Predictors of cardiovascular complications in patients with arterial hypertension and comorbid pathology

Aim. To study the relationship between central arterial pressure (BP) and cystatin C in patients with arterial hypertension and comorbid pathology, depending on gender differences. Materials and methods. The study involved 162 patients aged 39 to 82 years, suffering from hypertension and comorbid pathology. The average age of the surveyed was 58.6±10.3 years. The following nosological forms were revealed: coronary heart disease - 40.7% of the examined, overweight - 33.9%, 1st degree obesity - 30.8%, type 2 diabetes mellitus - 29.0%, chronic obstructive disease lungs - 16.6%, cerebrovascular diseases - 13.5%. All participants underwent general clinical examinations. The concentration of the lipid spectrum was investigated: the levels of total cholesterol, triglycerides, cholesterol high density lipoproteins (HDL cholesterol) and low density lipoprotein cholesterol (LDL cholesterol) and plasma cystatin C. Glomerular filtration rate (GFR) was calculated according to F. Hoek's formula (80.35/cystatin C - 4.32=GFR). Study of central aortic pressure (CAP), mm Hg Art., was carried out using the device "AngioScan". Echocardiography was performed on a "Vivid q" apparatus (USA, 2014) according to the generally accepted technique. All examined patients were divided into 2 subgroups. The 1st subgroup includes women, the 2nd - men. Results. In patients with hypertension and comorbid pathology, the most common abnormalities were an increased level of LDL cholesterol (58%), a decreased level of HDL cholesterol (51.8%), hypercholesterolemia (54.3%), hypertriglyceridemia (43.8%) and tachycardia (40.7%). In 51.8% of the surveyed, and more among males, the achievement of the target blood pressure level was detected. In women, the indicators of average age, body mass index, the content of total cholesterol, LDL cholesterol and HDL cholesterol were significantly higher. In male patients, the indicators of the diameter of the aortic outflow tract, end systolic and diastolic dimensions of the left ventricle (LV) significantly exceeded those of women, and the ejection fraction of the LV was significantly lower. The prevalence of LV hypertrophy (LVH) was 37% in the total sample, and it was higher in women than in men (45.9 and 26.6%, respectively, p=0.012). At the same time, the frequencies of concentric and eccentric types of LVH in both subgroups were similar. The incidence of LV concentric remodeling in women and men was 5.7 and 13.3%, respectively (p=0.001). In both subgroups, a negative correlation was found between the LV myocardial mass index and the calculated GFR. A positive correlation was noted between the levels of systolic blood pressure and CAP, the concentrations of cystatin C and plasma triglycerides. Conclusion. In hypertension, the structure of comorbid pathology is dominated by coronary heart disease, obesity and type 2 diabetes mellitus, when hyper- and dyslipidemia were often detected. The incidence of LVH in the general group of subjects was 37.0%, and in women this indicator was higher. In the subgroup of men, cases of LV concentric remodeling were significantly more frequent. An increase in the level of CAP and systolic blood pressure, as well as the concentration of cystatin C, was associated with an increase in the LV myocardial mass index, especially in the subgroup of women.

arterial hypertension, comorbid pathology, cystatin C, cardiovascular complications, gender differences

1. Chazova IE, Aksenova AV, Oschepkova EV. Clinical features of arterial hypertension in men and women (according to the National Registry of Arterial Hypertension). Terapevticheskii Arkhiv (Ter. Arkh.). 2019;91(1):4-12 (in Russian). doi: 10.26442/00403660.2019.01.000021

2. Singh S, Shankar R, Singh GP. Prevalence and associated risk factors of hypertension: a cross-sectional study in urban Varanasi. Int J Hypertens. 2017;2017:5491838. doi: 10.1155/2017/5491838

3. Ezzati M, Oza S, Danaei G, Murray CJL. Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States. Circulation. 2008;117(7):905-14. doi: 10.1161/circulationaha.107.732131

4. Chazova IE, Zhernakova YV. Diagnosis and treatment of arterial hypertension [Guidelines]. Systemic Hypertension. 2019;16(1):6-31 (in Russian). doi: 10.26442/2075082X.2019.1.190179

5. Lawes CM, Hoorn SV, Rodgers A. Global burden of blood-pressurerelated disease, 2001. Lancet. 2008;371(9623):1513-18. doi: 10.1016/s0140-6736(08)60655-8

6. Chesnikova AI, Batyushin MM, Terentyev VP. Arterial hypertension and comorbidity: state of the art. Arterial Hypertension. 2016;22(5):432-40 (in Russian). doi: 10.18705/1607-419X-2016-22-5-432-440

7. Chazova IE, Zhernakova YuV. Guidelines for diagnostics and treatment of hypertension 2018 – European experts’ opinion. Systemic Hypertension. 2018;15(3):6-10 (in Russian). doi: 10.26442/2075-082_2018.3

8. Hoek FJ, Kemperman FA, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant. 2003;18(10):2024-31. doi: 10.1093/ndt/gfg349

9. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79-108. doi: 10.1016/j.euje.2005.12.014

10. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977;55(4):613-8. PMID: 138494.

11. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041. doi: 10.1097/HJH.0000000000001940

12. Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7(10):915-26. doi: 10.1016/S1474-4422(08)70193-5

13. Shlyakhto EV, Konradi AO. Strukturno-funktsional'nye izmeneniia miokarda u bol'nykh gipertonicheskoi bolezn'iu. Kardiologiia.1999;2:49-55 (in Russian).

