduction in the vast majority of cases. The SBP VVV reduction was determined to be additively affected by the modifying of certain factors, as well as by achievement and maintenance of maximum CP.
The aim: To determine the relationship between modified, unmodified cardiovascular risk factors (CRF) and intervisit arterial pressure variability (IAPW) in men of working age with arterial hypertension (AH).Material and methods. We examined 160 men with uncomplicated AH, among them, 82 patients had high IAPW, and 78 patients – low IAPW. The average age in patients with high and low IAPW did not differ and was 50.65 ± 6.14 and 50.26 ± 6.27 years, respectively (p = 0.689). Indices of IAPW were calculated based on the standard deviation (SD) of measurements of office blood pressure during 4 visits to the clinic. The criterion for high IAPW was the value of systolic arterial pressor (AP) – 15 / 15 mm Hg (day / night), for diastolic AP – 14/12 mm Hg (day / night). The analysis was carried out using standard statistical methods for parametric and non-parametric parameters. Results. It has been established, that the frequency of both modified and unmodified risk factors is greater in patients with hypertension and high IAPW, than in patients with low IAPW. The presence of obesity (36 of 82 versus 7 of 78; р ≤ 0.0001), family anamnesis (71 of 82 versus 52 of 78; p = 0.004), smoking episodes (62 of 82 versus 12 of 78; р ≤ 0.0001) and alcohol use (24 of 82 versus 2 of 78; p ≤ 0.0001) is significantly more common in patients with high IAPW, than in patients with low level of IAPW. There was a direct correlation between the MBA value and the percentage of 10-year risk of cardiovascular death on the SCORE scale (r = 0.47; p ≤ 0.0001) іn patients with hypertension.Conclusion. The results of the study confirm the hypothesis that, it is expedient to determine IAPW in patients with AH, as an independent prognostic risk factor for cardiovascular complications.
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