THE CONNECTION BETWEEN THE DEVELOPMENT OF ISCHEMIC MYOCARDIAL EPISODES AND THE CHANGES OF BLOOD PRESSURE IN CHRONIC HEMODIALYSIS PATIENTS WITH CHD

THE AIM. To evaluate the connections between myocardial ischemia (MI) and parameters of 24 hours’ blood pressure profile in prevalent group of CHD hemodialysis patients (HD). PATIENTS AND METHODS. During the years 2003 – 2007 we investigated the prevalent group of stable patients of programmed hemodialysis with the stated diagnosis of CHD (n=61). Synchronous ECG monitoring (CM) and BP (in 61 patients during the 1^st 24 hours after hemodialysis, and 43 – after the 2^nd24 hours) were performed to all patients. The amount and total duration of MI; the dynamics of BP changes during the HD procedure; the mean values and quantative indexes of systolic (SBP), diastolic (DBP), pulse (PBP) and mean BP (mBP) in the day and night time of interdialysis period was analyzed. RESULTS. Out of 61 patients with stated diagnosis of CHD, the ischemic changes during CM were detected in 57,4 cases (n=35). During the 1^st 24 hours the ischemic episodes were detected in 34 out of 61 patients (55,7 %). During the next 24 hours the MI was registered almost twice as rare: out of 43 patients, after the second daily CM, the depression of ST was detected in 27 % (n=12). In overwhelming majority, during the second 24 hours the MI was detected in same patients as it was during the first 24 hours (11 out of 12). In the group of patients with MI the day and mean values of PBP during CM were reliably higher. The absolute values of SBP, DBP, PBP and mBP reliably did not differ during various periods of development of MI (during dialysis, 1^st and 2^ndinterdialysis 24 hours). In patients with ECG signs of MI in the 1^st 24 hour after HD the negative correlation connections between total number of ischemic episodes and mean values of PBP at night (R=-0,498, p=0,003) and SBP at night (R=-0,462, p=0,008) were detected. In the group of patients (n=12) with registered during the 2^nd24 hours after HD episodes of depression of ST, the quantity and total duration of the last were obviously inversely connected with day SBP during 1^st and 2^nd24 hours; the quantity of ischemic episodes - with day and night SBP during 1^st and 2^nd24 hours, with day and night PBP in 1^st24 hours, and also with night PBP during 2^nd24 hours. Besides that, the quantity of MI episodes was reliably connected with the day and night values of mAP during the 1^st night and 2^ndday. The values of MI during the 1^st 24 hours had positive connection with quantative indexes of AP, connected with the extend of decrease of threshold levels of day/night SBP and DBP (101/86 and 61/48 mm Hg accordingly). The threshold heart rate in each case of MI was reliably connected only with DBP (p=0,007), and not SBP or PBP. CONCLUSION. The development of MI in patients with CHD on HD was obviously connected with the degree of DBP and SBP decrease in interdialysis time period. The further accumulation of clinical data in this area and investigation of the mechanisms of the influence of system BP on the coronary perfusion may have an important meaning for improvement of the HD treatment.

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