Цель. Изучить клинико-функциональные особенности параметров артериальной жесткости у лиц пожилого возраста в зависимости от половых различий. Материалы и методы. В исследование включены 497 пациентов терапевтического профиля в возрасте от 60 до 74 лет. Средний возраст обследованных составил 65,1±3,9 года. Всем пациентам проведено комплексное клинико-инструментальное обследование. Исследование параметров артериальной жесткости и центрального артериального давления (АД) проводилось на аппарате «АнгиоСкан-01» (компания «АнгиоСкан-Электроникс», Россия). В зависимости от половых различий вся выборка разделена на две сопоставимые по возрасту группы: женщины (n=287) и мужчины (n=210). Результаты. В группе женщин уровни систолического (138±20 мм рт. ст. против 134±19 мм рт. ст.; р=0,018), центрального (137±20 мм рт. ст. против 133±19 мм рт. ст.; р=0,024), среднего (46±9 мм рт. ст. против 45±6 мм рт. ст.; р=0,018), пульсового АД (53±16 мм рт. ст. против 50±14 мм рт. ст.; р=0,038), величины двойного произведения (107,4±23,5 усл. ед. против 101,4±22,5 усл. ед.; р=0,004), аугментационного индекса – АИ [22,1 (13,5; 31,3)% против 15,9 (8,8; 24,9)%; р=0,005], индекса увеличения при частоте пульса 75 в минуту [23,2 (16,0; 30,5)% против 15,9 (9,2; 23,5)%; р=0,005] и продолжительности систолы в процентах (35,50±5,60 против 34,24±4,53; р=0,007) были достоверно выше, чем в группе мужчин. Кроме того, у мужчин отмечалось статистически значимое увеличение среднего значения альтернативного индекса жесткости (9,76±2,61 против 8,17±2,03; р=0,005) и зависимости величины АИ от возраста (p<0,05). В то же время в группе женщин регистрировалась статистически более значимая взаимосвязь параметров центральной и периферической гемодинамики с наличием повышенного АИ (p<0,05). Заключение. У женщин пожилого возраста увеличение показателей систолического, центрального, среднего, пульсового АД ассоциируется с повышением АИ и ростом величины двойного произведения. В группе мужчин пожилого возраста повышение альтернативного индекса жесткости сосудов способствует увеличению длительности пульсовой волны. Статистически более выраженные корреляционные взаимосвязи между величиной АИ и клинико-гемодинамическими показателями регистрировались у женщин пожилого возраста.
Aim. Purpose of the study. To study the clinical and functional features of the parameters of arterial stiffness in the elderly, depending on gender differences. Materials and methods. The study included 497 therapeutic patients aged from 60 to 74 years. The average age of the examined patients was 65.1±3.9 years. All patients underwent a comprehensive clinical and instrumental examination. The study of the parameters of arterial stiffness and central arterial pressure (BP) was carried out on the AngioScan-01 apparatus (AngioScan-Electronics, Russia). Depending on the sex differences, the entire sample was divided into two age-matched groups: women (n=287) and men (n=210). Results. In the group of women, systolic levels (138±20 mm Hg vs 134±19 mm Hg; p=0.018), central (137±20 mm Hg vs 133±19 mm Hg; p=0.024), average (46±9 mm Hg vs 45±6 mm Hg; p=0.018), pulse BP (53±16 mm Hg vs 50±14 mm Hg; p=0.038), the value of the double product (107.4±23.5 conventional units vs 101.4±22.5 conventional units; p=0.004), augmentation index (AI) [22.1 (13.5, 31,3)% vs 15.9 (8.8; 24.9)%; p=0.005], the increase index at a pulse frequency of 75 per minute [23.2 (16.0; 30.5)% vs 15.9 (9.2; 23.5)%; p=0.005] and systole duration in percent (35.50±5.60 vs 34.24±4.53; p=0.007) were significantly higher than in the group of men. In addition, men showed a statistically significant increase in the average value of the alternative stiffness index (9.76±2.61 vs 8.17±2.03; p=0.005) and the dependence of the AI on age (p<0.05). At the same time, a statistically more significant correlation of central and peripheral hemodynamic parameters with the presence of elevated AI (p<0.05) was recorded in the group of women. Conclusion. In older women, an increase in systolic, central, average, pulse BP is associated with an increase in AI and an increase in the magnitude of the double product. In the group of elderly men, the increase in the alternative vascular stiffness index contributes to an increase in the duration of the pulse wave. Statistically more pronounced correlation relationships between the value of the AI and clinical and hemodynamic parameters were recorded in elderly women.
