Dipper ve nondipper hipertansiyonlu hastalarda volüm yükü karşılaştırılması
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Tarih
2018
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info:eu-repo/semantics/embargoedAccess
Özet
Giriş ve Amaç; Hipertansiyon en sık görülen kronik hastalıklardan biridir. Kan basıncının sirkadiyen ritminin keşfi ile dipper ve nondipper kavramları tanımlanmış olup bu iki patternin farklılıkları üzerine çok sayıda çalışma yapılmıştır. Literatürde nondipper hipertansiyonda artmış morbidite ve mortalite nedeniyle bu paternin ortaya çıkmasında hangi mekanizmaların etkili olduğu önem kazanmıştır. Nondipper patternin ortaya çıkmasında gece uyku esnasında beklenenin aksine parasempatik sinir sistemi aktivitesinin sempatik sinir sistemine baskın olamaması ön planda suçlansa da RAAS aktivasyonundaki artışı, otonomik disfoksiyon, diyette artmış tuz miktarının etkili olduğu düşünülmektedir. Biz de bu fizyopatolojik nedenlerin yanı sıra gruplar arasında volüm yükünün etkisini araştırmak istedik. Materyal ve Metod; Çalışmamıza 2016 Ocak -2017 Aralık tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Araştırma ve Uygulama Hastanesi İç Hastalıkları ve Kardiyoloji polikliniğine başvuran, 18-65 yaş aralığında, yeni tanı almış henüz antihipertansif tedavi almayan 92 hastayı aldık. Ambulatuvar kan basıncı ölçümleri yapıldı ve JNC-8 kılavuzuna göre 24 saatlik ortalama sistolik KB?135 mmHg ve/veya diyastolik KB?85 olan hastalar hipertansif olarak kabul edildi. Gece kan basıncının düşüş yüzdesi ''Gece KB düşüşü (%) = (Gündüz KB- Gece KB) x 100 / Gündüz KB'‘formülü ile hesaplandı. Hastalara kan basıncı düşüşüne göre dipper (?10 mmHg) ve non- dipper (<10 mmHg) hipertansiyon tanısı kondu. Takiben hastaların vücut sıvı kompozisyonunun belirlenmesi için biyoimpedans analiz yapıldı. Bu analizle hastaların total vücut suyu (TBW), ekstrasellüler su (ECW), intrasellüler su (ICW), ECW/ICW oranı, rölatif su artışı (OH/ECW) değerlendirildi. Hastaların Vena Kava İnferior (VCİ), Sağ Atrium(RA) İnterventriküler Septum kalınlığı (İVSd) ekokardiyografik yöntemlerle ölçüldü. Ayrıca hastaların hipertansif retinopati açısından fundus muayenesi yapıldı. Bulgular ; Çalışmaya %42i erkek (n:39) %58i kadın (n:53) toplam 92 hasta dâhil edildi. Nondipper hasta oranı %52 idi (48/92). Dipper(n:44) ve nondipper(n:48) olarak gruplara ayrılan hastalar karşılaştırıldığında yaş (p:0,941) ve cinsiyette(p:0,104) istatiksel olarak anlamlı bir fark yoktu. Biyoimpedans analizde her iki grup arasında ECW (p: 0,031) ve ECW/ICW (p:0,001) ‘de istatiksel olarak anlamlı fark vardı. Ekokardiyografi sonrası gruplar arasında sağ atrium çapında istatiksel olarak anlamlı bir fark vardı (p:0,017). Fundus muayenesinde HTRP saptanan ve saptanmayan hastalar karşılaştırıldığında; gece yüksek sistolik (p=0.000) ve diastolik (p=0.003) kan basıncı ile hipertansif retinopatinin progresyonu arasında istatistiksel olarak güçlü bir ilişki olduğunu tespit ettik. Sonuç: Kan basıncı ile direkt ilişkili olan OH ve OH/ECW gruplar arasında farklılık göstermezken ECW ve ECW/ICW istatistiksel olarak farklılık gösteriyordu. Non dipper hipertansif grupta uç organ hasarı daha belirgindi. Bunu yeni tanı almış hipertansif hastalarda manifest olmayan volüm yükünün bulgusu olarak değerlendirdik. Bununla birlikte non dipper hipertansif grupta uç organ hasarı daha belirgindi. Anahtar kelimeler: Nondipper hipertansiyon, volüm yükü, biyoimpedans analiz
Introduction and objectives : Hypertension is one of the most common chronic diseases. Dipper and nondipper concepts have been defined by the discovery of circadian rhythm in blood pressure, and several studies have been carried out on the differences between these two patterns. In literature, due to increased morbidity and mortality in nondipper hypertension, which mechanisms are important for the emergence of this pattern has become important. In contrast to what is expected during night sleep during the emergence of nondipper pattern, parasympathetic nervous system activity is not predominant in the sympathetic nervous system. It is thought that increase in RAAS activation, autonomic disfusion, increased amount of salt in the diet is also effective in the frontal culpability. We wanted to investigate the effect of volumetric burden among these groups, as well as these physiopathological reasons. Materials and Methods: We included 92 patients who were admitted to Dicle University Medical Faculty Research and Practice Hospital Internal Medicine and Cardiology policlinic between January 2017 and December 2016 and who did not take antihypertensive medicines between the ages of 18-65. Ambulatory blood pressure measurements were performed and according to the JNC-8 guideline 24-hour mean systolic BP ? 135 mmHg and / or diastolic BP ? 