Arterial Stiffness Parameters and Subendocardial Viability Ratio in Patients with Arterial Hypertension Affected by Subclinical and Clinical Atherosclerosis

Abstract

Aim. Assessment the arteries' stiffness parameters and subendocardial viability ratio in hypertensive patients with various degrees of severity of the atherosclerotic process manifestation.Material and methods. 133 hypertensive patients were divided into 3 groups, similar in age and sex, depending on the severity of the atherosclerotic process: hypertensive patients without atherosclerosis (n=42; 53.3±7.6 years); patients with hypertension and subclinical atherosclerosis (SА) (n=52; 56.5±8.0 years); patients with hypertension and coronary artery disease (CAD) (n=39; 57.4±6.8years) and control group which consisted of individuals without cardiovascular diseases (n=33; 54.6±8.4 years). All participants underwent 24-hour blood pressure monitoring with assessment of arterial stiffness parameters and subendocardial viability ratio (SERV).Results. Subjects from all groups with hypertension have significantly higher mean systolic blood pressure (SBP) (131.1±11.9, 127.8±14.8, 128.6±15.3 respectively; p<0.001), as well as central systolic blood pressure (SBPao) (122.0±11.0, 118.8±12.7, 119.9±13.3 respectively; p<0.001), pulse pressure (PP) (46.4±9.8, 45.6±10.6, 48.9±12.0 respectively; p<0.05) and central pulse pressure (PPao) (35.5±8.5, 34.9±8.5, 38.5±9.6 respectively; p<0.05), pulse wave velocity in aorta (PWVao) (11.3±1.5, 12.3±1.8, 11.5±1.7 respectively; p<0.05) compared with control group (SBP 116.3±7.3; SBPao 108.9±6.4, PP 39.9±6.5, PPao 30.9±5.4, PWVao 10.4±1.3). In hypertensive patients with SA, PWVao was significantly higher compared to other groups (p<0.05). With bringing the indicator to SBP 100 mmHg and HR=60 beats/min, there were no differences between the control group and the group with hypertension (p=0.3), also groups with hypertension+SA and hypertension+CAD did not significantly differ from each other (p=0.6). SERV in subjects with hypertension+SA was significantly lower than in patients with hypertension (p<0.05) and no significant differences were detected with the group with hypertension+CAD (p=0.77).Conclusions. In hypertensive patients with SA, a decrease in subendocardial perfusion is associated with an increase in pulse wave velocity in aorta. Moreover, such a decrease in perfusion approaches to the values of patients suffering from coronary artery disease, which indicates significant changes in the small vessels of the heart that form the coronary reserve.

Keywords

• arterial hypertension
• arterial stiffness
• subendocardial viability ratio
• subclinical atherosclerosis