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TRANSITORY ARTERIAL HYPOTENSION IN PATIENTS WITH CHRONIC HEART FAILURE AND STATUS OF KIDNEY FUNCTION

V.A. Serov, A.M. Shutov, D.V. Serova, M.V. Menzorov, Y.S. Kuznetsova

Ulyanovsk State University

 

There are the results of study of blood pressure profile in 194 patients with chronic heart failure (CHF), depending on the glomerular filtration rate (GFR) in the article. Was revealed that holding ambulatory blood pressure monitoring (ABPM) in patients with chronic heart failure allows increasing the frequency of identification of potentially dangerous changes in blood pressure significantly. The target BP is achieved only in 42,9 % of patients with CHF with GFR≤45,1 ml/kg/1,73 m2 and 18,4 % of patients with CHF with GFR≥69,8 ml/kg/1,73 m2. Episodes of systolic hypotension were detected in 51,0 % of patients with CHF, GFR≤45,1 ml/kg/1,73 m2 and 26,5 % – in patients with CHF with GFR≥69,8 ml/kg/1,73 m2, diastolic hypotension episodes were diagnosed in 71,4 % of patients with CHF with GFR≤45,1 ml/kg/1,73 m2 and 61,2 % – in patients with CHF with GFR≥69,8 ml/kg/1,73 m2.

Keywords: ambulatory blood pressure monitoring, chronic heart failure, reduced glomerular filtration rate

 

References

  1. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр) // Сердечная недостаточность. – 2010. – №57 (1). – C. 3–62.

  2. Прогностическое значение хронической болезни почек у больных хронической сердечной недостаточностью / В.А. Серов и др. // Нефрология и диализ. – 2008. – №3–4. – С. 214–218.

  3. Суточное мониторирование артериального давления : методические вопросы / А.Н. Рогоза и др. ; под ред. Г.Г. Арабидзе, О.Ю. Атькова. – М., 1997. – 33 с.

  4. Суточное мониторирование артериального давления в клинической практике / Л.Г. Ратова и др. // Cons. Med. Артериальная гипертензия. – 2001. – №2 (Прил.). – С. 3–14.

  5. Agarwal, R. Systolic hypertension in hemodialysis patients / R. Agarwal // Semin. Dial. – 2003. – №16. – P. 208–213.

  6. Andersen, M.J. Home blood pressure monitoring in CKD / M.J. Andersen, W. Khawandi, R. Agarwal // Am. J. Kidney Dis. – 2005. – №45. – P. 994–1001.

  7. Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives / S. Hoshide et al. // Am. J. Hypertens. – 2003. – №16 (6). – P. 434–438.

  8. Association of blood pressure at hospital discharge with mortality in patients diagnosed with heart failure / D.S. Lee et al. // Circ. Heart Fail. – 2009. – №2. – P. 616–623.

  9. Association of diurnal blood pressure pattern with risk of hospitalization or death in men with heart failure / J. Shin et al. // J. Card. Fail. – 2007. – №13 (8). – P. 656–662.

  10. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate / M.B. Davidson et al. // Arch. Intern. Med. – 2006. – №166 (8). – P. 846–852.

  11. Blood pressure is a major risk factor for renal death: an analysis of 560 352 participants from the Asia-Pacific region / C.M. O'Seaghdha et al. // Hypertension. – 2009. – №54 (3). – P. 509–515.

  12. Causes and mechanisms of nondipping hypertension / M. Kanbay et al. // Clin. Exp. Hypertens. – 2008. – №30 (7) – P. 585–597.

  13. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization / A.S. Go et al. // N. Engl. J. Med. – 2004. – №351 (13). – P. 1296–1305.

  14. Diurnal blood pressure pattern and risk of congestive heart failure / E. Ingelsson et al. // JAMA. – 2006. – 295 (24). – P. 2859–2866.

  15. Endothelial dysfunction contributes to renal function-associated cardiovascular mortality in a population with mild renal insufficiency: the Hoorn study / F. Stam et al. // J. Am. Soc. Nephrol. – 2006. – №17 (2). – P. 537–545.

  16. Messerli, F.H. The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? / F.H. Messerli, G.S. Panjrath // J. Am. Coll. Cardiol. – 2009. – №54 (20). – P. 1827–1834.

