Structural and Functional Features of the Heart and Blood Vessels in Hypertensive Patients with Different Body Mass

Abstract

Introduction. Pathological effects of obesity are realized primarily through arterial hypertension, hypercholesterolemia, glucose intolerance, the prevalence of which is increasing among people with excessive body weight. However, numerous epidemiological studies have shown, an increased mortality rate from coronary heart disease and other non-infectious diseases is observed among the people with a low body mass index compared with the patients with an average body mass index. Aim. Finding out the features of structural-geometric, systole-diastolic remodeling of the left ventricle and endothelial dysfunction of the vessels, as an early marker of atherosclerosis, in patients with hypertension and varying body weight. Materials and methods. The study included 119 patients with arterial hypertension stage II, diagnosed according to the recommendations of the Ukrainian Association of Cardiologists (2008), aged 60 to 85 years (on average 75.0 ± 5.9 years). Of these, 45 had concomitant abdominal obesity, 35 – deficiency of body weight, 39 – normal body mass. A determination of the structural and morphological, systole-diastolic parameters of the left ventricular remodeling and vascular endothelial function parameters, endothelium function, using reactive hyperemia (endothelium-dependent vasodilation) and nitroglycerin (endothelium-independent vasodilation) tests was made. Results. Conventionally considered to be a normal reaction is a dilatation of the brachial artery in the case of reactive hyperemia of over 10,0 % of its diameter prior to the test, if it’s value is less or there is a vasoconstriction, it is considered to be pathological. In hypertensive patients with concomitant abdominal obesity the thickness of the interventricular septum and the posterior wall of the left ventricular, the end-systolic size and end-diastolic dimensions as well as the index of left ventricular mass were significantly bigger than in other groups of patients with hypertension, indicating the tendency to develop mainly concentric left ventricular hypertrophy. The changes, detected by the transmitral blood flow analysis, have the same direction in all groups of patients and reflect the formation of the hypertrophic type of diastolic function disorder. However, the intergroup analysis of the diastolic function changes in patients with normal body mass and abdominal obesity showed that most violations of diastolic filling of the left ventricle occurs in patients with concomitant abdominal obesity. Analysis of echocardiographic parameters in patients with deficiency of the body mass showed a tendency to form a concentric left ventricular hypertrophy and diastolic dysfunction of the first type. In patients with low body mass compared to a group of patients with satisfactory weight, there is a significantly smaller left ventricular mass, indicating a slightly lower level of left ventricular hypertrophy and decrease of the deceleration time of the early diastolic filling caused by an increase in myocardial stiffness, which adversely affects the contractility of the heart. Сonclusions. In patients with the second stage hypertension there was observed a significant decrease in abnormal endothelium-dependent vasodilatation of the brachial artery and a decrease of its sensitivity to shift tension, regardless of body weight, although more pronounced in patients with underweight and in patients with the concomitant abdominal obesity. At the same time the endothelium-independent vasodilation in response to nitrates was preserved.

Keywords

• hypertension
• structural and functional alteration of left ventricular endothelial dysfunction
• weight