COMBINED MONITORING OF DIURESIS AND BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AND HEART FAILURE

Abstract

Based on the data from 17 healthy volunteers and 110 patients with arterial hypertension (AH) and chronic heart failure (CHF), who underwent combined 24-hour monitoring of diuresis and blood pressure (BP), with three-hour and functional intervals (morning, midday, evening, night-time, and circadian) assessed, a complex parameter “diuresis – tension ratio” (DTR) was developed. This parameter reflects the ratio between diuresis (percentage of excreted to consumed water) and mean systolic BP (SBP) during the time (t) of diuresis measurement (DTRt = diuresis, % / mean SBP, mm Hg). In healthy people, normal DTR values were in the range of 75-90% / 120-135 mm Hg. In AH patients, fluid retention and BP increase in morning, midday, and, to a lesser extent, evening intervals were observed. Compensatory increase in night-time diuresis was inadequate in patients with CHF, being associated with circadian diuresis reduction to <65% and oedema development. The latter was an indication for diuretic therapy. The assessment of circadian DTR dynamics demonstrated the benefits of loop diuretic torasemide (5 mg), which had stronger, more even and long-lasting effect, comparing to hydrochlorothiazide (100 mg) and furosemide (20 mg). DTR assessment could be recommended for diagnostics of fluid metabolism disturbances and the choice of the optimal diuretic therapy regimen.

Keywords

• arterial hypertension
• heart failure
• 24-hour monitoring
• diuresis
• diuretics