Clinical-functional features and changes in psycho-emotional state in patients with arterial hypertension – participants of combat operations in Ukraine

Abstract

The aim – to investigate the clinical features, the nature of the daily rhythm of blood pressure, target organ damage and the psycho-emotional state of patients with hypertension who were direct participants in the military conflict in Ukraine.
Materials and methods. The analysis of the features of the course of hypertension was carried out in 58 men who were direct participants in the hostilities of the military conflict in Ukraine. Patients were divided into groups depending on the time of onset of hypertension, the presence or absence of signs of anxiety and depression according to the HADS hospital scale, the presence or absence of previous acubarotrauma. Objective condition, adherence to treatment, presence and nature of cognitive function disorders, psychoemotional status, results of daily blood pressure monitoring, morphofunctional condition of the left ventricle, functional condition of kidneys, and lipid metabolism were analyzed. The control group (CG) consisted of 36 male patients with АН, comparable in age, body mass index, initial values of blood pressure (DP), and the presence of concomitant pathology, who were examined and treated in the department of arterial hypertension and comorbid pathology before the start of hostilities in Ukraine.
Results and discussion. In 51.7 % of the examined, hypertension was already detected during the participation in hostilities in Ukraine. Most of the examined (53.4 %) had obesity of the first or second degree, another 31.0 % were overweight. Before entering the department, 81.0 % of patients were taking antihypertensive drugs, but the vast majority of them (72.3 %) had low adherence to treatment. Cognitive disorders according to the MMSE scale were found in 31 % of patients, psychosomatic disorders according to the HADS anxiety and depression scale – in 58.6 %. For patients with a long course of hypertension and with psychosomatic changes, a violation of the daily rhythm of blood pressure (ВР) according to the «non-dipper» type was characteristic, and for patients with recent hypertension and those who underwent acubarotrauma – an increase in the variability of ВР. Signs of remodeling of the left ventricle (91.4 %) were found in almost all of the examined subjects, while the vast majority (87.9 %) showed concentric changes in it, as well as disturbances in the lipid spectrum of the blood (93.1 %). The most significant changes in the lipid profile were characteristic of patients with acubarotrauma. The identified changes are factors that have a negative impact on the course of hypertension and the prognosis of patients.
Conclusions. Direct participation in combat operations is often accompanied by the appearance of signs of anxiety and depression, increased blood pressure variability and insufficient reduction during sleep, contributes to the development of concentric changes in the left ventricle of the heart; such patients, especially after acubarotrauma, have significant disturbances in the lipid spectrum of the blood. Most of such patients have low adherence to treatment. All this must be taken into account when choosing treatment tactics for such patients.