Keywords: arterial stiffness, augmentation index, central arterial pressure, advanced age, sex differences
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15. Ahimastos AA, Formosa M, Dart AM, Kingwell BA. Gender differences in large artery stiffness pre-and post puberty. J Clin Endocrinol Metab 2003; 88: 5375–80. DOI: 10.1210/jc.2003-030722
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17. Snijder MB, Henry RM, Visser M, et al. Regional body composition as a determinant of arterial stiffness in the elderly: the HOORN study. J Hypertens 2004; 22: 2339–47.
18. Dockery F, Agarwal S, Donaldson M, Bulpitt CJ. Androgen suppression in men leads to increased arterial stiffness and hyperinsulinaemia. Clin Sci 2003; 104: 195–201. DOI: 10.1042/cs1040195
19. Dockery F, Bulpitt CJ, Agarwal S, et al. Effect of androgen suppression compared with androgen receptor blockade on arterial stiffness in men with prostate cancer. J Andrology 2009; 30: 410–5. DOI: 10.2164/jandrol.108.006924
20. Staessen JA, Bulpitt CJ, Fagard R, et al. The influence of menopause on blood pressure. Hypertension in postmenopausal women. Springer, Berlin, Heidelberg 1994; p. 15–26. DOI: 10.1007/978-3-642-79077-5_3
21. Rajkumar C, Kingwell BA, Cameron JD, et al. Hormonal therapy increases arterial compliance in postmenopausal women. JACC 1997; 30: 350–6. DOI: 10.1016/S0735-1097(97)00191-5
22. Gordin D, Wadén J, Forsblom C, et al. Pulse pressure predicts incident cardiovascular disease but not diabetic nephropathy in patients with T1D (The FinnDiane Study). Diabetes Care 2011; 34: 886–91. DOI: 10.2337/dc10-2013
23. Groop PH, Thomas MC, Moran JL, et al. The presence and severity of chronic kidney disease predicts all-cause mortality in Type 1 D. Diabetes 2009; 58: 1651–8. DOI: 10.2337/db08-1543
24. Benjo AM, Ryoo S, White AR, et al. Arginase inhibition attenuates vascular stiffness in aged rats. Eur Heart J 2006; 27: 876.
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28. Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure–lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113: 1213–25.
29. McEniery CM, Schmitt M, Qasem A, et al. Nebivolol increases arterial distensibility in vivo. Hypertension 2004; 44: 305–10.
30. Tropeano AI, Boutouyrie P, Pannier B, et al. Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-convertinge enzyme inhibition in diabetic hypertensives. Hypertension 2006; 48 (1): 80–6.
31. Karalliedde J, Smith A, DeAngelis L. Mirenda V, et al. Valsartan improves arterial stiffness in type 2 diabetes independently of blood pressure lowering. Hypertension 2008; 51: 1617–23.
32. Ferrier KE, Muhlmann MH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and improves large artery stiffness in ISH. J Am Coll Cardiol 2002; 39: 1020–5. DOI: 10.1016/S0735-1097 (02)01717-5
________________________________________________
1. Lim MA, Townsend RR. Arterial compliance in the elderly: its effect on blood pressure measurement and cardiovascular outcomes. Clin Geriatr Med 2009; 25: 2: 191–205. DOI: 10.1016/j.cger.2009.01.001
2. Konradi AO. Hypertension treatment in the young age and in the elderly. Arterial’naya Gipertenziya (Arterial Hypertension). 2014; 20 (5): 406–14 (in Russian). DOI: 10.18705/1607-419X-2014-20-5-406-414
3. Rogoza AN, Kaveshnikov VS, Trubacheva IA, et al. Vascular wall in adult population of Tomsk in the framework of the project ESSAY RF. Systemic Hypertension. 2014; 11 (4): 42–8 (in Russian).
