Patologìâ (Dec 2020)
Influence of the statin therapy on cardiovascular remodeling in arterial hypertension, combined with subclinical hypothyroidism
Abstract
There is a proven relation between hypothyroidism and appearance of the pronounced structural and functional changes of the heart and blood vessels as well as atherosclerosis and its related diseases progress. At the same time, there is a lack of information regarding the influence of statins on indices of the structure and function of the heart and blood vessels in patients with arterial hypertension (AH) combined with subclinical hypothyroidism (SH). Aim. To study the effect of the long-term statin therapy on the cardiac structure and function, as well as on vascular remodeling in patients with arterial hypertension combined with subclinical hypothyroidism. Material and methods. The study involved 31 patients with arterial hypertension grade 1–3, stage II, of high and very high additional cardiovascular risk, with a concomitant SH. All patients received a combination of two or three first-line antihypertensive drugs at average therapeutic daily doses and atorvastatin at a dose of 20–30 mg per day. Prior to treatment and after one year of follow-up, all patients underwent an echocardiographic examination and a carotid artery scan on My Lab Seven (Italy) device as well as a 24h-blood pressure monitoring on a bifunctional device “Cardiotechnics-04” (Inkart, St. Petersburg, RF) with the simultaneous registration of BP and ECG. Results. Under the influence of therapy, the target level of systolic blood pressure was reached in 74 % (23/31) of patients during the daytime observation period, in 65 % (20/31) of patients during the nighttime observation period; target diastolic blood pressure for the daytime observation period – in 87 % (27/31) of patients, for the nighttime observation period – in 71 % (22/31) patients. However, there was no significant change in the size of cavities of the left atrium and both ventricles, ejection fraction (before treatment 68.84 ± 5.43 %, after 67.13 ± 5.45 %), thickness of the interventricular septum and posterior wall, relative wall thickness (before treatment 0.41 ± 0.07, after 0.41 ± 0.07, P = 0.871), LV mass index (before treatment 122.29 ± 37.36 g/m2, after 118.00 ± 31.00 g/m2, P = 0.849), indices of diastolic function of the left ventricle (LV). The specific gravity of patients with eccentric LV hypertrophy after a year of treatment increased from 32 % to 39 % (P = 0.5668), with concentric hypertrophy decreased from 42 % to 39 % (P = 0.8107), with normal LV geometry – from 19 % to 16 % (P = 0.7570). The number of patients with AH with a concomitant SH with signs of a concentric LV remodeling remained unchanged – before treatment 6 %, after 6 %. The influence of the statin therapy on vascular remodeling in patients with AH with a concomitant SH was characterized by a tendency towards a decrease in the thickness of the intima-media complex of the right (0.769 ± 0.276 mm vs. 0.701 ± 0.222 mm, P = 0.512) and left (0.759 ± 0.185 mm vs. 0.745 ± 0.179 mm, P = 0.988) common carotid arteries. Conclusion. In patients with AH with a concomitant SH, the antihypertensive therapy during the year with the first-line drugs with addition of statins was associated with achievement of the target SBP level in the active period in 74 %, in the passive period – in 65 % of patients (according to the 24h-BPM data), but was not accompanied by a significant decrease in the cavity size, wall thicknesses, LV mass, improvement of LV diastolic filling, reduction in thickness of the intima-media complex.
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