Idiopathic Arterial Hypotension Research Articles

ACTIVITY OF NITRO-OXIDATIVE PROCESSES IN PREGNANT WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION

Primary violation of vascular tone and reactivity is considered the main hemodynamic link in the pathogenesis of idiopathic arterial hypotension (IAH). Two gaseous messengers - nitric oxide (NO) and hydrogen sulfide (H2S) play an important role in the regulation of vascular tone.
 The research aims at determining the state of the NO system and the level of H2S in women with IAH and their effect on the uteroplacental blood flow.
 Material and Methods. A number of 20 pregnant women with IAH at 40-41 weeks of gestation were examined (group I); the second group included 20 pregnant women with normotony at 39-40 weeks of gestation. The concentration of the complex of nitrates and nitrites was determined by the reaction of formation of a colored complex by Griss reagent. The content and production of peroxynitrite in alkali and alkaline earth metals were determined according to the procedure described by Vanuffelen et al. Detection of hydrogen sulfide content in blood plasma was performed by the method of Dombkowski et al. Studies of uteroplacental blood flow were performed on ultrasonic diagnostic device "SA-8000 EX" using color Doppler mapping and pulse mapping dopplerometry of the blood flow in the uterine arteries (UA). The assessment of blood flow velocity curves was carried out by determining the pulsation index (PI) in both arteries taking into account the average value.
 Results. The results of the study showed that an average level of nitrites and nitrates in pregnant women with IAH was 37.0% higher than in women with normotension, and peroxynitrite values were 2.4 times higher, respectively. In contrast, the concentration of H2S in pregnant women with IAH was almost 1.4 times lower, than in pregnant women with normal blood pressure. Doppler study of blood flow indices in UA showed a moderate increase in PI in 28.0% of pregnant women with IAH. Thus, indices of vascular resistance in UA of pregnant women with IAH were higher, on average, by 19.0% than in pregnant women with normotension.
 Conclusions. High levels of nitrites and nitrates in pregnant women with IAH form the basis for the development of nitrosatous stress, which is accompanied by increasing concentration of highly toxic peroxynitrite. Significant increase in peroxynitrite is one of the causes of endothelial dysfunction. In pregnant women with IAH due to the low content of H2S - its vasoconstrictive effects are prevalent, which may indicate an indirect interaction between both of these systems of vasoregulation.

PROGNOSIS AND PREVENTION OF UTERUS BLEEDINGS IN EARLY POSTPARTUM PERIOD FOR WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION

The aim: To establish the effectiveness of thromboelastography (TEG) and tranexamic acid (TXA) for prognosis and prevention of early postpartum period bleedings (PPB) for postpartum women with idiopathic arterial hypotension (IAH). Materials and methods: Coagulogical research was conducted (coaugologram screening, dynamic function of platelets under the influence of adenosine diphosphate (ADP) (visual assessment), measurement of soluble fibrin-monomer complexes (FMC) and TEG of 36 in parturient women during the I chilbirth period with arterial hypotension. 14 parturient women with normal fibrinolysis were included into the first observation group; The second group includes 22 parturient women with TEG results which show signs of hyperfibrinolysis. Further, in cases when stronger fibrinolysis was detected during the late pushing phase of childbirth period, the TXA by amount of 1,0 g IV (bolus) was injected due to bleeding prevention. TEG was repeated during early postpartum period. Results: the inhibition of platelet aggregation activity with ADP was observed in every parturient woman with IAH in the first partum period. In 61,1% cases with TEG hyperfibrinolysis were shown, which was accompanied by significant increase in FMC levels in blood. The use of TXA as PPB prevention for parturient women with IAH and hyperfibrinolysis during TEG was fully oppressing the fibrinolytic activity and was not affecting the coagulation part of hemostasis. Conclusions: hemostasis testing during childbirth based on TEG gives the ability to prognose the hemorrhagic complications in parturient women with IAH and administer their prophylaxy using TXA.

