Zaporožskij Medicinskij Žurnal (Aug 2013)
Vascular wall remodeling in women with hypertension: relationship with heart rate variability and blood pressure
Abstract
Purpose. There is abundant evidence that increased sympathetic activity in patients with hypertension plays an important role in stimulating the growth of cardiomyocytes and myocardial fibroblasts, leading to structural remodeling of the left ventricle and to its hypertrophy. This is true for the pathophysiological processes taking place at the same time of remodeling of the vascular wall and its tunica media, but these processes have been studied much less detail. Aim.To assess the relationship between structural changes of the common carotid arteries wall in healthy women and women with hypertension, depending on heart rate variability and circadian blood pressure (BP). Materials and methods.We examined 90 female (to avoid sex difference) patients with AH I - II degree without any additional risk factors (disease duration 2 - 16 yrs), average age 47,5 ± 7,2 yrs. 36 apparently healthy women (the average age 43,3 ± 8,1 yrs) have formed the control group. To assess the structural changes of the common carotid artery we performed ultrasound scan on both sides of its wall by LOGIC P5 PRO (General Electric). BP monitoring (CBP) was performed on the apparatus AVRM-04 (Meditech, Hungary). We evaluated the mean systolic and diastolic BP (MSBP and MDBP), their time indices, variability and circadian index. Short-term heart rate variability was performed using an automated diagnostic complex "Cardio +" (NVP Metekol, Ukraine). Results and discussion. In the group of women with hypertension IMT was significantly greater than in the control group (p = 0.001). Intimal layer thickness between the two groups did not differ significantly (p = 0.190). Internal diameter of the carotid arteries in women with hypertension was 0,58 ± 0,07 cm, and in the control group – 0,56 ± 0,04 cm and was significantly greater (p = 0.031). The DBP variability was significantly higher in patients with hypertension than in the control group (p = 0.0001). The time index of systolic and diastolic blood pressure in women with hypertension was higher than normal value and significantly higher than in the control group. Vagosympathetic interaction index LF / HF in women with hypertension was in 47% higher compared to healthy women, indicating the prevalence of sympathetic influence. Conclusions.The morphological basis of vascular remodeling in hypertension is the IMT thickening, mainly due to media, and an increase in arterial diameter. The steady BP daily increase has a greater impact on the rate and severity of this type of vascular remodeling, rather than the absolute level of blood pressure increase. Revealed violations of autonomic regulation of the cardiovascular system are: increasing of the LF-waves capacity (LFn) and upward vagosympathetic ratio and total power spectrum contribute to the change of the common carotid artery wall.
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