14. Kobalava ZhD, Konradi AO, Nedogoda SV, et al. Russian Society of Cardiology position paper on 2018 Guidelines of the European Society of Cardiology/European Society of Arterial Hypertension for the management of arterial hypertension. Russian Journal of Cardiology. 2018;12:131-42 (in Russian). doi: 10.15829/1560-4071-2018-12-131-142

15. Rabahi MF, Pereira SA, Silva Junior JL, et al. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms. Int J Chron Obstruct Pulmon Dis. 2015;10(1):1525-9. doi: 10.2147/COPD.S85588

16. Hillas G, Perlikos F, Tsiligianni I, Tzanakis N. Managing comorbidities in COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:95-109. doi: 10.2147/COPD.S54473

17. Portegies ML, Lahousse L, Joos GF, et al. Chronic obstructive pulmonary disease and the risk of stroke: the Rotterdam study. Am J Respir Crit Care Med. 2015;193(3):251-8. doi: 10.1164/rccm.201505-0962OC

18. Kislyak OA, Myshlyaeva TO, Malysheva NV, et al. Type 2 diabetes, hypertension and the risk of cardiovascular complications. Diabetes Mellitus. 2008;1:45-9 (in Russian).

19. Derakhshan A, Bagherzadeh-Khiabani F, Arshi B, et al. Different combinations of glucose tolerance and blood pressure status and incident diabetes, hypertension, and chronic kidney disease. J Am Heart Assoc. 2016;5(8):e003917. doi: 10.1161/JAHA.116.003917

20. Bhatt DL, Steg PG, Ohman EM, et al. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA. 2006;295(2):180-9. doi: 10.1001/jama.295.2.180

21. Sachdev M, Sun JL, Tsiatis AA, et al. The prognostic importance of comorbidity for mortality in patients with stable coronary artery disease. J Am Coll Cardiol. 2004;43(4):576-82. doi: 10.1016/j.jacc.2003.10.031

22. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J. 2006;27(16):1979-2030. doi: 10.1093/eurheartj/ehl176

23. Fomin IV. Chronic heart failure in Russian Federation: what do we know and what to do. Russian Journal of Cardiology. 2016;8:7-13 (in Russian). doi: 10.15829/1560-4071-2016-8-7-13

24. Devereux RB, Pickering TG, Alderman MH, et al. Left ventricular hypertrophy in hypertension. Prevalence and relationship to pathophysiologic variables. Hypertension. 1987;9(2 Pt. 2):II53-60. doi: 10.1161/01.hyp.9.2_pt_2.ii53

25. Malyutina SK, Ryabikov AN, Shakhmatov SG, et al. Arterial hypertension and target organs damage: prognostic significance of myocardium hypertrophy in siberian population. The Bulletin of Siberian Branch of Russian Academy of Medical Sciences. 2001;5(31):53-8 (in Russian).

26. Gerdts E, Izzo R, Mancusi C, et al. Left ventricular hypertrophy offsets the sex difference in cardiovascular risk (the Campania Salute Network). Int J Cardiol. 2018;258:257-61. doi: 10.1016/j.ijcard.2017.12.086

27. Levy D, Anderson K, Savage D, et al. Risk of ventricular arrhythmias in left ventricular hypertrophy: The Framingham Heart Study. Am J Cardiol. 1987;60(7):560-5. doi: 10.1016/0002-9149(87)90305-5

28. Murkamilov IT, Fomin VV, Aitbaev KA, et al. Blood plasma cystatin С level and its relationship with the augmentation index and central arterial pressure in therapeutic patients. Clin Nephrol. 2018;3:31-40 (in Russian). doi: 10.18565/nephrology.20183.31-40

29. Murkamilov IT, Sabirov IS, Fomin VV, et al. Evaluation of nephrocerebral risk using cystatin C in patients with chronic kidney disease. S.S. Korsakov Journal of Neurology and Psychiatry. 2018;118(9):10-6 (in Russian). doi: 10.17116/jnevro201811809110

30. Murkamilov IT, Sabirov IS, Aitbaev KA, et al. Renal dysfunction and indicators of arterial hormity in persons of elderly and senile age. Advances in Gerontology. 2018;31(4):549-55 (in Russian).

31. Rudenko TE, Vasilyeva MP, Kutyrina IM, Solomakhina NI. Cystatin C and uric acid levels in detecting left ventricular hypertrophy in patients with chronic kidney disease. Nephrology (Saint Petersburg). 2015;19(2):68-75 (in Russian).

32. Taglieri N, Koenig W, Kaski JC. Cystatin C and Cardiovascular Risk. Clin Chem. 2009;55(11):1932-43. doi: 10.1373/clinchem.2009.128397

33. Reese PP, Feldman HI. More evidence that cystatin C predicts mortality better than creatinine. J Am Soc Nephrol. 2009;20(10):2085-92. doi: 10.1681/ASN.2009080832

34. Chung YK, Lee YJ, Kim KW, et al. Serum cystatin C is associated with subclinical atherosclerosis in patients with type 2 diabetes: a retrospective study. Diab Vasc Dis Res. 2018;15(1):24-30. doi: 10.1177/1479164117738156