Effectiveness of arterial hypertension control using ambulatory blood pressure monitoring in patients in the remote period after myocardial infarction and ischemic stroke

Authors

  • Andriy Yagensky Volyn Regional Center for Cardiovascular Pathology. Communal Enterprise «Lutsk Clinical Hospital" Vidrodzhennia ave., 13, Lutsk, Ukraine, 43024 Volyn branch of the Faculty of Postgraduate Education of Danylo Halytsky Lviv National Medical University Hrushevskoho ave., 21, Lutsk, Ukraine, 43005, Ukraine https://orcid.org/0000-0001-5610-0367
  • Mykhailo Pavelko Volyn Regional Center for Cardiovascular Pathology. Communal Enterprise «Lutsk Clinical Hospital" Vidrodzhennia ave., 13, Lutsk, Ukraine, 43024, Ukraine https://orcid.org/0000-0002-7898-2783
  • Yaroslav Oshtuk Volyn Regional Center for Cardiovascular Pathology. Communal Enterprise «Lutsk Clinical Hospital" Vidrodzhennia ave., 13, Lutsk, Ukraine, 43024, Ukraine https://orcid.org/0000-0003-4816-2861

DOI:

https://doi.org/10.15587/2519-4798.2020.209170

Keywords:

arterial hypertension, ambulatory blood pressure monitoring, myocardial infarction, ischemic stroke, blood pressure, arterial hypotension

Abstract

Arterial hypertension is one of the most important modified risk factors and its adequate control is a cornerstone of primary and secondary prevention. On the other hand, excessive lowering of blood pressure can be harmful, especially in patients with a history of ischemic events.

The aim: To evaluate daily blood pressure fluctuations with ambulatory blood pressure monitoring in patients with controlled hypertension according to office measurements in the remote period after myocardial infarction and ischemic stroke

Materials and methods: The study involved 64 patients with hypertension in remote period (at least 6 months) after myocardial infarction (38 patients) and ischemic stroke (26 patients) with systolic blood pressure during the last three months and at least two visits. in the range of 120-139 mm Hg and diastolic blood pressure 70–89 mm Hg. Patients with valvular heart disease, severe arrhythmias, significant heart failure (NYHA III-IV) were not included in the study.All patients underwent daily blood pressure monitoring. According to the recommendations of ESC / ESH in 2018, the optimal blood pressure control was considered to be the average daily blood pressure after myocardial infarction 130–140 / 70–79 mm Hg. at the age of >65 years, 120–130 / 70–79 mm Hg at the age of ≤65 years; after ischemic stroke 120–130 / <80 mm Hg. All values below the optimal levels were considered to be low blood pressure, higher than optimal – high blood pressure. Particular attention was paid to excessive reduction of blood pressure with the calculation of the number of excessive reductions and their duration during the day.

Results: The average daily blood pressure values corresponded to the definition of optimal in only 23.4 % of patients with ischemic events. In 63.2 % of patients after myocardial infarction, the mean daily values of systolic blood pressure and diastolic blood pressure were lower than recommended, and in patients after ischemic stroke, this number was significantly lower – 23.1 %. Conversely, in more than half of the patients after ischemic stroke (53.6 %) the average daily blood pressure levels exceeded the recommended ones. In patients after myocardial infarction, this number was only 13.2 %.

Excessive reductions in blood pressure were recorded in 58 of 64 patients (90.6 %), in 54 persons such episodes were observed during the day (84.3 %). Persistent (over 1 hour) excessive decrease in blood pressure was registered in 16 people (25.0 %), 8 of whom had persistent excessive blood pressure reductions ≥2/day (12.5 %). Predictors of excessive blood pressure lowering were males, myocardial infarction, beta-blockers.

Conclusions: Patients with hypertension after myocardial infarction or ischemic stroke require regular monitoring of blood pressure, even in cases where blood pressure is within the recommended range for some time. It is necessary to take into account the risk not only of increasing but also of excessive lowering of blood pressure

Author Biographies

Andriy Yagensky, Volyn Regional Center for Cardiovascular Pathology. Communal Enterprise «Lutsk Clinical Hospital" Vidrodzhennia ave., 13, Lutsk, Ukraine, 43024 Volyn branch of the Faculty of Postgraduate Education of Danylo Halytsky Lviv National Medical University Hrushevskoho ave., 21, Lutsk, Ukraine, 43005

MD, Professor

Department of Family Medicine 

Mykhailo Pavelko, Volyn Regional Center for Cardiovascular Pathology. Communal Enterprise «Lutsk Clinical Hospital" Vidrodzhennia ave., 13, Lutsk, Ukraine, 43024

Cardiologist

Yaroslav Oshtuk, Volyn Regional Center for Cardiovascular Pathology. Communal Enterprise «Lutsk Clinical Hospital" Vidrodzhennia ave., 13, Lutsk, Ukraine, 43024