Psychoemotional deadaptation and health problems as risk factors of decreasing learning at female students with idiopathic arterial hypotension

The aim of the work is to study the clinical and psychological manifestations of maladjustment of young female students with idiopathic arterial hypotension (IAH). Two groups, aged 18–35 years, were examined: 200 women with IAH with SBP level of 61–98 mm Hg, DBP – 59 mm Hg and less, and 130 women with normal blood pressure. The groups were compared by the frequency of complaints about health problems and the results of assessing mental performance, fatigue using the E. Kraepelin test. The studies were carried out as part of a preventive medical examination. A comparative analysis of complaints showed that women with IAH limit their physical activity due to a deterioration in subjective well-being – the appearance of shortness of breath, pain and discomfort in the chest and legs, dizziness, poor cold tolerance – chilliness of the hands and feet, episodes of involuntary urinary incontinence. With IAH, complaints of apathy, weakness and fatigue, and difficulty concentrating were more often recorded. Women with IAH under psychoemotional stress made more mistakes, and the proportion of women who made mistakes when performing a test was twice as high as in women with normal blood pressure. Thus, we can conclude that IAH in young women is characterized by more frequent complaints of health problems than in women with normal blood pressure, which is combined with a decrease in daily physical activity and cognitive impairment. IAH in female students can be regarded as a risk factor for psycho-emotional and social maladjustment, which negatively affects the effectiveness of learning in the higher education system.

Pathogenetic role of the autonomic nervous system in arterial hypotension cardiac remodeling in young women

Aim. To study the features of cardiac remodeling on condition of the autonomic nervous system (ANS) in young women with idiopathic arterial hypotension (IAH).Material and methods. A comparative analysis of the echocardiography data in women with IAH aged 18-25 years with a predominance of sympathetic (n=150) and parasympathetic (n=60) parts of the ANS was performed. The level of systolic blood pressure ≤98 mm Hg worked as the criterion of IAH. The activity of the ANS was evaluated by the I. Kérdö index.Results. It has been shown that women with IAH with sympathicotonia are characterized by a significant decrease in the structural parameters of the heart: the size of all chambers and the aortic ostium, contractile function decrease and a slower relaxation of the left ventricle (LV). Acceleration of intracardiac hemodynamics was observed: an increase in blood flow rates and pressure gradients on the mitral, tricuspid and pulmonary artery valves, an increase in the rates of early and late diastolic LV filling. Changes in early LV diastole are associated with an increase of pressure in the left atrium. We identified a restrictive type of diastolic dysfunction in women with parasympathicotonia.Conclusion. Sympathicotonia and parasympathicotonia in young women with IAH are associated with different heart remodeling variants. Cardiac hypotrophy, decrease of contractile function and impaired LV relaxation during hypotension are associated with low sympathetic activity against the background of parasympathicotonia. The restrictive type of diastolic dysfunction during hypotension is associated with parasympathicotonia. Use of cholinolytics and anticholinesterase reactivators are the potential way of correction of ANS dysfunction, IAH regression and cardiac remodeling.

Peculiarities of the systemic hemodynamics reaction and peripheral blood flow to reactive hyperhemia in young women with arterial hypotension

The aim of the study was to study a vascular reaction to a test with reactive hyperemia in young women with idiopathic arterial hypotension. 72 women with hypotension (SBP 98 mmHg or less) and 37 women with SBP 120-129 mmHg were examined. A comparative analysis of the response of systemic and peripheral hemodynamics to a test with reactive hyperemia by Celermajer D. In hypotension, occlusion was characterized by an increase in SBP, a change in the diameter and velocity of peripheral arterial and venous blood flow. Thus, the pathological reaction of systemic and peripheral hemodynamics in reactive hyperemia in women with hypotension is a sign of remodeling of the cardiovascular system.

Peculiarities of complaints among young women with idiopathic arterial hypotension

Aim. To study the peculiar features of complaints among young women with idiopathic arterial hypotension (IAH) and determine their frequency.
 Materials and methods. Comparative analysis of complaints frequency between two groups of women aged 18–23 was carried out: the test group of patients, suffering from IAH (n = 210) with SAP 97 (92–98) mm Hg and the control group (n = 96) with normal arterial pressure with SAP 123 (121–125) mm Hg.
 Results. 58 % of women with IAH walk less than 5 km a day that is reliably more frequently compared to women with normal arterial pressure. Women with IAH, having moderate physical and emotional load, more often have complaints of dyspnea (25 %) and thoracic pains (40 %). When suffering from IAH, patients more often complain of pain in their legs, especially while walking (35 %), dizziness (38 %), pain and paleness of hand and leg fingers in cold (36 %); 12% of women with IAH have nocturia.

