Treatment method for primary hypertension patients

FIELD: medicine, cardiology.

SUBSTANCE: to treat primary hypertension patients, than November March and July to August periods, balneo- and EHF-therapy are conducted daily, according to schedule as follows: from 11 to 15 o'clock, EHF procedures; from 14 to 16 o'clock, balneotherapy. Than April to June and September to October periods, balneotherapy and self-control energoneuroadaptive electrostimulation (SCENAR-therapy) are conducted from 9 to 11 o'clock, with high amplitude pulse bipolar current and biological feedback, 60 Hz frequency; procedure duration being 20 to 25 minutes. Exposure is conducted daily on collar area by gradual current increase until distinct painless vibration under the electrode is occurred; the technique being labile, course includes 10 procedures. EHF exposure is conducted on corporal biologically active spots by electromagnetic radiation with 60.9-61.3 GHz frequency, as follows: VC-17, E-36 (double), TR-5 (double), VG-20; exposition time being 3 to 5 minutes on each spot, total procedure duration 20 to 30 minutes, time from 11 to 15 o'clock, course includes 10 procedures. General iodide-bromine bath of concentration 20 g/l, temperature 36-37°C, during 10 minutes, are taken every other day from 14 to 16 o'clock, course includes 10 procedures.

EFFECT: vegetative regulation and myocardium diastolic function improvement, organism adaptive potential increase, hypotensive effect strengthening.

2 tbl, 2 ex

The invention relates to medicine, namely to physiotherapy and balneology.

There is a method of treatment of hypertensive patients with iodine-bromine baths [1]. The disadvantage of this method is the lack of a graded assignment iodide-bromine baths, depending on the time of day and season of the year, excluding periods of maximum and minimum blood pressure that without appropriate correction can lead to excessive activation of the production of thyroxine and triiodothyronine in certain seasons of the year and can neutralize the anti-hypertensive effect of iodine-bromine baths.

There is a method of treatment of hypertensive patients with electromagnetic radiation of millimeter range (UHF-therapy) from the "True" background drug treatment [2]. The disadvantage of this method is the absence of temporal differentiation prescribed procedures during the day and the year, which can lead in some cases to excessive reduction of blood pressure, in other cases insufficient hypotensive effect.

There is a method of treatment of hypertension with the use of electro-therapy on cervical sympathetic ganglia, in the medical complex includes physical exercise on the Bicycle Ergometer and psychoeducational therapy using devices bio is logicheskie feedback biofeedback PI [3]. The disadvantages of the method include limiting the application of the method only for patients with mild arterial hypertension with hypersympathicotonia, the need for a hospital procedure and devices, biological feedback, which leads to higher treatment in General. In addition, the purpose of treatment by this method does not take into account seasonal differences in severity gipersimpatikotonia in patients with hypertension that can lead to failure of adaptation and autonomic regulation, resulting in increased blood pressure in patients with cardiac profile.

New technical problem - increasing the effectiveness of rehabilitation treatment of patients with essential hypertension by improving vegetative regulation, diastolic function of the myocardium, increasing the adaptive capacity of the body and enhance the hypotensive effect of treatment in reducing the number of complications by conducting adapted to seasonal changes of the functional state of an organism of complex visiblerect with the inclusion of EHF and SCENAR-therapy.

To solve the problem in the treatment of patients with essential hypertension by conducting complex balneotherapy and physiotherapy in the period from November to March and July to August spend balneo - and EHF-therapy in the trail of the overall sequence during the day: from 11.00 to 15.00 procedures of EHF-therapy, from 14.00 to 16.00 balneotherapy; the treatment in the period from April to June and September to October are balneotherapy and self controlled Energo neuro adaptive electrical stimulation (SCENAR-therapy)appointed from 9.00 to 11.00 hours, high amplitude pulsed bipolar current with biologically feedback frequency 60 Hz when the duration of the procedure 20-25 minutes, exposure is performed on the collar area and gradually increase the current until a clear painless vibration under the electrode labile technique daily for a course of 10 treatments; EHF-influence conduct on corporal biologically active points of the electromagnetic radiation frequency 60,9-61,3 GHz in the following sequence: VC-17, E-36 (paired), TR-5 (pair), VG-20 exposure duration on one biologically active point 3-5 minutes, the total treatment time is 20-30 minutes from 11.00 to 15.00 hours on a course of 10 treatments; total bromine baths concentration of 20 g/l, temperature of 36-37°duration 10 minutes to carry through the day from 14.00 to 16.00 hours on a course of 10 treatments.

