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Objective. To identify features of arterial stiffness, to establish relationships with indicators of the daily blood pressure profile and peripheral artery disease in patients with hypertension (HTN) in combination with subclinical and manifested atherosclerotic lesions of the arteries of the lower extremities. Design and methods. 120 patients were divided into 3 groups: group 1-46 patients with HTN and clinically manifested AALE, group 2-39 patients with HTN and asymptomatic AALE, group 3-35 HTN patients without AALE. All patients underwent general clinical laboratory and instrumental research methods, including 24-hour blood pressure ambulatory monitoring (24h-ABPM) with the assessment of 24-hour blood pressure profile and arterial stiffness parameters, ultrasonic triplex scanning (USTS) of the arteries of the lower extremities. Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA). Results. Higher values of pulse wave velocity (PWVao), augmentation index (AIx) and ambulatory arterial stiffness index (AASI) were found in the 1st group in comparison to the 2nd and 3rd groups (p < 0,05). Lower reflected wave transit time (RWTT) (119,5 [112;127] ms) was found in the 1st group (128 [122;132], p = 0,001 and 126 [121;129] ms, p = 0,03 in the 2nd and and 3rd groups, respectively) groups. The maximum rate of blood pressure increase (dP/dtmax) in patients of the 1st (550 [466;666] mm Hg/s) and 2nd (634 [511;695] mm Hg/s) groups was significantly lower than in patients of the 3rd group (655 [526;806] mm Hg/s, p < 0,05). A direct correlation was found between AASI values and SBP (r = 0,291, p = 0,049) and its variability (r = 0,301, p = 0,042), AASI and PBP (r = 0,518, p < 0,001), its variability (r = 0,596, r < 0,001) in group 1, as well as AASI and PBP (r = 0,514, p < 0,001) and PBP variability (r = 0,632, p < 0,001) in group 2. A correlation between AIx and the degree of stenosis (%) of the arteries of the lower extremities was found in patients with AH and AALE of varying severity (r = 0,310, p = 0,004). Conclusions. In patients with subclinical course of AALE, lower values of dP/dtmax in comparison with HTN patients without AALE indicate an increase in arterial stiffness at the initial stages of peripheral atherosclerosis. Clinically manifested atherosclerotic lesions of the arteries of the lower extremities in HTN patients are associated with a more pronounced increase in arterial stiffness, which contributes to a higher cardiovascular risk.
Objective. To identify features of arterial stiffness, to establish relationships with indicators of the daily blood pressure profile and peripheral artery disease in patients with hypertension (HTN) in combination with subclinical and manifested atherosclerotic lesions of the arteries of the lower extremities. Design and methods. 120 patients were divided into 3 groups: group 1-46 patients with HTN and clinically manifested AALE, group 2-39 patients with HTN and asymptomatic AALE, group 3-35 HTN patients without AALE. All patients underwent general clinical laboratory and instrumental research methods, including 24-hour blood pressure ambulatory monitoring (24h-ABPM) with the assessment of 24-hour blood pressure profile and arterial stiffness parameters, ultrasonic triplex scanning (USTS) of the arteries of the lower extremities. Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA). Results. Higher values of pulse wave velocity (PWVao), augmentation index (AIx) and ambulatory arterial stiffness index (AASI) were found in the 1st group in comparison to the 2nd and 3rd groups (p < 0,05). Lower reflected wave transit time (RWTT) (119,5 [112;127] ms) was found in the 1st group (128 [122;132], p = 0,001 and 126 [121;129] ms, p = 0,03 in the 2nd and and 3rd groups, respectively) groups. The maximum rate of blood pressure increase (dP/dtmax) in patients of the 1st (550 [466;666] mm Hg/s) and 2nd (634 [511;695] mm Hg/s) groups was significantly lower than in patients of the 3rd group (655 [526;806] mm Hg/s, p < 0,05). A direct correlation was found between AASI values and SBP (r = 0,291, p = 0,049) and its variability (r = 0,301, p = 0,042), AASI and PBP (r = 0,518, p < 0,001), its variability (r = 0,596, r < 0,001) in group 1, as well as AASI and PBP (r = 0,514, p < 0,001) and PBP variability (r = 0,632, p < 0,001) in group 2. A correlation between AIx and the degree of stenosis (%) of the arteries of the lower extremities was found in patients with AH and AALE of varying severity (r = 0,310, p = 0,004). Conclusions. In patients with subclinical course of AALE, lower values of dP/dtmax in comparison with HTN patients without AALE indicate an increase in arterial stiffness at the initial stages of peripheral atherosclerosis. Clinically manifested atherosclerotic lesions of the arteries of the lower extremities in HTN patients are associated with a more pronounced increase in arterial stiffness, which contributes to a higher cardiovascular risk.
