Heart rate variability, large vessel remodelling and metabolic parameters in stage 1 hypertension according to the ACC/AHA 2017 guidelines

Abstract

Objective: Controversial defi nition of arterial hypertension (AH) by the ACC/AHA 2017 Guidelines renewed interest in the earlier stages of blood pressure (BP) elevation. The aim: to investigate the features of the heart rate variability (HRV), large vessel remodelling (VR) and metabolic parameters in subjects with stage 1 AH according to the new American guidelines (130–139 / or 80–89 mmHg). Design and method: We investigated 148 untreated subjects with the following BP levels (mmHg): < 120 / and < 80 (group 1; n = 33), 120–129 / and < 80 (group 2; n = 27), 130–139 / or 80–89 (group 3; n = 60), > = 140 / or > = 90 mmHg (group 4; n = 28). HRV indices were assessed by 24-hour Holter monitoring data, large vessel remodelling parameters - on the basis of applanation tonometry (Sphygmocor) and carotid echo-tracking (Artlab) data. The results are presented as mean ± standard deviation. Results: In comparison to group 1, group 2 had lower levels the high-density lipoproteins levels (61.7 ± 15.6 and 51.7 ± 11.6 mg/dl, respectively, p = 0.009), increased diameter of carotid artery (6.8 ± 0.4 and 7.5 ± 0.5 mm, respectively, p = 0.034) and similar pattern of HRV parameters. Group 3, compared to groups 1 and 2, had signifi cantly higher glucose and uric acid levels (p = 0.045 and p = 0.017, respectively), and also increased carotid-femoral pulse wave velocity, compared to groups 1 (7.8 ± 1.2 and 7.2 ± 0.9 m/s, respectively, p = 0.025). These alterations were associated with an increase in the high-frequency component of HRV (HF, p = 0.013 and r-MSSD, p = 0.022) and greater distensibility of the carotid vascular wall (p = 0.004), which were not observed in the group 4. Conclusions: Subjects with blood pressure of 130–139 / or 80–89 mmHg are characterized by distinct metabolic abnormalities, initial signs of vascular remodelling and alterations of HRV, which might predispose to further progression of BP elevation and development of target organ damage.