Взаимосвязь показателей качества жизни и выраженности сезонных колебаний артериального давления в утренние часы у больных артериальной гипертензией

Андреева Г.Ф., Деев А.Д., Горбунов В.М., Молчанова О.В. Взаимосвязь показателей качества жизни и выраженности сезонных колебаний артериального давления в утренние часы у больных артериальной гипертензией. КардиоСоматика. 2016; 7 (2): 14–20.

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Andreeva G.F., Deev A.D., Gorbunov V.M., Molchanova O.V. Correlation of quality of life and significant seasonal fluctuations blood pressure in the morning hours in patients with arterial hypertension. Cardiosomatics. 2016; 7 (2): 14–20.

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Аннотация

Цель представленного исследования – выявить взаимосвязи между качеством жизни больных с артериальной гипертензией (АГ) и степенью выраженности сезонных колебаний артериального давления (АД) в утренние часы у этих больных, а также проследить сезонную динамику средних утренних уровней АД у этой группы пациентов. Нами была проанализирована база данных различных исследований, проведенных в нашем центре за период с 1996 по 2011 г., которая содержала данные 953 суточных мониторирований АД. Анализировались данные суточного мониторирования АД у больных АГ без серьезных сопутствующих заболеваний, которые проводили мониторирование АД на фоне недельной отмены антигипертензивной терапии.
Результаты исследования. Было показано, что диастолическое АД в утренние часы (ДАДу) было максимальным зимой (83,5±13,7 мм рт. ст.), минимальным – летом (80,2±11,5 мм рт. ст.), что было типично для сезонной динамики АД в целом. Для систолического АДу (САДу) был характерен наибольший уровень АД осенью (133,3±18,7 мм рт. ст.), наименьший – зимой (131,8±17,6 мм рт. ст.). Различия между сезонами недостоверны. При анализе результатов при помощи обобщенной линейной модели (Generalized Linear Models) и расчета критерия Фишера (F) были выявлены следующие закономерности. Выраженность сезонных повышений АД (по сравнению со среднегодовым уровнем АД) находилась в обратной зависимости от уровня социальной поддержки друзей, сослуживцев, родственников (шкала VI опросника качества жизни): для ДАД F=4,29 (p<0,04), для САД F=11,29 (p<0,001). Кроме того, у мужчин и у людей старшего возраста сезонные колебания САДу более выражены: F=5,01 (p<0,03) и F=5,05 (p<0,03) соответственно.
Выводы. Таким образом, степень выраженности сезонных колебаний амбулаторных уровней ДАДу, САДу находилась в обратной зависимости от социальной поддержки больных АГ. Кроме того, для сезонных колебаний САДу были значимы возраст и пол. Сезонная динамика ДАДу была типичной: зимой уровни АД были максимальны, летом – минимальны. Вместе с тем для САДу наибольший уровень АД отмечался осенью, наименьший – зимой.

Ключевые слова: артериальная гипертензия, сезонная динамика артериального давления, качество жизни.

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The aim of the present study was to identify the relationship between the quality of life of patients with arterial hypertension (AH) and the degree of seasonal fluctuations in blood pressure (BP) in the morning hours in these patients, as well as to trace the seasonal dynamics of the average morning levels of blood pressure in this group of patients. We analyzed the database of various studies carried out in our center between 1996 and 2011, which contained data 953 ambulatory BP monitoring (ABPM). ABPM data were analyzed in patients with hypertension, without serious comorbidities, who conducted blood pressure monitoring on a weekly background of antihypertensive therapy.
Results of the study. It has been shown that diastolic blood pressure (DBP) in the morning (at) was the highest in winter (83.5±13.7 mm Hg), at the lowest – in summer (80.2±11.5 mm Hg), which was typical of the seasonal dynamics of blood pressure generally. The systolic blood pressure (SBP) was characterized by the highest level of the fall in blood pressure (133.3±18.7 mm Hg). The smallest – in the winter (131,8 В±17,6 mm Hg). The differences between the seasons are not reliable. When analyzing the results by using generalized linear models (Generalized Linear Models) and calculating the Fisher's exact test (F) The following patterns were identified. Intensity of seasonal increases in blood pressure (compared with the average level of blood pressure) was inversely related to the level of social support of friends, colleagues, relatives (Scale VI Quality of Life Questionnaire) (for F DBP was 4.29 (p<0.04), for SBP – F=11.29 (p<0.001)). In addition, men and older people, seasonal fluctuations in the garden are more pronounced (F=5.01 (p<0.03) and F=5,05 (p<0.03), respectively).
Conclusion. Thus, the severity of seasonal fluctuations outpatient SBP and DBP was inversely related to social support of patients with hypertension. In addition to seasonal fluctuations in the garden was a significant age and gender. Seasonal dynamics of DBP was typical: BP levels were maximal in winter, in the summer – are minimal. At the same time, with the SDP of the highest level of blood pressure was observed in the fall, the lowest – in the winter.

