Cardiac and vascular remodeling in arterial hypertension: the role of concomitant obesity

• Main Author: V. N. Kandilova
• Format: Article
• Language: Russian
• Published: ABV-press 2020-05-01
• Series: Klinicist
• Subjects: arterial hypertension; atherosclerosis; obesity; heart remodeling; left ventricular hypertrophy; carotid artery remodeling; left ventricular diastolic dysfunction; endothelial vasomotor dysfunction; blood plasma lipid profile; cardiovascular diseases risk factors
• Online Access: https://klinitsist.abvpress.ru/Klin/article/view/423

The aim of the study evaluation of the structural and functional changes of the heart and common carotid arteries (CCA) in patients with AH I–III degree with the definition of significant criteria for their remodeling in patients with the absence and presence of accompanying obesity (OB) of varying degrees.Materials and methods. 124 patients (86 men and 38 women) aged 27 to 81 years (average age 55.7 ± 1.01 years) were examined. In 19 of them (12 men and 7 women) AH of I degree, in 87 (65 men and 22 women) II degree AH, in 18 (9 men and 9 women) III degree AH was diagnosed. The diagnosis of AH and its degree was verified in accordance with the existing current clinical guidelines (European Society of Hypertension / European Society of Cardiology’s, 2013). Clinical-anamnestical and instrumental examination of patients were carried out with the assessment of their reflection of myocardial remodeling in accordance with the recommendations. Availability and degree of concomitant OB was carried out in accordance with the calculated body mass index and recommended gradations. Echocardiographic examination, ultrasound scanning were used to study the heart and CCA on both sides and reactive hyperemia test used for studying a number of parameters reflecting the remodeling of myocardium and arteries. Laboratory examination included determination of the main parameters of blood plasma lipid profile. The data analysis was carried out with the help of Statistica 12.6 application package.Results. Patients with AH and concomitant OB have a number of differences in the heart and arteries compared to patients with AH without OB. Heart: increased size and volume, myocardial mass, myocardial mass index, decreased contractility and more frequent detection of diastolic dysfunction of the left ventricle of the heart. Arteries: increase in thickness of the intimamedia complex, decrease in intraadventitial diameter of the right and left common carotid arteries, more frequent detection of endothelial vasomotor function impairment using the right brachial artery as an example. The analysis of the obtained data confirmed the presence of significant remodeling of the cardiovascular system (CVS) in patients with AH, which is dependent on the presence and degree of concomitant OB: a more pronounced progress in remodeling of the heart and arteries was observed in some patients with AH with concomitant OB, partly dependent on the degree of the latter and, apparently, associated with hormonal changes that lead to an acceleration of processes underlying the formation of CVS remodeling.Conclusion. The combination of AH with OB of different degrees leads to an increase in the frequency of cases of remodeling of the CVS as a whole in comparison with patients with AH without accompanying OB, with changes in the lipid profile of the blood at the accompanying AH OB of different degrees characterized by an increase in its atherogenic fractions, exacerbated with the increase in the degree of OB.