Aim. To study the relationship of orthostatic hypotensive reactions (OHR), detected using active (AOT) and passive orthostatic tests (POT) with the state of cognitive functions in patients with arterial hypertension (AH) in older age groups. Materials and methods. 75 patients with hypertension I-III stage were examined (67±5 years). Patients received regular antihypertensive therapy, excluding medication on the day of the study. The study of the OHR was carried out using a 5-minute AOT and 5-minute POT with a minute-by-minute measurement of blood pressure on the shoulder using the oscillometric method and continuous non-invasive measurement of systolic (SBP) and diastolic (DBP) blood pressure in the finger artery by a photocompensation method (Task Force Monitor, CNSystems, Austria). The presence or absence of classical orthostatic hypotension (COH) and initial orthostatic hypotension (IOH) was assessed according to the criteria of the European Society of Cardiology (ESC-2018). The study of cognitive functions was carried out using a brief study of the mental state (Mini-Mental State Examination - MMSE), the clock drawing test and the Münstenberg test. The analysis was performed using Statistica 6.0. Data from sets with normal distribution were compared using student's t-test, Mann-Whitney test was used when comparing data with a distribution different from the normal one. To compare the groups on qualitative characteristics used Fisher's exact test. Results. In 23 (31%) patients, different types of OHR were identified, of them, 9 (12%) had isolated IOH, 14 (19%) had COH, among which 7 patients had a combination of COH+IOH). The revealed COH was neurogenic in all patients. The test result for drawing clocks in patients with OHR was significantly worse compared with patients without OHR (7.5±1.5 vs 8.4±0.8, p0.05; MMSE test: 25.7±2.3 vs 26.9±1.2, p>0.05 respectively). Conclusion. OHR was detected in 31% of patients with AH in older age groups. The most pronounced decrease in cognitive functions was observed in patients with hypertension with COH.
Aim. To study the condition of cerebrovascular autoregulation and reactivity in different variants of orthostatic hypotensive reactions (OНR) in elderly patients with hypertension (АН). Materials and methods. 50 patients with AH were examined (80% of women) aged 60 to 82 years (68.55.3). The duration of hypertension is from 2 to 43 years (16.811.6 years).The daily blood pressure profile was evaluated by the method of daily monitoring of blood pressure (BPLab, Russia). A study of OНR was carried out using an active orthostatic test (AOP) with continuous monitoring of cerebral blood flow (CBF) and with a minute measurement of blood pressure by the oscillometric method and continuous non-invasive measurement of SBP (systolic blood pressure) and DBP (diastolic blood pressure) in the finger artery (Task Force Monitor CNSystems Austria). The CBF velocity in the middle cerebral artery (SMA) was estimated using a transcranial sensor with a frequency of 2 MHz on an Angiodin-2K ultrasound machine (BIOSS company, Russia). In SMA, systolic (Vs), diastolic (Vd), average cerebral blood flow velocity ACBF (Vm), pulsation index (Pi), and vascular resistance index (Ri) were recorded. The difference between the indicators was calculated initially and during AOP (in the first 30 seconds and for 3 minutes): Vm30s, %, Vm3m, %. Reactivity was assessed using a hypercapnic test (HCP) with breath holding. The relative change in the CBF indicators in the MCA was calculated by the formula: Kr = (Vm1Vm2)100%/Vm1, where Kr is the reactivity coefficient, Vm1 ACBF at rest; Vm2 ACBF during the test. Statistical analysis was performed using the non-parametric MannWhitney method using Statistica 6.0. Results. In 17 (34%) patients with AH, OGR was detected. In 6 (12%) examined patients, initial OHR (IOH) was detected, in 6 (12%) classic OHR (COH), in 5 (10%) there was a combination of COH+IOH. According to the ABPM data, in patients with OHR compared with patients without OHR, there were no significant differences in the daily level of blood pressure (mmHg), SBP: 131.712.2 vs 131.313.8, p0.05; DBP 74.311.8 vs 75.38.9, p0.05). In AOP, patients with OHR significantly decreased Vm in orthostasis compared with patients without OHR, both in the first30 seconds and at 3 minutes (Vm30s: 25.05.5 vs 30.44.7, p0.05; Vm3m: 27.05.2 vs 31.24.7, p0.05; Vm30s,%: 17.06.5 vs 8.34, 1, p0.05; Vm3m,%: 11.76.3 vs 5.82.4, p0.05). When performing HCТ between patients with OHR and without OHR, statistically significant differences in the indices Pi (0.790.08 vs 0.780.16, p0.05) and Ri (0.510.09 vs 0.530.07, p0.05) was not detected, however, in patients with OHR there is a tendency to a less pronounced increase in АCBF at the peak of HCT compared with patients without OHR (36.86.4 vs 40, 06.6, p=0.13). In patients with OHR, the cerebral reactivity coefficient was lower than in patients without OHR (13.43.9 vs 20.76.6, p0.05). Conclusions. In patients with AH of older age groups with OHR, a statistically significant decrease in ACBF in orthostasis was revealed. Patients with IOH showed a decrease in ACBF in the first seconds of orthostasis with its subsequent stabilization. Persons with COH have preserved the mechanisms of cerebral autoregulation in the first seconds of orthostasis, but with prolonged orthostatic load (3 minutes), the effectiveness of autoregulatory mechanisms decreases. OHR in patients with hypertension of older age groups is associated with a decrease in cerebral reactivity.
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