Жесткость сосудистой стенки у молодых мужчин с артериальной гипертонией и обструктивным апноэ сна

Цель. Оценить жесткость сосудистой стенки у мужчин младше 45-ти лет с артериальной гипертонией в зависимости от наличия или отсутствия обструктивного апноэ сна, и независимо от иных факторов, потенциально влияющих на жесткость сосудистой стенки.

Материалы и методы. Включено 75 мужчин 18-44-х лет с АГ. Всем больным проведена общеклиническая, лабораторная и инструментальная диагностика, включая: биохимический анализ крови, суточное мониторирование артериального давления (СМАД), ночное кардиореспираторное мониторирование, объемная сфигмография, аппланационная тонометрия.

Результаты. Средний возраст включенных пациентов 35,0 лет [29,0; 40,0]. Пациенты с обструктивным апноэ сна (ОАС) (индекс апноэ/гипопноэ (ИАГ) ≥ 5соб/ч) были старше по возрасту (38,5 лет [35,0; 43,0] против 30,0 [28,0; 40,0], р=0,00), чаще страдали ожирением (84,4% против 30,2%, р=0,00), имели более высокие значения уровня глюкозы (5,5 ммоль/л [5,2; 6,0] против 5,1 [4,9; 5,4] р=0,00) и каротидно-феморальной скорости пульсовой волны (кфСПВ) (8,6 м/с [7,5; 9,8] против 7,4 [6,8; 8,2] р=0,00). При этом частота наличия дислипидемии, уровни артериального давления (АД) по данным клинических измерений и СМАД, а также иные показатели структурно-функционального состояния сосудистой стенки значимо не различались между группами. По данным ROC-анализов и многофакторной логистической регрессии определено, что ИАГ > 4,9 соб/ч, уровень клинического систолического АД (САД) > 130 мм рт. ст., уровень глюкозы > 5,1 ммоль/л и возраст > 37 лет, являются независимыми маркерами высокого риска повышенной сосудистой жесткости у мужчин моложе 45-ти лет.

Заключение. Обструктивное апноэ сна, наряду с возрастом, уровнем глюкозы и повышенным уровнем САД, является независимым маркером наличия повышенной сосудистой жесткости. С целью минимизации негативного влияния описанных факторов на жесткость сосудистой стенки, необходимо не только контролировать САД и уровень глюкозы, но и лечить ОАС у молодых мужчин, в особенности – в возрастной категории старше 37-ми лет.

1. Stone K, Veerasingam D, Meyer ML, Heffernan KS, Higgins S, Maria Bruno R, et al. Reimagining the value of brachial-ankle pulse wave velocity as a biomarker of cardiovascular disease risk-a call to action on behalf of VascageNet. Hypertension 2023;80:1980-92. https://doi.org/10.1161/hypertensionaha.123.21314

2. An DW, Hansen TW, aparicio LS, Chori B, Huang Q-f, Wei f-f, et al. Derivation of an outcome-driven threshold for aortic pulse wave velocity: an individual-participant meta-analysis. Hypertension 2023;80:1949-59. https://doi.org/10.1161/hypertensionaha.123.21318

3. Vasan RS, Pan S, Xanthakis V, Beiser a, Larson MG, Seshadri S, et al. arterial stiffness and long-term risk of health outcomes: the framingham heart study. Hypertension 2022;79:1045-56. https://doi.org/10.1161/hypertensionaha.121.18776

4. Vasan RS, Song RJ, Xanthakis V, Beiser a, DeCarli C, Mitchell Gf, et al. Hypertension-mediated organ damage: prevalence, correlates, and prognosis in the community. Hypertension 2022;79:505-15. https://doi.org/10.1161/hypertensionaha. 121.18502

5. McEvoy, John William et al. “2024 ESC Guidelines for the management of elevated blood pressure and hypertension. European heart journal. 2024 Oct 7;45(38):3912-4018. https://doi.org/10.1093/eurheartj/ehae178

6. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019;16(1):6-31. https://doi.org/10.26442/2075082X.2019.1.190179

7. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'. Eur Heart J. 2010 Oct;31(19):2338-50. Epub 2010 Jun 7. PMID: 20530030; PMCID: PMC2948201. https://doi.org/10.1093/eurheartj/ehq165

8. Lin, X. et al. Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis. Eur arch Otorhinolaryngol. 2016 Dec;273(12):4081-4088. https://doi.org/10.1007/s00405-016-3914-8

9. Sirenko Yu, Krushynska N, Rekovets O, Torbas O, Kushnir S (2020) association between arterial stiffness and obstructive sleep apnea in patients with arterial hypertension and continuous positive airway pressure therapy. J Integr Cardiol. 2020;6: 1-8. https://doi.org/10.15761/JIC.1000302

10. Collen J, Lettieri C, Wickwire E, Holley a. Obstructive sleep apnea and cardiovascular disease, a story of confounders! Sleep Breath. 2020 Dec;24(4):1299-1313. Epub 2020 Jan 9. PMID: 31919716. https://doi.org/10.1007/s11325-019-01945-w

11. Ali SS, Oni ET, Warraich HJ, Blaha MJ, Blumenthal RS, Karim a, Shaharyar S, Jamal O, fialkow J, Cury R, Budoff MJ, agatston aS, Nasir K. Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block! Sleep Med Rev. 2014 Oct;18(5):379-91. Epub 2014 feb 3. PMID: 24650521. https://doi.org/10.1016/j.smrv.2014.01.004

12. Ежов М. В., Кухарчук В. В., Сергиенко И. В., Алиева А. С., Анциферов М. Б., Аншелес А. А., Арабидзе Г. Г., Аронов Д. М., Арутюнов Г. П., Ахмеджанов Н. М., Балахонова Т. В. и соавт. Нарушения липидного обмена. Клинические рекомендации 2023. Российский кардиологический журнал. 2023;28(5):5471. https://doi.org/10.15829/1560-4071-2023-5471

13. Guimarães filho GC, araújo RCG, Cabral KB, Paula CR. Comparison of angiotensin Receptor Blockers and angiotensin-Converting Enzyme Inhibitors in the Management of arterial Stiffness and Target Organ Damage in Patients with Hypertension. Int J Cardiovasc Sci 2023;36:e20220162. http://doi.org/10.36660/ijcs.20220162

14. Tsai JP, Hsu BG. arterial stiffness: a brief review. Tzu Chi Med J. 2020 Sep 16;33(2):115-121. PMID: 33912407; PMCID: PMC8059465. http://doi.org/10.4103/tcmj.tcmj_44_20

15. Baier, D., Teren, a., Wirkner, K. et al. Parameters of pulse wave velocity: determinants and reference values assessed in the population-based study LIfE-adult. Clin Res Cardiol. 2018 Nov;107(11):1050-1061. https://doi.org/10.1007/s00392-018-1278-3

16. Reference Values for arterial Stiffness' Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'. Eur Heart J. 2010 Oct;31(19):2338-50. Epub 2010 Jun 7. PMID: 20530030; PMCID: PMC2948201. https://doi.org/10.1093/eurheartj/ehq165

17. Mitchell Gf. arterial Stiffness in aging: Does It Have a Place in Clinical Practice? Recent advances in Hypertension. Hypertension. 2021 Mar 3;77(3):768-780. Epub 2021 feb 1. PMID: 33517682. https://doi.org/10.1161/HYPERTENSIONaHa.120.14515

18. Ahmed B, Rahman aa, Lee S, Malhotra R. The Implications of aging on Vascular Health. Int J Mol Sci. 2024 Oct 17;25(20):11188. PMID: 39456971; PMCID: PMC11508873. https://doi.org/10.3390/ijms252011188

