Features of venous hemodynamic of the lower extremities in chronic venous diseases in men with arterial hypertension

Letyagina S. V.
Doctor, Department of Ultrasound Diagnostics¹

Shmeleva S. A.
PhD, Associate Professor, Chair for Anesthesiology, Resuscitation and Emergency Medicine²

Agafonova T. Yu.
PhD, Associate Professor, Chair for Propaedeutics of Internal Medicine²

Igumnova O. A.
PhD, Assistant, Chair of Faculty Therapy²

1 - Hospital of the Ministry of Internal Affairs of the Russian Federation for the Perm Region, Perm, Russia
2 - Wagner Perm State Medical University of the Ministry of Health, Perm, Russia

Corresponding Author: Igumnova Oksana; e-mail: Radiotemp68@rambler.ru. Conflict of interest. None declared. Funding. The study had no sponsorship.

The aim was to study the characteristics of the venous circulation of the lower extremities in cases of chronic venous diseases (CVD) in men with arterial hypertension (AH). A comparative analysis of the parameters of the venous blood flow of the lower extremities between two groups of men with hypertension aged 30-50 years was performed: a test group with hypertension and CVD (63 people) and a control group with hypertension without CVD (30 people). Type of research – single-step. AH was diagnosed according to ESC/ESH (2018). The presence of CVD was assessed by the CEAP classification and the results of ultrasound diagnostics of pathological refluxes in the superficial, deep, and perforating veins of both limbs. Using the Doppler study, the following parameters were recorded at rest (lying) in the superficial, deep, and perforating veins on the left: diameter and area of the vessel lumen, venous blood flow velocity, and venous pressure. In the test group higher values for diameter and area of the lumen of the superficial veins, blood flow velocity in the superficial, deep and perforating veins were recorded. The test group was characterized by a higher venous pressure than the control group. Conclusion. Expansion of the veins, acceleration of blood flow and an increase in venous pressure should be considered a characteristic feature of hypertension and chronic venous insufficiency. AH and CVD have a common pathogenetic mechanism – phlebohypertension, the presence of which must be taken into account when prescribing antihypertensive therapy to patients with AH and CVD.

arterial hypertension, chronic venous diseases, men

10.29234/2308-9113-2019-7-4-25-33

1. Shlyahto E.V., Konradi A.O., Zvartau N.E. Arterial'naya gipertenziya. Kardiologiya: nacional'noe rukovodstvo. [Arterial hypertension. Cardiology: national guidelines]. Moscow. GEOTAR-Media. 2015:382-398. ISBN 978-5-9704-2845-0 (In Russ.)

2. Chazova I.E. Arterial'naya gipertoniya v svete sovremennyh rekomendacij. [Arterial hypertension in view of current recommendations]. Terapevticheskij arhiv [Therapeutic archive] 2018; 9: 4-7. doi: 10.26442/terarkh20189094-7 (In Russ.)

3. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Hypertension. 2018; 71: e13-e115. doi: 10.1161/HYP.0000000000000065

4. Vuylsteke M.E., Thomis S., Guillaume G., Modliszewski M.L., Weides N., Staelens I. Epidemiological study on chronic venous disease in Belgium and Luxembourg: prevalence, risk factors, and symptomatology. Eur J Vasc Endovasc Surg. 2015; 49(4): 432-9. doi: 10.1016/j.ejvs.2014.12.031

5. Varaki S.E., Gargiulo G.D., Penkala S., Breen P.P. Peripheral vascular disease assessment in the lower limb: a review of current and emerging non-invasive diagnostic methods. Biomed Eng Online 2018; 17(1): 61. doi: 10.1186/s12938-018-0494-4.

