THE INFLUENCE OF METABOLIC SYNDROME ON HEART ABNORMALITIES IN PATIENTS WITH ARTERIAL HYPERTENSION

Cover Page


Cite item

Full Text

Abstract

Aim: To evaluate structural and functional heart abnormalities in patients with arterial hypertension (AH) with and without metabolic syndrome.

Materials and methods: The study included 303  patients with AH I, II and III, aged from 25 to  70  years (mean±SD 52±18 years). All patients were categorized into 3 groups according to severity of AH (AH I, II and III corresponded to groups 1, 2 and 3, respectively). Within each group, patients were subdivided into 2 subgroups: without metabolic syndrome (n=151) and with metabolic syndrome (n=152). Assessments included measurements of blood glucose and lipids, 24-hour monitoring of blood pressure, echocardiography with calculation of myocardial mass index of left ventricle and the use of conventional and tissue myocardial dopplerography.

Results: Already at early stage of AH (gr. I), 60% patients with metabolic syndrome and 32% patients without metabolic abnormalities had some degree of left ventricular remodeling, including concentric type of remodeling in 12 and 20%, excentric hypertrophy in 18 and 6%, concentric left ventricular hypertrophy in 30 and 6%, respectively. In AH I, an increase of myocardial mass index of left ventricle was found in 39% of patients with metabolic syndrome and in 12% patients without it. In patients with AH I, abnormalities of left ventricular diastolic function according to the results of tissue myocardial dopplerography was seen in 82% of patients with metabolic syndrome and in 42% of patients without metabolic syndrome. Patients with AH I–III and metabolic syndrome had almost 5-fold higher probability of heart abnormalities than AH patients without metabolic disturbances (odds ratio 4.8, 95% confidence interval 1.9–6.4, p< 50 and>50 years).

Conclusion: Metabolic syndrome contributes to heart abnormalities irrespective of gender, age and AH grade. 

About the authors

G. Kh. Sharipova

Russian Cardiology Research and Production Complex, Moscow

Author for correspondence.
Email: gulandom05@mail.ru

Sharipova Gulandom Kholmuradovna – MD, PhD, Senior Research Fellow, Department of Coordination and Monitoring of Research Programs

* 15а 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation. Tel.: +7 (926) 345 16 75. E-mail: gulandom05@mail.ru

Россия

M. A. Saidova

Russian Cardiology Research and Production Complex, Moscow

Email: gulandom05@mail.ru
Saidova Marina Abdulatipovna – MD, PhD, Professor, Head of Laboratory of Ultrasound Investigations of the Department of New Methods of Investigations, Institute of Clinical Cardiology named after A.L. Myasnikov Россия

Yu. V. Zhernakova

Russian Cardiology Research and Production Complex, Moscow

Email: juli001@mail.ru

Zhernakova Yuliya Valer'evna – MD, PhD, Senior Research Fellow, Department of Coordination and Monitoring of Research Programs

* 15а 3-ya Cherepkovskaya ul., Moscow, 121552, Russian Federation. Tel.: +7 (905) 745 71 12. E-mail: juli001@mail.ru

Россия

I. E. Chazova

Russian Cardiology Research and Production Complex, Moscow

Email: juli001@mail.ru
Chazova Irina Evgen'evna – MD, PhD, Professor, Correspondent Member of the Russian Academy of Sciences, Director of the Institute of Clinical Cardiology named after A.L. Myasnikov Россия

