Impact of increased arterial stiffness and autonomic nervous system dysfunction in hypertensive patients with orthostatic hypotension

Introduction: The evaluation of arterial stiffness and autonomic nervous system dysfunction (DSNA) in relations with age, sex, cardiovascular risk factors and comorbidities in hypertensive patients with orthostatic arterial hypotension (OAH). Methods: In hypertensive patients with symptomatic or asymptomatic OAH and sinus rhythm we assessed aortic we assessed aortic stiffness by 2D transthoracic echocardiography M mode calculating aortic stiffness index (ASI) and aortic strain. DSNA was appreciated by Holter ECG with 24 hours recording using the time parameters of sinus rhythm variability (RR interval, SDNN and NN50). The increased aortic stiffness was defined by ASI (aortic stiffness index) > 0.551 (cut-off value) and DSNA by SDNN < 70 ms. Statistics performed with Pearson linear correlation test. Results: 34 patients (pts) with hypertension, symptomatic or asymptomatic OAH, 20F (58.82%) and 14M (41.17%), mean age 66.94 ± 11.94 years, 21 pts (61,76%) in stage II and 13 pts in stage III (38,23%) of hypertension, 6 pts (17.64%) with diabetes mellitus, 9 pts (26.34%) with uncontrolled dyslipidemia, 4 pts (11.76%) with eGFR < 60 ml/min./m2 (MDRD formula). Increased ASI values recorded in 8 pts (23,52%) were signifi cantly correlated with the presence of obesity (p < 0.002), stage III of hypertension (p < 0.003) and with diabetes mellitus (p < 0.001). DSNA present in 6 pts (17.64%) was significantly correlated with chronic kidney disease (p < 0.001) and diabetes (p < 0.004). Conclusions: In hypertensive patients, asymptomatic and symptomatic hypotension is associated with increased aortic stiffness, autonomic nervous system dysfunction and is correlated with stage III of arterial hypertension, chronic kidney disease and diabetes mellitus.

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