Features of Intra- and Extracranial Blood Flow, Structural-Geometric and Functional Changes of the Heart and the State of the Autonomic Nervous System in Patients with Essential Hypertension Stage II Depending on Smoking Status

V.V. Syvolap, Ye.A. Poznanskaia, Ye.V. Vizir

Abstract


Systematic tobacco smoking is a serious public health threat, especially in individuals who have an increased risk of cardiovascular diseases. Questions about the extent, in which smoking affects the progression of the hypertension, impaired autonomic balance, cerebral blood flow, target organ damage, remain unsolved.
Objective. Analysis of the specific features of the cerebral blood flow, structural-geometrical, functional reconstruction of the heart, autonomic imbalance in patients with essential hypertension (EH) stage II.
Material and Methods. The study involved 100 patients: 53 men and 47 women. The average age of the patients was 52.51 ± 1.46 years. Depending on the smoking status (at least 10 years), all patients were divide into 2 groups: group of smokers included 30 patients, group of non-smokers — 70. All patients underwent clinical examination with measurement of body weight and height, with the calculation body mass index, office measurement of blood pressure (BP) and heat rate, laboratory tests, ambulatory BP monitoring, ultrasound of the extra- and intracranial arteries of the neck and head, heart rate variability was determined, transthoracic echocardioscopy was performed.
Results. Hypertensive smokers revealed a statistically significant increase in low frequency by 16.5 % (p = 0.04), a decrease in high frequency by 18.2 % (p = 0.04), and increased sympathovagal index by 70.0 % (p = 0.01), the predominance of average daily systolic BP (SBP) by 6.5 % (p = 0.04) and average daily diastolic BP (DBP) by 7.9 % (p = 0.04), the size of the left atrium in diastole by 8.1 % (p = 0.014), in systole — by 10.8 % (p = 0.026), thickness of posterior left ventricular (LV) wall by 6.1 % (p = 0.028), interventricular septum thickness in diastole by 11.6 % (p = 0.004), interventricular septum thickness in systole by 10.7 % (p = 0.034), LV mass index by 12.2 % (p = 0.034), diastolic intramyocardial tension by 13.9 % (p = 0.025), lengthening of the period of isometric relaxation by 33.3 % (p = 0.026), resistivity index in the right common carotid artery (CCA) by 3.3 % (p = 0.033), in the middle cerebral artery (MCA) by 8.5 % (p = 0.05), in the left MCA by 7.1 % (p = 0.042), exceeding «vasoconstriction reserve» indicator by 4.63 times (p = 0.029) in the internal carotid artery (ICA) and by 3.01 times (p = 0.031) in the right ICA. We have obtained a significant predominance of female smokers compared with male smokers in terms of resistivity index in the right ICA by 10.8 % (0.65 ± 0.02 c.u. vs 0.58 ± 0.01 c.u.; p = 0.03) and maximum linear blood flow velocity in ICA on the left by 22.0 % (2.88 ± 0.08 cm/s vs 2,36 ± 0.04 cm/s, p = 0.05). At the same time, female smokers reported significantly lower values of systolic and diastolic index in the CCA on the right by 8.7 % (3.55 ± 0.19 c.u. vs 3.86 ± 0.16 c.u.; p = 0.027), and resistivity index in the left MCA by 4.9 % than that of male smokers (0.450 ± 0.034 c.u. vs 0.472 ± 0.024 c.u.; p = 0.027).
Conclusions. Smoking in hypertensive patients is associated with increased activity of the sympathetic part and decreased of parasympathetic part of autonomic nervous system. Hypertensive smokers have significantly higher average daily SBP by 6.5 % (p = 0.04), the average daily DBP by 7.9 % (p = 0.04) compared with non-smokers patients with EH. The modulating effect of smoking on the pathological cardiac remodeling in hypertensive patients results in increased systolic and diastolic dimensions of the left atrium, wall thickness and left ventricular mass, without dilation of cardiac cavities, with an increase in diastolic left ventricular intramyocardial tension. Changes of the heart in hypertensive patients under the influence of smoking enable the reduction of the active relaxation and changes in left ventricular diastolic fil-
ling: increase the contribution of late filling and lengthening of isometric relaxation time. Cerebral blood flow acute disturbances in hypertensive smokers compared with hypertensive non-smokers are characterized by a more pronounced spasm of the carotid arteries, as evidenced by the prevalence of vascular resistivity index and «vasoconstriction reserve» indicator in the common carotid and middle cerebral arteries in smokers. Blood flow parameters in vertebrobasilar system in hypertensive smokers and non-smokers have not significant changes. Gender differences at Doppler ultrasonography of the great vessels of the neck and head in smokers with EH are characterized by a higher vascular resistance in the common and internal carotid arteries in women, and in the middle cerebral arteries in men.


Keywords


essential hypertension; smoking; target organ damage

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DOI: https://doi.org/10.22141/2224-1485.1.39.2015.80400

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