SPECIFICS OF 24-HOUR BLOOD PRESSURE AND HEART RATE VARIABILITY IN HYPERTENSIVE PATIENTS DEPENDING ON PHYSICAL ACTIVITY AND PSYCHOEMOTIONAL LOAD

Aim. To study the specifics of 24-hour blood pressure (BP) profile and heart rate variability (HRV) according to levels of physical activity and psychoemotional load in arterial hypertension (AH) patients.

Material and methods. Totally, 76 male patients studied, having AH of I or II stage (mean age 46,75±0,56 y. o.). Group 1 included 36 patients with AH and obesity, group 2 — 40 AH non-obese patients. All patients underwent 24-hour BP monitoring and ECG monitoring with HRV analysis. Psychoemotional load analysis was assessed with PSM-25 score. The level of reactive and trait anxiety was assessed with Spielberger (translated by Khanin) questionnaire. For physical activity assessment we used short international questionnaire (IPAQ).

Results. In analysis of 24-hour BP monitoring there was significant increase of systolic BP variability in 1 group patients, if hypodynamic (17,97±0,64 mmHg) comparing to those having enough activity (15,43±0,73 mmHg, р=0,003). In hypodynamia the 24-hour BP rhythm was a non-dipper type (68,8%) comparing to those with enough exertion (51,6%). Also, in hypodynamia there was significant decrease of time-related HRV — SDNNi and RMSSD, representing the dysbalance of autonomous neural regulation of cardiovascular system, and there was negative correlation of SDNNi and RMSSD with the level of psychoemotional load. In all studied groups there was positive correlation of systolic and diastolic BP variability with the level of reactive and trait anxiety and with psychoemotional load. There was non-sufficient level of systolic and diastolic BP decrease in patients with high level of trait (r=-0,67; p<0,00001 and r=-0,60; p=0,0001) and reactive anxiety (r=-0,54; р=0,0006 и r=-0,43; р=0,009).

Conclusion. In AH patients hypodynamia, as the chronic psychoemotional overload are separated factors leading to increase of variability and decrease of nocturnal BP decline, as to HRV decrease irrelevant to obesity.

1. Chazova IE, Trubacheva IA, Zhernakova YV, et al. The prevalence of arterial hypertension as a risk factor of cardiovascular diseases in one of the cities in Siberian Federal district. Systemic Hypertension. 2013; 10(4):30-37. Russian (Чазова И.Е., Трубачева И.А., Жернакова Ю.В. и др. Распространенность артериальной гипертонии как фактора риска сердечно-сосудистых заболеваний в крупном городе Сибирского федерального округа. Системные гипертензии. 2013; 10(4):30-37).

2. Oganov RG. Cardiovascular disease at the beginning of the XXI century: medical, social, demographic aspects and ways of prevention. Federal book. 2013; 13:257-264. Russian. http://federalbook.ru/files/FSZ/soderghanie/Tom%2013/IV/Oganov.pdf (Оганов Р.Г. Сердечно-сосудистые заболевания в начале XXI века: медицинские, социальные, демографические аспекты и пути профилактики. Федеральный справочник. Здравоохранение России. 2013; 13:257-264).

3. Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Annual review of public health. 2013; 34:337-354.

4. Gafarova AV, Gafarov VV, Gromova EA, et al. The effects of stress on risk of arterial hypertension in general male population of 25-64 years old: 14 years of follow up (epidemiological study on the basis of the WHO program «MONICA—PSYCHOSOCIAL»). Arterial Hypertension. 2013; 19(1):27-31. Russian (Гафарова А.В., Гафаров В.В., Громова Е.А., и др. Изучение влияния стресса на риск артериальной гипертензии в открытой популяции среди мужчин 25-64 лет (Эпидемиологическое исследование на основе программы ВОЗ «MONICA—РSYCHOSOCIAL»). Артериальная гипертензия. 2013; 19(1):27-31.

5. Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vézina M. Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control-support and effort–reward imbalance models. Scandinavian journal of work, environment & health. 2014;40(2):109-132.

6. Mancia G, Grassi G. The autonomic nervous system and hypertension. Circulation research. 2014; 114(11):1804-1814.

7. Hamer M. Psychosocial stress and cardiovascular disease risk: the role of physical activity. Psychosomatic Medicine. 2012;74(9):896-903. doi:10.1097/PSY.0b013e31827457f4

8. Thayer JF, Ahs F, Fredrikson M, et al. A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neuroscience & Biobehavioral Reviews. 2012; 36(2):747-756.

9. Reyes del Paso GA, Langewitz W, Mulder LJ, et al. The utility of low frequency heart rate variability as an index of sympathetic cardiac tone: a review with emphasis on a reanalysis of previous studies. Psychophysiology. 2013; 50(5):477-87.

10. Davidovich IM, Afonaskov OV. Arterial hypertension in young officers of land forces: psychophysiological peculiarities. Vestnik Roszdravnadzora. 2012; 5:51-55. Russian (Давидович И.М., Афонасков О.В. Артериальная гипертензия у мужчин молодого возраста, офицеров сухопутных войск: психофизиологические особенности. ВестникРосздравнадзора. 2012; 5:51-55).

11. Lin G, Xiang Q, Fu X, et al. Heart rate variability biofeedback decreases blood pressure in prehypertensive subjects by improving autonomic function and baroreflex. J Altern Complement Med. 2012; 18(2):143-52.

12. Salles GF, Ribeiro FM, Guimarães GM, et al. A reduced heart rate variability is independently associated with a blunted nocturnal blood pressure fall in patients with resistant hypertension. J Hypertens. 2014; 32(3):644-51.

13. Chazova IE, Ratova LG, Boitsov SA, et al. Recommendations for the management of arterial hypertension. Russian Medical Society of Arterial Hypertension and Society of Cardiology of the Russian Federation. Systemic Hypertension. 2015; 3:5-26. Russian (Чазова И.Е., Ратова Л.Г., Бойцов С.А., и др. Диагностика и лечение артериальной гипертензии. Рекомендации Российского медицинского общества по артериальной гипертонии и Всероссийского научного общества кардиологов. Системные гипертензии. 2010; 3: 5-26).

14. Vodopianova NE. Psychodiagnostics of stress. SPb: Piter, 2009. р. 336. Russian (Водопьянова Н.Е. Психодиагностика стресса. СПб: Питер, 2009. с. 336).

15. Bubnova MG, Aronov DM, Boytsov SA. Provision of physical activity in people with limitations in health. Moscow, 2015. p. 95. Russian (Бубнова М.Г., Аронов Д.М., Бойцов С.А. Методические рекомендации. Обеспечение физической активности у граждан, имеющих ограничения в состоянии здоровья. Москва, 2015. с. 95).