85 were considered hypertensive. The percentage of night blood pressure decline was calculated as' 'Night BP decline (%) = (Day BP - Night BP) x 100 / Day Bp'. Dipper (?10 mmHg) and non-dipper (<10 mmHg) hypertension were diagnosed according to the disease blood pressure decline. Following that bioimpedance analysis was performed to determine the body fluid composition of the patients. Patients were assessed for total body water (TBW), extracellular water (ECW), intracellular water (ICW), ECW/ICW ratio and relative water increase(OH / ECW). Vena Kava Inferior (VCI), Right Atrium (RA) Interventricular Septum Thickness (IVSd) were measured by echocardiographic methods. In addition, fundus were examined for hypertensive retinopathy of the patients. Results ; A total of 92 patients were included in the study, 42% male (n: 39) and 58% female (n: 53). Nondipper patient rate was 52% (48/92). There was no statistically significant difference in age (p: 0,941) and gender (p: 0,104) when comparing the patients who were divided into groups dipper(n:44) and nondipper(n:48) groups. Bioimpedance analysis showed a statistically significant difference in ECW (p: 0.031) and ECW / ICW (p: 0.001) between the two groups. There was a statistically significant difference in right atrium diameter between the two groups in echocardiographic findings (p: 0.017). When patients with and without HTRP were examined on fundus examination, we found that there was a statistically strong correlation between night-time high systolic (p = 0.000) and diastolic (p = 0.003) blood pressure and progression of hypertensive retinopathy. Conclusion: ECW and ECW / ICW were statistically different while OH and OH / ECW, which are directly related to blood pressure, did not differ between the groups. End organ damage was more prominent in the non dipper hypertensive group. We evaluated this as a finding of non-manifest volumetric load in newly diagnosed hypertensive patients. However, end organ damage was more prominent in the non-dipper hypertensive group. Key words: Nondipper hypertension, volume load, bioimpedance analysis
Introduction and objectives : Hypertension is one of the most common chronic diseases. Dipper and nondipper concepts have been defined by the discovery of circadian rhythm in blood pressure, and several studies have been carried out on the differences between these two patterns. In literature, due to increased morbidity and mortality in nondipper hypertension, which mechanisms are important for the emergence of this pattern has become important. In contrast to what is expected during night sleep during the emergence of nondipper pattern, parasympathetic nervous system activity is not predominant in the sympathetic nervous system. It is thought that increase in RAAS activation, autonomic disfusion, increased amount of salt in the diet is also effective in the frontal culpability. We wanted to investigate the effect of volumetric burden among these groups, as well as these physiopathological reasons. Materials and Methods: We included 92 patients who were admitted to Dicle University Medical Faculty Research and Practice Hospital Internal Medicine and Cardiology policlinic between January 2017 and December 2016 and who did not take antihypertensive medicines between the ages of 18-65. Ambulatory blood pressure measurements were performed and according to the JNC-8 guideline 24-hour mean systolic BP ? 135 mmHg and / or diastolic BP ? 85 were considered hypertensive. The percentage of night blood pressure decline was calculated as' 'Night BP decline (%) = (Day BP - Night BP) x 100 / Day Bp'. Dipper (?10 mmHg) and non-dipper (<10 mmHg) hypertension were diagnosed according to the disease blood pressure decline. Following that bioimpedance analysis was performed to determine the body fluid composition of the patients. Patients were assessed for total body water (TBW), extracellular water (ECW), intracellular water (ICW), ECW/ICW ratio and relative water increase(OH / ECW). Vena Kava Inferior (VCI), Right Atrium (RA) Interventricular Septum Thickness (IVSd) were measured by echocardiographic methods. In addition, fundus were examined for hypertensive retinopathy of the patients. Results ; A total of 92 patients were included in the study, 42% male (n: 39) and 58% female (n: 53). Nondipper patient rate was 52% (48/92). There was no statistically significant difference in age (p: 0,941) and gender (p: 0,104) when comparing the patients who were divided into groups dipper(n:44) and nondipper(n:48) groups. Bioimpedance analysis showed a statistically significant difference in ECW (p: 0.031) and ECW / ICW (p: 0.001) between the two groups. There was a statistically significant difference in right atrium diameter between the two groups in echocardiographic findings (p: 0.017). When patients with and without HTRP were examined on fundus examination, we found that there was a statistically strong correlation between night-time high systolic (p = 0.000) and diastolic (p = 0.003) blood pressure and progression of hypertensive retinopathy. Conclusion: ECW and ECW / ICW were statistically different while OH and OH / ECW, which are directly related to blood pressure, did not differ between the groups. End organ damage was more prominent in the non dipper hypertensive group. We evaluated this as a finding of non-manifest volumetric load in newly diagnosed hypertensive patients. However, end organ damage was more prominent in the non-dipper hypertensive group. Key words: Nondipper hypertension, volume load, bioimpedance analysis
Açıklama
Anahtar Kelimeler
Nondipper hipertansiyon, Volüm yükü, Biyoimpedans analiz, Nondipper hypertension, Volume load, Bioimpedance analysis