FEATURES OF THE RESPONSE OF ARTERIAL BLOOD FLOW TO THE ORTHOSTATIC LOAD IN YOUNG WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION

The aim of the study was to evaluate the response of arterial blood flow to the orthostatic load in young women with idiopathic arterial hypotension (IAH).Material and methods. A comparative analysis of systemic hemodynamics and peripheral arterial blood flow parameters was performed for orthostasis between two groups of women aged 1825: test with IAH (n = 73) and control (n=37). The SBP level in the test group was 90-98 mm Hg, in the control group - 120-129 mm Hg. BP, heart rate and angio-scanning were performed twice: at rest, lying after 15 minutes rest and during the first minute of orthostasis. Blood flow was studied in the right vertebral, radial and posterior tibial arteries. The following parameters were evaluated: diameter during diastole, peak systolic and terminal diastolic blood flow velocity.Results. In young women with IAH, as those with normal arterial pressure, orthostasis was accompanied by an increase in SBP, DBP and an increase in heart rate. With hypotension, an increase in the diameter of the vertebral artery and a decrease in the diameter of the posterior tibial artery were detected. In both groups, orthostasis was accompanied by a decrease in the rate of blood flow, both during systole and diastole.The conclusion. Orthostasis with IAH is accompanied by an increase in SBP, DBP and heart rate. The response of peripheral arteries to orthostasis is characterized by a change in the diameter of the vessels, which indicates a pronounced adaptive response to the physiological stress load.

POSITIVE CLINICAL EFFECTS OF AN M-CHOLINOLYTIC IN IDIOPATHIC ARTERIAL HYPOTENSION

Aim. Evaluation of an m-cholinolytic influence on blood circulation, mental performance and fatigability, self-feeling in young women with idiopathic arterial hypotension (IAH). Material and methods. The study object were 20 females with IAH defined as systolic BP ≤98 mmHg, age 19-32 y. o. The study subject — circulation parameters (SBP, DBP, HR), mental performance and fatigability by E. Kraepelin, self-rate of health (self-feeling). Experimental drug was taken once as one pill. Results. In 1 hour post one dosage of the drug, there was SBP increase from 94 (92-96) mmHg to 108 (106-112) mmHg, and DBP and HR (p<0,05); increase of summations performed by 26% (p<0,01); improvement of self-feeling — in 45% of participants. In 24 h, 85% reported improvement of self-feeling. Conclusion. In idiopathic arterial hypotension in young women one dosage of the m-cholinolytic shown the following positive effects: increase of SBP, DBP and mental performance (in 1 h) and improvement of self-feeling (in 1 h and 24 h).

RESPONSE OF PERIPHERAL BLOOD FLOW ON APNEA IN YOUNG WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION

Aim. To study the response of peripheral vessels hemodynamics to apnea in young women with idiopathic arterial hypotension. Materials and methods. Comparative analysis of the results of ultrasonic scanning of peripheral arteries and veins using apnea test between 19 women with idiopathic arterial hypotension - SAP 98 (92-98) mm Hg and 11 women with normal arterial pressure - SAP 124 (121-126) mm Hg was carried out. Women’s age in both groups was 18-25 years. Arterial pressure and peripheral oxygen saturation were measured. Angioscanning in lying position and at rest as well as angioscanning prior to and 20 seconds after breath-holding was fulfilled. Diameter and blood velocity were estimated in the brachial, radial and posterior tibial arteries and veins. Results. Apnea in young hypotensive women was found to induce increase in the diameter of a larger number of arteries than in the control group and fall in arterial blood velocity with the absence of venous blood velocity dynamics. Conclusions. The abovementioned changes in the peripheral blood flow among women with hypotension are to be considered as manifestation of deadaptation, expressed by extreme endothelium-dependent dilatation of resistive vessels and inhibition of vasotonic response, probably, associated with excessive nitric oxide endothelial production.