4. Murkamilov IT, Sabirov IS, Fomin VV, et al. Evaluation of nephrocerebral risk using cystatin C in patients with chronic kidney disease. Zhurnal Nevrologii i Psikhiatrii imeni S.S.Korsakova. 2018; 118 (9): 10–6 (in Russian). DOI: 10.17116/jnevro201811809110
5. Vasyuk YA, Ivanova SV, Shkolnik EL, et al. Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice. Cardiovascular Therapy and Prevention. 2016; 15 (2): 4–19 (in Russian). DOI: 10.15829/1728-8800-2016-2-4-19
6. Laurent S, Cockcroft J, van Bortel L, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 2588–605. DOI: 10.1093/eurheartj/ehl254
7. Zheleznova EA, Zhernakova YuV, Chazova IE, et al. Communication of subcutaneous, visceral, periaortic, epicardial fat and metabolic parameters with arterial stiffness in young people with abdominal obesity. Systemic Hypertension. 2018; 15 (4): 76–82 (in Russian). DOI: 10.26442/2075082X.2018.4.180131
8. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness. A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2010; 55 (13): 1318–27. DOI: 10.1016/j.jacc.2009.10.061
9. Arnold N, Gori T, Schnabel RB, et al. Relation between Arterial Stiffness and Markers of Inflammation and Hemostasis–Data from the Population-based Gutenberg Health Study. Scientific Reports 2017; 7 (1): 6346. DOI: 10.1038/s41598-017-06175-2
10. Oskola EV, Shubina AT, Zairova AR, et al. Arterial stiffness, renal function and renal blood flow in patients with coronary artery disease, arterial hypertension and type 2 diabetes mellitus. Saharnyi Diabet. 2014; 3: 96–106 (in Russian). DOI: 10.14341/DM2014396-106
11. Vsemirnaya organizatsiya zdravookhraneniya. Vsemirnyy doklad o starenii i zdorov’e. 2016. Available at: http://www.who.int/ageing/publications/world-report-2015/ru. Accessed 28.01.2016 (in Russian).
12. Parfenov AS. Early diagnosis of cardiovascular diseases using hardware-software complex "Аngioscan-01". Poliklinika. 2012; 2 (1): 70–4 (in Russian).
13. Fortier C, Agharazii M. Arterial stiffness gradient. Pulse 2015; 3 (3–4): 159–66. DOI: 10.1159/000438852
14. Smulyan H, Asmar RG, Rudnicki A, et al. Comparative effects of aging in men and women on the properties of the arterial tree. J Am Coll Cardiol 2001; 37: 1374–80. DOI: 10.1016/S0735-1097 (01)01166-4
15. Ahimastos AA, Formosa M, Dart AM, Kingwell BA. Gender differences in large artery stiffness pre-and post puberty. J Clin Endocrinol Metab 2003; 88: 5375–80. DOI: 10.1210/jc.2003-030722
16. Bulpitt CJ, Rajkumar C, Cameron JD. Vascular Compliance as a measure of biological age. J Am Geriat Soc 1999; 47: 657–63. DOI: 10.1111/j.1532-5415.1999.tb01586.x
17. Snijder MB, Henry RM, Visser M, et al. Regional body composition as a determinant of arterial stiffness in the elderly: the HOORN study. J Hypertens 2004; 22: 2339–47.