Key words: arterial hypertension, blood pressure, seasonal dynamics, quality of life.

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Список литературы

1. Kruse HJ, Wieczorek I, Hecker H et al. Seasonal variation of endothelin-1, angiotensin II, and plasma catecholamines and their relation to outside temperature. J Lab Clin Med 2002; 140 (4): 236–41.
2. Hansen AM, Garde AH, Skovgaard LT, Christensen JM. Seasonal and biological variation of urinary epinephrine, norepinephrine, and cortisol in healthy women. Clin Chim Acta 2001; 309 (1): 25–35.
3. Lam RW, Tam EM, Yatham LN et al. Seasonal depression: the dual vulnerability hypothesis revisited. J Affect Disord 2001; 63 (1–3): 123–32.
4. Hata T, Ogihara T, Maruyama A et al. The seasonal variation of blood pressure in patients with essential hypertension. Clin Exp Hypertens A 1982; 4 (3): 341–54.
5. Hayashi T, Ohshige K, Sawai A et al. Seasonal influence on blood pressure in elderly normotensive subjects. Hypertens Res 2008; 31 (3): 569–74.
6. Modesti PA, Morabito M, Bertolozzi I et al. Weather-related changes in 24-hour blood pressure profile: effects of age and implications for hypertension management. Hypertension 2006; 47 (2): 155–61.
7. Fedecostante M, Barbatelli P, Guerra F et al. Summer does not always mean lower: seasonality of 24 h, daytime, and night-time blood pressure. J Hypertens 2012; 30 (7): 1392–8.
8. Sega R, Cesana G, Bombelli M et al. Seasonal variation in home ambulatory blood pressure in the PAMELA population. Pressione Arteriose Monitorate E Loro Associazioni. J Hypertens 1998; 16: 1585–92.
9. Murakami S, Otsuka K, Kono T et al. Impact of outdoor temperature on prewaking morning surge and nocturnal decline in blood pressure in a Japanese population. Hypertens Res 2011; 34 (1): 70–3.
10. Kario K, White WB. Early morning hypertension: what does it contribute to overall cardiovascular risk assessment? J Am Soc Hypertens 2008; 2: 397–402.
11. Zakopoulos NA, Tsivgoulis G, Barlas G et al. Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness. Hypertension 2005; 45: 505.
12. Kario K. Morning surge in blood pressure and cardiovascular risk evidence and perspectives. Hypertension 2010; 56: 765–73.
13. Kario K, Pickering TG, Umeda Y et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives – A prospective study. Circulation 2003; 107: 1401–6.
14. Dolan E, McCormack P, Staessen JA, O’Brien E. The morning surge in systolic blood pressure predicts cardiovascular mortality: Dublin outcome study. J Hypertens 2008; 26: S30.
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16. Gosse P, Lasserre R, Minifie C et al. Blood pressure surge on rising. J Hypertens 2004; 22: 1113–8.
17. Stergiou GS, Mastorantonakis SE, Roussias LG. Morning blood pressure surge: the reliability of different definitions. Hypertens Res 2008; 31: 1589–94.
18. Verdecchia P, Angeli F, Mazzotta G et al. Day-night dip and early-morning surge in blood pressure in hypertension: prognostic implications. Hypertension 2012; 60: 34–42.
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20. Asayama K, Ohkubo T, Kikuya M et al. Prediction of Stroke by Home “Morning” Versus “Evening” Blood Pressure Values. The Ohasama Study. Hypertension 2006; 48: 737–43.
21. Bilo G, Koch W, Hoshide S, Parati G. Efficacy of olmesartan/amlodipine combination therapy in reducing ambulatory blood pressure in moderate-to-severe hypertensive patients not controlled by amlodipine alone. Hypertens Res 2014; 37: 836–44.
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23. Rocha AS, Araújo MP, Campos A e al. Circadian rhythm of hospital deaths: comparison between intensive care unit and non-intensive care unit. Rev Assoc Med Bras 2011; 57 (5): 519–23.
