VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN RURAL MALES WITH ARTERIAL HYPERTENSION: ASSOCIATION WITH NON-VALVULAR ATRIAL FIBRILLATION
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Keywords

blood pressure, visit-to-visit variability, arterial hypertension, atrial fibrillation.

How to Cite

Nimtsovych, T., Kravchenko, A., Mishcheniuk, O., MikhalievК., & Chursina, T. (2020). VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN RURAL MALES WITH ARTERIAL HYPERTENSION: ASSOCIATION WITH NON-VALVULAR ATRIAL FIBRILLATION. Clinical and Preventive Medicine, (2), 90-109. https://doi.org/10.31612/2616-4868.2(12).2020.06

Abstract

Purpose: to study the association of blood pressure (BP) visit-to-visit variability (VVV) with non-valvular atrial fibrillation (AF) in rural dwellers with arterial hypertension (HTN).

Material and methods. The cross-sectional study retrospectively analyzed complex data from consecutive 160 males with primary HTN (mean age 50 ± 6 years). Patients with major HTN complication were excluded. We analyzed the office systolic BP (SBP) and diastolic BP (DBP) levels, obtained at four consecutive doctor`s visits. As a metric of BP VVV, we used standard deviation (SD) and coefficient of variation (CV) values. The criteria for high BP VVV were Patients were ascertained to have high BP VVV in case of SD (SBP) ≥15 mm Hg and/or SD (DBP) ≥14 mm Hg. Totally, high BP VVV status was in 82 (51,3 %) patients. Paroxysmal AF was detected in 29 (18,1 %) patients.

Results. HTN with AF group (vs. HTN alone) was characterized by higher average values of BB VVV metrics (median, interquartile range): SD (SBP) (16,7 (15,9-17,5) vs. 8,7 (4,6-15,2) mm Hg, respectively); SD (DBP) (11,5 (8,9-14,6) vs. 5,7 (3,9-8,9) mm Hg, respectively); CV (SBP) (10,1 (9,6-10,7) vs. 5,6 (2,9-9,2) %, respectively); and CV (DBP) (12,9 (9,3-15,5) vs. 6,3 (4,1-9,7) %, respectively) (р<0,001 in all the comparisons). Additionally, HTN with AF group associated with worse kidney filtration function (estimated glomerular filtration rate (eGFR): 57 (53-59) vs. 67 (62-77) ml/mim/1,73 m2, respectively) and more pronounced albuminuria (urine albumin/creatinine ratio (A/Cu): 36,1 (32,3-40,6) vs. 10,3 (6,5-26,9) mg/mmol, respectively) (р<0,001 in both comparisons). While integral assessment of eGFR and A/Cu values, we determined higher frequency of patients with high and very high cardiovascular and renal adverse events risk (AER) in HTN with AF group. Moreover, patients with HTN and AF presented with higher left atrial antero-posterior dimension (LAD) (4,3 (4,2-4,6) сm vs. 3,9 (3,6-4,1) cm, respectively; р<0,001), as well as with more advanced left ventricular remodeling. At multivariable analysis, SD (SBP) ≥15 mm Hg and SD (DBP) ≥14 mm Hg, along with AER and LAD, were the most significant factors independently associated with AF.

Conclusion. In rural males with HTN, the presence of high BP VVV is one of the factors associated with non-valvular AF risk increase. High BP VVV could be proposed as an additional modified AF risk factor in patients with HTN.

https://doi.org/10.31612/2616-4868.2(12).2020.06
ARTICLE PDF (Українська)

References

State Statistics Service of Ukraine. (2019). Chyselnist naiavnoho naselennia Ukrainy na 1 sichnia 2019 roku [Population of Ukraine as of January 1, 2019]. Kyiv, 2019, 83 [In Ukrainian].

Gorbas, I., Smirnova, I., Vakalyuk, I., Kaydashev, I., Kvasha, O., & Sribna, O. et al. (2013). Journal «Medicine of Ukraine», 7(173), 88-91 [In Ukrainian].

