HYPERTENSIVE HEART DISEASE IN COVERT ARTERIAL HYPERTENSION OF A LARGE FACTORY EMPLOYEE

Aim. To study structural and functional changes of myocardium, that are explained as the signs of hypertensive heart disease (HHD), in covert arterial hypertension (CAH) at the workplace of a large factory employee using echocardiography (EchoCG). Material and methods. One-time cohort study under the frames of annual prophylactic medical screening of a large factory employee. Totally 376 workers studied with normotension and arterial hypertension (AH) (47,9% males), with office blood pressure (OBP) <180/110 mmHg not depended on the fact of hypertension therapy (AHT), mean age 52,7±7,5. Workers with OBP <140/90 mmHg without AHT were included if had ≥1 risk factors. In addition to standard assessment and OBP measurement ambulatory blood pressure monitoring (ABPM) used and EchoCG. Criteria for CAH were OBP <140/90 mmHg with work time BP ≥135/85 mmHg. Criteria for left ventricle hypertrophy (LVH) were the left ventricle myocardial mass index (LVMMI) >115 g/m2 in men and >95 g/ m2 in women.
Results. Among workers with normal OBP not receiving AHT, CAH revealed in 50% cases; in workers with AHT, covert treatment insufficiency of AH (CTI AH) — in 24,8%. In CAH and CTI AH by the data of EchoCG there are signs of LVH: increase of the left ventricle thickness, back wall, LVMMI, that are comparable with those in patients with stable AH (St. AH) — the ambulatory BP (Amb.BP) and OBP also increased. In CAH comparing to normotonics there is an increase of E/A equation by increase of the A (p<0,0001). The most prevalent in CAH and CTI AH was concentric LVH — in 60% and 78,1 cases, respectively, and concentric remodeling — in 15% cases in both groups, that is comparable to the patients with St. AH, receiving and not receiving AHT. Eccentric LVH was found in 5% and 1,6%, normal LV structure  in 20% and 4,7% in groups with SAH and CTI AH, respectively.
Conclusion. Prominence and prevalence of HHI in CAH at workplace as at the background of AHT, and without it, are comparable to the prominence and prevalence of myocardium damage in workers with nontreated St. AH and workers receiving non-effective AHT. Due to high prevalence of CAH and CTI AH found during annual prophylactic screenings, especially in those with AH risk factors, it is important to use ABPM and EchoCG for on time prescription and correction of AHT.

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