19. Koenen M, Hill Ma, Cohen P, Sowers JR. Obesity, adipose Tissue and Vascular Dysfunction. Circ Res. 2021 apr 2;128(7):951-968. Epub 2021 apr 1. PMID: 33793327; PMCID: PMC8026272. https://doi.org/10.1161/CIRCRESaHa.121.318093

20. Safar M.E., Czernichow S., Blacher J. Obesity, arterial stiffness, and cardiovascular risk. J. am. Soc. Nephrol. 2006;17:S109-S111. https://doi.org/10.1681/aSN.2005121321

21. Recio-Rodriguez J.I., Gómez-Marcos M.a., Patino-alonso M.C., agudo-Conde C., Rodriguez-Sanchez E., Garcia-Ortiz L. abdominal obesity vs general obesity for identifying arterial stiffness, subclinical atherosclerosis and wave reflection in healthy, diabetics and hypertensive. BMC Cardiovasc. Disord. 2012;12:3. https://doi.org/10.1186/1471-2261-12-3

22. Fu S., Luo L., Ye P., Liu Y., Zheng J., Bai Y., Bai J., Zhu B. Overall and abdominal obesity indicators had different association with central arterial stiffness and hemodynamics independent of age, sex, blood pressure, glucose, and lipids in Chinese community-dwelling adults. Clin. Interv. aging. 2013;8:1579- 1584. https://doi.org/10.2147/CIa.S54352

23. Para I, albu a, Porojan MD. adipokines and arterial Stiffness in Obesity. Medicina (Kaunas). 2021 Jun 25;57(7):653. PMID: 34202323; PMCID: PMC8305474. https://doi.org/10.3390/medicina57070653

24. Petersen K., Blanch N., Keogh J.B., Clifton P.M. Effect of weight loss on pulse wave velocity. arter. Thromb. Vasc. Biol. 2015;35:243-252. https://doi.org/10.1161/aTVBaHa.114.304798

25. Baba M, Maris M, Jianu D, Luca CT, Stoian D, Mozos I. The Impact of the Blood Lipids Levels on arterial Stiffness. J Cardiovasc Dev Dis. 2023 Mar 16;10(3):127. PMID: 36975891; PMCID: PMC10056627. https://doi.org/10.3390/jcdd10030127

26. Tomiyama H., Shiina K. State of the art Review: Brachial-ankle PWV. J. atheroscler. Thromb. 2020;27:621– 636. https://doi.org/10.5551/jat.RV17041

27. Wang H, Mo Z, Sui H, Qi Y, Xu P, Zheng J, Zhang T, Qi X, Cui C. association of baseline and dynamic arterial stiffness status with dyslipidemia: a cohort study. front Endocrinol (Lausanne). 2023 Nov 23;14:1243673. PMID: 38075050; PMCID: PMC10704037. https://doi.org/10.3389/fendo.2023.1243673

28. Wu Z, Yu S, Zhang H, Guo Z, Zheng Y, Xu Z, Li Z, Liu X, Li X, Chen S, Zhang J, Tao L, Guo X. Combined evaluation of arterial stiffness, glycemic control and hypertension for macrovascular complications in type 2 diabetes. Cardiovasc Diabetol. 2022 Nov 28;21(1):262. PMID: 36443820; PMCID: PMC9706858. https://doi.org/10.1186/s12933-022-01696-1

29. Zhang W, Huo W, Hu H, Li T, Yuan L, Zhang J, feng Y, Wu Y, fu X, Ke Y, Wang M, Wang L, Chen Y, Gao Y, Li X, Sun L, Pang J, Zheng Z, Hu f, Zhang M, Liu Y, Hu D, Zhao Y. Dose-response associations of triglyceride to high-density lipoprotein cholesterol ratio and triglyceride-glucose index with arterial stiffness risk. Lipids Health Dis. 2024 apr 20;23(1):115. PMID: 38643148; PMCID: PMC11031917. https://doi.org/10.1186/s12944-024-02095-z

