Gender and age differences in the relationship between left ventricular diastolic function and central hemodynamics and vascular stiffness in patients with uncontrolled uncomplicated arterial hypertension
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Abstract
The aim – to determine the relationship between left ventricular diastolic function measured by echocardiography and central hemodynamics and vascular stiffness by applanation tonometry in patients with uncontrolled uncomplicated arterial hypertension, depending on age and gender.
Materials and methods. The study included 142 patients with uncontrolled uncomplicated essential hypertension of I–II stage, 1–2 degrees, aged 35–75 years (mean 57.3±14.1 years), with blood pressure (BP) ≥ 160/100 mm Hg in patients who had not previously been treated or BP ≥ 140/90 mm Hg in those who had received antihypertensive treatment. All patients underwent general clinical and laboratory examinations, measurements of brachial BP, applanation tonometry, 24-hours ambulatory BP monitoring and echocardiography. Patients were divided into groups based on gender and age: men and women ≤ 60 years and > 60 years: 36 (25.4 %), 26 (18.2 %), 36 (25.4 %) and 44 (31 %), respectively.
Results. The groups were comparable by the level of BP according to the results of 24-hours ambulatory BP
monitoring, central and brachial systolic BP (SBP) (Р>0.05). In younger women, in comparison with men of the same age group, pulse pressure amplification and the difference between brachial and central SBP and PP were lower
(РРА – 127.7±15.9 and 140.3±19.4 %, ∆SBP – 10.2±6.0 and 14.7±6.1, ∆PР – 11.4±6.3 and 16.0±6.0 mm Hg, respectively; all Р<0.05). While the augmentation index (AIx), AIx75, the augmentation pressure (PA) in both age groups were lower in men than in women (19.5±11.4 and 29.9±12.5; 19.0±9.7 and 28.1±10.5 %, 8.8±7.1 and 12.9±5.8 mm Hg, respectively in patients ≤ 60 years (all Р<0.05); 24.1±10.5 and 32.3±8.3, 22.8±6.1 and 28.7±6.7 %, 11.3±6.0 and 16.3±7.5 mm Hg, respectively in patients > 60 years (all Р<0.01)). In elderly women, we found a moderate positive relationship between left atrium volume index, central and brachial SBP (central SBP – r=0.65, Р=0.007; brachial
SBP – r=0.59, Р=0.02) and PP (central PP – r=0.7, Р=0.002; brachial PP – r=0.63, Р=0.009), РА (r=0.65, Р=0.009), and moderate negative relationship between the pulse wave velocity (PWV) and е´ (r=–0.47, Р=0.043). In the elderly men we found a moderate positive relationship between E/A and central SBP (r=0.46, Р=0.035) and PP (r=0.61, Р=0.004), РА (r=0.71, Р=0.001) and AІx (r=0.6, Р=0.004) and between Е/е´ and AІx (r=0.41, Р=0.011), and РА (r=0.43, Р=0.007), and also negative relationship between Е/А and РРА (r=–0.58, Р=0.006), between Е/е´ and РРА (r=–0.44, Р=0.049).
Conclusion. Among patients with uncontrolled uncomplicated arterial hypertension with comparable blood pressure levels throughout the day, in women, the relationship between the diastolic function by echocardiography and PWV was found, and in men older than 60 years the relationship was found between LV diastolic function and parameters of pulse wave reflection by applanation tonometry. This may point at different mechanisms of LV diastolic dysfunction and further formation of heart failure with preserved LV ejection fraction in this cohort of patients depending on gender and age.
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References
Alghatrif M., Strait J., Morrell C. et al. Longitudinal trajectories of arterial stiffness and the role of blood pressure: the Baltimore Longitudinal Study of Aging // Hypertension.– 2013.– Vol. 62.– P. 934–941.
Borlaug B.A., Kass D.A. Ventricular-vascular interaction in heart failure // Cardiol. Clin.– 2011.– Vol. 29.– P. 447–459.
Borlaug B., Melenovsky V., Redfield M. et al. Impact of arterial load and loading sequence on left ventricular tissue velocities in humans // J. Am. Coll. Cardiol.– 2007.– Vol. 50 (16).– P. 1570–1577.
Borlaug B.A., Paulus W.J. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment // Eur. Heart J.– 2011.– Vol. 32.– P. 670–679.
Canepa М., AlGhatrif M., Strait J. et al. Early contribution of arterial wave reflection to left ventricular relaxation abnormalities in a community-dwelling population of normotensive and untreated hypertensive men and women // J. Human Hypertension.– 2014.– Vol. 28.– P. 85–91.
Chantler P.D., Lakatta E.G., Najjar S.S. Arterial-ventricular coupling: Mechanistic insights into cardiovascular performance at rest and during exercise // J. Appl. Physiol.– 2008.– Vol. 105.– P. 1342–1351.