Manoilenko, T., Dorokhina, A., Tsyzh, O., Revenko, I., Bieliaieva, T., Adaricheva, Z.; Kovalenko VM (ed.), Kornatskyi V.M. (ed.). (2019). Stan zdorovia narodu Ukrainy ta medychnoi dopomohy tretynnoho rivnia: posibnyk [Health status of the people of Ukraine and tertiary medical care: a textbook]. Kyiv: SI «National Scientific Center «Academist M.D. Strazhesko Institute of Cardiology», 2019, 222 [In Ukrainian].

Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., & Burnier, M. et al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39(33), 3021-3104. https://doi.org/10.1093/eurheartj/ehy339.

Ionov, M. V., Zvartau, N. E., Konradi, A. O. (2019). Status of hypertension in Russia and Eastern Europe. E-Journal Of Cardiology Practice, 17(24). Retrieved from: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-17/status-of-hypertension-in-russia-and-eastern-europe.

Doroshenko, O., Khan, O., Fraser-Hurt, N., Wilson, D., Zhao, F. (2019). Hypertension Care in Ukraine : Breakpoints and Implications for Action (Ukrainian). Ukraine continuum of care analyses – Breast Cancer, Cervical Cancer, Diabetes, Hypertension. Washington, D.C. : World Bank Group. Retrieved from : http://documents.worldbank.org/curated/en/209221547239438627/Hypertension-Care-in-Ukraine-Breakpoints-and-Implications-for-Action.

Svishchenko, I., Bagrii, A., Iena, L., Kovalenko, V., Koval, S., & Mellina, I. et al. (2008) Rekomendatsii Ukrainskoi Asotsiatsii kardiolohiv z profilaktyky ta likuvannia arterialnoii hipertenzii [Guidelines of Ukrainian Society of Cardiology on prevention and treatment of arterial hypertension]. Kyiv: PP VMB, 80 [In Ukrainian].

Harrington, R., Califf, R., Balamurugan, A., Brown, N., Benjamin, R., & Braund, W. et al. (2020). Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association. Circulation, 141(10). doi: 10.1161/cir.0000000000000753.

Zharinov, O. Аrterialna hipertenziia i fibryliatsiia peredserd [Arterial hypertension and atrial fibrillation]. HYPERTENSION, 5(19), 16-22 [In Ukrainian].

Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., & Casadei, B. et al. (2016). 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Journal Of Cardio-Thoracic Surgery, 50(5), e1-e88. doi: 10.1093/ejcts/ezw313.

Camm, A., Savelieva, I., Potpara, T., Hindriks, G., Pison, L., & Blömstrom-Lundqvist, C. (2016). The changing circumstance of atrial fibrillation – progress towards precision medicine. Journal Of Internal Medicine, 279(5), 412-427. doi: 10.1111/joim.12478.

Sychov, O., Kovalenko, V., Dziak, G., Korkushko, A., Gryn, V., & Zharinov, O. et al. (2015). Diahnostyka ta likuvannia fibryliatsii peredserd. Rekomendatsii robochoi hrupy z porushen rytmu sertsia Asotsiatsii kardiolohiv Ukrainy [Guidelines for the diagnosis and management of atrial fibrillation. The Task Force for the diagnosis and management of arrhythmias of the Ukrainian Society of Cardiology]. Kyiv, 167 [In Ukrainian].

Proietti, M., Romiti, G., Olshansky, B., & Lip, G. (2017). Systolic Blood Pressure Visit-to-Visit Variability and Major Adverse Outcomes in Atrial Fibrillation. Hypertension, 70(5), 949-958. doi: 10.1161/hypertensionaha.117.10106.

Boev, S., Dotsenko, N., Gerasimenko, L., & Shekhunova, I. (2018). Aktualni aspekty variabelnosti arterialnoho tysku pry arterialnii hipertenzii [Actual aspects of blood pressure variability in arterial hypertension]. HYPERTENSION, 0(2.58), 44-51. doi: 10.22141/2224-1485.2.58.2018.131065. [In Ukrainian].

Ostroumova, O., Borisova, E., Pavleeva, E. (2017). Variabelnost arterialnogo davleniya. Mezhvizitnaya variabelnost arterialnogo davleniya. [Blood Pressure Variability. Visit-to-Visit Blood Pressure Variability]. Kardiologiia, 57(11), 68-75. doi: 10087/cardio.2017.11.10056. [In Russian].