6. Flinterman L.E., van Hylckama Vlieg A., Cannegieter S.C. et al. Long-Term Survival in a Large Cohort of Patients with Venous Thrombosis: Incidence and Predictors. PLoS Med. 2012. 9(1): e1001155. doi: 10.1371/journal.pmed.1001155

7. Zolotukhin I., Seliverstov E., Shevtsov Y., Avakiants I.P., Nikishkov A.S., Tatarintsev A.M., Kirienko A.I. Prevalence and risk factors for chronic venous disease in the general Russian population. European Journal of Vascular and Endovascular Surgery 2017;54(6):752-758. doi: 10.1016/j.ejvs.2017.08.033

8. Vagapov T.F., Baev V.M. Klinicheskie osobennosti hronicheskih zabolevanij ven nizhnih konechnostej u muzhchin s arterial'noj gipertenziej. [Clinical features of chronic diseases of the veins of lower extremities in men with hypertension]. Prakticheskaya medicina [Practical Medicine] 2018; 16(6): 201-204. doi: 10.32000/2072-1757-2018-16-6-201-204 (In Russ.)

9. Baev V.M., Vagapov T.F. Snizhenie rabotosposobnosti i kachestva zhizni pri komorbidnosti arterial'noj gipertenzii i hronicheskih zabolevanij ven u muzhchin. [Comorbid arterial hypertension and chronic venous diseases in men: the impact on work efficiency and quality of life]. Arterial’naya Gipertenziya [Arterial Hypertension]. 2018; 24(5): 556-561. doi: 10.18705/1607-419X-201824-5-556-561 (In Russ.)

10. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018; 39, 3021-3104. doi: 10.1093/eurheartj/ehy339

11. Eklöf B., Rutherford R.B., Bergan J.J., Carpentier P.H., Gloviczki P., Kistner R.L., Meissner M.H., Moneta G.L., Myers K., Padberg F.T., Perrin M., Ruckley C.V., Smith P.C., Wakefield T.W. Revision of the CEAP classification for chronic venous disorders: Consensus statement. Journal of Vascular Surgery. 2004, 6: 1248-1252. doi: 10.1016/j.jvs.2004.09.027

12. Vasquez M.A., Munschauer C.E. Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology 2008; 23(6): 259-75. doi: 10.1258/phleb.2008.008018

13. Katorkin S.E., Kletskin A.E., Suchkov I.A., Kalinin R.E. Rossijskie klinicheskie rekomendacii po diagnostike i lecheniyu hronicheskih zabolevanij ven. [Diagnostics and Treatment of Chronic Venous Disease: Guidelines of Russian Phlebological Association]. Flebologiya [Flebologiya]. 2018; 3: 146-240. doi: 10.17116/flebo20187031146 (In Russ.)

14. Youn Y.J., Lee J. Chronic venous insufficiency and varicose veins of the lower extremities. Korean J Intern Med. 2019; 34(2): 269-283. doi: 0.3904/kjim.2018.230

15. Vagapov T.F., Baev V.M., Druzhina L.N., Letyagina C.V. Osobennosti strukturno-funkcional'nyh parametrov poverhnostnyh ven nizhnih konechnostej u muzhchin s arterial'noj gipertenziej. [Features of structural and functional parameters of superficial veins of lower extremities in men with arterial hypertension]. Medicinskij alfavit [Medical Alphabet]. 2019;.16(391):.18-21. (In Russ.). doi: 10.33667/2078-5631-2019-1-16(391)-18-21

16. Baev V.M., Vagapov T.F., Letyagina S.V. Osobennosti strukturno-funkcional'nyh parametrov glubokih ven nizhnih konechnostej u muzhchin s arterial'noj gipertenziej. [Structural and Functional Parameters of Lower-Limb Deep Veins in Hypertensive Male Patients]. Doktor.Ru [Doctor.Ru] 2019; 157(2): 37-40. doi: 10.31550/1727-2378-2019-157-2-37-40 (In Russ.)

17. Baev V.M., Vagapov T.F., Shmeleva S.A. Vyrazhennaya parasimpatikotoniya u muzhchin s arterial'noj gipertenziej soprovozhdaetsya uvelicheniem chastoty priznakov hronicheskih zabolevanij ven. [Severe parasympathicotonia in men with hypertension is accompanied by an increase in the chronic venous diseases’ signs]. Rossijskij kardiologicheskij zhurnal [Russian Journal of Cardiology]. 2019; 24(1): 52-55. doi: 10.15829/1560-4071-2019-1-52-55 (In Russ.)