30. Markus M.R.P., Rospleszcz S., Ittermann T., Baumeister S.E., Schipf S., Siewert-Markus U., Lorbeer R., Storz C., Ptushkina V., Peters a. Glucose and insulin levels are associated with arterial stiffness and concentric remodeling of the heart. Cardiovasc. Diabetol. 2019;18:145. https://doi.org/10.1186/s12933-019-0948-4

31. Liu f, Ling Q, Xie S, Xu Y, Liu M, Hu Q, Ma J, Yan Z, Gao Y, Zhao Y, Zhu W, Yu P, Luo J, Liu X. association between triglyceride glucose index and arterial stiffness and coronary artery calcification: a systematic review and exposure-effect meta-analysis. Cardiovasc Diabetol. 2023 May 13;22(1):111. PMID: 37179288; PMCID: PMC10183133. https://doi.org/10.1186/s12933-023-01819-2

32. Rubin J, Nambi V, Chambless LE, Steffes MW, Juraschek SP, Coresh J, Sharrett aR, Selvin E. Hyperglycemia and arterial stiffness: the atherosclerosis Risk in the Communities study. atherosclerosis. 2012 Nov;225(1):246-51. Epub 2012 Sep 13. PMID: 23031361; PMCID: PMC3936879. https://doi.org/10.1016/j.atherosclerosis.2012.09.003

33. Wei R, Wang W, Pan Q, Guo L. Effects of SGLT-2 Inhibitors on Vascular Endothelial function and arterial Stiffness in Subjects With Type 2 Diabetes: a Systematic Review and Meta-analysis of Randomized Controlled Trials. front Endocrinol (Lausanne). 2022 feb 16;13:826604. PMID: 35250882; PMCID: PMC8889103. https://doi.org/10.3389/fendo.2022.826604

34. Wilson J, Webb aJS. Systolic Blood Pressure and Longitudinal Progression of arterial Stiffness: a Quantitative Meta-analysis. J am Heart assoc. 2020 Sep;9(17):e017804. Epub 2020 aug 28. PMID: 32856498; PMCID: PMC7660776. https://doi.org/10.1161/JaHa.120.017804

35. Humphrey JD. Mechanisms of Vascular Remodeling in Hypertension. am J Hypertens. 2021 May 22;34(5):432-441. PMID: 33245319; PMCID: PMC8140657. https://doi.org/10.1093/ajh/hpaa195

36. Saeed S, Romarheim a, Solheim E, Bjorvatn B, Lehmann S. Cardiovascular remodeling in obstructive sleep apnea: focus on arterial stiffness, left ventricular geometry and atrial fibrillation. Expert Rev Cardiovasc Ther. 2022 Jun;20(6):455-464. Epub 2022 Jun 8. PMID: 35673889. https://doi.org/10.1080/14779072.2022.2081547

37. Pengo Mf, Bonafini S, fava C, Steier J. Cardiorespiratory interaction with continuous positive airway pressure. J Thorac Dis 2018;10:S57-S70. https://doi.org/10.21037/jtd.2018.01.39

38. aminuddin a, Lazim MRMLM, Hamid aa, Hui CK, Mohd Yunus MH, Kumar J, Ugusman a. The association between Inflammation and Pulse Wave Velocity in Dyslipidemia: an Evidence-Based Review. Mediators Inflamm. 2020 aug 18;2020:4732987. PMID: 32908450; PMCID: PMC7450307. https://doi.org/10.1155/2020/4732987

39. Lacolley P, Regnault V, Laurent S. Mechanisms of arterial Stiffening: from Mechanotransduction to Epigenetics. arterioscler Thromb Vasc Biol. 2020 May;40(5):1055-1062. Epub 2020 feb 20. PMID: 32075419. https://doi.org/10.1161/aTVBaHa.119.313129

40. Theorell-Haglöw J, Hoyos CM, Phillips CL, Yee BJ, Melehan KL, Liu PY, Cistulli Pa, Grunstein RR. associations Between Obstructive Sleep apnea and Measures of arterial Stiffness. J Clin Sleep Med. 2019 feb 15;15(2):201-206. PMID: 30736873; PMCID: PMC6374088. https://doi.org/10.5664/jcsm.7616

