Arterial stiffness in hypertensive patients with peripheral artery disease

Abstract

Objective. To identify features of arterial stiffness, to establish relationships with indicators of the daily blood pressure profile and peripheral artery disease in patients with hypertension (HTN) in combination with subclinical and manifested atherosclerotic lesions of the arteries of the lower extremities. Design and methods. 120 patients were divided into 3 groups: group 1-46 patients with HTN and clinically manifested AALE, group 2-39 patients with HTN and asymptomatic AALE, group 3-35 HTN patients without AALE. All patients underwent general clinical laboratory and instrumental research methods, including 24-hour blood pressure ambulatory monitoring (24h-ABPM) with the assessment of 24-hour blood pressure profile and arterial stiffness parameters, ultrasonic triplex scanning (USTS) of the arteries of the lower extremities. Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA). Results. Higher values of pulse wave velocity (PWVao), augmentation index (AIx) and ambulatory arterial stiffness index (AASI) were found in the 1st group in comparison to the 2nd and 3rd groups (p < 0,05). Lower reflected wave transit time (RWTT) (119,5 [112;127] ms) was found in the 1st group (128 [122;132], p = 0,001 and 126 [121;129] ms, p = 0,03 in the 2nd and and 3rd groups, respectively) groups. The maximum rate of blood pressure increase (dP/dtmax) in patients of the 1st (550 [466;666] mm Hg/s) and 2nd (634 [511;695] mm Hg/s) groups was significantly lower than in patients of the 3rd group (655 [526;806] mm Hg/s, p < 0,05). A direct correlation was found between AASI values and SBP (r = 0,291, p = 0,049) and its variability (r = 0,301, p = 0,042), AASI and PBP (r = 0,518, p < 0,001), its variability (r = 0,596, r < 0,001) in group 1, as well as AASI and PBP (r = 0,514, p < 0,001) and PBP variability (r = 0,632, p < 0,001) in group 2. A correlation between AIx and the degree of stenosis (%) of the arteries of the lower extremities was found in patients with AH and AALE of varying severity (r = 0,310, p = 0,004). Conclusions. In patients with subclinical course of AALE, lower values of dP/dtmax in comparison with HTN patients without AALE indicate an increase in arterial stiffness at the initial stages of peripheral atherosclerosis. Clinically manifested atherosclerotic lesions of the arteries of the lower extremities in HTN patients are associated with a more pronounced increase in arterial stiffness, which contributes to a higher cardiovascular risk.