Use in the inventive method, iodide-bromine baths due to their pronounced inhibitory effect on the Central and autonomic nervous system at all levels of its regulation, normalization of lipid metabolism, decreased activity of sympathoadrenal system when normalize the AI of the thyroid gland and the clinical and hemodynamic characteristics gipersimpatikotonia in patients with cardiac profile.

Inclusion in the medical complex short-wave radiation is based on the known properties of this physical factor to increase nonspecific resistance of the organism to various factors chemical, physical and biological nature, to normalize the pathological reactivity of the autonomic nervous system, activate antiradical system of the body and reduce the intensity of the processes of lipoperoxidation in patients with essential hypertension. Selection of biologically active points-based recommendations for the treatment of arterial hypertension with the purpose of correction of autonomic imbalance, normalize the function of kidney and heart [4].

The duration of the course of EHF-therapy in 8-10 procedures determined by the efficiency of treatment of patients. Decreasing the duration of the course of treatment effectiveness was decreased, and if it gets not increased.

Self controlled Energo neuro adaptive electrical stimulation (SCENAR-therapy) in the claimed method is prescribed for the correction of autonomic imbalance and gipersimpatikotonia, normalization of lipid peroxidation and antioxidant protection, increased General nonspecific reactivity and adaptation capabilities of the organism. The purpose of neuroadaptive of electrical stimulation in the period from April to June and from September to October, due to the fact that in these months the city is Yes according to our data is excessive activation of the sympathetic division of the autonomic nervous system and the deterioration processes of the temporal adaptation of the hormonal status in the form of increased glucocorticoid function adrenal glands (secretion of 17-ACS) and thyroid hormones [5, 6], and SCENAR-therapy helps to normalize adaptive capacity, reduced activity of the sympathoadrenal system and the level of processes of lipid peroxidation [7, 8].

Traditionally balneological treatment is carried out through the day, which improves tolerability in comparison with daily vacation procedures. Temperature and exposure time iodide-bromine baths, selected in accordance with the range that is most preferred in cardiology practice.

The duration of treatment is determined based on the data that the improvement of clinical symptoms in balneotherapy comes after 5-7 procedures. Therefore, the lower limit of the duration of treatment was 8 procedures. On 11-12 procedures has increased sympatho-adrenal activity, an increase in the frequency asteno vegetative disorders that have defined the limit of the course of treatment 10 treatments.

The time of the procedure, peloid - and balneotherapy selected based oxalosuccinic biorhythms activity of sympathoadrenal system in patients with cardiac profile. The morning hours are the recovery phase functions homeostatic systems, the prevalence of processes of excitation. Physiotherapy (UHF - and SCENAR-therapy) is administered in the morning to stimulate the exchange of the s process, aimed at the correction of lipid metabolism, reduced lipoperoxidative, increase adaptive capacity, increased hypotensive effect of treatment by reducing gipersimpatikotonia. In the afternoon there is a growth of inhibitory processes in the Central and autonomic nervous systems, the purpose of balneotherapy at this time enhances the hypotensive effect of treatment due to correction of increased activity of the hypothalamic-pituitary-adrenal system.

Example 1. Patient, 41 years of age, medical history, No. 895, arrived for treatment in rehabilitation therapy Department of the Tomsk scientific research Institute of balneology and physiotherapy 06.04.2007 with a diagnosis of Hypertension, stage II, the degree of arterial hypertension 2 risk 3. Dyslipoproteinemia. Triglyceridemia. Accompanying diseases: osteochondrosis of the cervical and thoracic spine, the stage of remission. Upon receipt complained of increased blood pressure to 150/90 mm Hg, pain in the heart stabbing character, not related to physical activity, intractable nitroglycerin that occur after emotional stress, palpitations, shortness of breath during physical activity, povyshennuyu fatigue, weakness, irritability, headaches, dizziness.

From the anamnesis: the first enhancement artery the high pressure and pain in the heart area appeared about 5 years ago after stressful situations in the family. Increased blood pressure periodically, the maximum level of hypertension 170/100 mm Hg Objective status: Overall condition is satisfactory. The skin and mucous clean skin moisture increased. Lymph nodes are not enlarged. Heart sounds clean, rhythmic accent of II tone of the aorta, heart rate 78 per minute. HELL when entering 150/90 mm Hg vesicular Breathing, rales in the lungs is not heard. The abdomen is soft, painless on palpation.

Blood biochemical parameters before treatment: total lipids 8.6 g/l (at a rate of up to 8 g/l), total cholesterol 5,79 mmol/l (normal up to 5.17 mmol/l), cholesterol-high-density lipoprotein 1.01 mmol/l (at a rate of more than 1.0 mmol/l in men), cholesterol-low-density lipoprotein 2,53 mmol/l (normal up to 3.0 mmol/l), cholesterol-lipoprotein very low density of 1.95 mmol/l (normal up to 0,49 mmol/l), atherogenic index 4,7 (at a rate of up to 3.0), catalase 35.9 ákat/l (normal 16-30 µkat/l)ceruloplasmin 429 mg/l (at a rate of up to 400 mg/l), malonic dialdehyde 2.7 mmol/l (normal up to 3.6 mmol/l). Adaptive response measured as the calm reaction of activation of high level of reactivity (the number of lymphocytes 38% at a rate of up to 40%). Tolerance to physical load method of Bicycle ergometry average is 100 W, the index of profitability 2,85 $ PV according to Echocardiography 73% (at burrows is e 60% and above), DAC 2,7 (at a rate of up to 3.5 cm), the CRA 4,7 (at a rate of up to 5.0 cm), the ratio of the velocity of early filling of the left ventricle to the velocity of late filling of the left ventricle to 0.72 $ (at a rate above $ 1,0) - impaired diastolic function of the left ventricle. When conducting kardiointervalografii identified hypersympathicotonia as initial autonomic tone (norm - atonia or sympathicotonia).

The treatment was carried out in accordance with the claimed method. From the first day of stay in hospital was administered SCENAR-therapy 9.00 to 11.00 hours, high amplitude pulsed bipolar current with biologically feedback (automatic shut-off at the equation level of impedance inside the device and in the skin), frequency 60 Hz, the duration of the procedure 20-25 minutes, exposure is performed on the collar area (with a gradual increase current until a clear painless vibration under the electrode) labile technique daily for a course of 10 treatments; total bromine baths concentration of 20 g/l, temperature 36°duration 10 minutes through the day appointed in the afternoon (14.00), a course of 10 treatments. Treatment the patient endured well. Clinical manifestations of baldereschi were not recorded. Sharp fluctuations in autonomic indices characterizing autonomic tone and reactivity, not identified. After l the treatment by the present method in a patient with headaches disappeared, false angina, palpitations, decreased significantly emotional disorders. Normalization of the level of ceruloplasmin to 340 mg/l in Blood pressure after treatment decreased from 150/90 to 120/70 mm Hg exercise Tolerance increased to 130 watts of power with a reduced need of oxygen (index efficiency decreased to 2.7 USD). Normalized ratio of early and late filling of the left ventricle from 0.72 to 1.21 $ (the norm than 1.0 USD). While there was an improvement in the lipid spectrum of blood: the concentration of total lipids decreased to 6.2 g/l, total cholesterol of 5.6 mmol/l, cholesterol-high density lipoprotein increased to 1.72 mmol/l, cholesterol-low-density lipoprotein concentrations remained within normal limits - 3.03 mmol/l, the concentration of atherogenic fractions of cholesterol-lipoprotein very low density decreased to 0.84 mmol/l, the atherogenic index decreased to 2.27 (at a rate of up to 3.0). Autonomic tone after treatment - sympathicotonia. The immediate results of the treatment is generally assessed as a significant improvement.

Example 2. Patient M, 50, case history No. 1968, was admitted for treatment in the rehabilitation therapy Department of the Tomsk scientific research Institute of balneology and physiotherapy 19.07.2004 with a diagnosis of Hypertension, stage I, the degree of arterial hypertension 1, risk 2. DISL aprotinine. Comorbidities: Varicose veins of lower extremities, stage of compensation. Upon receipt complained of increased blood pressure to 150/90 mm Hg, pain in the heart stabbing character, not related to physical activity, intractable nitroglycerin that occur after emotional stress, palpitations, shortness of breath on exertion, fatigue, weakness, irritability, headaches, dizziness.

From the anamnesis: the first increase in blood pressure and pain in the heart area appeared about 2 years ago. Increased blood pressure is constant, the maximum level of hypertension 155/95 mm Hg Objective status: high power growth 188, weight 97 kg General condition is satisfactory. The skin and mucous net, the moisture of the skin is normal. Lymph nodes are not enlarged. Heart sounds clean, rhythmic accent of II tone of the aorta, the heart rate of 87 per minute. HELL when entering 150/90 mm Hg vesicular Breathing, rales in the lungs is not heard. The abdomen is soft, painless on palpation.

