2016


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2016/№4

The use of bifunctional 24-h monitoring in patients with decompensated chronic pulmonary heart in combination with arterial hypertension

Aydargalieva N.E., Teleusheva A.Zh.
Republican State Enterprise, "S.D. Asfendiyarov Kazan National Medical University ", Tole‑bi 94, Almaty, the Republic of Kazakhstan

Keywords: bifunctional monitoring, arterial hypertension, blood pressure, chronic pulmonary heart

DOI: 10.18087/rhfj.2016.4.2214

Background. A combination of COPD and AH complicates the disease and results in earlier and more severe HF. Aim. To study the effect of AH on the pattern and features of heart rhythm disorders in patients with decompensated chronic pulmonary heart (dCPH) in combination with grade 1 and 2 AH using bifunctional BP and ECG monitoring. Materials and methods. 102 patients with the bronchopulmonary form of dCPH 2B CHF and in combination with 1 and 2 grade AH were evaluated. In 100% of cases, CPH was caused by mixed stage 4 COPD (according to GOLD). Bifunctional monitoring including 24‑h BP monitoring and Holter ECG monitoring was performed for all patients. Patients were divided into 3 groups based on the BP level: group 1 consisted of 36 patients with dCPH 2B CHF in combination with grade 1 AH (dCPH+AH1); group 2 consisted of 36 patients with 2B dCPH CHF in combination with grade 2 AH (dCPH+AH2); and group 3 (control group) included 30 patients with dCPH with 2B CHF. All groups with gender‑ and age‑matched. Mean age was 65.6±2.9. Results. In patients with dCPH, nighttime DBP was increased to the level corresponding grade 1 AH. In patients with grade 1 and 2 AH in combination with dCPH, features of the diurnal profile included significant increases in pulse BP (р<0.01) and magnitude of morning SBP elevation (р<0.05); load to target organs (р<0.01), which was more pronounced at nighttime; and prevalence of patients with insufficient decline of nighttime BP. Patients with grade 2 BP were characterized by excessive drop of nighttime BP, which was associated with high risk of cerebrovascular disorders. Bifunctional BP and ECG monitoring showed that the increased nighttime BP load on target organs, which observed in patients with dCPH and dCPH in combination with grade 1 and 2 AH, resulted in the increased number of prognostically unfavorable, paired ventricular extrasystoles while dCPH in combination with grade 2 AH resulted in the increased total number of single and group ventricular extrasystoles and bigeminy. In addition, the increased BP variability in AH groups contributes to the increase in ventricular trigemini and in the grade 2 AH group – also to increases in ventricular bigeminy and group ventricular extrasystoles. Conclusion. The use of bifunctional monitoring allows to identify features of heart rhythm disorders and to determine factors influencing their development in patients with dCPH in combination with grade 1 and 2 AH.
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Aydargalieva N.E., Teleusheva A.Zh. The use of bifunctional 24-h monitoring in patients with decompensated chronic pulmonary heart in combination with arterial hypertension. Russian Heart Failure Journal. 2016;17 (4):259–265

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