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28. Fortmann AL, Gallo LC. Social Support and Nocturnal Blood Pressure Dipping: A Systematic Review. Am J Hypertens 2013; 26 (3): 302–10.
29. Spruill TM, Gerin W. Ogedegbe G. Socioeconomic and Psychosocial Factors Mediate Race Differences in Nocturnal Blood Pressure Dipping. Am J Hypertens 2009; 22 (6): 637–42.
30. Sakakura K, Ishikawa J, Okuno M et al. Exaggerated ambulatory blood pressure variability is associated with cognitive dysfunction in the very elderly and quality of life in the younger elderly. Am J Hypertens 2007; 20 (7): 720–7.
31. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281–357.
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35. Zuther P, Witte K, Lemmer B. ABPM-FIT and CV-SORT: an easy-to-use software package for detailed analysis of data from ambulatory blood pressure monitoring. Blood Press Monit 1996; 1: 347–54.
36. Hermida RC, Ayala DE, Mojón A, Fernández J.R. Blunted sleep-time relative blood pressure decline increases cardiovascular risk independent of blood pressure level – the "normotensive non-dipper" paradox. Chronobiol Int 2013; 30 (1–2): 87–98.
37. 2013 ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals. International Society for Chronobiology; American Association of Medical Chronobiology and Chronotherapeutics; Spanish Society of Applied Chronobiology, Chronotherapy, and Vascular Risk; Spanish Society of Atherosclerosis; Romanian Society of Internal Medicine, Hermida RC, Smolensky MH, Ayala DE, Portaluppi F. Chronobiol Int 2013; 30 (3): 355–410. doi: 10.3109/07420528.2013.750490.
38. Hermida RC, Ayala DE, Mojón A, Fernández JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int 2010; 27 (8): 1629–51.
39. Pogosova N, Saner H, Pedersen SS. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J Prev Cardiol 2014; p. 1–17.
40. Смирнова М.И., Горбунов В.М., Волков Д.А. и др. Сезонные изменения гемодинамических параметров у больных с контролируемой артериальной гипертонией и высоким нормальным артериальным давлением в двух регионах Российской Федерации с различными климатическими характеристиками. Часть 2. Основные результаты исследования 1423 пациентов. Профилактическая медицина. 2014; 17 (6): 32–8. / Smirnova M.I., Gorbunov V.M., Volkov D.A. i dr. Sezonnye izmeneniia gemodinamicheskikh parametrov u bol'nykh s kontroliruemoi arterial'noi gipertoniei i vysokim normal'nym arterial'nym davleniem v dvukh regionakh Rossiiskoi Federatsii s razlichnymi klimaticheskimi kharakteristikami. Chast' 2. Osnovnye rezul'taty issledovaniia 1423 patsientov. Profilakticheskaia meditsina. 2014; 17 (6): 32–8. [in Russian]
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1. Kruse HJ, Wieczorek I, Hecker H et al. Seasonal variation of endothelin-1, angiotensin II, and plasma catecholamines and their relation to outside temperature. J Lab Clin Med 2002; 140 (4): 236–41.
2. Hansen AM, Garde AH, Skovgaard LT, Christensen JM. Seasonal and biological variation of urinary epinephrine, norepinephrine, and cortisol in healthy women. Clin Chim Acta 2001; 309 (1): 25–35.
3. Lam RW, Tam EM, Yatham LN et al. Seasonal depression: the dual vulnerability hypothesis revisited. J Affect Disord 2001; 63 (1–3): 123–32.
4. Hata T, Ogihara T, Maruyama A et al. The seasonal variation of blood pressure in patients with essential hypertension. Clin Exp Hypertens A 1982; 4 (3): 341–54.
5. Hayashi T, Ohshige K, Sawai A et al. Seasonal influence on blood pressure in elderly normotensive subjects. Hypertens Res 2008; 31 (3): 569–74.
