Left ventricular myocardial dysfunction and parameters of ambulatory blood pressure monitoring in patients with arterial hypertension and frailty

Aim. To study and analyze the systolic and diastolic left ventricle (LV) function, parameters of the ambulatory blood pressure (BP) monitoring in patients over 65 years of age with arterial hypertension, depending on the presence of frailty. Materials and methods. We examined 77 patients over 65 years of age (25 men and 52 women) with arterial hypertension, who were divided into two groups: with the presence of frailty (38 people) and its absence (39 people). To detect frailty, we used the "Age is not a hindrance" questionnaire validated in Russia and the "Get up and go" test. The examination included echocardiography with tissue doppler and ambulatory BP monitoring. Results. In both groups, LV systolic function remained within normal values, while diastolic function was impaired. In the group of people without frailty, type 1 of left ventricular diastolic dysfunction prevailed in 63% of cases, in the group with frailty, type 2 of left ventricular diastolic dysfunction with increased filling pressure was registered in 77% of cases. In both groups, both isolated systolic arterial hypertension and normal indicators of SBP and DBP were recorded during the day. Systolo-diastolic hypertension and hypotension have been presented by individual cases. At the same time, significant differences (p<0.05) in the groups were revealed by the index of time of hypertension SBP at night and were higher in patients with frailty. Correlations were found between the time index of hypertension and SBP at night with the volume index of the left atrium in groups with frailty (0.34; p<0.05) and without frailty (0.40; p<0.05), as well as the time index of hypertension and SAD at night with the maximum rate of regurgitation on the tricuspid valve (0.42; p<0.05) and with estimated systolic pressure in the pulmonary artery (0.41; p<0.05) in the group with frailty. Conclusion. In the group of patients with arterial hypertension older than 65 years without frailty, violations of the left ventricular diastolic function by the type of slowing relaxation predominate, while in the group of patients with senile asthenia, violation of the left ventricular diastolic function by the type of pseudonormalization with increased filling pressure prevails. Features of the ambulatory BP monitoring of patients with hypertension older than 65 years with the presence of frailty are higher values of the time index of hypertension SBP at night. An increase in the time index of hypertension and SBP in patients with hypertension older than 65 years with frailty is associated with an increase in the volume of the left atrium, the rate of tricuspid regurgitation and systolic pressure in the pulmonary artery. The obtained data may indicate an adverse effect of frailty on the progression of heart failure in patients with arterial hypertension, which requires a comprehensive approach with the participation of a geriatrician in the management of such patients.

arterial hypertension, frailty, echocardiography, left ventricle, systolic function, diastolic function, ambulatory blood pressure monitoring, blood pressure