  17. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification / A.S. Levey et al. // Ann. Intern. Med. – 2003. – №139 (2). – P. 137–147.

  18. Night-time blood pressure patterns and target organ damage: a review / F.S. Routledge et al. // Can. J. Cardiol. – 2007. – 23 (2). – P. 132–138.

  19. Nocturnal blood pressure and progression to end-stage renal disease or death in nondiabetic chronic kidney disease stages 3 and 4 / J. Redon et al. // J. Hypertens. – 2010. – №28 (3). – P. 602–607.

  20. Patients with renal dysfunction require a longer duration until blood pressure dips during the night / M. Fukuda et al. // Hypertension. – 2008. – №52 (6) – P. 1155–1160.

  21. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients / A. de la Sierra et al. // Hypertension. – 2009. – №53 (3). – P. 466–472.

  22. Prisant, L.M. Blunted nocturnal decline in blood pressure / L.M. Prisant // J. Clin. Hypertens. (Greenwich). – 2004. – №6 (10). – P. 594–597.

  23. Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure / C.E. Raphael et al. // Heart. – 2009. – №95 (1). – P. 56–62.

  24. Sympathetic activation in chronic renal failure / M.P. Schlaich et al. // J. Am. Soc. Nephrol. – 2009. – 20 (5). – P. 933–939.

  25. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure / M. Gheorghiade et al. // JAMA. – 2006. – №296 (18). – P. 2217–2226.

  26. The association between blood pressure and mortality in patients with heart failure / T.T. Lee et al. // Am. Heart J. – 2006. – №151 (1). – P. 76–83.

  27. What is the optimal blood pressure in patients after acute coronary syndromes? Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial / S. Bangalore et al. // Circulation. – 2010. – №122 (21). – P. 2142–2151

 

 

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УДК 616.12-008.331.4: 616.12-008.4: 616.61

ТРАНЗИТОРНАЯ АРТЕРИАЛЬНАЯ ГИПОТОНИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ И СОСТОЯНИЕ ФУНКЦИИ ПОЧЕК

В.А. Серов, А.М. Шутов, Д.В. Серова, М.В. Мензоров, Ю.С. Кузнецова

Ульяновский государственный университет

 

В статье приведены результаты изучения суточного профиля артериального давления у 194 больных хронической сердечной недостаточностью (ХСН) в зависимости от скорости клубочковой фильтрации (СКФ). Выявлено, что проведение суточного мониторирования артериального давления (СМАД) у больных ХСН позволяет существенно повысить частоту выявления потенциально опасных изменений АД. Целевое АД достигается только у 42,9 % больных ХСН с СКФ≤45,1 мл/кг/1,73 м2 и у 18,4 % больных ХСН с СКФ≥69,8 мл/кг/1,73 м2. Эпизоды систолической артериальной гипотонии выявлены у 51,0 % больных ХСН с СКФ≤45,1 мл/кг/1,73 м2 и у 26,5 % – в группе больных ХСН с СКФ≥69,8 мл/кг/1,73 м2, эпизоды диастолической артериальной гипотонии диагностированы у 71,4 % больных ХСН с СКФ≤45,1 мл/кг/1,73 м2 и у 61,2 % – в группе больных ХСН с СКФ≥69,8 мл/кг/1,73 м2.

Ключевые слова: суточное мониторирование артериального давления, хроническая сердечная недостаточность, снижение скорости клубочковой фильтрации.

 

Литература

  1. Национальные рекомендации ВНОК и ОССН по диагностике и лечению ХСН (третий пересмотр) // Сердечная недостаточность. – 2010. – №57 (1). – C. 3–62.

  2. Прогностическое значение хронической болезни почек у больных хронической сердечной недостаточностью / В.А. Серов и др. // Нефрология и диализ. – 2008. – №3–4. – С. 214–218.

  3. Суточное мониторирование артериального давления : методические вопросы / А.Н. Рогоза и др. ; под ред. Г.Г. Арабидзе, О.Ю. Атькова. – М., 1997. – 33 с.

  4. Суточное мониторирование артериального давления в клинической практике / Л.Г. Ратова и др. // Cons. Med. Артериальная гипертензия. – 2001. – №2 (Прил.). – С. 3–14.