Coutinho T., Borlaug B., Pellikka P. et al. Sex differences in arterial stiffness and ventricular–arterial interactions // J. Am. Coll. Cardiol.– 2013.– Vol. 61.– P. 96–103.
Desai A., Mitchell G., Fang J. et al. Central aortic stiffness is increased in patients with heart failure and preserved ejection fraction // J. Card. Fail.– 2009.– Vol. 15.– P. 658–664.
Devereux R.B., Alonso D.R., Lutas E.M. et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findigs // Amer. J. Cardiology.– 1986.– Vol. 57.– P. 450–458.
Fukuta H., Goto T., Wakami K., Ohte N. Effects of drug and exercise intervention on functional capacity and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials // Eur. J. Prev. Cardiol.– 2016.– Vol. 23.– P. 78–85.
Joyner M., Barnes J., Hart E. et al. Neural Control of the Circulation: How Sex and Age Differences InteractinHumans // Comprehensive Physiology.– 2015.– Vol. 5 (1).– P. 193–215.
Kawaguchi M., Hay I., Fetics B., Kass D. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations // Circulation.– 2003.– Vol. 107 (5).– P. 714–720.
KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease // Kidney Int. Suppl.– 2013.– Vol. 3 (1).– P. 1–150.
Kim Hack-Lyoung, Lim Woo-Hyun, Seo Jae-Bin et al. Association between arterial stiffness and left ventricular diastolic function in relation to gender and age // Medicine.– 2017.– Vol. 96 (1).– P. 1-6
Ky B., French B., Khan A. et al. Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure // J. Am. Coll. Cardiol.– 2013.– Vol. 62.– P. 72–1165.
Lam C., Roger V., Rodeheffer R. et al. Cardiac structure and ventricular-vascular function in persons with heart failure and preserved ejection fraction from Olmsted County, Minnesota // Circulation.– 2007.– Vol. 115.– P. 1982–1990.
Lang R.M., Bierig M., Devereux R.B. et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology // J. Am. Soc. Echocardiogr.– 2005.– Vol. 18.– P. 1440–1463.
Laurent S., Boutouyrie P., Asmar R. et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients // Hypertension.– 2001.– Vol. 37.– P. 1236–1241.
Magana-Serrano J., Almahmeed W., Gomez E. et al. Prevalence of heart failure with preserved ejection fraction in Latin American, Middle Eastern, and North African Regions in the I PREFER study (Identification of Patients With Heart Failure and PREserved Systolic Function: an epidemiological regionalstudy // Am. J. Cardiol.– 2011.– Vol. 108.– P. 1289–1296.
Mancia G., Fagard R., Narkiewicz K. et al. 2013 ESH/ESC guidelines for the management of arterial hypertension // Hypertension.– 2013.– Vol. 31.– P. 1281–1357.
McEniery C., Yasmin Hall I., Qasem A. et al. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT) // J. Am. Coll. Cardiol.– 2005.– Vol. 46 (9).– P. 1753–1760.
Mitchell G., Parise H., Benjamin E. et al. Сhanges in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study // Hypertension.– 2004.– Vol. 43.– P. 1239–1245.
Nagueh S., Smiseth O., Appleton C. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging // J. Am. Soc. Echocardiogr.– 2016.– Vol. 29.– P. 277–314.
Okada Y., Galbreath M., Shibata S. et al. Relationship between sympathetic baroreflex sensitivity and arterial stiffness in elderly men and women // Hypertension.– 2012.– Vol. 59.– P. 98–104.
Owan T., Hodge D., Herges R. et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction // N. Engl. J. Med.– 2006.– Vol. 355.– P. 251–259.
Paratia G., Stergiouc G., O’BriendЕ. et al. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring // J. Hypertens.– 2014.– Vol. 32.– P. 1359–1366.
Ponikowski Р.,Voors A., Anker S. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC // Eur. J. Heart Fail.– 2016.– Vol. 18 (8).– P. 891–975.
Russo C., Jin Z., Palmieri V. et al. Arterial stiffness andwave reflection: sex differences and relationship with left ventricular diastolic function // Hypertension.– 2012.– Vol. 60.– P. 362–368.
Seeland U., Brecht A., Nauman A. et al. Prevalence of arterial stiffness and the risk of myocardial diastolic dysfunction in women // Biosci. Rep.– 2016.– Vol. 36 (5).– P. e00400.
Shim C., Park S., Choi D. et al. Sex differences in central hemodynamics and their relationship to left ventricular diastolic function // J. Am. Coll. Cardiol.– 2011.– Vol. 57.– P. 1226–1233.
Van Riet E.E.S., Hoes A.,Wagenaar K. et al. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults overtime. A systematic review // Eur. J. Heart Fail.– 2016.– Vol. 18 (3).– P. 242–252.
World Health Organization. A global brief on hypertension: silent killer, global public health crisis // World Health Day. – 2013.– Report.– P. 1–39.