Predictors of the development of abnormal patterns of circadian blood pressure rhythm in patients with hypertension after a new coronavirus infection

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Abstract

Objective. To determine the predictors of the development of abnormal patterns of circadian blood pressure (BP) rhythm in patients with arterial hypertension (AH) after a new coronavirus infection (NСVI).

Materials and methods. The study is a comparative clinical research of the same patients with hypertension before and after NCVI with retrospective evaluation of the data. Within 2 years from 842 patients with cardiovascular risk factors, according to the inclusion and non-inclusion criteria 70 patients with target levels of office BP, home monitoring and 24-hour blood pressure monitoring (ABPM) on the background of a continuous antihypertensive therapy were included in the study. Abnormal patterns of circadian BP were recorded after NCVI during ABPM in all of them. All patients with hypertension underwent a complete examination before and after NCVI.

Results. After NCVI in patients with AH who had achieved the target ranges of office BP before its development, at home measurement and ABPM against the background of continuous antihypertensive therapy with high adherence to treatment, in more than 50 % of patients BP readings were not in the target values, in more than 50 % of the examined patients, BP variability was higher than the permissible values, in 73 % of patients the average daily BP was above 53 mm Hg. Abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI were detected in 61.5 %: "Non-dipper" in 28.6 %; "Night-dipper" – in 21.9 %, masked nocturnal hypertension – in 17.1 %.

Conclusion. The indicative significance of the development of abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI was demonstrated by 3 qualitative indicators: glomerular filtration rate with cystatin C < 60 ml/min/1.73 m2, cardio-ankle vascular index (CAVI) ≥ 9, and a high frequency of AGT gene polymorphism – T/T genotype (in 54.3 % of patients).

About the authors

N. M. Syuzeva

E.A. Vagner Perm State Medical University

Email: nakoziolova@mail.ru
ORCID iD: 0000-0001-8754-2950

Assistant of the Department of Propaedeutics of Internal Diseases № 2

Russian Federation, Perm

O. V. Masalkina

E.A. Vagner Perm State Medical University

Email: nakoziolova@mail.ru
ORCID iD: 0009-0006-3364-0591

PhD (Medicine), Associate Professor of the Department of Propaedeutics of Internal Diseases № 2

Russian Federation, Perm

N. A. Koziolova

E.A. Vagner Perm State Medical University

Author for correspondence.
Email: nakoziolova@mail.ru
ORCID iD: 0000-0001-7003-5186

DSc (Medicine), Professor, Head of the Department of Propaedeutics of Internal Diseases № 2

Russian Federation, Perm

A. I. Chernyavina

E.A. Vagner Perm State Medical University

Email: nakoziolova@mail.ru
ORCID iD: 0000-0002-0051-6694

DSc (Medicine), Associate Professor of the Department of Propaedeutics of Internal Diseases № 2

Russian Federation, Perm

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. ROC curve for GFCS < 60 ml/min/1.73 m2 as a predictor of the development of abnormal circadian rhythm patterns in patients with HD after NCVI (AUG = 0.873 ± 0.073, p = 0.005; sensitivity – 81%, specificity – 76%); False Positive Fraction – false positive result, TruePositive Fraction – false negative result

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3. Fig. 2. ROC curve for the CAVI index as a predictor of the development of abnormal circadian rhythm patterns of blood pressure in patients with GB after NCVI (AUG = 0.794 ± 0.071, p = 0.002; sensitivity – 78%, specificity – 84%); False Positive Fraction – false positive result, TruePositive Fraction – false negative result

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4. Fig. 3. ROC curve for AGT gene polymorphism – T/T genotype as a predictor of the development of abnormal circadian rhythm patterns in patients with HD after NCVI (AUG = 0.906 ± 0.043, p < 0.001; sensitivity – 88%, specificity – 80%); False Positive Fraction – false positive result, TruePositive Fraction – false negative result

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