Episodes of symptomatic hypotension in patients with hypertension and their relationship with indicators of daily blood pressure profile


DOI: https://dx.doi.org/10.18565/therapy.2021.3.28-35

Ermasova S.A., Schwartz E.Yu., Popov K.A., Sokolov I.M.

1) V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia; 2) V.A. Almazov National Medical Research Centre of the Ministry of Healthcare of Russia, Saint Petersburg
Aim: to study the relationship between the symptomatic hypotensive episodes (SHE) and the parameters of the daily blood pressure profile according to the ambulatory blood pressure monitoring (ABPM) data in patients with hypertension.
Material and methods. 66 patients aged between 40 and 79 years with hypertension were studied. A questionnaire developed by the authors was used to identify symptomatic hypotension. During the study all the subjects had ABPM. We took into account the average values of SBP, DBP, heart rate, the minimum values of these indicators, and the variability of blood pressure, calculated as a standard deviation from the average. Pulse blood pressure and mean blood pressure were also determined. Uncomplicated hypertension is referred to patients without a history of heart attack and/or stroke, the presence of the symptoms is referred to as complicated hypertension
Results. Among all patients, SHE was observed in 40 (60,6%). In uncomplicated hypertension – 22 (52,4%), in complicated hypertension – 18 (75%) participants (p=0,05). With uncomplicated AH and SHE, the high variability of daily SBP was observed in 36 % of the subjects and averaged 14.3 mm Hg, in the absence of SHE, the variability of daily SBP was 16.3 mm Hg, with a variety of blood pressure exceeding the norm, 80% of the participants (p <0,05). With complicated AH and the presence of SHE, the variability of daytime (18,0 mm Hg) and nighttime (14,8 mm Hg) SBP was the highest. The proportion of participants with daily SBP variability exceeding the norm was 78%. In the absence of SHE, the blood pressure variability indicators did not deviate from the norm (p<0.05). In the group of patients with uncomplicated AH and SHE, a relatively high level of the minimum daily SBP of 97.5 mm Hg was observed compared to those without SHE of 88.1 mm Hg (p=0,03). In complicated AH in combination with SHE, the minimum SBP during the day was also higher than 96,3 mmHg. Compared to the absence of SHE 89,7 mmHg, the minimum level of DBP was lower in individuals with SHE 48,4 mmHg vs 57,3 mmHg (p <0,05). Patients with SHE with both complicated and uncomplicated AH were characterized by relatively low mean blood pressure (97,7±9,9 mmHg vs 93,0±9,9 mmHg), and higher pulse pressure (56,4±9,4 mmHg vs 52,5±9,2 mmHg) during the day (p <0,05).
Conclusion. Symptomatic episodes of hypotension are common among patients with AH, which are not unidirectionally associated with the variability of blood pressure. The character of this relationship is associated with the presence of heart attack and/or stroke diseases in anamnesis.
Keywords: hypertension, episodes of symptomatic hypotension, myocardial infarction, stroke, blood pressure variability, mean arterial blood pressure
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About the Autors

Svetlana A. Ermasova, assistant of the Department of faculty therapy, Faculty of general medicine of V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. Tel.: +7 (906) 300-45-71. Е-mail: sver4@yandex.ru. ORCID: 0000-0003-3778-1288
Elena Yu. Schwartz, resident of the Department of cardiovascular surgery of the Institute of medical education,
V.A. Almazov National Medical Research Centre of the Ministry of Healthcare of Russia. Address: 197341, Saint Petersburg, 2 Akkuratova Str. E-mail: shwartz58@yandex.ru
Konstantin A. Popov, resident of Department of faculty therapy, Faculty of general medicine of V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str.
Tel.: +7 (927) 277-38-84. Е-mail: kostyanze@yandex.ru. ORCID: 0000-0001-5517-4591
Ivan M. Sokolov, MD, professor of the Department of faculty therapy, Faculty of general medicine of V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str.
Tel.: +7 (927) 223-89-91. Е-mail: docsim@bk.ru. ORCID: 0000-0002-9547-705X

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