Gender Related Orthostatic Hypertension in Patients With Arterial Hypertension

Objective: Evaluation the character of cardiovascular indices changes in men and women with arterial hypertension developing orthostatic hypertension as well as the level of metanephrine during orthostatic test. Design and method: Study enrolled 31 men and 24 women with arterial hypertension (HTN) of 1st degree who were exposed to orthostatic test. After 1 min indices of peripheral hemodynamics and blood levels of metanephrine were assayed, compared with before test values. Likewise, a control series was formed by 31 men and 24 women with HTN which developed orthostatic arterial hypotension. Results: During the test, women showed greater increases in blood pressure indices than men: systolic (15.18 vs 14.32%), diastolic (13.37 vs 12.77%), and mean arterial pressure (14.42 vs 13.46%). In controls these indices decreased in a range of 7.71-17.74% during test. In this regard it is important to underline that heart rate increment was higher in women than men: 18.22% (median 15b/min) vs 14.32% (median 11b/min), while in controls the increase did not exceed 10.51%. Likewise, it is notable the higher level of peripheral vascular resistance enhancement in women compared to men: 22.27% vs 12.79%, despite similar baseline values. In control series increasing rate of this index was negligible (0.9-1.9%). Increase of peripheral vascular resistance during test correlated with conduit arteries compliance fall according to dynamics of elasticity index diminution, which was more considerable in women: 46.81 vs 15.54%. Decrease of small arteries compliance was similar. Metanephrine levels were similar before the test in both series (from 1.88 up to 2.14 nM/L), and increased similarly after it (19.3-21.5%), remaining slightly higher in patients with orthostatic hypertension, and without gender differences. Conclusions: Among patients with arterial hypertension developing orthostatic hypertension women were more receptive, manifested by a higher increase of blood pressure indices, heart rate, peripheral vascular resistance, and a bigger diminution of conduit artery compliance compared to men. Since metanephrine, a marker of sympathetic activity, had a similar elevation level during test like control and showed no gender differences might be suggested the increased adrenergic receptor activity in patients with orthostatic hypertension, particularly in women.