动脉性高血压合并慢性心力衰竭和老年虚弱综合征患者血管僵硬的特点

V. Safronenko, A. Chesnikova, N. Sementsova
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To identify SAS, we used the “Age is not a barrier” questionnaire and a short battery of physical functioning tests. The parameters of vascular stiffness were determined using a device for daily monitoring of blood pressure BPLab using Vasotens technology (Peter Telegin, Nizhny Novgorod). The obtained data were processed using STATISTICA 12.0 (StatSoft Inc., USA), SPSS 21.0, MedCalc (version 9.3.5.0).Results. Analysis of the effect of SAS on vascular stiffness showed that in patients with AH, CHF and SAS, compared with patients with AH, CHF without SAS, there were statistically significantly lower values of the reflected wave propagation time (RWTT) (p = 0,001) against the background of higher values pulse wave velocity in the aorta (РWVао) (p < 0,001), arterial stiffness index (ASI) (p = 0,0001) and ambulatory arterial stiffness index (AASI) (p = 0,002), which indicates more pronounced vascular stiffness in patients with AH, CHF in the presence of SAS. In the group of patients with AH and SAS without CHF, compared with patients with AH without CHF and without SAS, higher values of РWVао (p < 0,001) and “adjusted” index of augmentation index (AIх@75) (p < 0,001) were revealed, which allows to judge the effect of SAS on the development of arterial stiffness in patients with AH without CHF. Analysis of the effect of CHF on vascular stiffness showed that in patients with AH, SAS and CHF, compared with patients with AH, SAS without CHF, statistically significantly lower values of RWTT (p < 0,001) and higher values of РWVао (p = 0,024) were noted, ASI (p < 0,001), AASI (p < 0,001), maximum rate of blood pressure rise (dP/dtmax) (p < 0,001) and AIх@75 (p < 0,001). In the group of patients with AH, CHF without SAS, compared with patients with AH without CHF and without SAS, lower values of RWTT (p < 0,001) and higher values of РWVаo (p = 0,004), ASI (p < 0,001), AASI (p < 0,001) and dP/dtmax (p < 0,001), which in turn demonstrates the contribution of CHF to the development of vascular stiffness in AH patients without SAS. CS.Conclusions. In hypertensive patients over 80 years of age, the development of both SAS and CHF was accompanied by limited compliance of the aortic walls and increased vascular stiffness in the peripheral arteries. 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In the group of patients with AH and SAS without CHF, compared with patients with AH without CHF and without SAS, higher values of РWVао (p < 0,001) and “adjusted” index of augmentation index (AIх@75) (p < 0,001) were revealed, which allows to judge the effect of SAS on the development of arterial stiffness in patients with AH without CHF. Analysis of the effect of CHF on vascular stiffness showed that in patients with AH, SAS and CHF, compared with patients with AH, SAS without CHF, statistically significantly lower values of RWTT (p < 0,001) and higher values of РWVао (p = 0,024) were noted, ASI (p < 0,001), AASI (p < 0,001), maximum rate of blood pressure rise (dP/dtmax) (p < 0,001) and AIх@75 (p < 0,001). 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引用次数: 0