References

  1. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome – a new worldwide definition. Lancet. 2005;366(9491):1059–62.
  2. Оганов РГ, Мамедов МН, Колтунов ИН. Метаболический синдром: путь от научной концепции до клинического диагноза. Врач. 2007;(3):3–7. (Oganov RG, Mamedov MN, Koltunov IN. [The metabolic syndrome: the way from a scientific concept to clinical diagnosis]. Vrach. 2007;(3):3–7. Russian).
  3. Конради АО, Жукова АВ, Винник ТА, Шляхто ЕВ. Структурно-функциональные параметры миокарда у больных гипертонической болезнью в зависимости от массы тела, типа ожирения и состояния углеводного обмена. Артериальная гипертензия. 2002;8(1):7–12. (Konradi AO, Zhukova AV, Vinnik TA, Shlyakhto EV. [Structural and functional myocardial parameters in hypertensive patients depending on body mass, obesity type and carbohydrate metabolism]. Arterial'naya gipertenziya. 2002;8(1):7–12. Russian).
  4. Stokes J 3rd, Kannel WB, Wolf PA, D'Agostino RB, Cupples LA. Blood pressure as a risk factor for cardiovascular disease. The Framingham Study–30 years of follow-up. Hypertension. 1989;13(5 Suppl):I13–8.
  5. Диагностика и лечение артериальной гипертензии. Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов. Системные гипертензии. 2010;(3):5–26. (Recommendations for the management of arterial hypertension. Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Sistemnye gipertenzii. 2010;(3):5–26. Russian).
  6. de Simone G, Pasanisi F, Contaldo F. Link of nonhemodynamic factors to hemodynamic determinants of left ventricular hypertrophy. Hypertension. 2001;38(1):13–8.
  7. Аметов АС. Ожирение – эпидемия XXI века. Терапевтический архив. 2002;(10):5–7. (Ametov AS. [Obesity: the epidemic of the 21st century]. Terapevticheskiy arkhiv. 2002;(10): 5–7. Russian).
  8. Зимин ЮВ, Родоманченко ТВ, Бойко ТА, Федосеева АВ. Клиническая и гемодинамическая характеристика гипертонической болезни, ассоциированной с инсулинорезистентностью, связь массы миокарда левого желудочка сердца с гиперсекрецией инсулина. Кардиология. 1998;(4):9–13. (Zimin YuV, Rodomanchenko TV, Boyko TA, Fedoseeva AV. [Clinical and haemodynamic characteristics of arterial hypertension associated with insulin resistance, relation of left ventricular myocardial mass to insulin oversecretion]. Kardiologiya. 1998;(4):9–13. Russian).
  9. Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321(4):225–36.
  10. Knopman D, Boland LL, Mosley T, Howard G, Liao D, Szklo M, McGovern P, Folsom AR; Atherosclerosis Risk in Communities (ARIC) Study Investigators. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology. 2001;56(1):42–8.
  11. Вигдорчик ВИ, Прокопенко ВД, Симонов ДВ. Диастолическая функция левого желудочка сердца у больных артериальной гипертензией, ассоциированной с метаболическим синдромом. Вестник новых медицинских технологий. 2004;(4):57–9. (Vigdorchik VI, Prokopenko VD, Simonov DV. [Diastolic function of the aortic ventricle of heart in patients with arterial hypertension associated with a metabolic syndrome]. Vestnik novykh meditsinskikh tekhnologiy. 2004;(4):57–9. Russian).
  12. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991;114(5):345–52.
  13. Саидова МА, Сергакова ЛМ, Атауллаханова ДМ, Ботвина ЮВ, Салтыкова ММ. Современные эхокардиографические подходы к оценке гипертрофии миокарда и структурного состояния левого желудочка у больных артериальной гипертонией. Методическое пособие для врачей. М.; 2007. (Saidova MA, Sergakova LM, Ataullakhanova DM, Botvina YuV, Saltykova MM. Current echocardiographic approaches to assessment of myocardial hypertrophy and structural status of the left ventricle in patients with arterial hypertension. Guide for physicians. Moscow; 2007. Russian).
  14. Ткаченко СБ, Берестень НФ. Тканевое допплеровское исследование миокарда. М.: Реальное время; 2006. 60 c. (Tkachenko SB, Beresten’ NF. Tissue Doppler assessment of myocardium. Moscow: Real'noe vremya; 2006. 60 p. Russian).
  15. Bountioukos M, Schinkel AF, Bax JJ, Lampropoulos S, Poldermans D. The impact of hypertension on systolic and diastolic left ventricular function. A tissue Doppler echocardiographic study. Am Heart J. 2006;151(6):1323.e7–12.
  16. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63.
  17. de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O, Alderman MH. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol. 1992;20(5):1251–60.
