PROGNOSIS OF THE DEVELOPMENT OF ORTHOSTATIC HYPOTENSION IN YOUNG MALES WITH HYPERTENSION
Abstract
The aim of the study was to improve the prognosis of orthostatic hypotension (OH) in young males with hypertension (AH) during antihypertensive therapy.
Materials and methods. 62 male patients were examined, mean age 31.5 ± 3.6 years with AH of the 1st and 2nd degrees. The control group consisted of 20 practically healthy persons (mean age 31.0 ± 3.7 years). All patients underwent general clinical examination, measurement of office blood pressure (BP), daily monitoring of BP with the help of the ABPM-02 device (Meditech, Hungary), active orthostatic test (AOT) with determination of the Kerdo vegetative index (KI). During AOT, ECG and heart rate variability (HRV) were monitored according to the conventional methodology using monitors CardioTens-01 («Meditech», Hungary). All patients underwent antihypertensive therapy In 80.6% of patients, AH was controlled with drugs.
Results. The incidence of OH in patients with AH was 17.7% and did not differ significantly from the control group – 15%. Patients with AH showed a decrease of the degree of parasympathetic effect according to KI data, while in the control group KI became positive. It was found that at baseline, in the subgroup of young males with AH and OH in the orthostatic test, the spectral indices of HRV (LF and total power of the spectrum) were significantly lower than in patients with AH and negative orthostatic trial. Analysis of the dynamics of the HRV spectral indices during AOT showed that no significant changes were detected in the subgroup of patients with AH and OH. Therefore, in the course of AOT, absence of changes in HRV parameters in patients with AH confirms the presence of autonomic dysfunction and dysfunction of the autonomic supply, and also allows to predict the development of OH.
Conclusion. Thus, prognosis of the development of OH in case of AH in young patients will allow more effective correction of BP in the specified cohort of patients.
References
Kotseva K, De Bacquer D, De Backer G, Ryden L, Jennings C, Gyberg V, Abreu A, Aguiar C, Conde AC, Davletov K, Dilic M, Dolzhenko M, Gaita D, Georgiev B, Gotcheva N, Lalic N, Laucevicius A, Lovic D, Mancas S, Milicic D, Oganov R, Pajak A, Pogosova N, Reiner Z, Vulic D, Wood D, On Behalf Of The Euroaspire Investigators. Lifestyle and risk factor management in people at high risk of cardiovascular disease. A report from the European Society of Cardiology European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV cross-sectional survey in 14 European regions. Eur J Prev Cardiol. 2016;23(18):2007–18.
Vera G., Nataša D, Svetlana K, Sonja S, Jasmina G, Sonja T. Epidemiology of Hypertension in Serbia: Results of a National Survey // J Epidemiol. – 2012.- Vol.22(3).- P.261-6. .doi: 10.2188/jea.JE20110077
Biaggioni I. Orthostatic Hypotension in the Hypertensive Patient // Am. J. Hypertens.- 2018.- Vol.31(12).-P.1255-1259. doi: 10.1093/ajh/hpy089.
Ali A, Ali NS, Waqas N, Bhan C, Iftikhar W, Sapna F, Jitidhar F, Cheema AM, Ahmad MQ, Nasir U, Sami SA, Zulfiqar A, Ahmed A. Management of Orthostatic Hypotension: A Literature Review // Cureus. 2018 Aug 20; 10(8): e3166.
Thomas KN, Cotter JD, Galvin SD, Williams MJ, Willie CK, Ainslie PN. Initial orthostatic hypotension is unrelated to orthostatic tolerance in healthy young subjects // J Appl Physiol. – 2009.- Vol.107(2).- P.506–517.
Romero-Ortuno R., O’Connell M.DL, Finucane C., Soraghan C., Fan C.W., Kenny R.A.Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA) // BMC Geriatrics.- 2013.- Vol.13.-P.73. doi:10.1186/1471-2318-13-73
Juraschek S.P., Appel L.J., Miller E.R., Mukamal K.J., Lipsitz L.A. Hypertension Treatment Effects on Orthostatic Hypotension and Its Relationship With Cardiovascular Disease // Hypertension.- 2018.- Vol.72(4).- P.986-993. doi: 10.1161/HYPERTENSIONAHA.118.11337.
Fedorowski A., Burri P., Melander O. Orthostatic hypotension in genetically related hypertensive and normotensive individuals // Hypertens. – 2009. –Vol. 27. –Р. 976-982.
Bliziotis I.A., Destounis A., Stergiou G.S. Home vs. ambulatory and office blood pressure in predicting target organ damage in hypertension: a systematic review and meta-analysis // J. Hypertens. – 2012. – Vol.30. – P. 1289–1299.
Koźluk E, Cybulski G., Piątkowska A., Zastawna I., Niewiadomski W., Strasz A., Gąsiorowska A., Kempa M., Kozłowski D., Opolski G. Early hemodynamic response to the tilt test in patients with syncope // Arch Med Sci. – 2014.- Vol.10(6). - P.1078–1085. DOI: https://doi.org/10.5114/aoms.2014.47820
Buszko K., Kujawski S., Newton J.L., Zalewski P. Hemodynamic Response to the Head-Up Tilt Test in Patients With Syncope as a Predictor of the Test Outcome: A Meta-Analysis Approach // Approach.Front. Physiol. – 2019.- Vol.10.- P.184. doi: 10.3389/fphys.2019.00184
Tasic D., Tasic N., Dragisic D., Mitrovic M. Orthostatic Hypotension and Therapy with an ACE Inhibitor in Hypertensive Patients // Serbian Journal of Experimental and Clinical Research.- 2017.- Vol.18, Issue s1.- P. 61–66. DOI: https://doi.org/10.1515/sjecr-2017-0035
Shibao C., Lipsitz L.A., Biaggioni I. Evaluation and treatment of orthostatic hypotension // J Am Soc Hypertens.- 2013.- Vol.7.- P.317-324.