Diurnal blood pressure profile and features of the hemodynamic response to simulated psychoemotional stress in patients with arterial hypertension and obesity

Objective: to evaluate the characteristics of the daily profile of blood pressure, central aortic pressure, arterial stiffness, and hemodynamic response to simulated psychoemotional stress in patients with arterial hypertension and varying degrees of obesity. Materials and methods: the study included 63 patients (29 with stage I obesity, 34 with stage II) with uncontrolled arterial hypertension. All subjects underwent office blood pressure (BP) measurement, 24-hour BP monitoring ABPM) with assessment of the 24-hour BP profile, central aortic pressure (CAP), and arterial stiffness. Simulated psychoemotional stress (SPS) was carried out using the following mental tests: arithmetic counting according to E. Kraepelin, searching for numbers in K.K. Platonov’s red-and-black table, a task of public reading of an unfamiliar text with critical comments and a time limit if the patient was interested. It was assumed that 3 types of hemodynamic response of systolic BP (SBP) to SPS were distinguished: type 1 — an increase of 5–19 mm Hg. from the initial, type 2 — by 20–39 mm Hg and type 3 — by 40 mm Hg or more. Results: when assessing the parameters of ABPM, CAP, and arterial stiffness in patients depending on the severity of obesity, a relationship was found: individuals with hypertension and stage I obesity had lower values of the studied parameters compared to respondents with stage II obesity. Against the background of SPS, patients with hypertension and stage I obesity most often observed type 1 hemodynamic response (90,5% of cases, respectively), and a small number recorded a decrease in SBP by an average of 5,1 mmHg. In respondents with stage II obesity, compared with the group with stage I, statistically significantly (p < 0,001) more often recorded more pronounced types of hemodynamic response (2 and 3) — 73,5% and 3% of cases, as well as an increase in diastolic blood pressure and heart rate. Conclusion: when assessing the indicators of ABPM, CAP, arterial stiffness and the response of blood pressure and heart rate to SPS, the highest values of the studied parameters and a pronounced hypertensive response were recorded in patients with hypertension and stage II obesity compared to individuals with stage I obesity, which may confirm the greater “stress susceptibility” of this category of respondents.

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