Peculiarities of cardiovascular remodeling in hypertensive patients at high additional risk with concomitant subclinical hypothyroidism

Abstract

Arterial hypertension affects over 12 million people in Ukraine, which accounts for about 30 % of the adult population, and is a powerful independent risk factor for cardiovascular morbidity and mortality. Subclinical hypothyroidism (SH) is also an independent causative factor of the cardiovascular risk and is associated with the development of ischemic heart disease, myocardial infarction, chronic heart failure and increased mortality from cardiovascular diseases regardless of sex, age or pre-existing cardiac pathology. Therefore, there is a need to study the influence of subclinical hypothyroidism on the cardiovascular remodeling peculiarities in patients with arterial hypertension (AH). Material and methods. The study involved 124 patients with AH stage II divided into two groups. The group of patients with AH without SH included 92 patients (women 81.52 % (75), men 18.48 % (17)) and 32 patients (women 87.5 % (28), men 12.5 % (4)) represented the group with AH and concomitant SH. The groups of patients were comparable in age (P = 0.093), sex (P = 0.44319), height (P = 0.993), weight (P = 0.719), body surface area (P = 0.901), body mass index (P = 0.669). In all patients underwent arterial blood pressure measurement (OMRON 750 IT,Japan), echocardiography and ultrasound of carotid arteries using the original QIMT software on My Lab 50 (Esaote,Italy). Results. In patients with AH with the concomitant SH, in contrast to patients with AH without SH, a significant increase in indexes of the intima-media complex thickness of the right common carotid artery by 8.2% (P < 0.05) and the left common carotid artery by 7.9 % (P < 0.05) was observed. Changes of structural, geometrical and functional indexes of the heart in patients with AH and SH were significant increase in the left atrial size by 3.5 % (P < 0.05), end diastolic size by 3.0 % (P < 0.05) and end systolic size of the left ventricle by 2.3 % (P < 0.05), myocardial mass index by 11.1 % (P < 0.05), index Е/Е´ by 13.0 % (P < 0.05), gradient of transpulmonary flow by 6.6 % (P < 0.05) in comparison to patients with AH without SH. Conclusions. In patients with AH and concomitant SH in contrast to patients with AH without SH, an increase in thickness of the intima-media complex of both common carotid arteries with comparable diameters of vessels has been established, as well as increase in size of the left atrium, left ventricular myocardial mass index mainly due to the left ventricular dilation, Е/Е´ index and pressure gradient in the pulmonary artery suggesting an increase in the end diastolic pressure and the left ventricular diastolic dysfunction.

Keywords

• hypothyroidism
• hypertension
• ventricular remodeling
• vascular remodeling