Intern

References

  1. Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M. et. al. (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal, 39 (33), 3021–3104. doi: https://doi.org/10.1093/eurheartj/ehy339
  2. Richards, A. M., Nicholls, M. G., Troughton, R. W., Lainchbury, J. G., Elliott, J., Frampton, C. et. al. (2002). Antecedent hypertension and heart failure after myocardial infarction. Journal of the American College of Cardiology, 39 (7), 1182–1188. doi: https://doi.org/10.1016/s0735-1097(02)01737-0
  3. D’Agostino, R. B., Belanger, A. J., Kannel, W. B., Cruickshank, J. M. (1991). Relation of low diastolic blood pressure to coronary heart disease death in presence of myocardial infarction: the Framingham Study. BMJ, 303 (6799), 385–389. doi: https://doi.org/10.1136/bmj.303.6799.385
  4. Flack, J. M., Neaton, J., Grimm, R., Shih, J., Cutler, J., Ensrud, K., MacMahon, S. (1995). Blood Pressure and Mortality Among Men With Prior Myocardial Infarction. Circulation, 92 (9), 2437–2445. doi: https://doi.org/10.1161/01.cir.92.9.2437
  5. Rothwell, P. M., Howard, S. C., Dolan, E., O’Brien, E., Dobson, J. E., Dahlöf, B. et. al. (2010). Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. The Lancet, 375 (9718), 895–905. doi: https://doi.org/10.1016/s0140-6736(10)60308-x
  6. Antonini, L., Colivicchi, F., Greco, S., Guido, V., Malfatti, S., Gandolfi, A. et. al. (2003). Ambulatory Blood Pressure Monitoring After Acute Myocardial Infarction. High Blood Pressure & Cardiovascular Prevention, 10 (2), 75–80. doi: https://doi.org/10.2165/00151642-200310020-00003
  7. Zhang, Y., Wang, H., Xu, K., Wang, P., Li, X.-Y., Zhao, J.-B., Tang, Y. (2018). Ambulatory blood pressure variability within the first 24 hours after admission and outcomes of acute ischemic stroke. Journal of the American Society of Hypertension, 12 (3), 195–203. doi: https://doi.org/10.1016/j.jash.2017.12.012
  8. Shin, D. H., Song, S., Lee, Y. B. (2019). Comparison of the Effect of Fimasartan versus Valsartan on Blood Pressure Variability in Acute Ischemic Stroke: A Double-Blind Randomized Trial. Cardiovascular Therapeutics, 2019, 1–8. doi: https://doi.org/10.1155/2019/7836527
  9. Georgianou, E., Georgianos, P. I., Petidis, K., Markakis, K., Zografou, I., Karagiannis, A. (2019). Effect of Nebivolol and Olmesartan on 24-Hour Brachial and Aortic Blood Pressure in the Acute Stage of Ischemic Stroke. International Journal of Hypertension, 2019, 1–9. doi: https://doi.org/10.1155/2019/9830295
  10. Xie, X., Xu, J., Gu, H., Tao, Y., Chen, P., Wang, Y., Wang, Y. (2017). The J-curve Association between Systolic Blood Pressure and Clinical Outcomes in Ischemic Stroke or TIA: The BOSS Study. Scientific Reports, 7 (1). doi: https://doi.org/10.1038/s41598-017-10887-w
  11. Chwojnicki, K., Yagensky, A., Wierucki, L., Sichkaruk, I., Sydor, N., Nyka, W. M. et. al. (2011). Assessment of the Quality of Secondary Ischemic Stroke Prevention in Selected Urban Areas of Poland and Ukraine: The ASCEP Study Results. European Neurology, 65 (6), 323–331. doi: https://doi.org/10.1159/000327576
  12. Yahenskyi, A. V., Sichkaruk, I. M. (2019). Prykhylnist do likuvannia patsientiv u viddalenyi period pislia infarktu miokarda. Ratsionalna farmakoterapiya, 1-2, 24–27.
  13. Sleight, P., Redon, J., Verdecchia, P., Mancia, G., Gao, P., Fagard, R. et. al. (2009). Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study. Journal of Hypertension, 27 (7), 1360–1369. doi: https://doi.org/10.1097/hjh.0b013e32832d7370
  14. Mancia, G., Kjeldsen, S. E., Zappe, D. H., Holzhauer, B., Hua, T. A., Zanchetti, A. et. al. (2015). Cardiovascular outcomes at different on-treatment blood pressures in the hypertensive patients of the VALUE trial. European Heart Journal, 37 (12), 955–964. doi: https://doi.org/10.1093/eurheartj/ehv633
  15. Anderson, R. J., Bahn, G. D., Moritz, T. E., Kaufman, D., Abraira, C., Duckworth, W. (2010). Blood Pressure and Cardiovascular Disease Risk in the Veterans Affairs Diabetes Trial. Diabetes Care, 34 (1), 34–38. doi: https://doi.org/10.2337/dc10-1420
  16. Kotti, K., Bagarhatta, R., Rathore, M., Bagarhatta, P. (2018). Is ambulatory blood pressure measurement a new indicator for survival among advanced heart failure cases. Indian Heart Journal, 70, S73–S78. doi: https://doi.org/10.1016/j.ihj.2017.08.028

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Published

2020-07-31

How to Cite

Yagensky, A., Pavelko, M., & Oshtuk, Y. (2020). Effectiveness of arterial hypertension control using ambulatory blood pressure monitoring in patients in the remote period after myocardial infarction and ischemic stroke. ScienceRise: Medical Science, (4 (37), 8–14. https://doi.org/10.15587/2519-4798.2020.209170

Issue

No. 4 (37) (2020)

Section

Medical Science

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Copyright (c) 2020 Andriy Yagensky, Mykhailo Pavelko, Yaroslav Oshtuk

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