  5. Agarwal, R. Systolic hypertension in hemodialysis patients / R. Agarwal // Semin. Dial. – 2003. – №16. – P. 208–213.

  6. Andersen, M.J. Home blood pressure monitoring in CKD / M.J. Andersen, W. Khawandi, R. Agarwal // Am. J. Kidney Dis. – 2005. – №45. – P. 994–1001.

  7. Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives / S. Hoshide et al. // Am. J. Hypertens. – 2003. – №16 (6). – P. 434–438.

  8. Association of blood pressure at hospital discharge with mortality in patients diagnosed with heart failure / D.S. Lee et al. // Circ. Heart Fail. – 2009. – №2. – P. 616–623.

  9. Association of diurnal blood pressure pattern with risk of hospitalization or death in men with heart failure / J. Shin et al. // J. Card. Fail. – 2007. – №13 (8). – P. 656–662.

  10. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate / M.B. Davidson et al. // Arch. Intern. Med. – 2006. – №166 (8). – P. 846–852.

  11. Blood pressure is a major risk factor for renal death: an analysis of 560 352 participants from the Asia-Pacific region / C.M. O'Seaghdha et al. // Hypertension. – 2009. – №54 (3). – P. 509–515.

  12. Causes and mechanisms of nondipping hypertension / M. Kanbay et al. // Clin. Exp. Hypertens. – 2008. – №30 (7) – P. 585–597.

  13. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization / A.S. Go et al. // N. Engl. J. Med. – 2004. – №351 (13). – P. 1296–1305.

  14. Diurnal blood pressure pattern and risk of congestive heart failure / E. Ingelsson et al. // JAMA. – 2006. – 295 (24). – P. 2859–2866.

  15. Endothelial dysfunction contributes to renal function-associated cardiovascular mortality in a population with mild renal insufficiency: the Hoorn study / F. Stam et al. // J. Am. Soc. Nephrol. – 2006. – №17 (2). – P. 537–545.

  16. Messerli, F.H. The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? / F.H. Messerli, G.S. Panjrath // J. Am. Coll. Cardiol. – 2009. – №54 (20). – P. 1827–1834.

  17. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification / A.S. Levey et al. // Ann. Intern. Med. – 2003. – №139 (2). – P. 137–147.

  18. Night-time blood pressure patterns and target organ damage: a review / F.S. Routledge et al. // Can. J. Cardiol. – 2007. – 23 (2). – P. 132–138.

  19. Nocturnal blood pressure and progression to end-stage renal disease or death in nondiabetic chronic kidney disease stages 3 and 4 / J. Redon et al. // J. Hypertens. – 2010. – №28 (3). – P. 602–607.

  20. Patients with renal dysfunction require a longer duration until blood pressure dips during the night / M. Fukuda et al. // Hypertension. – 2008. – №52 (6) – P. 1155–1160.

  21. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients / A. de la Sierra et al. // Hypertension. – 2009. – №53 (3). – P. 466–472.

  22. Prisant, L.M. Blunted nocturnal decline in blood pressure / L.M. Prisant // J. Clin. Hypertens. (Greenwich). – 2004. – №6 (10). – P. 594–597.

  23. Quantifying the paradoxical effect of higher systolic blood pressure on mortality in chronic heart failure / C.E. Raphael et al. // Heart. – 2009. – №95 (1). – P. 56–62.

  24. Sympathetic activation in chronic renal failure / M.P. Schlaich et al. // J. Am. Soc. Nephrol. – 2009. – 20 (5). – P. 933–939.

  25. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure / M. Gheorghiade et al. // JAMA. – 2006. – №296 (18). – P. 2217–2226.

  26. The association between blood pressure and mortality in patients with heart failure / T.T. Lee et al. // Am. Heart J. – 2006. – №151 (1). – P. 76–83.

  27. What is the optimal blood pressure in patients after acute coronary syndromes? Relationship of blood pressure and cardiovascular events in the PRavastatin OR atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction (PROVE IT-TIMI) 22 trial / S. Bangalore et al. // Circulation. – 2010. – №122 (21). – P. 2142–2151.