Parameters of arterial stiffness, wave reflection and ventricular-vascular coupling in patients with hypertension and heart failure with preserved and reduced left ventricular ejection fraction
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Abstract
The aim – to compare the relationship between brachial and central blood pressure, wave reflections parameters, pulse wave velocity and ventricular-arterial coupling in patients with hypertension and various types of heart failure (HF) with preserved or reduced left ventricular ejection fraction (LVEF), compared to patients with uncomplicated hypertension.
Material and methods. Among 180 patients with essential hypertension, 75 patients (age 57.6±10.7 years) were selected «case control» method. Patients were comparable regarding age, gender, brachial systolic blood pressure (BP), which corresponded to hypertension 1-2 degree: 25 patients with uncomplicated hypertension without HF
(1st group), 25 patients with HF and LVEF ≥ 50 % (2nd group), 25 patients with HF and LVEF 30–49 % (3rd group). All patients underwent general clinical examinations, laboratory examination and determination of NT pro BNP, brachial blood pressure measurements, pulse wave analysis and measurement of the carotid-femoral pulse wave velocity (PWV) by applanation tonometry, Doppler echocardiography and calculation of the ventricular-vascular coupling parameter (Ea/Ees).
Results. Patients with HF in both groups in contrast to patients with uncomplicated hypertension had larger left atrium volume index, higher values of E/e´ and lower e´, a´, LVEF (all Р<0.05–0.01). Patients in both groups with HF were matched by e´ and E/e´ (Р>0.05). Both groups of patients with HF had lower mean brachial BP, brachial and central diastolic BP, and higher pulse pressure compared to patients with uncomplicated hypertension (Р<0.05). Patients with HF and EF < 50 %, compared with patients with HF with preserved LVEF, had higher heart rate, while all parameters of brachial and central BP didn’t differ (P>0.05). Patients with HF and EF > 50 %, compared to uncomplicated hypertension, had higher augmentation pressure (РА – 11.8±5.0 versus 8.2±6.2 mm Hg), PWV (9.4±1.9 versus 8.1±1.9 m/s) and lower pulse pressure amplification (PPA 126.5±11.4 versus 139.0±19.7 %) (all Р<0.05), in the absence of the
difference in the augmentation index (AIx) (Р>0.05). Compared to patients without HF, patients with HF and EF < 50 % had lower PA (5.1±3.8 vs. 8.2±6.2 mm Hg), AIx (10.2±10.1 versus 22.6±13.9 %) (all Р<0.01), in the absence of
differences in PPA and PWV (Р>0.05), which differed from patients with HF and EF > 50 % (PPA – 146.1±19.8 versus 126.5±11.4 %, and PWV – 7.8±1.7 versus 9.4±1.9 m/s, all Р<0.05). Groups of patients with HF with preserved LVEF and hypertension were comparable regarding the values of Ea, Ees and Ea/Ees (Р>0.05). While patients with HF with reduced LVEF had a higher level of Ea/Ees (1.48±0.49 versus 0.65±0.15 and 0.57±0.10) because of lower level of the Ees (1.24±0.45 versus 3.17±1.18 and 3.47±0.78) compared to other two groups (all Р<0.01).
Conclusions. Patients with hypertension and HF with reduced LVEF matched by age, gender and brachial systolic blood pressure with patients with hypertension and HF with preserved LVEF had lower augmentation pressure, augmentation index and a higher level of pulse pressure amplification and lower pulse wave velocity as a result of changes of the ventricular-arterial coupling caused by the decrease of the ventricular elastance (Ees).
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