Preclinical predictors of arterial hypertension

Abstract

Arterial hypertension (AH) remains one of the most common diseases and a leading risk factor for cardiovascular diseases (CVD) in the 21st century. It determines the importance of a search for new factors provoking an increase in blood pressure. This review focuses on studies of preclinical predictors of hypertension. Orthostatic circulatory disorders with clinical signs of cardiovascular deconditioning are risk factors for the development of hypertension and CVD, accompanied by a more rapid increase in vascular stiff ness. Such abnormalities, even minor ones without clinical manifestations, increase the risk of hypertension development in the young population. The review deals with orthostatic changes in hemodynamics and features of neurohormonal change. It has been shown that adaptive processes counteracting an increase in hydrostatic pressure contribute to a significant transient increase in vascular stiff ness. The evolution of orthostatic hemodynamic disorders from preclinical to clinical forms accelerates the process of vascular wall remodeling, leading to a spontaneous increase in its rigidity — one of the significant risk factors for hypertension and CVD. To identify preclinical predictors, a new protocol of passive orthostatic test (POT) was developed. It was standardized not by the tilt angle, but by the height of the hydrostatic column. Further research is needed to evaluate the prognostic capabilities of predictors, to reveal the pathogenetic connection of orthostatic disorders with the development of hypertension, and to remodeling the vascular wall, which causes an increase in its rigidity. It is also required to search for ways to correct preclinical orthostatic disorders in healthy young population for early prevention of hypertension.

Detection of Preclinical Orthostatic Disorders in Young African and European Adults Using the Head-Up Tilt Test with a Standardized Hydrostatic Column Height: A Pilot Study

“…Asymptomatic orthostatic disturbances (“rise” and “drop”) can be defined as preclinical OHT and OH. Orthostatic changes with a ΔSBP of ±5 mmHg that were accompanied by a minimal risk of developing AH could be defined as orthostatic normotension (ONT) [ 22 ]. This terminology emphasizes the theoretical possibility that preclinical OH and OHT can potentially evolve into clinical disorders (OH and OHT).…”

“…This protocol allowed the results of orthostatic circulatory regulation to be assessed, irrespective of the effect of the individual’s height (hydrostatic pressure). Given the higher prevalence of AH in African countries compared to European countries, it was important to explore possibilities for the early detection of preclinical orthostatic abnormalities [ 22 ] and their racial differences using the new HUTT test to assess young healthy European and African adults.…”

Preclinical Orthostatic Abnormalities May Predict Early Increase in Vascular Stiffness in Different Age Groups: A Pilot Study

“…In contrast to clinical orthostatic abnormalities, the association of preclinical abnormalities with vascular stiffening remains poorly understood [25,26]. Nevertheless, it has been shown that orthostatic abnormalities corresponding to preclinical OHT significantly increase the risk of AH in a young population under 30 years of age [27], and preclinical OH increases the risk of AH in a population over 45 years of age [28].…”