Rothwell, P., Howard, S., Dolan, E., O'Brien, E., Dobson, J., & Dahlöf, B. et al. (2010). Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. The Lancet, 375(9718), 895-905. doi: 10.1016/s0140-6736(10)60308-x.

Rothwell, P. (2010). Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. The Lancet, 375(9718), 938-948. doi: 10.1016/s0140-6736(10)60309-1.

Diaz, K., Tanner, R., Falzon, L., Levitan, E., Reynolds, K., Shimbo, D., & Muntner, P. (2014). Visit-to-Visit Variability of Blood Pressure and Cardiovascular Disease and All-Cause Mortality. Hypertension, 64(5), 965-982. doi: 10.1161/hypertensionaha.114.03903.

European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). (2016). Europace, euw242. doi: 10.1093/europace/euw242.

Sribna, O., Sychov, O., Kvasha, O., & Smyrnova, I. (2017). Arterialna hipertenziia ta fibryliatsiia/tripotinnia peredserd: asotsiatyvnist zviazku za danymy epidemiolohichnoho doslidzhennia [Hypertension and atrial fibrillation/flutter: associativeness of relationship according to the data of epidemiological research]. HYPERTENSION, 0(5.55), 27-31. doi: 10.22141/2224-1485.5.55.2017.115336. [In Ukrainian].

Webb, A., & Rothwell, P. (2010). Blood Pressure Variability and Risk of New-Onset Atrial Fibrillation. Stroke, 41(9), 2091-2093. doi: 10.1161/strokeaha.110.589531.

Mehlum, M., Liestøl, K., Wyller, T., Hua, T., Rostrup, M., & Berge, E. (2019). Blood pressure variability in hypertensive patients with atrial fibrillation in the VALUE trial. Blood Pressure, 28(2), 77-83. doi: 10.1080/08037051.2018.1524707.

Lee, S., Choi, Y., Choi, E., Han, K., Lee, E., & Cha, M. et al. (2020). Blood Pressure Variability and Incidence of New-Onset Atrial Fibrillation. Hypertension, 75(2), 309-315. doi: 10.1161/hypertensionaha.119.13708.

Lee, S., Choi, E., Han, K., Lee, S., & Oh, S. (2020). Effect of the variability of blood pressure, glucose level, total cholesterol level, and body mass index on the risk of atrial fibrillation in a healthy population. Heart Rhythm, 17(1), 12-19. doi: 10.1016/j.hrthm.2019.07.006.

Grundy, S., Arai, H., Barter, P., Bersot, T., Betteridge, D., & Carmena, R. et al. (2014). An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia-Full report. Journal Of Clinical Lipidology, 8(1), 29-60. doi: 10.1016/j.jacl.2013.12.005.

KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. (2013). Kidney International Supplements, 3 (1), 1-150.

Levey, A., de Jong, P., Coresh, J., Nahas, M., Astor, B., & Matsushita, K. et al. (2011). The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney International, 80(1), 17-28. doi: 10.1038/ki.2010.483.

Lang, R., Badano, L., Mor-Avi, V., Afilalo, J., Armstrong, A., & Ernande, L. et al. (2015). Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal Of The American Society Of Echocardiography, 28(1), 1-39.e14. doi: 10.1016/j.echo.2014.10.003.

Ponikowski, P., Voors, A., Anker, S., Bueno, H., Cleland, J., & Coats, A. et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129-2200. doi: 10.1093/eurheartj/ehw128.

Yu, Z., Li, D., Chen, X., Zheng, P., Lin, H., & Tang, M. et al. (2019). Association of Visit-to-Visit Variability of Blood Pressure with Cardiovascular Disease among Type 2 Diabetes Mellitus Patients: A Cohort Study. Diabetes & Metabolism Journal, 43(3), 350. doi: 10.4093/dmj.2018.0108.

