This review highlights the relationship of age and arterial hypertension observed in the aging process. The main structural and functional changes underlying the increase in vascular stiffness are analyzed. The similarity of vascular changes in aging and arterial hypertension was noted. The negative effect of increased central blood pressure on target organs is considered. Attention is paid to the analysis of arterial stiffness as a marker of vascular aging. The parameters of the carotid-femoral pulse wave propagation velocity, the cardio-ankle vascular index (CAVI), the ankle-brachial index, the finger-brachial index, and the augmentation index were examined separately. The prognostic and clinical value of the parameters of vascular stiffness is considered. In particular, the clinical guidelines for arterial hypertension report the need to use arterial stiffness indicators to improve the accuracy of cardiovascular risk stratification, especially in medium-risk patients. Measurement of vascular stiffness and central aortic pressure should be recommended as one of the methods for stratifying cardiovascular risk in patients with intermediate SCORE risk, as well as in those whose target organ damage was not detected by routine methods. The article also notes the independent diagnostic and prognostic value of the CAVI.

Aim. To study and analyze the systolic and diastolic left ventricle (LV) function, parameters of the ambulatory blood pressure (BP) monitoring in patients over 65 years of age with arterial hypertension, depending on the presence of frailty. Materials and methods. We examined 77 patients over 65 years of age (25 men and 52 women) with arterial hypertension, who were divided into two groups: with the presence of frailty (38 people) and its absence (39 people). To detect frailty, we used the "Age is not a hindrance" questionnaire validated in Russia and the "Get up and go" test. The examination included echocardiography with tissue doppler and ambulatory BP monitoring. Results. In both groups, LV systolic function remained within normal values, while diastolic function was impaired. In the group of people without frailty, type 1 of left ventricular diastolic dysfunction prevailed in 63% of cases, in the group with frailty, type 2 of left ventricular diastolic dysfunction with increased filling pressure was registered in 77% of cases. In both groups, both isolated systolic arterial hypertension and normal indicators of SBP and DBP were recorded during the day. Systolo-diastolic hypertension and hypotension have been presented by individual cases. At the same time, significant differences (p<0.05) in the groups were revealed by the index of time of hypertension SBP at night and were higher in patients with frailty. Correlations were found between the time index of hypertension and SBP at night with the volume index of the left atrium in groups with frailty (0.34; p<0.05) and without frailty (0.40; p<0.05), as well as the time index of hypertension and SAD at night with the maximum rate of regurgitation on the tricuspid valve (0.42; p<0.05) and with estimated systolic pressure in the pulmonary artery (0.41; p<0.05) in the group with frailty. Conclusion. In the group of patients with arterial hypertension older than 65 years without frailty, violations of the left ventricular diastolic function by the type of slowing relaxation predominate, while in the group of patients with senile asthenia, violation of the left ventricular diastolic function by the type of pseudonormalization with increased filling pressure prevails. Features of the ambulatory BP monitoring of patients with hypertension older than 65 years with the presence of frailty are higher values of the time index of hypertension SBP at night. An increase in the time index of hypertension and SBP in patients with hypertension older than 65 years with frailty is associated with an increase in the volume of the left atrium, the rate of tricuspid regurgitation and systolic pressure in the pulmonary artery. The obtained data may indicate an adverse effect of frailty on the progression of heart failure in patients with arterial hypertension, which requires a comprehensive approach with the participation of a geriatrician in the management of such patients. Keywords: arterial hypertension, frailty, echocardiography, left ventricle, systolic function, diastolic function, ambulatory blood pressure monitoring, blood pressure For citation: Fomina ES, Nikiforov VS, Frolova EV, Reshetnik DA. Left ventricular myocardial dysfunction and parameters of ambulatory blood pressure monitoring in patients with arterial hypertension and frailty. Consilium Medicum. 2021; 23 (1): 80–83. DOI: 10.26442/20751753.2021.1.200476

Introduction. Increased arterial stiffness is one of the key links in the formation of cardiovascular pathology in older age groups. At the same time, the effect of vascular stiffness on myocardial function in cardiac patients with frailty remains insufficiently studied.Aim of study. Тo analyze the data of arterial stiffness and diastolic function of left ventricle (LV) in patients older than 65 years with arterial hypertension and frailty.Materials and methods. The study included 90 outpatient and inpatient patients older than 65 years with the presence of arterial hypertension. All patients were divided into two groups: with the presence and absence of frailty. To identify frailty, we used the questionnaire “Age is not a hindrance”, a short battery of physical activity tests. Methods of volumetric sphygmometry, echocardiography, including tissue Doppler were used. The obtained data were analyzed using a package of statistical programs.Results. The results of a comparative simultaneous non-randomized descriptive study of two groups of patients are presented. The study found that the systolic function, diastolic dysfunction of the left ventricle by the type of slowing down of LV relaxation in both groups did not significantly differ in their indicators. In the group of patients with frailty, LV diastolic dysfunction was significantly more often detected by the type of pseudonormalization – with an increase in filling pressure. When analyzing data of arterial stiffness, differences were obtained in both groups in the left cardio-ankle vascular index (LCAVI), systolic blood pressure (LB SAD), pulse pressure (LB PD) in the left shoulder area, and the delta of average blood pressure in the left ankle area (LA% IDA), which were significantly higher in patients with frailty.Conclusion. In the group of patients with hypertension older than 65 years with frailty, a violation of the LV diastolic function by the  type of  pseudonormalization with an increase in  filling pressure prevails. An increase in  filling pressure in  the  group of patients older than 65 years with hypertension and the presence of frailty is associated with an increase in the complex of indicators characterizing arterial stiffness – the cardio-ankle vascular index, systolic blood pressure, pulse pressure in the left shoulder area, the delta of average blood pressure in the left ankle area.