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[MORPHOFUNCTIONAL MYOCARDIAL CHARACTERISTICS IN PATIENTS WITH MASKED ARTERIAL HYPERTENSION AND WHITE COAT

A N Britov, E M Platonova, M I Smirnova

Klinicheskaia Meditsina

|March 12, 2016

Insights

Masked hypertension and white coat hypertension impact heart structure and function, especially without effective treatment. Ambulatory blood pressure monitoring is crucial for assessing cardiovascular risk and guiding workplace interventions.

Area of Science:

Cardiology
Hypertension Research
Diagnostic Imaging

Background:

Arterial hypertension (AH) diagnosis and management are critical for cardiovascular health.
Understanding morpho-functional myocardial changes in different hypertension subtypes is essential.
Workplace health monitoring can identify at-risk populations.

Purpose of the Study:

To investigate myocardial characteristics in masked AH and white coat hypertension (WCH).
To compare patients receiving antihypertensive therapy (AHT) with those not on AHT.
To correlate ambulatory blood pressure (AP) with cardiac function and identify risks.

Main Methods:

Cross-sectional cohort study of industrial enterprise employees.
24-hour ambulatory AP monitoring and echocardiography during the workday.
Categorization into 6 groups based on clinical and ambulatory AP, including masked AH, WCH, and AHT effectiveness.
Statistical analysis using ANOVA and Pearson's Chi-square test.

Main Results:

72% of employees had AH; ambulatory AP monitoring better predicted target organ damage than clinical AP.
Masked AH patients showed higher rates of left ventricular hypertrophy and diastolic dysfunction.
Patients with ineffective AHT exhibited greater left ventricular wall thickness and impaired relaxation compared to those with optimal AHT.

Conclusions:

Ambulatory AP monitoring is superior to clinical readings for assessing cardiovascular risk in AH.
Masked AH and ineffective AHT are associated with significant adverse myocardial remodeling.
Workplace interventions targeting hypertension management can improve occupational prognosis.

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Abstract:

The aim of this work was to study morpho-functional myocardial characteristics in patients with masked arterial hypertension (AH) and white coat hypertension (WCH) given antihypertensive therapy (AHT) and without it. This cross-sectional cohort study included employees of a large industrial enterprise who annually underwent routine medical examination supplemented by 24 hr AP monitoring and echocardiography carried out at specified time of the working day. The participants of the study were divided into 6 groups based on the relationship between clinical AP and mean AP during work. Group I comprised 20 (7%) subjects with normal AP, group 2--20 (7%) with masked AH, group 3--40 (14%) with WCH, group 4--81 (28.3%) with optimal A HT effect, group 5--64 (22.4%) with unmanifest inefficiency of AHT, group 6--40 (14%) with WCH during AHT. Criteria for masked AH and unmanifest AHT inefficiency were clinical AP below 140 and 90 mm Hg in combination with mean AP during work 135 and/or 85 mm Hg and higher. Echocardiography was performed in a standard positions in M- and B-modes as well as in three Doppler regimes. One-factor ANOVA was used to analyze differences between the groups and Pearson's Chi-square test to determine the relationship between categorical variables. 206 (72%) of the 286 employees of the large industrial enterprise had a diagnosis of AH. It was shown that ambulatory AP values obtained by 24 hr monitoring better characterized the patient's condition than clinical AP since they correlated with the frequency of disorders in the target organs and the risk of cardiovascular complications in patients with AH. Patients with masked AH more frequently developed left ventricular hypertrophy and diastolic dysfunction than those having normal clinical and ambulatory AP. The mean width of the left ventricle wall and left ventricular isovolumic relaxation time (therefore, the degree of LV hypertrophy and diastolic dysfunction) in the patients with unmanifest inefficiency of AHT were greater than in those with optimal AHT effect. The occurrence of WCH was comparable in the two groups. These data were used to determine intensity of preventive AHT at the workplace with a view to improving medical and occupational prognosis.

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