  18. Cалтыкова ММ, Рогоза АН, Ощепкова ЕВ, Атауллаханова ДМ, Лазарева НВ, Саидова МА. Проблемы индексации миокарда левого желудочка на размеры тела у пациентов с избыточной массой тела. Терапевтический архив. 2006;(9):92–5. (Saltykova MM, Rogoza AN, Oshchepkova EV, Ataullakhanova DM, Lazareva NV, Saidova MA. [The problems of correction of left ventricular myocardium for body surface area in overweight patients]. Terapevticheskiy arkhiv. 2006;(9):92–5. Russian).
  19. Бойцов СА. Сердце как орган-мишень при артериальной гипертонии. В: Чазов ЕИ, Чазова ИЕ, ред. Руководство по артериальной гипертонии. М.: Медиа Медика; 2005. с. 201–17. (Boytsov SA. The heart as a target organ in arterial hypertension. In: Chazov EI, Chazova IE, editors. A textbook on arterial hypertension. Moscow: Media Medika; 2005. p. 201–17. Russian).
  20. García-Fernández MA, Azevedo J, Moreno M, Bermejo J, Pérez-Castellano N, Puerta P, Desco M, Antoranz C, Serrano JA, García E, Delcán JL. Regional diastolic function in ischaemic heart disease using pulsed wave Doppler tissue imaging. Eur Heart J. 1999;20(7):496–505.
  21. Чазова ИЕ, Мычка ВБ. Метаболический синдром. М.: Медиа Медика; 2004. (Chazova IE, Mychka VB. Metabolic syndrome. Moscow: Media Medika; 2004. Russian).
  22. Чазова ИЕ, Ратова ЛГ. Роль суточного мониторирования артериального давления в оценке эффективности антигипертензивной терапии (Результаты суточного мониторирования артериального давления в программе КЛИП-АККОРД). Системные гипертензии. 2007;(1):18–26. (Chazova IE, Ratova LG. [The role of 24-hour blood pressure monitoring in assessment of efficacy of antihypertensive treatment (results of 24-hour blood pressure monitoring in the program KLIP-ACCORD)]. Sistemnye gipertenzii. 2007;(1):18–26. Russian).
  23. Grandi AM, Maresca AM, Giudici E, Laurita E, Marchesi C, Solbiati F, Nicolini E, Guasti L, Ven co A. Metabolic syndrome and morphofunctional characteristics of the left ventricle in clinically hypertensive nondiabetic subjects. Am J Hypertens. 2006;19(2):199–205.
  24. Ferrara LA, Guida L, Ferrara F, De Luca G, Staiano L, Celentano A, Mancini M. Cardiac structure and function and arterial circulation in hypertensive patients with and without metabolic syndrome. J Hum Hypertens. 2007;21(9): 729–35.
  25. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288(21):2709–16.
  26. Galderisi M, Tagliamonte MR, D'Errico A, Carella C, Varricchio G, Mondillo S, de Divitiis O, Paolisso G. Independent association of plasma leptin levels and left ventricular isovolumic relaxation in uncomplicated hypertension. Am J Hypertens. 2001;14(10):1019–24.
  27. Smalcelj A, Puljević D, Buljević B, Brida V. Left ventricular hypertrophy in obese hypertensives: is it really eccentric? (An echocardiographic study). Coll Antropol. 2000;24(1):167–83.
  28. de Simone G, Olsen MH, Wachtell K, Hille DA, Dahlöf B, Ibsen H, Kjeldsen SE, Lyle PA, Devereux RB. Clusters of metabolic risk factors predict cardiovascular events in hypertension with target-organ damage: the LIFE study. J Hum Hypertens. 2007;21(8):625–32.
  29. Scognamiglio R, Avogaro A, Negut C, Piccolotto R, Vigili de Kreutzenberg S, Tiengo A. Early myocardial dysfunction in the diabetic heart: current research and clinical applications. Am J Cardiol. 2004;93(8A):17A–20A.
  30. Palatini P, Visentin P, Mormino P, Mos L, Canali C, Dorigatti F, Berton G, Santonastaso M, Dal Follo M, Cozzutti E, Garavelli G, Pegoraro F, D'Este D, Maraglino G, Zanata G, Biasion T, Bortolazzi A, Graniero F, Milani L, Pessina AC. Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension. HARVEST Study Group. Am J Hypertens. 1998;11(2):147–54.
  31. Саидова МА, Шитов ВН, Гусейнова БА, Блинова ЕВ, Чихладзе НМ, Сивакова ОА, Чазова ИЕ. Роль тканевой миокардиальной допплерэхокардиографии в раннем выявлении структурно-функциональных изменений миокарда у больных мягкой и умеренной артериальной гипертонией. Терапевтический архив. 2008;(4):21–8. (Saidova MA, Shitov VN, Guseynova BA, Blinova EV, Chikhladze NM, Sivakova OA, Chazova IE. [The role of tissue myocardial Doppler-echocardiography in early detection of structural and functional myocardial abnormalities in patients with mild and moderate arterial hypertension]. Terapevticheskiy arkhiv. 2008;(4):21–8. Russian).
  32. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561–6.
  33. Saitoh M, Nishimura H, Tanaka T, Kondoh T. Gender-related differences in target organ damage in untreated patients with essential hypertension. Intern Med. 2006;45(6):377–83. 34.García-Fernández MA, Azevedo J, Moreno M, Arroja I, Zamorano J, Caso P. Doppler tissue imaging. Rev Port Cardiol. 2001;20 Suppl 1:I33–47.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2015 Sharipova G.K., Saidova M.A., Zhernakova Y.V., Chazova I.E.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies