A method for the treatment of primary hypertension
(57) Abstract:The invention relates to medicine, namely cardiology, and can be used for the treatment of primary hypertension. On the background of chronic administration of angiotensin-converting enzyme inhibitor additionally take antioxidant. As an antioxidant accept-tocopherol acetate in three courses over the month. An interval of 4 to 5 months. The method allows to increase the sensitivity to antihypertensive agent. This increases the effectiveness of the treatment. 1 C.p. f-crystals. The invention relates to medicine, namely cardiology, and can be used for the treatment of primary hypertension (PAG).There is a method of treatment of primary hypertension - hypertension (see Zonov About A. Oxygen supply to tissues, microcirculation, lipid peroxidation in patients with essential hypertension and drug correction of the revealed infringements// abstract. Diss. Kida. the honey. Sciences. - Sverdlovsk, 1991 - 20 C.), consisting in a joint application within 3 weeks of the calcium antagonist nifedipine and antioxidants (a-tocopherol acetate, wazikashi - MC, lipid metabolism, the level of lipid peroxidation - FLOOR, increases the sensitivity to antihypertensive drug (nifedipine).The disadvantage of this method is the short time of observation, which does not allow to detect changes of intracardiac hemodynamics.There is a method of treatment of PAG, which contains the application within 3 weeks of angiotensin-converting enzyme inhibitor (ACEI) enalapril in treatment of hypertension (see Maslova, N. P., Lebedev, E. C., Baranov, E. I., Karpov A. P. Influence of treatment Enap on the performance of Central and intracardiac hemodynamics in patients with essential hypertension // Actual problems of modern echocardiography: proceedings of the II International Symposium "Clinical echocardiography" - St. Petersburg, 30-31 may 1996 - S. 61-63). The known method, taken as a prototype, helps to normalize the blood pressure, lower total peripheral vascular resistance.The disadvantage of this method is the lack of significant influence on the performance of intracardiac hemodynamics - ejection fraction (EF), volume and dimensions of the left ventricle (LV).The essence of the invention lies in the fact that simplebrowser enzyme, additionally apply an antioxidant, while taking antioxidant produced on the background of chronic administration of angiotensin-converting enzyme inhibitor in three courses over the month, with an interval between courses of 4-5 months. In addition, as an antioxidant used-tocopherol acetate.Application of the proposed method allows to normalize HELL, the state of the MC, GENDER, improve sensitivity to antihypertensive agent, as well as the results of loading tests improves the portability of sick physical activity, according to echocardiography (EchoCG) improves intracardiac hemodynamics increases ejection fraction and reduces end-diastolic dimension LV, decreases the weight of the myocardium, improves the health of patients at 5-7 days of therapy (reduction in headache, recovery sleep), reduces symptoms of the metabolic syndrome (destabilization of cell membranes, hyperlipidemia, hyperglycemia), reduces the number of complications PAG (hypertensive crises, coronary artery disease, heart rhythm disturbances) and reduces the incidence of hospitalizations of patients.The claimed method is as follows.Patients with primary arterial hypertensia - enalapril maleate (in the first 30 days of observation at a daily dose of 20 to 30 mg, and then in supporting individual doses of 5 - 20 mg), additionally, get therapy, antioxidant (vitamin E) courses for 30 days (courses 4-5 months) in a daily dose of 600 mg.Examples of specific performance.Example 1. Patient A., 48 years old, was admitted to the hospital with a diagnosis of primary hypertension, reasonable shape, moderately progressive course. H II A.Upon receipt bothered pressing pain in the occipital region, insomnia, mood lability, stabbing pain in the heart and shortness of breath on mild exertion. Hypertensive crises to 2-4 times per month.Objectively: the state closer to satisfactory. Moderate cyanosis, redness of the sclera. The vesicular breathing hard. Borders of the heart: left - 1 cm outwards from the mid-clavicle line, right, top - normal. Heart sounds rhythmic, I tone II tone. HELL 180/110 mm RT.article.Lab: lipid peroxidation 276 imp./(N 160), the stability of the membrane (CM) 94 (N more than 120), cholesterol (LDL) 6.2 mmol/l, glucose 6.2 mmol/l, triglycerides (TG) 3.2 mmol/L.Integral rheography of the body (IRGT): stroke volume (PP) 65 ml, the opposition (oops) 4700 dissm-5; Echocardiography: left atrium (PL) 35 mm, end-diastolic dimension LV (CRA) 58 mm, end-diastolic volume (BWW) 195 ml, end-systolic dimension (DAC) 39 mm, end-systolic volume (CSR) 59 ml, ejection fraction (EF) of 69%. Interventricular septum (MoHSP) 11 mm, the thickness of the posterior wall of the left ventricle (TCS) 12 mm Weight infarction (MM) 326 mgAccording to rheoencephalography (REG): enhancement of vascular tone, signs of venous hyperemia, a decrease in the amplitude of pulse blood.The patient received enalapril daily dose of 20 mg for 12 months and a-tocopherol acetate 600 mg per day orally 3 courses for 30 days.After 30 days, noted the absence of headache, recovery sleep, improved mood. The blood pressure has stabilized (up to 140/80 mm RT. Art.), heart rate 76 min Echocardiography: PL=35 mm, LV KDR=57 mm, BWW=185 ml, DAC=38 mm, CSR=55 ml, PV=70%, annuals=11 mm, TCS=12 mm, MM=326 mgAfter 12 months of treatment: AD = 130/80 mm RT. senior Health is satisfactory, crises were noted. Improved sleep. The mood is smooth. Increased efficiency. Almost not bother shortness of breath. Exact: PL=34 mm, LV KDR= 54 mm, BWW=157 ml, DAC=36 mm, CSR=46 ml, PV=70%, annuals=10 mm, TCS=11 mm, MM= 262 mg. IGG: UO= 70 ml, IOC= 4.9 litres/minm2, C=1.9 l/min, oops=2700 di is">REG no specifics.Example 2. Patient B., aged 52, was admitted to the hospital with a diagnosis of primary hypertension, stage II, severe, moderate, progressive course. H II A.Upon receipt bothered severe headaches in the occipital region during the whole day, more in the evening, fatigue, decreased performance, decreased urine output within 3-5 days, and pain in the heart when raising HELL, a disruption of the heart, shortness of breath when walking up to 300 metersObjectively: the state closer to satisfactory. Moderate power, normostenik. Skin warm, mild cyanosis of the lips. The vesicular breathing hard. NPV=21. Borders of the heart: the left is increased by 2 see the Colours of hearts I > II, arrhythmic (up to 2-3 PVCs / min), heart rate of 72 per minute, HELL 210/120 mm RT. Art.The patient is assigned to amlodipine at a dose of 30 mg per day (20 mg in the morning and 10 mg in the evening) and a-tocopherol at a dose of 600 mg per day within 30 days.Tests: complete blood count and complete urine analysis without features, XC 6.2 mmol/l, TG 2.6 mmol/l, glucose of 6.1 mmol/l; FLOOR 312 imp./C; CM 102 C. a Sample of zimnitsky tests without features. Sample Rehberg - reduction of glomerular filtration rate to 87%. Ultrasound of the kidneys - without features.EARTH: SI 1.3 ml/min, PP 65 ml, IOC 4.2 l/minm2.Echocardiography: LV DAC 42 mm, the CRA 59 mm, CSR 74 ml, MLC 205 ml, PHI 63%, annuals 10 mm, TCS 12 mm, MM 325 mg Radiography of the chest: an increase in LV. Signs of stagnation in a small circle.After 30 days of therapy being improved, headaches, worry less, improved mood, recovered diuresis. Almost no pain in her heart, no interruptions. Increased tolerance to physical loads.Objectively: the patient is in satisfactory condition. Remains easy cyanosis of the lips. The vesicular breathing, without adverse respiratory noise. NPV 18 in minutes heart sounds rhythmic, I > II, 72 HR, min, BP 150/90 mm RT. senior Analyses without changes.After 12 months of treatment with enalapril and again in 4-5 months, courses-tocopherol being satisfactory. Objective: HELL 140/80 mm RT. senior HR 70 minutes Tests: complete blood count and urine without features, XC 5.3 mmol/l, triglycerides 1.7 mmol/l, glucose of 5.4 mmol/l, FLOOR 154 imp. /sec. CM 217 S. Microcirculation: decreased effects of perivascular edema and spasm of the arterioles.REG: remain signs of venous hyperemia.
the primary arterial hypertension, include the use of angiotensin-converting enzyme inhibitor, characterized in that it further apply an antioxidant, while taking antioxidant produced on the background of chronic administration of angiotensin-converting enzyme inhibitor in three courses over the month, with an interval between courses of 4-5 months.2. The method according to p. 1, characterized in that the antioxidant is used-tocopherol acetate.
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