18. Dockery F, Agarwal S, Donaldson M, Bulpitt CJ. Androgen suppression in men leads to increased arterial stiffness and hyperinsulinaemia. Clin Sci 2003; 104: 195–201. DOI: 10.1042/cs1040195
19. Dockery F, Bulpitt CJ, Agarwal S, et al. Effect of androgen suppression compared with androgen receptor blockade on arterial stiffness in men with prostate cancer. J Andrology 2009; 30: 410–5. DOI: 10.2164/jandrol.108.006924
20. Staessen JA, Bulpitt CJ, Fagard R, et al. The influence of menopause on blood pressure. Hypertension in postmenopausal women. Springer, Berlin, Heidelberg 1994; p. 15–26. DOI: 10.1007/978-3-642-79077-5_3
21. Rajkumar C, Kingwell BA, Cameron JD, et al. Hormonal therapy increases arterial compliance in postmenopausal women. JACC 1997; 30: 350–6. DOI: 10.1016/S0735-1097(97)00191-5
22. Gordin D, Wadén J, Forsblom C, et al. Pulse pressure predicts incident cardiovascular disease but not diabetic nephropathy in patients with T1D (The FinnDiane Study). Diabetes Care 2011; 34: 886–91. DOI: 10.2337/dc10-2013
23. Groop PH, Thomas MC, Moran JL, et al. The presence and severity of chronic kidney disease predicts all-cause mortality in Type 1 D. Diabetes 2009; 58: 1651–8. DOI: 10.2337/db08-1543
24. Benjo AM, Ryoo S, White AR, et al. Arginase inhibition attenuates vascular stiffness in aged rats. Eur Heart J 2006; 27: 876.
25. Boutouyrie P, Tropeano AI, Asmar R, et al. Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study. Hypertension 2002: 39: 10–5.
26. Wohlfahrt P, Wichterle D, Seidlerová J, et al. Relation of central and brachial blood pressure to left ventricular hypertrophy. The Czech Post-MONICA Study. J Hum Hypertens 2012; 26: 14. DOI: 10.1038/jhh.2011.78
27. Murkamilov IT, Sabirov IS, Aitbaev KA, et al. Renal dysfunction and indicators of arterial hormity in persons of elderly and senile age. Advances in gerontology. 2018; 4 (31): 549–55 (in Russian).
28. Williams B, Lacy PS, Thom SM, et al. Differential impact of blood pressure–lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113: 1213–25.
29. McEniery CM, Schmitt M, Qasem A, et al. Nebivolol increases arterial distensibility in vivo. Hypertension 2004; 44: 305–10.
30. Tropeano AI, Boutouyrie P, Pannier B, et al. Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-convertinge enzyme inhibition in diabetic hypertensives. Hypertension 2006; 48 (1): 80–6.
31. Karalliedde J, Smith A, DeAngelis L. Mirenda V, et al. Valsartan improves arterial stiffness in type 2 diabetes independently of blood pressure lowering. Hypertension 2008; 51: 1617–23.
32. Ferrier KE, Muhlmann MH, Baguet JP, et al. Intensive cholesterol reduction lowers blood pressure and improves large artery stiffness in ISH. J Am Coll Cardiol 2002; 39: 1020–5. DOI: 10.1016/S0735-1097 (02)01717-5
1 Кыргызская государственная медицинская академия им. И.К. Ахунбаева, Бишкек, Киргизия;
2 ГОУ ВПО «Кыргызско-Российский Славянский университет им. первого Президента Российской Федерации Б.Н. Ельцина», Бишкек, Киргизия;
3 Научно-исследовательский институт молекулярной биологии и медицины, Бишкек, Киргизия;
4 ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
5 Ошский государственный университет, Ош, Киргизия
*murkamilov.i@mail.ru
________________________________________________
Ilkhom T. Murkamilov*1,2, Kubanych A. Aitbaev3, Viktor V. Fomin4, Zhamila A. Murkamilova2, Nodira A. Redzhapova5, Furkat A. Yusupov5
1 Akhunbaev Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan;
2 Kyrgyz Russian Slavic University named after the First President of Russia B.N. Yeltsin, Bishkek, Kyrgyzstan;
3 Scientific Research Institute of Molecular Biology and Medicine, Bishkek, Kyrgyzstan;
4 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
5 Osh State University, Osh, Kyrgyzstan
*murkamilov.i@mail.ru