Method for normalising functional reactivity of cardiovascular system among patients suffering from arterial hypertension at stage of recovery form cerebral circulation disorder without pareses or paralyses

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology, and concerns normalisation of cardiovascular system (CVS) functional reactivity among patients suffering from arterial hypertension at the stage of recovery form cerebral circulation disorder without pareses or paralyses. To that end, the state of CVS functional reactivity at psychoemotional stress is assessed by recording systolic, diastolic and average dynamic blood pressure. These data serve as the basis for determining functional reactivity index (FRI) prior to and after the stress, according to the following formula: FRI = (BP av.dyn. × heat rate)100 (conv. un.). If FRI value after stress rises by more than 20 conventional units, telmisartan and labetalole are administered in doses of 40 mg per day and 200 mg twice a day respectively.

EFFECT: method normalises functional reactivity of cardiovascular system and increases tolerance to psychoemotional stresses at the specified group of patients during a 2 month course of therapy.

2 ex

 

The invention relates to medicine, namely cardiology, and can be used in therapeutic departments of clinics and hospitals. Analogues of the method of normalization of the functional reactivity of the cardiovascular system during the recovery phase in patients with arterial hypertension after suffering a cerebral circulation without paresis and paralysis does not exist.

The aim of the invention is to increase the efficiency of correction of the functional reactivity of the cardiovascular system during the recovery phase in patients with arterial hypertension after suffering a cerebral circulation without paresis and paralysis.

The essence of the proposed method of correction of the functional activity of the cardiovascular system is to increase the tolerance in the recovery phase in patients with arterial hypertension after suffering a cerebral circulation without paresis and paralysis to emotional stress and increase functional reactivity of cardiac-vascular system in the execution of their metered emotional load and reducing the risk of cardiovascular complications during emotional stress, measured after holding dosed emotional load with the ever increasing pace at t the value of 18-20 minutes with every minute registration parameters of Central hemodynamics: arterial systolic pressure (SBP), blood pressure diastolic (Add), arterial pressure medium dynamic (Addren) and heart rate (HR), determine the value of the functional reactivity (FIU), which is the work of the AD medium dynamic on heart rate, calculate the relative increment values FIU when performing load compared with the value at rest and largest values FIU assess the type of functional reactivity of the cardiovascular system: when the FIU is more than 20 usled reactivity assessed as hyperfunctional, when FIU is less than 10 usled response to the load estimate as Hypo-functional and, when values of the FIU from 10 to 20 used type functional reactivity assessed as normal. Time psychoemotional load no more than 20 minutes. For normalization of the functional indicator of reactivity in the recovery phase in patients with arterial hypertension after suffering a cerebral circulation without paresis and paralysis applies a combination of telmisartan and labetalola for at least 2 months.

The inventive method is carried out as follows. The value of the FIU is determined by Lebedeva OD, Radziejewski S.A., Bugaeva S.A. Method of assessment of the functional reactivity of the cardiovascular is istemi. EN 2207044. The patient is seated in front of the screen. The patient on the left shoulder impose cuff for measuring blood pressure systolic blood pressure diastolic arterial pressure medium dynamic and heart rate prior to loading and during loading. The patient offer two sets of 4 letters: 'ÀNEU and BLOG, of which he must choose to remember one. After registration of the hemodynamic parameters within 3 minutes and the memory (30) of the selected set of letters begin conducting psycho-emotional loads, namely, that the subject pressing notes scattered letters from the selected set of progress on the monitor screen square frames situated in a random sequence the letters of the alphabet. The speed of advancement of the frames in the series of letters in the process of conducting samples increases with 3 letters 1 at the beginning of the load up to 6 letters 1, starting from 6 min load, and this provides a gradual vrabatavaemomu patient. Errors in elevation of letters from a selected set of auditory signals, for which the subject may be oriented in the proper execution of the load and try to adjust its execution. After the load calculates the average value of the BPA, Add, Map. Dean. and heart rate in the periods before the Naga is narrow and during load. HELL the average dynamic calculated by the formula: HELL srcin=Add+[0,42(SBP-Add)].

HELL the average dynamic is a complex resultant of all variables HELL. The test with emotional stress in healthy individuals the HELL the average dynamic changes slightly, and the heart rate usually increases. According to studies, increased heart rate and HELL leads to increased demand of oxygen and increase its energy costs. In pathology, for example, when AG vessels in a state of spasm, unable to provide the required increased amount of oxygen, which can increase hypoxia, incoming cerebral circulation, develop angina, etc.

On the basis of the data used to calculate the functional reactivity, which allows an integrative measure of the increase in hemodynamic load on the heart and, consequently, the risk of developing cardiovascular complications, defined as follows:

FIU=(Adsin·HR)/100 (used).

The increment values FIU during the transition from rest to execution of the load determines the index:

FIU=PFR-PFR,

where the FIU is the dierence between the values of the FIU before and during loading

PFR - averaged value of the index before load

PFR - average value of indicators is when I load.

The relative increment values FIU assess the type of functional reactivity of the cardiovascular system.

When you study in the dynamics of treatment the patient was given to remember a different set of letters in order to prevent addiction.

When the increment values after conducting dosed emotional load FIU from 10 to 20 usled functional type of reactivity is assessed as normal. When the FIU to load more than 20 usled the patient during the recovery phase in patients with arterial hypertension after suffering a cerebral circulation without paresis and paralyses you must assign at least 2 months in a combination of telmisartan 40 mg in the morning of 1 times and labetalola 200 mg 2 times a day.