Blood biochemical parameters before treatment: the total lipids of 6.9 g/l (at a rate of up to 8 g/l), total cholesterol 5.46 mmol/l (normal up to 5.17 mmol/l), cholesterol-high-density lipoprotein 1.06 mmol/l (at a rate above 10 men), cholesterol-low-density lipoprotein 3,74 mmol/l (normal up to 2.2 mmol/l), atherogenic index of 4.2 (at a rate of up to 3.0), catalase 17.3 ákat/l (normal 16-30 µkat/l)ceruloplasmin 400 mg/l (at a rate of up to 400 mg/l), malonic dialdehyde 2.9 mmol/l (normal up to 3.6 mmol/l). Adaptive response measured as the reaction preactivate low level of reactivity (the number of lymphocytes 42% at a rate of up to 40%). Tolerance to physical load method of Bicycle ergometry high - 160 W, the index of profitability 2,01 $ PV according to Echocardiography 64% (at a rate of between 60% and above), sex workers 3,6 (at a rate of up to 3.5 cm), the CRA 5,7 (at a rate of up to 5.0 cm) - impaired diastolic function of the left ventricle.

The treatment was carried out in accordance with the claimed method. From the first day of stay in hospital was administered EHF-therapy on corporal biologically active points frequency 60,9-61,3 GHz in the following sequence: VC-17, E-36 (paired), TR-5 (pair), VG-20, the exposure duration for one biologically active point 3-5 minutes, the total treatment time is 20-30 minutes from 11.00 to 15.00 hours on a course of 10 treatments, total bromine baths concentration of 20 g/l, temperature 36°duration 10 minutes, appointed a day in the afternoon (15.00), in the course of 10 treatments. Treatment the patient endured well. Clinical manifestations of baldereschi were not recorded. After treatment by the present with the person in a patient with decreased frequency and severity of cardialgia and emotional disorders. Normalization of the level of ceruloplasmin to 357 mg/l in Blood pressure after treatment decreased from 155/95 to 134/81 mm Hg Tolerance to physical activity remained at a high level (160 watts) while reducing the need of oxygen (efficiency index of 1.76 USD). Increased myocardial contractility, which is reflected in the increase in PV from 64 to 68%, the decrease in DAC to 3.5 cm, reducing the CRA to 5.6 see there was observed a tendency to normalization of blood lipid spectrum: the concentration of total lipids 6.5 g/l, total cholesterol, 5.43 mmol/l, cholesterol-high density lipoprotein 1,09 mmol/l, cholesterol-low density lipoprotein of 3.69 mmol/l, the index of atherogenic 3,98 (at a rate of up to 3.0). The immediate results of the treatment is generally assessed as an improvement.

For the first time a method for complex balneophysiotherapy patients with essential hypertension, with balneotherapy and physiotherapy is carried out in well-defined time of day and seasons of the year.

Treatment by the present method received 62 patients in the periods from April to June and from September to October, 92 patients in the periods from July to August and from December to March. The control group consisted of 38 patients treated in the same periods of the year medical complex non-seasonally functioning of the body and without correction by SCENAR-therapy. The middle is th age of patients was 50,8± 6,88 years, mean disease duration being 9.61±2,22 years. Verification of diagnosis GB was carried out on the basis of anamnesis, the daily monitoring of HELL, echocardiography according to who recommendations. Criteria of efficiency of treatment were as follows: decrease in average AD, increase physical performance level of tolerance to physical activity (TFN), correction of violations of anti-oxidant protection, improved lipid profile, improved autonomic regulation of the cardiovascular system.

In the periods April-June and September-October the sick GB was appointed medical complex, including SCENAR-therapy. Dynamics of clinical manifestations of the disease in group I (treatment by the proposed method) and II (treatment without SCENAR-therapy) were not significant intergroup differences, and the incidence of complaints about false angina, headaches, and emotional disorders decreased 6-8 times in both groups. The hypotensive effect of the treatment by the proposed method and without SCENAR-therapy according to the office BP measurement method Korotkov was more pronounced in the group with SCENAR-therapy: reducing GARDEN with 163,6±31,1 to 131, 5mm±11,04 mm Hg (p<0,0001) in the main group and 151,5±18.2 to 127,8±10,18 mm Hg (p<0,0001) in the control group, DBP - 101,5±17,09 to 82.2±rate of 7.54 mm Hg (p<0,0001) and 94,6±11,48 to 81,± 6,38 mm Hg (p<0,0001), respectively. According to the daily monitoring of HELL had significant inter-group differences in favour of treatment by the proposed method by reducing the average GARDEN, the average dad in the daytime and at night. Showed normalization of circadian rhythms in blood pressure in the form of increase in the daily index of the GARDEN from 7.7±2.98 to 13,57±3,31 mm Hg (p=0.03) and diastolic from 9.9±6,38 to 12,38±2,99 mm Hg, testified to the growing number of patients with normal type daily curve AD (dipper) by 36%. With treatment without SCENAR-therapy in this period, there has been a trend towards improvement in Smad, not confirmed statistically.

