Uticaj 24-časovnog profila arterijskog krvnog pritiska na strukturu i funkciju desne komore kod bolesnika sa novootkrivenom arterijskom hipertenzijom

Abstract

Cilj: Svrha ovog istraživanja je da se odredi uticaj non-dipping profila krvnog pritiska na strukturu, dijastolnu i globalnu funkciju desne komore (DK) kod novootkrivenih pacijenata sa arterijskom hipertenzijom. Metodologija: Ova studija preseka je uključila 167 hipertenzivnih pacijenata sa novootkrivenom hipertenzijom. Svim ispitanicima je urađeno 24-časovno praćenje krvnog pritiska i kompletan ehokardiografski pregled (dvodimenzioni pregled, pulsni i tkivni Doppler). DK hipertrofija je definisana debljinom zida DK ≥ 6.0 mm kod muškaraca i ≥ 5.5 mm kod žena. Rezultati: Dipping profil krvnog pritiska je nađen kod 101 (60%) pacijenta, dok je non-dipping profil bio prisutan kod 66 (40%) hipertenzivnih pacijenata. Dijastolna i globalna funkcija leve komore (LK) su značajno više bile poremećene kod non-dippera u poređenju sa dipperima. Većina parametara dijastolne funkcije LK (E/A, e´/a´, E/e´) se značajno i postepeno pogoršavala idući od ekstremnih dippera ka inverznim dipperima. Nasuprot tome, strukturni parametri LK (IVS, RWT, LK masa indeks) su se značajno razlikovali samo kada su dipperi i ekstremni dipperi poređeni sa ostalim pacijentima. Debljina zida DK kao i (E/e´)t odnos i Tei indeks DK su statistički bili značajno povišeni kod non-dippera u odnosu na dippere. Svi navedeni parametri (debljina zidova DK, (E/e´)t i Tei indeks) progresivno su se rasli od ekstremnih dippera prema inverznim dipperima. Analize rezultata su pokazale da su noćni sistolni i dijastolni pritisak, kao i (E/e´)t odnos nezavisno povezani sa debljinom zida desne komore (p < 0.01 za sve). Non-dipping profil, debljina zida DK, relativna debljina zida LK, (E/e´)m i sistolni oritisak u desnoj komori su nezavisno prediktori dijastolne funkcije DK (E/e´)t, dok su dnevne vrednosti sistolnog i dijastolnog pritiska, kao i noćni dijastolni pritisak i inverzni dipping profil predstavljali prediktore globalne funkcije DK (Tei index DK). Zaključak: Struktura, dijastolna i globalna funkcija DK su značajno poremećene kod non-dippera. Non-dipping i inverzni dipping profil krvnog pritiska predstavljaju nezavisne prediktore dijastolne i globalne funkcije DK.

Objective: The purpose of this study was to determine the influence of a non-dipping arterial blood pressure pattern on the right ventricular (RV) structure, diastolic, and global function in recently diagnosed hypertensive patients. Methods: This cross-sectional study included 167 recently diagnosed hypertensive patients. All participants underwent 24 h ambulatory blood pressure monitoring and a complete two-dimensional, pulsed and tissue Doppler echocardiography. RV hypertrophy was defined by RV wall thickness at least 6.0mm in men and at least 5.5 mm in women. Results: The dipping blood pressure pattern was found in 101 (60%) participants, whereas the non-dipping pattern was present in 66 (40%) hypertensive patients. Left ventricular (LV) diastolic and global function were more impaired in non-dippers comparing with dippers. Most of the parameters of the left ventricular diastolic function (E/A, e´/a´, E/e´) significantly and progressively deteriorated from the extreme dippers to the reverse dippers. In contrast, LV structural parameters (IVS, RWT, LV mass index) showed a statistically important difference only by comparing the dippers and the extreme dippers with the rest of the patients. The RV wall thickness as well as the (E/e´)t ratio and the RV Tei index were significantly increased in the non-dippers comparing with dippers. All these parameters (RV wall thickness, (E/e´)t and Tei index) progressively increased from extreme dippers to inverse dippers. Analyses revealed that night-time systolic and diastolic blood pressure, and (E/e´)t ration were independently associated with RV wall thickness (p < 0.001 for all). Non-dipping profile, RV wall thickness, relative wall thickness, (E/e´)m and systolic pressure in right ventricle were identified as independent predictors of RV diastolic function (E/e´)t, whereas daytime systolic and diastolic blood pressure, night-time diastolic blood pressure and inverse dipping profile were independent predictors of RV global function (RV Tei index). Conclusion: RV structure, diastolic, and global functions were significantly impaired in non-dippers. A non-dipping and inverse dipping blood pressure patterns represent the independent predictors of RV diastolic and global function.