Timely and effective correction of the FIU during the recovery phase in patients with arterial hypertension after suffering a cerebral circulation without paresis and paralysis of will in a short period of time to normalize the functional reactivity of the cardiovascular system that will reduce these patients the period of temporary disability, renders prophylactic action against strokes and heart attacks, reduce the number of outputs on disability and reduce mortality among patients in the recovery phase in patients with arterial hypertension after suffering a drug is deprivation of cerebral circulation without paresis and paralysis.

Example 1. Examined patient S., 51 years old, suffering from hypertension grade II-III stage H0. Suffered acute focal ischemic stroke in the basin of the middle cerebral artery without paralysis a week ago. In the study of hemodynamics in the initial state before the holding of the psychic activities of the Association amounted to 136 mm Hg, Add - on 90 mm Hg, Map. Dean to 109.3 mm Hg, heart rate of 80 beats per 1 minute FIU before psychoemotional load was equal (8744)/100=87,4 used When conducting psycho-emotional loads BPA increased to 168 mm Hg, Add - 102 mm Hg, Map. Dean to 128.6 mm Hg, heart rate of 96 beats per 1 minute, the FIU is increased to (12860)/100=of 128.6 used, i.e. the increment PPV on the load or what is the same - FIU, was 41.2 used (87,4 used to 128.6 used), which can be considered as a manifestation of hyperthyroidism cardiovascular system. The patient is assigned to a combination of telmisartan 40 mg in the morning and labetalol 200 mg in the morning and evening. After 2 months of treatment, the magnitude of the FIU fell before the load compared to the same before the treatment: the BPA - up to 127 mm Hg, Add - up to 80 mm Hg, Map. DIN - up to 99.7 mm Hg, heart rate up to 66 beats per 1 minute, FIU - to 65.8 used When performing load marked decrease compared with the condition before treatment the increase in value of the BPA - up to 143 mm Hg, Add - up to 88 mm Hg, Map. DIN - up 111,1 mm Hg, heart rate 76 beats per 1 minute, FIU - to 84.4 c.u, that is, the observed increment values FIU, or FIU, 18.6 used (before treatment - 41.2 used), which may be indicative of increased tolerance of the cardiovascular system to psycho-emotional stress, about the reduction of hyperthyroidism cardiovascular system and, consequently, about the economization of cardiac activity.

Example 2. Examined patient G., aged 45, who suffers from hypertension III stage, III phase, HI. Suffered an acute ischemic stroke in the basin of the middle cerebral artery without paresis 9 days ago. In the study of hemodynamics in the initial state before the holding of the psychic activities of the Association amounted to 159 mm Hg, Add - 107 mm Hg, Map. Dean of 128.8 mm Hg, heart rate of 98 beats per 1 minute FIU before psychoemotional load was equal (12626)/100=126,3 used When conducting psycho-emotional loads BPA increased to 188 mm Hg, the Add - on 110 mm Hg, Map. Dean to 142,7 mm Hg, heart rate of 110 beats per 1 minute, the FIU is increased to (15697)/100=156,9 used, i.e. the increment PPV on the load or what is the same - FIU, totaled 30.6 used (126,3 used to 156,9 used), which can be considered as a manifestation of hyperthyroidism cardiovascular system. The patient is assigned to a combination of telmisartan 40 mg in the morning and labetalola 200 mg in the morning and evening. After 2 months of treatment, the magnitude of the FIU fell before the load compared to the same prior treatment what s: Dt - to 146 mm Hg, Add - up to 90 mm Hg, Map. DIN - up 113,5 mm Hg, heart rate is 72 beats per minute, FIU - up 81,7 used When performing load marked decrease compared with the condition before treatment the increase in value of the BPA - up to 150 mm Hg, Add - up to 96 mm Hg, Map. DIN - up 118,6 mm Hg, heart rate of 80 beats per 1 minute, the FIU to 94.8 used, that is marked increment values FIU, or FIU, 13.1 used (before treatment by 30.6 used), which may be indicative of increased tolerance of the cardiovascular system to psycho-emotional stress, about the reduction of hyperthyroidism cardiovascular system and, consequently, about the economization of cardiac activity.

As a result of application of the proposed method of correction of functional reactivity of the cardiovascular system in hypertensive patients after suffering a cerebral circulation without paresis and paralysis is achieved normalization of the functional reactivity of the cardiovascular system for dosed psycho-emotional stress, which allows you to use the way for the normalization of the tolerance of patients with arterial hypertension after suffering a cerebral circulation without paresis and paralysis to psycho-emotional stress, which can reduce the degree of hemodynamic load when exposed to stress, reducing the risk of the development in the psycho-emotional loads adverse vascular events (myocardial infarction, repeated violations of cerebral circulation, and others).

The method of normalization of the functional reactivity of the cardiovascular system (CVS) in patients with arterial hypertension in the recovery stage after suffering a cerebral circulation without paresis and paralysis, including assessment of functional reactivity SSS during emotional load, which record systolic, diastolic, srednetehnicheskoe pressure, based on these data, determine the rate of functional reactivity (FIU) before and after exercise, using the formula: FIU=(Adsin.×HR)/100 (used), and with increasing values FIU after load of more than 20 usled enter telmisartan dose of 40 mg per day and labetalol dose of 200 mg 2 times a day for at least 2 months.



 

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