摘要

目标。该研究的目的是评估慢性心力衰竭(CHF)和老年性衰弱综合征(SAS)存在的动脉性高血压(AH)患者血管刚性的特征。设计和方法。320例AH患者分为两组:1组AH合并CHF患者(n = 161), 2组AH合并CHF患者(n = 159)。根据有无SAS将每组患者分为:1A亚组- AH、CHF、SAS患者(n = 84), 1B亚组- AH、CHF无SAS患者(n = 77), 2A亚组- AH、SAS无CHF患者(n = 84), 2B亚组- AH、CHF、SAS无SAS患者(n = 75)。为了识别SAS,我们使用了“年龄不是障碍”问卷和一系列简短的身体功能测试。血管硬度参数采用Vasotens技术每日监测血压BPLab装置(Peter Telegin, Nizhny Novgorod)测定。采用STATISTICA 12.0 (StatSoft Inc., USA)、SPSS 21.0、MedCalc (version 9.3.5.0)软件对所得数据进行处理。SAS对血管僵硬度的影响分析显示,在AH、CHF和SAS患者中,与AH、CHF不加SAS的患者相比,在主动脉脉波速度(РWVао) (p < 0.001)、动脉僵硬指数(ASI) (p = 0.0001)和动态动脉僵硬指数(AASI) (p = 0.002)较高的背景下,反射波传播时间(RWTT) (p = 0.001)较低,具有统计学意义。这表明在SAS存在下,AH、CHF患者的血管僵硬更为明显。在AH和SAS无CHF患者组中,与AH无CHF和SAS患者相比,РWVао (p < 0.001)和“调整”后的增强指数(AIх@75) (p < 0.001)值更高,可以判断SAS对AH无CHF患者动脉僵硬发展的影响。分析CHF对血管僵硬度的影响显示,AH、SAS、CHF患者与AH、SAS无CHF患者相比,RWTT (p < 0.001)、РWVао (p = 0.024)、ASI (p < 0.001)、AASI (p < 0.001)、最大血压升高率(dP/dtmax) (p < 0.001)、AIх@75 (p < 0.001)均有统计学意义。在AH患者组中,与不伴有SAS的AH患者相比,不伴有SAS的CHF患者RWTT值较低(p < 0.001), РWVаo (p = 0.004)、ASI (p < 0.001)、AASI (p < 0.001)和dP/dtmax值较高(p < 0.001),这反过来表明CHF对不伴有SAS的AH患者血管僵硬的发展有贡献。CS.Conclusions。在80岁以上的高血压患者中,SAS和CHF的发展都伴随着主动脉壁的有限顺应性和外周动脉血管僵硬度的增加。与AH合并CHF或AH合并SAS患者相比,AH、CHF和SAS合并患者血管僵硬参数的变化更为明显,这表明血管僵硬度增加,因此,这种合并病理中心血管疾病的风险更高。
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Features of vascular rigidity in patients with arterial hypertension in combination with chronic heart failure and senile asthenia syndrome
Objective. The aim of the study was to evaluate the features of vascular rigidity in patients with arterial hypertension (AH) depending on the presence of chronic heart failure (CHF) and senile asthenia syndrome (SAS).Design and methods. 320 patients with AH were divided into two main groups: group 1 — patients with AH and CHF (n = 161), group 2 — patients with AH without CHF (n = 159). Depending on the presence of SAS, patients of each group were divided as follows: subgroup 1A — patients with AH, CHF and SAS (n = 84), subgroup 1B — patients with AH, CHF without SAS (n = 77), subgroup 2A — patients with AH, SAS without CHF (n = 84), subgroup 2B — patients with AH without CHF and without SAS (n = 75). To identify SAS, we used the “Age is not a barrier” questionnaire and a short battery of physical functioning tests. The parameters of vascular stiffness were determined using a device for daily monitoring of blood pressure BPLab using Vasotens technology (Peter Telegin, Nizhny Novgorod). The obtained data were processed using STATISTICA 12.0 (StatSoft Inc., USA), SPSS 21.0, MedCalc (version 9.3.5.0).Results. Analysis of the effect of SAS on vascular stiffness showed that in patients with AH, CHF and SAS, compared with patients with AH, CHF without SAS, there were statistically significantly lower values of the reflected wave propagation time (RWTT) (p = 0,001) against the background of higher values pulse wave velocity in the aorta (РWVао) (p < 0,001), arterial stiffness index (ASI) (p = 0,0001) and ambulatory arterial stiffness index (AASI) (p = 0,002), which indicates more pronounced vascular stiffness in patients with AH, CHF in the presence of SAS. In the group of patients with AH and SAS without CHF, compared with patients with AH without CHF and without SAS, higher values of РWVао (p < 0,001) and “adjusted” index of augmentation index (AIх@75) (p < 0,001) were revealed, which allows to judge the effect of SAS on the development of arterial stiffness in patients with AH without CHF. Analysis of the effect of CHF on vascular stiffness showed that in patients with AH, SAS and CHF, compared with patients with AH, SAS without CHF, statistically significantly lower values of RWTT (p < 0,001) and higher values of РWVао (p = 0,024) were noted, ASI (p < 0,001), AASI (p < 0,001), maximum rate of blood pressure rise (dP/dtmax) (p < 0,001) and AIх@75 (p < 0,001). In the group of patients with AH, CHF without SAS, compared with patients with AH without CHF and without SAS, lower values of RWTT (p < 0,001) and higher values of РWVаo (p = 0,004), ASI (p < 0,001), AASI (p < 0,001) and dP/dtmax (p < 0,001), which in turn demonstrates the contribution of CHF to the development of vascular stiffness in AH patients without SAS. CS.Conclusions. In hypertensive patients over 80 years of age, the development of both SAS and CHF was accompanied by limited compliance of the aortic walls and increased vascular stiffness in the peripheral arteries. Significantly more pronounced changes in vascular stiffness parameters were noted in patients with a combination of AH, CHF and SAS compared with those in patients with AH and CHF or AH and SAS, which indicates an increase in vascular stiffness, and, consequently, a higher risk of cardiovascular diseases in this combined pathology.
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来源期刊
Arterial Hypertension (Russian Federation)
Arterial Hypertension (Russian Federation) Medicine-Cardiology and Cardiovascular Medicine
CiteScore
0.90
自引率
0.00%
发文量
38
期刊介绍: The main aims of the Journal include collecting and generalizing the knowledge in hypertensiology; education and professional development of cardiologists and medical doctors of other specialties, who deal with different issues regarding diagnostics, management and prevention of hypertension in both clinical practice and research. The Journal also calls attention to the most urgent and up-to-date questions in hypertensiology, cardiology and related sciences. There are additional objectives, such as increasing the availability, accessibility and recognition of Russian medical scientific achievements at the international level by improving the quality of the publication and the way they are presented; enabling the exchange of opinions and information between scientists and their wider communication. The main criteria for publication selection fit with the mentioned objectives and include currency, singularity, scientific and practical novelty, applied relevance etc.
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