Title Krutost krvnih žila i oštećenje ciljnih organa u liječenih hipertoničara Title (english) Arterial stiffness and target organ damage in treated hypertensive patients Author Vladimir Prelević Mentor Bojan Jelaković (mentor)Committee member Diana Delić-Brkljačić (predsjednik povjerenstva)Committee member Maja Čikeš (član povjerenstva)Committee member Mario Laganović (član povjerenstva)Granter University of Zagreb Defense date and country 2024-12-05, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616 - Pathology. Clinical medicine Abstract Procjena krutosti velikih krvnih žila mjerenjem brzine pulsnoga vala (PVW) uvrštena je u međunarodne smjernice procjene ukupnog kardiovaskularnog rizika na temelju velikih opservacijskih studija, te intervencijskih kliničkih pokusa. Zadnjih nekoliko godina posebno mjesto pridodaje se novoj metodi mjerenja PWV, koja obuhvaća dinamičko, 24h određivanje brzine pulsnoga vala, čime se dobijaju podaci o cirkardijarnom ritmu, o noćnim vrijednostima, te o varijabilnosti. U istraživanje će uključeno 154 bolesnika s dijagnozom esencijalne arterijske hipertenzije, starijih od 18 godina s potpisanom informiranom pristankom.
Glavni cilj istraživanja je bio odrediti povezanost 24h mjerenja PVW sa znakovima oštećenja ciljnih organa. Dodatni ciljevi su podrazumijevali analizu karakteristika 24h PVW u našoj skupini ispitanika: varijabilnost, cirkardijarni obrazac, noćnu krutost, jutarnji skok krutosti, maskirnu krutost, te „krutost bijele kute“, te usporedbu vrijednosti PVW izmjerenoga tijekom 24 sata s vrijednostima izmjerenim u ordinaciji.
Dobiveni rezultati potvrdili će kliničku vrijednost 24 satnog mjerenja PWV u liječenih hipertoničara. Utvrđeno je da je 24 satno mjerenje PWV bolji pokazatelj oštećenja ciljnih organa u odnosu na ordinacijsko mjerenje PWV. Ovo je potvrđeno za PWV mjeren tijekom 24 sata pomoću Mobil-O-Graph-a a uzimajući u obzir broj korelacija s pokazateljima oštećenja ciljnih organa, te jačinu koeficijenata korelacija. Vrijednosti PWV-a mjerenoga tijekom 24 sata (pomoću Mobil-O-Graph-a) bile su statistički značajno niže u odnosu na vrijednosti PWV mjerene ordinacijski pomoću SphygmoCor-a, dok nije nađena statistički značajna razlika u usporedbi s PWV mjerenim tijekom 24 sata pomoću Arteriograph-a. Vrijednosti PWV-a mjerene tijekom 24 sata pomoću Arteriograph-a bile su statistički značajno više u odnosu na 24 satne vrijednosti mjerene pomoću Mobil-O-Graph-a. Prosječne dnevne vrijednosti PWV bile su veće u odnosu na prosječne noćne vrijednosti PWV, na nivou statističke značajnosti mjerene pomoću obje oscilometrijske metode (Mobil-O-Graph i Arteriograph). Dnevno-noćni obrazac PWV-a pratio je dnevno-noćni obrazac AT-a. Analizirajući fenomene arterijske krutosti kao što je jutarnji skok krutosti verificirana je snažna povezanost s jutarnjim skokom AT (bez utjecaja drugih metaboličkih čimbenika, dobi, spola, termina poroda i porođajne mase u univarijatnome korelacijskom modelu analize), te je također verificirana statistički značajna korelacija između „efekta bijele kute“ za krutost mjerenu PWV-om i efekta „maskirne krutosti“ za PWV odnosu na iste fenomene AT-a tijekom 24 satnog mjerenja, čime je odgovoreno na zadane ciljeve istraživanja.
Abstract (english) Estimation of arterial stiffness by measuring pulse wave velocity (PVW) has been included in international guidelines for assessment of general cardiovascular risk based on large observational studies and interventional clinical trials. In the last few years, a special attention has been given to a new method of measuring PVW, i.e. dynamic, 24-hour measurement of
the pulse wave velocity, which provides data on circadian rhythm, night values, and variability. It was included 154 patients with primary arterial hypertension, older than 18 years with signed informed consent.
The main goal of the study was to determine the association of 24 hours PVW measurements with target organ damages. Additional goals include analysis of 24 hours PVW characteristics in our group of subjects: variability, circadian pattern, night stiffness, increased morning stiffness, masked stiffness, and "white coat stiffness", and comparison of PVW values
measured during 24 hours with values measured in the office.
The obtained results confirmed the clinical value of 24 hours PVW measurements in treated hypertensive patients. It was found that 24 hours PWV measurement is a better indicator of target organ damages compared to office PWV measurement. This was confirmed for PWV measured over 24 hours using the Mobil-O-Graph, taking into account the number of correlations with indicators of target organ damage, and the strength of the correlation coefficients. Pulse wave velocity values measured during 24 hours (using Mobil-O-Graph) were statistically significantly lower compared to PWV values measured in the office using SphygmoCor, while no statistically significant difference was found compared to PWV
measured during 24 hours using Arteriograph. PWV values measured over 24 hours using the Arteriograph were statistically significantly higher compared to 24 hour values measured using the Mobil-O-Graph. An average daytime PWV values were higher compared to an average nighttime PWV values, at the level of statistical significance measured using both oscillometric methods (Mobil-O-Graph and Arteriograph). The day-night pattern of PWV followed the day-night pattern of arterial pressure. Analyzing the phenomena of arterial stiffness such as the morning surge in stiffness, a strong association with the morning surge in arterial pressure was verified (without the influence of other metabolic factors, age, sex, date of birth and birth weight in the univariate correlation model of the analysis), and a statistically significant correlation was also verified between "white coat effect" for stiffness measured by PWV and the effect of "masked stiffness" for PWV in relation to the same phenomena in arterial pressure during 24 hours measurement, what answered the main goals of the research.
Keywords
arterijska hipertenzija
24 satna brzina pulsnoga vala
krutost krvnih žila
kardiovaskularni rizik
oštećenje ciljnih organa.
Keywords (english)
arterial hypertension
24 hours pulse wave velocity
arterial stiffness
cardiovascular risk
target organ damage.
Language croatian URN:NBN urn:nbn:hr:105:059302 Study programme Title: Biomedicine and Health Sciences Type of resource Text Extent 219 str. File origin Born digital Access conditions Open access Terms of use Created on 2024-12-09 10:30:25
