SPECIFICS OF NEUROHUMORAL ACTIVITY AND CLINICAL PRESENTATION OF MASKED ARTERIAL  HYPERTENSION IN YOUNG MALES

Aim. To assess the neurohumoral state, specifics of clinical presentation, prevalence and prominence of cardiovascular and behavioral risk factors in males of young age with masked arterial hypertension (MAH).

Material and methods. To the full coverage screening study, 643 participants included, age 18-30 y. o. (mean age 22). Complete clinical and laboratory, instrumental assessments performed, with analysis of neurohumoral activity by the levels of adrenaline, noradrenaline, angiotensin II. All participants were selected to groups: MAH (n=61), manifest AH (n=46), normotonics (n=536). Diagnostics of MAH was done in case of positive test of 30 second respiration pause and 24 hour blood pressure (BP) monitoring.

Results. In males, MAH was found in 9,5% cases, manifest AH in 7,1%, normotonia in 83,4%. In MAH and manifest AH participants the level of adrenaline was higher than in normotonics: 4,55 pM/L [3,53; 5,1], 6,25 pM/L [4,75; 8,65] and 2,1 pM/L [1,2; 4,5], respectively. Males with MAH had almost 2 times higher level of noradrenaline (19,5 pM/L [18,8; 22,8]) comparing to “normotonics” (8 pM/L [6; 12,1]) and 1,5 times higher than in manifest AH (13,1 pM/L [11,5; 14,4]). Angiotensin II assessment showed that in MAH males it was higher (18,5 pM [15,75; 21,9]), than in normotonics (15,7 pM [13;18,3]), but lower than in manifest AH
(20,15 pM [18,9; 21,9]). Food related behavior assessment as of a factor of sodium overconsumption, the higher values were found in MAH patients and in manifest AH (50% and 50%) comparing to normotonics (25%). Early age of smoking beginning found in 28% of MAH males, more prevalent than in normotonics (24%) and manifest AH (15%).

Conclusion. In young males MAH is revealed more often than manifest AH. Development of MAH in young males is related to hypersympathicity with raised catecholamines level, disordered 24 hour rhythm “non-dipper”, disorder of BP variability and higher smoking level, than in normotonics.

1. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Russ J Cardiol. 2014; 1 (105): 7-94. (In Russ.) Рекомендации по лечению артериальной гипертонии. ESH/ESC 2013. Российский кардиологический журнал 2014; 1 (105): 7-94. DOI:10.15829/1560-4071-2014-1-7-94

2. Sundström J, Neovius M, Tynelius P, et al. Association of blood pressure in late adolescence with subsequent mortality: cohort study of Swedish male conscripts. BMJ. 2011; 342: d643. DOI: 10.1136/bmj.d643

3. Reddy VS, Jacob GP, Ballala K, et al. A study on the prevalence of hypertension among young adults in a coastal district of Karnataka, South India. International J. of Healthcare and Biomedical Research. 2015; 3 (3): 32-9.

4. Lyamina NP, Lyamina SV, Senchihin VN, et al. Functional test on latent arterial hypertension detection in young adults. Kardiologiia. 2011; 51 (4): 28-30. (In Russ.) Лямина Н. П., Лямина С. В., Сенчихин В. Н. и др. Функциональная проба для выявления латентной артериальной гипертензии у лиц молодого возраста. Кардиология. 2011; 51 (4): 28-30.

5. Lyamina NP, Smit ML, Nalivaeva AV, et al. Prognostic value of 30-sec breath hold test in diagnostics of masked arterial hypertension in young adults. 2015; 9: 63-7. (In Russ.) Лямина Н. П., Смит М. Л., Наливаева А. В. и др. Прогностическая ценность теста 30-секундной задержки дыхания в диагностике маскированной артериальной гипертензии у лиц молодого возраста. Фарматека. 2015; 9: 63-7.

6. Muntner P, Lewis CE, Diaz K, et al. Racial differences in abnormal ambulatory blood pressure monitoring measures: Results from the Coronary Artery Risk Development in Young Adults (CARDIA) study. J. Hypertens. 2015; 28 (5): 640-8. DOI: 10.1093/ajh/ hpu193.

7. Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension vs. true normotension: a meta-analysis. J. Hypertens. 2007; 25: 2193-8. DOI: 10.1097/HJH.0b013e3282ef6185.

8. Lyamina NP, Smith ML, Lyamina SV, et al. Pressor response to 30-s breathhold: a predictor of masked hypertension. J. Blood Press 2012; 21 (6): 372-6. DOI: 10.3109/08037051.2012.694213.

9. Shljahto E. V., Konradi A. O. Reasons and effects of sympathyc nervous system activation in arterial hypertension. Arterial hypertension. 2003; 9 (3): 81-8. (In Russ.) Шляхто Е. В., Конради А. О. Причины и последствия активации симпатической нервной системы при артериальной гипертензии. Артериальная гипертензия. 2003; 3: 81-8.

10. Rogoza AN, Agal’cov MV, Sergeeva MV. Ambultory blood pressure monitoring: variants of medical reports and comments. N. Novgorod: DEKOM, 2005: 64 р. (In Russ.) Рогоза А. Н., Агальцов М. В., М. В. Сергеева. Суточное мониторирование артериального давления: варианты врачебных заключений и комментарии. Н. Новгород: ДЕКОМ, 2005: 64 с.

11. Chazova IE, Zhernakova JuV, Oshchepkova EV, et al. Prevalence of risk factors of cardiovascular diseases in Russian population of patients with arterial hypertension. Cardiology. 2014; 54 (10): 4-12. (In Russ.) Чазова И. Е., Жернакова Ю. В., Ощепкова Е. В. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014; 10: 4-12.

12. Shimbo D, Newman J, Schwartz JE. Masked hypertension and prehypertension: diagnostic overlap and relationships with left ventricular mass: masked hypertension study. J. Hypertens. 2012; 25 (6): 664-71. DOI: 10.1038/ajh.2012.15.

13. Lyamina NP, Dolotovskaya PV. High normal blood pressure in young patients — disease or risk factor? Cardiovascular Therapy and Prevention. 2005; 4: 6-20. (In Russ.) Лямина Н. П., Долотовская П. В. Высокое нормальное артериальное давление у лиц молодого возраста — болезнь или фактор риска? Кардиоваскулярная терапия и профилактика. 2005; 4: 6-20.

14. Lyamina SV, Lyamina NP, Senchihin VN, et al. Variability of blood pressure and bloodflow in young age patients with arterial hypertension. Fundamental research. 2009; 10: 16-20. (In Russ.) Лямина С. В., Лямина Н. П., Сенчихин В. Н. и др. Вариабельность артериального давления и сосудистый кровоток в молодом возрасте при артериальной гипертонии. Фундаментальные исследования. 2009; 10: 16-20.