Rogoza, A., Agaltsov, M., Sergeeva, M. (2005). Sutochnoe monitorirovanie arterialnogo davleniya: variantyi vrachebnyih zaklyucheniy i kommentarii [24-Hour blood pressure monitoring: medical opinions and comments]. Nizhniy Novgorod: DEKOM, 63 [In Russian].

Chow, C., Teo, K,, Rangarajan, S., Islam, S., Gupta, R., & Avezum, A. et al. (2013). Prevalence, Awareness, Treatment, and Control of Hypertension in Rural and Urban Communities in High-, Middle-, and Low-Income Countries. JAMA, 310(9), 959. doi: 10.1001/jama.2013.184182.

Lashkul, Z. (2014). Osoblyvosti epidemiolohii arterialnoi hipertenzii ta yii uskladnen na rehionalnomu rivni z 1999 po 2013 roky [Features epidemiology of hypertension and its complications at the regional level in 1999–2013]. Modern Medical Technologies, 2, 134-141. [In Ukrainian].

Norioka, N., Iwata, S., Ito, A., Tamura, S., Kawai, Y., & Nonin, S. et al. (2018). Greater nighttime blood pressure variability is associated with left atrial enlargement in atrial fibrillation patients with preserved ejection fraction. Hypertension Research, 41(8), 614-621. doi: 10.1038/s41440-018-0060-2.

Olbers, J., Gille, A., Ljungman, P., Rosenqvist, M., Östergren, J., & Witt, N. (2018). High beat-to-beat blood pressure variability in atrial fibrillation compared to sinus rhythm. Blood Pressure, 27(5), 249-255. doi: 10.1080/08037051.2018.1436400.

Corino, V., Lombardi, F., & Mainardi, L. (2014). Blood pressure variability in patients with atrial fibrillation. Autonomic Neuroscience, 185, 129-133. doi: 10.1016/j.autneu.2014.08.002.

Webb, A., Fischer, U., Mehta, Z., & Rothwell, P. (2010). Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. The Lancet, 375(9718), 906-915. doi: 10.1016/s0140-6736(10)60235-8.

Bansal, N., Zelnick, L., Alonso, A., Benjamin, E., de Boer, I., & Deo, R. et al. (2017). eGFR and Albuminuria in Relation to Risk of Incident Atrial Fibrillation: A Meta-Analysis of the Jackson Heart Study, the Multi-Ethnic Study of Atherosclerosis, and the Cardiovascular Health Study. Clinical Journal Of The American Society Of Nephrology, 12(9), 1386-1398. doi: 10.2215/cjn.01860217.

Xintarakou, A., Tzeis, S., Psarras, S., Asvestas, D., & Vardas, P. (2020). Atrial fibrosis as a dominant factor for the development of atrial fibrillation: facts and gaps. EP Europace, 22(3), 342-351. doi: 10.1093/europace/euaa009.

Cipollini, F., Arcangeli, E., & Seghieri, G. (2016). Left atrial dimension is related to blood pressure variability in newly diagnosed untreated hypertensive patients. Hypertension Research, 39(8), 583-587. doi: 10.1038/hr.2016.29.

Ayubi, E., & Sani, M. (2016). Left atrial dimension is related to blood pressure variability in newly diagnosed untreated hypertensive patients: methodological and statistical issues. Hypertension Research, 40(3), 299-299. doi: 10.1038/hr.2016.131.

Nimtsovych, T., Mischeniuk, O., & Kravchenko, A. (2019). Faktory sertsevo-sudynnoho ryzyku ta mizhvizytna variatyvnist arterialnoho tysku [Factors of cardiovascular risk and intervisit arterial pressure variability]. Clinical and Preventive Medicine, 1(7), 17-24. doi: 10.31612/2616-4868.1(7).2019.03. [In Ukrainian].

Nimtsovych, T. (2019). Osoblyvosti zakhvoriuvanosti na arterialnu hipertenziiu ta mizhvizytna variatyvnist arterialnoho tysku u meshkantsiv Khmelnytskoi oblasti [Pecularities of arterial hypertension prevalence and intervisit variability of blood pressure in Khmelnytskyi region]. Family Medicine, 5-6(85-86), 91-95. [In Ukrainian].

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