Aspirantskiy Vestnik PovolzhiyaAspirantskiy Vestnik Povolzhiya2072-23542410-3764Samara State Medical University4383010.17816/2072-2354.2019.19.1.65-69Research ArticleINFLUENCE OF NOCTURNAL INCREASE OF BLOOD PRESSURE ON CARDIAC REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSIONMiroshnichenkoA. IPostgraduate Student, Department of Propaedeutics of Internal Diseasesmiroshnichenko.nast@yandex.ruIvanovK. MDoctor of Medical Sciences, Professor, Head of the Propaedeutics of Internal Diseases Departmentkmiwanov@mail.ruOrenburg State Medical University15032019191-2656908092020Copyright © 2019, Miroshnichenko A.I., Ivanov K.M.2019Actuality. Arterial hypertension (AH) is the main risk factor for the development of cardiovascular diseases, disability and cardiovascular mortality. Episodes of blood pressure (BP) increase during the day in patients receiving antihypertensive therapy are an unfavourable factor contributing to the development and progression of cardiac remodeling. Aim. The purpose of the research is to study the features of changes in the structural and functional state of the heart under the influence of high blood pressure at night in patients with arterial hypertension with the dynamic three-year observation. Material and methods. 47 patients with the diagnosis of AH were examined. Patients were divided into two groups, randomized by age, duration and severity of AH. Group 1 included 24 patients who as a result of ambulatory blood pressure monitoring (ABPM) on the background of combined antihypertensive therapy suffered from constantly increased BP at night. The second group combined 23 patients without the increase in BP during the night according to the ABPM with antihypertensive therapy. The examination included measurement of the office BP, ABPM, two-fold echocardiography with a three-year interval. Results. When assessing the indices of office BP in the groups, there were no significant differences, all patients achieved the target values of BP. In patients in Group 1, higher values of BP were observed during the day, according to ABPM. Echocardiography over a three year period of observation revealed a more pronounced increase in diastolic interventricular septum thickness, the thickness of the left ventricle posterior wall during diastole, sizes of left atrium in the patients of the first group, patients of the second group had a more pronounced thickness of the left ventricle posterior wall during systole. The increase in the size of the right ventricle was revealed in both groups. Conclusions. 1) In patients with the increase in blood pressure at night, the values of BP variability were higher during the day. 2) Three-year dynamic observation revealed that the increase in BP at night in patients with hypertension facilitated acceleration of cardiac remodelling and was associated with an increase in the left ventricular posterior wall, interventricular septum thickness, the size of the left atrium, and the size of the right ventricle.hypertensionnight increase in blood pressureheart remodelingартериальная гипертонияночное повышение артериального давленияремоделирование сердца[Гапон Л.И., Шуркевич Н.П., Ветошкин А.С., и др. Структурно-функциональные изменения сердца у больных артериальной гипертонией в условиях тюменского севера, взаимосвязь с данными СМАД // Уральский медицинский журнал. - 2010. -№ 7. - С. 40-50][Гофман И.Б., Другова К.С., Шапошник И.И. Продольная функция желудочков при концентрической гипертрофии левого желудочка у пациентов с артериальной гипертонией // Уральский медицинский журнал. - 2007. - № 7. - С. 76-82][Звартау Н.Э., Свиряев Ю.В., Коростовцева Л.С., Конради А.О. Механизмы развития резистентности к антигипертензивной терапии при синдроме обструктивного апноэ во время сна // Артериальная гипертензия. - 2012. - Т. 18. - № 3. - С. 184-190][Крюков Н.Н., Артемьева И.В. Ремоделирование правых отделов сердца и изменение центральной гемодинамики у больных артериальной гипертонией различного генеза // Журнал МедиАль. - 2011. -№ 1. - С. 4-5][Минеева Е.Е., Гвозденко Т.А. Гемодинамические особенности формирования артериальной гипертонии у мужчин // Бюллетень СО РАМН. - 2010. -Т. 30. - № 1. - С. 19-23][Ратова Л.Г., Атауллаханова Д.М., Толпыгина С.Н., Чазова И.Е. Сравнительная оценка гипотензивного и кардиопротективного эффектов лозартана и его фиксированной комбинации с гидрохлортиазидом // Системные гипертензии. - 2004. -№ 2. - С. 26-32][Хромцова О.М., Архипов М.В. Структурно-функциональные особенности левого желудочка сердца и их связь с суточным профилем артериального давления у больных артериальной гипертонией // Рациональная фармакотерапия в кардиологии. -2009. - Т. 5. - № 1. - C. 46-50][Drager LF, Bortolotto LA, Pedrosa RP, et al. Left atrial diameter is independently associated with arterial stiffness in patients with obstructive sleep apnea: potential implications for atrial fibrillation. Int J Cardiol. 2010;144(2):257-259][Kraiczi H, Caidahl K, Samuelsson A, et al. Impairment of vascular endothelial function and left ventricular filling : association with the severity of apnea-induced hypoxemia during sleep. Chest. 2001;119(4):1085-1091][Manning G, Rushton L, Millar-Craig W. The relationship between office ambulatory blood pressure level and left ventricular hypertrophy in hypertension. In: Proceedings of the 17th Scientific Conference of the International Society of Hypertension. 1998. P. 27-34]