Daily Blood Pressure and Carotid Arterial Stiffnessin Patients with Office Controlled Hypertension Combinedwith Rheumatoid Arthritis
The objective of the study. Determining the features of daily blood pressure (BP) and carotid arterial stiffness parameters in patients with arterial hypertension (AH) combined with rheumatoid arthritis (RA). Materials and methods. The study involved 62 patients (6 men, 56 women) aged 45-65 years (median - 54 [51; 60] years) with AH and adequate office BP control. The first study group consisted of 42 patients with AH combined with RA of low activity and stable adjusted therapy, the second group - of 20 patients with AH without concomitant RA. All patients underwent a general clinical examination, ultrasound of the carotid vessels with determining intima-media thickness, elastic properties, ambulatory blood pressure monitoring. Results. We have identified violations of elastic properties of the carotid arteries in 38 (90.5 %) patients with AH combined with RA, who have had significantly higher levels of the stiffness index, Peterson’s modulus and significantly lower elasticity coefficient, Young’s modulus compared to a group with isolated AH (p < 0.05). 32 (76.2 %) patients with a combined course of AH and RA had disturbances in the indices of circadian blood pressure monitoring (CBPM). Level of average night-time CBPM, daily variability of CBPM, speed of morning rise in blood pressure, the degree of CBPM reduction at night were significantly higher in patients of the first group - 74.81 [69.34; 77.27] mmHg; 14.08 [12.15; 15.89] mmHg; 11 [8; 14] mmHg/h; 11.23 [9.52; 13.69] % respectively (p < 0.05). Average daily systolic blood pressure (SBPV) and diastolic blood pressure variability (DBPV) exceeded normative values in most patients with AH combined with RA - 32 (76.2 %) and 29 (69.1 %), respectively, that was significantly more frequent than in the group of isolated AH (p < 0.05). 21 (50 %) and 4 (20 %) patients of the first and second groups had a non-dipper blood pressure (p < 0.05). Patients with established changes in the elastic properties of the carotid arteries had significantly higher levels of SBPV, DBPV, systolic and diastolic BP loads. Conclusions. The majority of patients with combination of AH and RA had changes in daily blood pressure and violations of elastic properties of the carotid arteries that was significantly more frequent as compared to the group of isolated AH. Arteriosclerotic remodeling of carotid arteries in the combination of AH and RA was associated with changes in the parameters of DBPV, pressure loads, degree of blood pressure reduction.