Objective: To study the features of the parameters of 24-hour blood pressure monitoring (24h-BPM) in patients with hypertension and atherosclerosis of the arteries of the lower extremities (AALE).Materials and Methods: A total of 120 patients with hypertension were divided into 3 groups: Group I consisted of 46 patients with hypertension and clinically manifested AALE; Group II included 39 patients with hypertension and asymptomatic AALE; Group III included 35 patients with hypertension without AALE. Laboratory and instrumental studies were performed, including 24h-BPM and ultrasound triplex scanning (USTS) of the arteries of the lower extremities. Statistical analysis was performed using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA).Results: Higher values of systolic blood pressure (SBP) were revealed in Group I patients compared with Group III (P <0.05). Increased variability of daily average and daytime SBP were found in Group I patients (16 [13; 17] and 15.5 [12; 18] mm Hg), which significantly differed from those in Group III (P = 0.005). The patients of Group II showed higher values of diastolic blood pressure (DBP) compared with Group I (P <0.017). Higher values of pulse blood pressure (PBP) were found in Group I compared with Groups II and III (P = 0.001). In Group I, the normal type of 24-hour index of SBP was 2 times less common (P <0.017).Conclusions: The clinical manifestation of AALE is associated with higher SBP and PBP values, SBP variability and lower DBP values, which indicates a higher risk of cardiovascular complications.
Objective: estimation of parameters of vascular stiffness in patients with arterial hypertension (AH) and atherosclerosis of the arteries of the lower extremities (AALE) taking into account statin therapy. Materials and methods: 120 patients with AH were divided into 3 groups: group 1 — 46 patients with AH and clinically manifested AALE, group 2 — 39 patients with AH and asymptomatic AALE, group 3 — 35 patients with AH without AALE. The patients of each group were divided into 2 subgroups: the 1st subgroup — not receiving statins, the 2nd subgroup — taking statins. All patients underwent laboratory and instrumental studies, including the determination of vascular stiffness parameters using the Vasotens software («Peter Telegin», Nizhny Novgorod) and ultrasonic triplex scanning of the arteries of the lower extremities. Statistical data processing was carried out using Microsoft Office Excel 16 (2015, Microsoft, USA), Statistica 10.0 (StatSoft, USA), IBM SPSS Statistica 26.0 (IBM, USA). Results: lower values of total cholesterol were found in patients of the 2nd subgroup of all studied groups (p<0,05), as well as lower values of low-density lipoprotein cholesterol (LDLС) among patients of the 2nd subgroup of the second and third groups (<0,05). In patients of all groups, when using statins, the target values of LDLC were not achieved. Lower values of the arterial stiffness index (ASI) and augmentation index (AIx) were found in patients of the first group of the 2nd subgroup receiving statins in comparison with patients of the 1st subgroup (p<0,05). In patients of the second group of the 2nd subgroup, while taking statins, there was a clear trend towards a lower ASI value compared to the 1st subgroup (p=0.07). Conclusions: the use of statins in patients with hypertension and AALE of varying severity, despite the lack of achievement of target levels of LDLC, contributed to a decrease in vascular stiffness, and, consequently, a decrease in cardiovascular risk.
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