The contribution of modifiable risk factors to the formation of cardiovascular remodelling and vegetative balance in patients with essential hypertension

Abstract

Objective. The aim of this study is to determine the influence of individual modifiable risk factors (RF) and their combination on the structural and functional alteration of heart and blood vessels, the state of vegetative balance of the heart rhythm parameters in patients with essential hypertension stage II. Materials and methods. The examined patients with essential hypertension (EH) stage II with the presence of one RF were divided into three groups: the first group included 69 patients with hypercholesterolemia (HCE), the second group consisted of 30 patients with the status of smoker (SS) and the third comprised 82 patients with overweight (OW). The control group included 10 patients with EH without RF. All patients were subjected to the evaluation of general physical examinations, calculation of body mass index, determination of serum total colesterol (TC) level, ECG Holter monitoring with analysis of heart rate variability, ambulatory blood pressure monitoring, echocardiography and duplex pulsed wave dopplerography of extracranial vessels. Results. Patients with EH with any one RF did not differ from patients with EH without RF and among themselves in parameters of office blood pressure, as well as on parameters of ABPM. The mean diastolic blood pressure per day and the time index were significantly higher in patients with EH with any RF compared to EH patients without RF. Patients with EH with OW and patients with EH who smoke did not differ in the TC level but both groups had a significantly higher level of TC compared to patients in the control group. The addition of any single RF in patients with EH is associated with an increase in the size of left atrium, left ventricular myocardial mass index mainly due to thickening of the interventricular septum, diastolic dysfunction of the left ventricle. The addition of any RF in the examined patients is accompanied by a tendency to decrease in blood flow in all vessels basins, but mainly in the common carotid arteries. The highest LF/HF ratio was in patients with EH who have SS, that is, the presence of this risk factor is associated with maximum activation of the sympathetic link of the autonomic nervous system in patients with EH. Patients with EH who have two risk factors also did not differ in the majority of anthropometric parameters, all data of office blood pressure, ambulatory blood pressure monitoring, structural and functional alteration of the heart, cerebral blood flow and heart rate variability. Conclusions. The presence of any risk factor in EH patients has an unidirectional negative effect on the structural, geometric and functional alteration of the heart, is associated with a tendency to reduce blood flow in all of extra- and intracranial vessels. Patients with EH who smoke are characterized by sympathetic link of autonomic nervous system activation. Patients with EH and different combinations of two risk factors do not differ among themselves by the majority of anthropometric parameters, values of office BP, ABPM, structural and functional alteration of the heart, cerebral blood flow and heart rate variability.

Keywords

• hypertension
• blood pressure
• cardiac remodelling
• risk factors