Method of optimising functional reactivity of cardio-vascular system in case of crisis course of arterial hypertension with disturbance of glucose tolerance

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology, and deals with normalisation of functional reactivity of cardio-vascular system (CVS) in case of crisis course of arterial hypertension with disturbance of glucose tolerance. For this purpose estimation of CVS functional reactivity state under psychoemotional load is carried out by registration of systolic diastolic everage dynamic pressure (APav.dyn.) and heart rate (HR). On the basis of obtained data functional reactivity index (FRI) is determined before and after load, using the formula: FRI= APav.dyn.x HR)100 (conv. units). If FRI value after load increases on more than 20 conv.units, treatment including irbersartan 150 mg in the morning 1 time and lacidipine 4 mg in the morning 1 time during not less than 2 months.

EFFECT: such complex of medicamentary therapy in combination with empirically selected treatment duration ensures normalisation of CVS functional reactivity in said group of patients due to potentiation of therapeutic effect of applied medications.

1 ex

 

The invention relates to medicine, 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 when krizova for arterial hypertension (AH) with impaired glucose tolerance (IGT) does not exist.

The aim of the invention is to increase the efficiency of correction of the functional reactivity of the cardiovascular system when krizova for hypertension and IGT.

The essence of the proposed method of correction of the functional activity of the cardiovascular system is to increase the tolerance of patients with crisovan over AG and IGT to emotional stress and increase the functional reactivity of the cardiovascular 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 speed for 18-20 minutes with every minute registration parameters of Central hemodynamics: arterial systolic pressure (SBP), diastolic blood pressure (Add), arterial pressure medium dynamic (Adsin.) and heart rate reducing the deposits (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 (with AG), the FIU is less than 10 usled response to the load estimate as Hypo-functional and, when values of the FIU from 10 to 20 usled type functional reactivity assessed as normal. Time psychoemotional load no more than 20 minutes. To normalize the indicator functional reactivity in patients with crisovan over arterial hypertension with IGT uses a combination of irbesartan and lacidipine 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 system 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, Arte the territorial 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, ADC, Adsin. and heart rate in the periods: prior to loading and during loading. HELL the average dynamic calculated by the formula: Adsin. = 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 SS, as a rule, 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 krizova for AG with IGT, the vessels in a state of spasm, unable to provide the required increased amount of oxygen, which can increase hypoxia, incoming cerebral circulation, 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, accordingly, 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 - averaged value of the index under load.

The relative increment values FIU assess the type of functional reactivity of the cardiovascular system: if the value is *, then divide by 100 to obtain conventional units (used - the double digits).

When you study in the dynamics of treatment ill the mu give to remember another 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 type functional reactivity assessed as hyperfunctional. In this case, a patient with crisovan over AG with IGT, you must assign at least 2 months in a combination of irbesartan 150 mg in the morning of 1 times and lacidipine 4 mg in the morning 1 times.

Timely and effective correction of the FIU in patients with crisovan over AG with IGT will allow in the short term 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 with hypertension with crisovan over and IGT.

Example. Examined patient A., 46 years old, suffering from crisovan over AG with IGT 8 years. In the study of hemodynamics in the initial state before the holding of the psychic activities of the Association amounted to 142 mm RT. Art., Add - 92 mm RT. Art., Adsin. - 113 mm RT. Art., heart rate 76 beats per 1 minute FIU before psychoemotional load was equal (8588)/100 - 85,8 used When conducting psycho-emotional loads BPA increased to 172 mm RT. Art., Add - 106 mm RT. Art., Adsin. to 133,7 mm RT. senior HR up to 92 beats per 1 minute, the value of P Is P increased to (12300)/100=123 used, that is, the increment PPV on the load or what is the same - FIU, amounted to 37.2 used (85,8 used to 123 used), which can be considered as a manifestation of hyperthyroidism cardiovascular system. Patient assigned to the combination of irbesartan 150 mg in the morning and lacidipine 4 mg in the morning. 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 134 mm RT. Art., Add up to 83 mm RT. Art., Adsin. to 104,4 mm RT. senior HR up to 64 beats per 1 minute, FIU - to 66.8 used When performing load marked decrease compared with the condition before treatment the increase in values of SBP 140 mm RT. Art., ADC - up to 89 mm RT. Art., Adsin. - up to 110 mm RT. Art., heart rate 76 beats per 1 minute, FIU - to 83.9 used, that is marked increment values FIU, or FIU, 17.1 used (before treatment - 37.2 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.

As a result of application of the proposed method of correction of functional reactivity of the cardiovascular system in patients with crisovan over arterial hypertension with IGT is achieved normalization of the functional reactivity of the cardiovascular system for dosed emotional load is, that allows you to use the way for the normalization of the tolerance of patients with crisovan over AG with IGT to psycho-emotional stress, which can reduce the degree of hemodynamic load when exposed to stress, reducing the risk of development of psycho-emotional loads adverse cardiovascular reactions (angina, myocardial infarction, ischemic, and others).

The method of normalization of the functional reactivity of the cardiovascular system (CVS) at krizova for hypertension with impaired glucose tolerance, including assessment of functional reactivity SSS during emotional load, which record systolic, diastolic, srednetehnicheskoe pressure (Adsin.), based on these parameters define the indicator functional reactivity (FIU) before and after exercise, using the formula: FIU = (Adsin. · HR)/100 (used), and increments the value of the FIU more than 20 usled enter a combination of irbesartan 150 mg in the morning of 1 times and lacidipine 4 mg 1 time in the morning for at least 2 months.



 

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