41. Mattos S, Cunha MR, Klein MRST, Oigman W, Neves Mf. arterial Stiffness associated with Sympathetic Hyperactivity in Obese Individuals with Moderate to Severe Obstructive Sleep apnea. High Blood Press Cardiovasc Prev. 2023 Jul;30(4):367-375. Epub 2023 Jul 28. PMID: 37505439. https://doi.org/10.1007/s40292-023-00592-3

42. Adeva-andany MM, Domínguez-Montero a, Castro-Quintela E, funcasta-Calderón R, fernándezfernández C. Hypoxia-Induced Insulin Resistance Mediates the Elevated Cardiovascular Risk in Patients with Obstructive Sleep apnea: a Comprehensive Review. Rev Cardiovasc Med. 2024 Jun 25;25(6):231. PMID: 39076340; PMCID: PMC11270082. https://doi.org/10.31083/j.rcm2506231

43. Ali, S. S. et al. Systematic review on noninvasive assessment of subclinical cardiovascular disease in obstructive sleep apnea: new kid on the block! Sleep Med Rev. 2014 Oct;18(5):379-91. https://doi.org/10.1016/j.smrv.2014.01.004

44. Baguet, J. P. et al. Early cardiovascular abnormalities in newly diagnosed obstructive sleep apnea. Vasc Health Risk Manag. 2009:5:1063-1073. https://doi.org/10.2147/vhrm.s8300

45. Torres, G., Sanchez-de-la-Torre, M. & Barbe, f. Relationship Between OSa and Hypertension. Chest. 2015 Sep;148(3):824-832. https://doi.org/10.1378/chest.15-0136

46. Seetho, I. W. et al. Obstructive sleep apnea is associated with increased arterial stiffness in severe obesity. J Sleep Res. 2014 Dec;23(6):700-708. https://doi.org/10.1111/jsr.12156

47. Phillips, C. L., Butlin, M., Wong, K. K. & avolio, a. P. Is obstructive sleep apnoea causally related to arterial stiffness? a critical review of the experimental evidence. Sleep Med Rev. 2013 feb;17(1):7-18. https://doi.org/10.1016/j.smrv.2012.03.002

48. Drager, L. f., Bortolotto, L. a., Krieger, E. M. & Lorenzi-filho, G. additive effects of obstructive sleep apnea and hypertension on early markers of carotid atherosclerosis. Hypertension. 2009 Jan;53(1):64-9. https://doi.org/10.1161/HYPERTENSIONaHa.108.119420

49. Kim, J., Lee, S.K., Yoon, D.W. et al. Obstructive sleep apnoea is associated with progression of arterial stiffness independent of obesity in participants without hypertension: a KoGES Prospective Cohort Study. Sci Rep. 2018 May 25;8(1):8152. https://doi.org/10.1038/s41598-018-26587-y

50. Chalegre ST, Lins-filho OL, Lustosa TC, frança MV, Couto TLG, Drager Lf, Lorenzi-filho G, Bittencourt MS, Pedrosa RP. Impact of CPaP on arterial stiffness in patients with obstructive sleep apnea: a meta-analysis of randomized trials. Sleep Breath. 2021 Sep;25(3):1195-1202. Epub 2020 Oct 22. PMID: 33094411. https://doi.org/10.1007/s11325-020-02226-7

51. Cardoso CRL, Roderjan CN, Cavalcanti aH, Cortez af, Muxfeldt ES, Salles Gf. Effects of continuous positive airway pressure treatment on aortic stiffness in patients with resistant hypertension and obstructive sleep apnea: a randomized controlled trial. J Sleep Res. 2020 aug;29(4):e12990. Epub 2020 feb 12. PMID: 32048379. https://doi.org/10.1111/jsr.12990