Orthostatic responses of peripheral and central blood pressure in patients with hypertension and atherosclerotic carotid stenosis

• Gurevich A.P.
• Emelyanov I.V.
• Ionov M.V.
• Rotar O.P.
• Boyarinova M.A.
• Moguchaia E.V.
• Kolesova E.P.
• Chernyavskiy M.A.
• Konradi A.O.

Abstract

Objective. The purpose of this study was to determine the frequency and severity of orthostatic responses of central and peripheral blood pressure (BP) during the active stand test (AST) in patients with arterial hypertension (HTN) and hemodynamically significant stenosis of the internal carotid artery (ICA).

Patients and methods. The study group included patients aged 18 years and older with HTN and ≥ 60% ICA stenosis (NASCET criteria). It consisted of 77 patients (mean age 68±6 years, 44 men). The control group comprised 77 ambulatory patients (mean age 68±6 years, 43 men) with hypertension but with no lesion of the internal carotid artery. The patients of both groups underwent the active stand test, i. e., measuring peripheral blood pressure in the sitting position and 3 minutes after standing up. Orthostatic hypotension was defined as a systolic blood pressure (SBP) drop of 20 mm Hg or more and/or a diastolic blood pressure (DBP) drop of 10 mm Hg and more upon standing. Besides, the study group patients were additionally subjected to assessing central blood pressure during the AST and pulse wave contour analysis.

Results. Overall, orthostatic hypotension was diagnosed in 21 (27%) patients of the study group and in 17 (22%) patients of the control group (p=0.46), with systolic orthostatic hypotension more frequently observed in the study group patients (21 vs 9 cases, p=0.015). A decrease in central systolic blood pressure was more pronounced than that of peripheral SBP (p_pSBP-cSBP <0.001). Changes in peripheral systolic blood pressure during the AST were found to be associated with the presence of a significant ICA lesion (β_ICA+= 0.201, p=0.03) and the baseline level of SBP (β=-0.348, p=0.001). The same variables (the fact of ICA stenosis and baseline SBP) mostly explained the development of systolic orthostatic hypotension (OR_ICA+ = 2.95 (95% CI [1.1 – 7.7], p=0.03 and β=0.437, p<0.001, respectively).

Conclusions. Asymptomatic OH occurred in 27% of patients with arterial hypertension and ICA stenosis, more frequently in the form of isolated systolic OH. In orthostasis, the range of change in central blood pressure significantly exceeded the range of change in peripheral blood pressure. The presence of an ICA lesion in patients with arterial hypertension is a factor exerting significant influence on changes in systolic blood pressure in orthostasis and the occurrence of OH.

Funding. This research was supported by the Russian Science Foundation (Grant № 23-25-00272).

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design – Gurevich A.P., Emelyanov I.V., Ionov M.V., Konradi A.O.; data collection and handling – Gurevich A.P., Ionov M.V., Boyarinova M.A., Moguchaia E.V., Kolesova E.P.; statistical processing – Gurevich A.P., Ionov M.V.; draft manuscript preparation – Gurevich A.P., Ionov M.V.; manuscript revision – Rotar O.P., Chernyavskiy M.A.

For citation: Gurevich A.P., Emelyanov I.V., Ionov M.V., Rotar O.P., Boyarinova M.A., Moguchaia E.V., Kolesova E.P., Chernyavskiy M.A., Konradi A.O. Orthostatic responses of peripheral and central blood pressure in patients with hypertension and atherosclerotic carotid stenosis. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 33–41. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-33-41

Keywords: arterial hypertension; carotid stenosis; orthostatic hypotension; active stand test; central blood pressure