Episodes of Symptomatic Hypotension in Patientwith Hypertension, Relationship with Antihypertensive Therapy, and Prognosis
Purpose. To analyze the frequency and possible relationships of the episodes of symptomatic hypotension with the clinical characteristics, prognosis, and antihypertensive therapy in hypertensive patientsMaterials and methods. A cross-sectional comparative study was conducted. We examined 364 patients with hypertension aged from 40 to 80 years. The study included patients, who had myocardial infarction and/or stroke, and outpatient ones, who did not have cardiovascular events. For retrospective analysis, the patients, who had the first appeared myocardial infarction or stroke were identified. Medical documentation was analyzed, a survey of patients was conducted. To identify symptomatic hypotension, a questionnaire developed by the authors was used.Results and discussion. Among all persons, the episodes of symptomatic hypotension are detected in 66.5%. In the group of hospitalized patients, most of them (75.5%) have the episodes of symptomatic hypotension. In outpatients, 56% have such episodes (p<0.01). Symptomatic hypotension is detected in 77.8% of patients, who had myocardial infarction, 76.3% with stroke, 76.1% with angina pectoris, and 70.5% of patients with chronic heart failure (p<0.01). During the logistic regression analysis, angina pectoris and stroke were the independent risk factors for symptomatic hypotension (p<0.05). A retrospective analysis among patients during their first acute cardiovascular event showed that 72.6% of them had a history of symptomatic hypotension episodes (p<0.01), which is significantly more than in patients with uncomplicated hypertension (p<0.05); 73.4% of patients with uncomplicated hypertension noted the symptoms of hypotension when systolic blood pressure was less than 100 mm Hg. The previous myocardial infarction, stroke accompanied by more frequent episodes of symptomatic hypotension, the percentage of subjects with hypotension symptoms with systolic blood pressure higher than 100 mm Hg was significantly higher (36.7%) if compared with outpatients (p<0.01). In patients with myocardial infarction, stroke symptomatic hypotensive episodes did not depend on the treatment regimen and was high with regular (77.2%), episodic (80%) or the absence of antihypertensive therapy (78.9%). Among patients with uncomplicated hypertension, symptomatic hypotensive episodes were significantly less frequent in episodic use of antihypertensive drugs (38.6%), in comparison with regular (65.9%) or absence of antihypertensive therapy (60.2%) (p<0.05).Conclusion. More than half of hypertensive patients suffer from episodes of symptomatic hypotension. Patients with angina pectoris, chronic heart failure, myocardial infarction, stroke have symptomatic hypotensive episodes more often. Symptomatic hypotensive episodes may be a risk factor for cardio- and cerebrovascular events. The frequency of hypotensive episodes is not clearly independent of the regularity of taking antihypertensive drugs.