Prospects for outpatient screening of cardiovascular adaptation in patients with arterial hypertension

Objective: integration into outpatient practice of monitoring cardiovascular adaptation in patients with hypertension using simple computational cardiac indices.

Material and methods: in 79 patients with hypertension (43 men and 36 women) aged 18 to 59 years, in addition to physical examination, anthropometry, and bioimpedance analysis, clinical and instrumental parameters were determined to calculate such primary cardiovascular parameters as systolic blood pressure (SBP) and diastolic blood pressure (DBP), mean hemodynamic blood pressure (MGP), stroke index (SI), cardiac index (CI), stroke blood volume (SBV), minute blood volume (MBV). As integral indicators of the state the cardiovascular system, considered peripheral vascular resistivity (PVS), the integral index of the equilibrium of the cardiac and vascular components (IIECVC) and the adaptive potential (AP) were considered.

Results: in 69.6% of patients, hypertension was uncontrolled. The presence of a high level of visceral fat (VF≥9 conventional units) in patients with AH compared to their normal values was accompanied by higher values of SBP and DBP; at the same time, the statistically significant correlation of the level of VF with the values of SBP, DBP, MGP and PVS was direct, and with SBV, SI, IIECVC, AP was inverse; in patients younger than 44 years, in contrast to those in the age range from 44 to 59 years, the increase in VF was not accompanied by an increase in SI and PVS. None of the patients with hypertension had a satisfactory level of adaptation (AP≤2,1 conventional units). In patients with unsatisfactory adaptation, in contrast to patients with strain of adaptation mechanisms, higher (p<0,05) values of SBP, MGP, HR, SBV, MBV, as well as direct correlations of AP with IIECVC and inverse correlations of AP with PVS and PVS with IIECVC, which reflected pressor vascular activity and increased load on the heart with a decrease in its pumping function, were found.

Conclusion: Depending on the AP subclass, integration into clinical practice of such simple integral cardiovascular parameters as PVS, which reflects vascular resistance, and PVS, indicating the balance of the cardiac and vascular components, makes it possible to assess the degree of cardiac adaptation, the pumping function of the heart, and the degree of vascular resistance to assess the effectiveness of treatment and prevention of AH complications without the need to resort to additional expensive diagnostic methods.

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