6. Modesti PA, Morabito M, Bertolozzi I et al. Weather-related changes in 24-hour blood pressure profile: effects of age and implications for hypertension management. Hypertension 2006; 47 (2): 155–61.
7. Fedecostante M, Barbatelli P, Guerra F et al. Summer does not always mean lower: seasonality of 24 h, daytime, and night-time blood pressure. J Hypertens 2012; 30 (7): 1392–8.
8. Sega R, Cesana G, Bombelli M et al. Seasonal variation in home ambulatory blood pressure in the PAMELA population. Pressione Arteriose Monitorate E Loro Associazioni. J Hypertens 1998; 16: 1585–92.
9. Murakami S, Otsuka K, Kono T et al. Impact of outdoor temperature on prewaking morning surge and nocturnal decline in blood pressure in a Japanese population. Hypertens Res 2011; 34 (1): 70–3.
10. Kario K, White WB. Early morning hypertension: what does it contribute to overall cardiovascular risk assessment? J Am Soc Hypertens 2008; 2: 397–402.
11. Zakopoulos NA, Tsivgoulis G, Barlas G et al. Time rate of blood pressure variation is associated with increased common carotid artery intima-media thickness. Hypertension 2005; 45: 505.
12. Kario K. Morning surge in blood pressure and cardiovascular risk evidence and perspectives. Hypertension 2010; 56: 765–73.
13. Kario K, Pickering TG, Umeda Y et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives – A prospective study. Circulation 2003; 107: 1401–6.
14. Dolan E, McCormack P, Staessen JA, O’Brien E. The morning surge in systolic blood pressure predicts cardiovascular mortality: Dublin outcome study. J Hypertens 2008; 26: S30.
15. Metoki H, Ohkubo T, Kikuya M et al. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline – the Ohasama study. Hypertension 2006; 47: 149–54.
16. Gosse P, Lasserre R, Minifie C et al. Blood pressure surge on rising. J Hypertens 2004; 22: 1113–8.
17. Stergiou GS, Mastorantonakis SE, Roussias LG. Morning blood pressure surge: the reliability of different definitions. Hypertens Res 2008; 31: 1589–94.
18. Verdecchia P, Angeli F, Mazzotta G et al. Day-night dip and early-morning surge in blood pressure in hypertension: prognostic implications. Hypertension 2012; 60: 34–42.
19. Israel S, Israel A, Ben-Dov IZ, Bursztyn M. The morning blood pressure surge and all-cause mortality in patients referred for ambulatory blood pressure monitoring. Am J Hypertens 2011; 24: 796–801.
20. Asayama K, Ohkubo T, Kikuya M et al. Prediction of Stroke by Home “Morning” Versus “Evening” Blood Pressure Values. The Ohasama Study. Hypertension 2006; 48: 737–43.
21. Bilo G, Koch W, Hoshide S, Parati G. Efficacy of olmesartan/amlodipine combination therapy in reducing ambulatory blood pressure in moderate-to-severe hypertensive patients not controlled by amlodipine alone. Hypertens Res 2014; 37: 836–44.
22. Muller JE, Ludmer PL, Willich SN. Circadian variation in the frequency of sudden cardiac death. Circulation 1987; 75 (1): 131–8.
23. Rocha AS, Araújo MP, Campos A e al. Circadian rhythm of hospital deaths: comparison between intensive care unit and non-intensive care unit. Rev Assoc Med Bras 2011; 57 (5): 519–23.
24. Bardage C, Isacson DG. Hypertension and health-related quality of life. An epidemiological study in Sweden. J Clin Epidemiol 2001; 54 (2): 172–81.
25. Youssef RM, Moubarak II, Kamel MI. Factors affecting the quality of life of hypertensive patients. East Mediterr Health J 2005; 11 (1–2): 109–18.
26. Wang R, Zhao Y, He X et al. Impact of hypertension on health-related quality of life in a population-based study in Shanghai. Public Health 2009; 123 (8): 534–9.
