[Correlation between the parameters of 24-hour monitoring of arterial pressure and changes in arterial wall structure based on the results of a prospective trial].

AIM: To evaluate prognostic value of 24-h monitoring of blood pressure (BPM-24) for assessment of structural changes in arterial walls in patients with essential hypertension living in West Siberia. MATERIAL AND METHODS: In the course of 5-year prospective study we made two extended clinical and device examinations with use of BPM-24 and ultrasonic measurements of arterial intima-media complex (IMC) in 160 patients (mean age 48.97+/-8.18 years). RESULTS: An independent significant correlation was found between initial drop of the circadian index (CI) of blood pressure, systolic blood pressure (SBP)/diastolic blood pressure (DBP) at night (r = 0.24/0.22, p = 0.012/0.024) and thickness of IMC in 5 years (r = -0.28/-0.30, p = 0.004/ 0.002). The risk of increased thickness of arterial wall in the group with abnormal CI was 1:4. There was no relationships between IMC increase and baseline office blood pressure (r = 0. 18/0.12, p = 0. 057/0.188). In evaluation of office BP effects on progression of arterial atherosclerosis insignificant correlation coefficients for SBP/DBP were obtained (r = 0. 18/0.18, p = 0. 150/0.149) contrary to BPM-24 parameters: mean circadian SBP (r = 0.22, p = 0.046) and heart rate (r = 0.23, p = 0.038), SBP temporal index for 24 hours (r = 0.24, p = 0.035). CONCLUSION: . BPM-24 parameters are more significant predictors of structural changes in arterial wall than standard office blood pressure. This allows calculations of possible risk of such changes.

[Recognition of actual periods of nocturnal rest from 24-hour heart rate profile].

UNLABELLED: Inability to delineate exactly periods of nocturnal sleep and diurnal wakefulness during 24-hour blood pressure (BP) monitoring causes reporting of erroneous BP values for these periods. We suggested a simple mathematical algorithm for detection of periods of nocturnal rest determined as period of low values of cardiac rhythm using data of BP monitoring itself. AIM: To compare novel method of recognition of periods of sleep with 2 standard techniques: use of fixed time interval between 23 and 7 hours (1), or period of sleep according to patient's diaries (2). Reproducibility of nocturnal BP lowering between two 24-hour intervals during 48-hour blood pressure monitoring was used as a measure of precision of determination of diurnal/nocturnal BP. METHODS: Ambulatory 48-hour BP monitoring was carried out in 33 patients with uncomplicated stage II hypertensive disease. Automatic analysis of BP monitoring data was performed with the use of specially designed computer application. Standard deviation (SD) of differences (SDD) between pairs of nocturnal BP lowering during 48 hours was used as a measure of reproducibility. RESULTS: Reproducibility of values obtained with novel algorithm (SDD for systolic/diastolic BP 6.7/8.2 mm Hg) was substantially better than those obtained with standard methods (1) and (2) (SDD 13.0/14.8 and 13.5/18.3 mm Hg, respectively). CONCLUSION: The proposed method of recognition of the period of nocturnal rest substantially improved precision of automatic analysis of 24-hour BP monitoring.

[Relationship between changes of endothelial vasodilator function, vascular and cardiac structure and derangements of blood pressure 24-hour profile]. / Sviaz' izmenenii vazodilatatornoi funktsii éndoteliia, struktury sosudov i serdtsa s narusheniem sutochnogo profilia arterial'nogo davleniia.

AIM: To assess relationship between 24-hour blood pressure (BP) rhythm and structural and functional state of the heart and blood vessels. MATERIAL AND METHODS: Echocardiography, sonography of carotid artery intima-media, and assessment of endothelium dependent (flow mediated) and endothelium independent (nitroglycerine) brachial artery vasodilatation were used in the study of 83 patients with stage I-II essential hypertension (mean age 49.2+/-6.2 years). Seventy four patients received indapamide and enalapril for 24 weeks. RESULTS: According to results of 24-hour BP monitoring the patients were divided into 2 groups with normal (dippers) and abnormal (non-dippers) BP rhythm. Non-dippers compared with dippers had more pronounced lowering of endothelium-dependent autoregulation of arterial tone, bigger left ventricular mass thicker carotid artery wall. Linear correlation was found between changes of 24-hour BP rhythm and structural and functional parameters of the heart and vessels. More pronounced regression of their derangements occurred during antihypertensive therapy in those patients in whom normalization of 24-hour rhythm was achieved.

[A decrease in left ventricular hypertrophy and the dynamics of the parameters of circadian BP monitoring under the influence of ramipril in patients with essential arterial hypertension]. / Umen'shenie gipertrofii levogo zheludochka i dinamika parametrov sutochnogo monitorirovaniia AD pod vliianiem ramiprila u bol'nykh éssentsial'noi arterial'noi gipertoniei.

To evaluate factors of action of ramipril, an inhibitor of angiotensin-converting enzyme, which may induce a decrease in left ventricular hypertrophy (LVH), 45 LVH patients aged 21-53 years with mild and moderate essential hypertension have underwent echo-CG determination of left ventricular mass and 24-h monitoring of arterial pressure (AP). Multiple regression was used to examine prognostic significance of such parameters as age, sex, height, weight, duration of the disease, mean 24-h AP, its variability and the degree of nocturnal fall. It was found that ramipril reduced LVH irrespective of the hypotensive effect.