Системные гипертензии (Mar 2013)
Comparative characterizations of patients with hypertensive disease in the mid-1980s and in the 2010s (the patients’ portraits in the context of factor analysis)
Abstract
Aim: to study the clinical characteristics of patients with hypertensive disease (HD) in the first decade of the 21st century versus the mid-1980s, by using multivariate statistical methods for the further optimization of therapeutic and diagnostic guidelines. Materials and methods. 234 case histories of patients with HD in the periods 1985 to 1987 (Group 1) and 2010–2012 (Group 2) were analyzed. Factor analysis of 110 signs identified 7 factors or leading symptom complexes. Results. Comparison of HD patients’ portraits in the mid-1980s and the first decade of the 21st century may lead to a number of main conclusions: firstly, HD has undergone certain alternations in the past quarter of a century, which is associated with changes in both the socioeconomic characteristics of society and those in approaches to therapy and with the advent of novel groups of antihypertensive drugs; secondly, the emergence of drugs with a proven nephroprotective effect (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) resulted in the reduced negative impact of BP on renal functions. Thus, three of the seven factors in Group 1 are directly related to the renal function of patients with HD while Group 2 shows only one factor of systemic and intraglomerular hypertension; thirdly, metabolic disturbances assume great importance in the characterization of Group 2 patients. Metabolic syndrome is typical of them; fourthly, for the patients of the early 21st century, of particular significance is tobacco smoking that is not only a risk factor of cardiovascular diseases in general, but also a factor influencing of the diurnal BP variation that promotes the formation of its particularly unfavorable variants – a night peaker, and finally fifthly, the patients of the early 21st century are characterized by a greater adherence to systemic antihypertensive therapy, which positively affects primarily on the course of the disease, by preventing target organ damage. Conclusion. The findings make it possible to optimize therapeutic and diagnostic efforts in patients with HD and to make more goal-oriented secondary prevention of complications.
