K.M. Amosova, N.V. Shyshkina, O.I. Rokyta, I.Yu. Katsitadze, Yu.V. Rudenko, K.P. Lazareva, Z.V. LysakGender and age differences in the relationship between left ventricular diastolic function and central hemodynamics and vascular stiffness in patients with uncontrolled uncomplicated arterial hypertension

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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