27. Erickson SR, Williams BC, Gruppen LD. Relationship between symptoms and health-related quality of life in patients treated for hypertension. Pharmacotherapy 2004; 24 (3): 344–50.
28. Fortmann AL, Gallo LC. Social Support and Nocturnal Blood Pressure Dipping: A Systematic Review. Am J Hypertens 2013; 26 (3): 302–10.
29. Spruill TM, Gerin W. Ogedegbe G. Socioeconomic and Psychosocial Factors Mediate Race Differences in Nocturnal Blood Pressure Dipping. Am J Hypertens 2009; 22 (6): 637–42.
30. Sakakura K, Ishikawa J, Okuno M et al. Exaggerated ambulatory blood pressure variability is associated with cognitive dysfunction in the very elderly and quality of life in the younger elderly. Am J Hypertens 2007; 20 (7): 720–7.
31. 2013 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281–357.
32. Fagard R, Brguljan J, Thijs L, Staessen J. Prediction of the actual awake and asleep blood pressures by various methods of 24 h pressure analysis. J Hypertens 1996; 14: 557–63.
33. Siegrist J, Junge A. Conceptual and methodological problems in research on the quality of life in clinical medicine. Soc Sci Med 1989; 29 (3): 463–8.
34. Metelitsa VI, Douda SG, Ostrovskaya TP et al. Long-term monotherapy with antihypertensives and quality of life in patients with mild to moderate arterial hypertension: a multicentre study. J Drug Dev Clin Pract 1996; 8 (2): 61–76.
35. Zuther P, Witte K, Lemmer B. ABPM-FIT and CV-SORT: an easy-to-use software package for detailed analysis of data from ambulatory blood pressure monitoring. Blood Press Monit 1996; 1: 347–54.
36. Hermida RC, Ayala DE, Mojón A, Fernández J.R. Blunted sleep-time relative blood pressure decline increases cardiovascular risk independent of blood pressure level – the "normotensive non-dipper" paradox. Chronobiol Int 2013; 30 (1–2): 87–98.
37. 2013 ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals. International Society for Chronobiology; American Association of Medical Chronobiology and Chronotherapeutics; Spanish Society of Applied Chronobiology, Chronotherapy, and Vascular Risk; Spanish Society of Atherosclerosis; Romanian Society of Internal Medicine, Hermida RC, Smolensky MH, Ayala DE, Portaluppi F. Chronobiol Int 2013; 30 (3): 355–410. doi: 10.3109/07420528.2013.750490.
38. Hermida RC, Ayala DE, Mojón A, Fernández JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int 2010; 27 (8): 1629–51.
39. Pogosova N, Saner H, Pedersen SS. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J Prev Cardiol 2014; p. 1–17.
40. Smirnova M.I., Gorbunov V.M., Volkov D.A. i dr. Sezonnye izmeneniia gemodinamicheskikh parametrov u bol'nykh s kontroliruemoi arterial'noi gipertoniei i vysokim normal'nym arterial'nym davleniem v dvukh regionakh Rossiiskoi Federatsii s razlichnymi klimaticheskimi kharakteristikami. Chast' 2. Osnovnye rezul'taty issledovaniia 1423 patsientov. Profilakticheskaia meditsina. 2014; 17 (6): 32–8. [in Russian]
41. Andreeva G.F., Deev A.D., Gorbunov V.M. Vliianie kachestva zhizni na sezonnye kolebaniia arterial'nogo davleniia u bol'nykh so stabil'noi arterial'noi gipertenziei. Profilakticheskaia meditsina. 2014; 17 (3): 18–23. [in Russian]

Авторы

Г.Ф.Андреева*, А.Д.Деев, В.М.Горбунов, О.В.Молчанова

ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3
*gandreeva@gnicpm.ru

________________________________________________

G.F.Andreeva*, A.D.Deev, V.M.Gorbunov, O.V.Molchanova

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101990, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3
*gandreeva@gnicpm.ru

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