Treatment with SCENAR-therapy led to complete relief of unstable reactions preactivation and stress, and improving the frequency response training as the most cost-effective in terms of usage of energy resources of the organism. The data presented in the table 1 Distribution of patients by types of adaptive responses and the level of reactivity in the spring and fall seasons (in%), where here and below in tables * - significance of differences in group p<0,05; ** - significance of differences in group p<0,01; ^ - significance of differences between groups. The level of non-specific reactivity in this group increased by 43% (in the control GRU is PE only 23%). More important was the positive influence of SCENAR-therapy on the system status of lipid peroxidation and antioxidant protection. The frequency of elevated values of ceruloplasmin, reflecting the voltage of the antioxidant system, was decreased in the study group by 50%in the control 17.6% in the normalization of the original modified averages with 418,7±18.7 to 315,5±31,07 mg/l (p=0,0038) in the main group and 443,3±8,72 to 401,1±12,3 mg/l (p=0.04) in the control group. SCENAR-therapy contributed surplus activity lipoperoxidative determined by the level of MDA, 33.3%, whereas in the control group of patients treated without seasonal and diurnal correction procedures, the incidence of elevated values of MDA was not changed (15,8%). The mean values of MDA after treatment significantly normalized in both groups. When evaluating indices of systolic and diastolic function of the myocardium according to the ejection fraction (EF), end-systolic (DAC) and diastolic (CRA) the size of the heart revealed that SCENAR-therapy contributed to significant improvement of myocardial contractility (EF increase from 60,7±3,83% to 67.8±to 4.41%, p=0.04). However, only in the group of SCENAR-therapy, there was an improvement in diastolic function (decrease in DAC with 3,17±0.33 to 3,09±and 0.61 cm (p=0.01), the CRA with 5,01±0,42 to 4.71±0,41 cm (p=0.001), increased with the relationship of speed transmitral blood flow with 0,78± 0.01 to 1,21± $ 0,021 (p=0.002). In the control group dynamics of indices of systolic and diastolic myocardial function was invalid.

Data on tolerability and clinical efficacy of the treatment by the present method and in the control group are presented in table 2, "Clinical efficacy", from which it follows that the quality of treatment by the present method is higher than in the control group without taking into account seasonal and daily biorhythms of the body functioning with hypertension.

Thus, the application of the proposed method increases the effectiveness of rehabilitation treatment of patients with essential hypertension by improving vegetative regulation, diastolic function of the myocardium, increasing the adaptive capacity of the body and enhance the hypotensive effect of treatment in reducing the number of complications was well tolerated.

Sources of information

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A method of treating hypertensive patients by conducting complex balneotherapy and physiotherapy, characterized in that during the period from November to m the RT and July and August are conducted balneo - and EHF-therapy in the following sequence during the day: from 11.00 to 15.00 procedures of EHF-therapy, from 14.00 to 16.00 balneotherapy; the treatment in the period from April to June and September to October are balneotherapy and self controlled Energo neuro adaptive electrical stimulation (SCENAR-therapy)appointed from 9.00 to 11.00, high amplitude pulsed bipolar current with biologically feedback, frequency 60 Hz, the duration of the procedure 20-25 min, the impact of the conduct on the collar area and gradually increase the current until a clear painless vibration under the electrode, labile methodology, daily, for a course of 10 treatments; EHF-influence conduct on corporal biologically active points of the electromagnetic radiation frequency 60,9-61,3 GHz in the following sequence: VC-17, E-36 (paired), TR-5 (pair), VG-20, the exposure duration for one biologically active point 3-5 min, the total treatment time 20-30 min, from 11.00 to 15.00 h, in the course of 10 treatments; total bromine baths concentration of 20 g/l, temperature of 36-37°duration 10 minutes, spend a day from 14.00 to 16.00 h, in the course of 10 treatments.