Structural-functional peculiarities of peripheral hemodynamics in young women with idiopathic arterial hypotension

Structural-functional peculiarities of peripheral hemodynamics in young women with idiopathic arterial hypotension

Structural-functional characteristics of heartband blood rheology in young women with idiopathic arterial hypotension

Introduction. 7-33 % of women and 4-5 % of men have low blood pressure. Hypoperfusion of human s organs reduces the quality of life leading to myocardial malnutrition, and is associated with increased blood viscosity. The maintenance of a comprehensive study of the mechanisms of keeping blood pressure in the early stages of arterial hypotension effects on the body is of big interest. The aim of the research is to study the structural - functional characteristics of the myocardium and blood rheology of young women with low blood pressure. Material and methods. The object of the study were young women (age 19-23 years). Test group: 31 people with systolic blood pressure of 98 mm Hg and lower; Control group: 25 people with systolic blood pressure 120-129 mmHg. Study Type - single-step. Methods used: echocardiography, blood viscometry, quantitative analysis of hemogram and morphology of red blood cells. The test and control groups were similar in age, height, heart rate, blood volume circulating. Results and discussion. Women test group had a lower weight, a smaller thickness of the rear wall of the left ventricle to systole and septum to systole and diastole (p = 0.00-0.03). There were no difference between groups in the parameters of cardiac hemodynamics, minute volume of blood, quantitative indicators hemogram, blood viscosity, aggregation and deformability of red blood cells. In the test group, percentage poikilocytosis (23 %) is 4.5 times higher compared with the control group (5 %), p = 0.00. In the test group PWTs is correlated with blood viscosity at a shear rate of 20 s-1 (r = -0.38), the number of leukocytes (r = -0.36), red blood cells (r = -0.37), hemoglobin (r = - 0.44), hematocrit (r = -0.45), in the control group is correlated with erythrocyte aggregation index (r = -0.43), p <0.05. Conclusions. Reduction of the left ventricular wall thickness of young women with idiopathic arterial hypotension does not reduce minute volume of blood, but negatively correlates with blood viscosity and hematocrit. Young women with idiopathic arterial hypotension lack compensatory increase in blood viscosity. Being present increasing poikilocytes in the test group is a predictor of increasing the viscosity of the blood, which in course of time can lead to aggravation of perfusion abnormalities.

CLINICAL AND HEMODYNAMIC SPECIFICS OF LOWER EXTREMITIES VENOUS CIRCULATION IN YOUNG WOMEN WITH IDIOPATHIC SYSTEMIC HYPOTENSION

Aim. To assess clinical signs and characteristics of venous circulation disorders in lower extremities in young women with idiopathic arterial hypotension (IAH). Material and methods. The comparison was performed, of the prevalence of subjective and objective signs of the chronic vein disease (CVD), and parameters of ultrasound vessel imaging of lower extremities circulation in 105 women with IAH (SBP 98 mmHg and below) and 48 women with normal arterial pressure (SBP 120- 129 mmHg). Mean age in both groups 19 (18-22) y.o. Results. Young hypotensive women present with complaints associated with CVD: leg pain in 31%, cramps at night in 27%, knee and feet edema by the end of the day — in 12%, trophic disorder of the skin — in 4%. CVD is characterized by a high prevalence of objective early signs of chronic veins diseases — teleangioectasia/reticular varicose (30%) that 2 times more common in low blood pressure. In IAH there is a decline found of structural and functional parameters of the low extremities veins comparing to normal blood pressure: lower diameter and the area of the lumen of the veins; lower thickness of walls and lower the tone; lower velocity of flow and lower the duration and velocity of venous reflux. In IAH there are ultrasound signs of CVD: in 45% — venous failure, varicose veins in 4%. In 78% young women with hypotension and venous reflux with low tone, there are complaints on leg pain 5 times more common than in normal pressure. Conclusion. In IAH young women more commonly present with CVD that show more prominent clinical picture and venous hemodynamics disorder than in normal blood pressure.

ISOLATED DIASTOLIC DYSFUNCTION AS A RESULT OF HYPERNITRICOXIDEMIA IN ARTERIAL HYPOTENSION

Aim. The assessment of cardiac hemodynamics in the test with reactive hyperemia in young females with idiopathic arterial hypotension. Material and methods . The comparative analysis was done, of echocardiography in the standard test with reactive hyperemia within brachial area among 72 women with idiopathic arterial hypotension — systolic blood pressure 94-98 mmHg, and in 37 females normotensive — systolic BP 120-123 mmHg. In both groups the age was 19 (18-22) y.o. Results . Reactive hyperemia in hypotension is followed by a significant increase of maximum velocities relation of the early (peak E) and delayed (peak A) diastolic filling of the left ventricle by 18%. In normotensive women there was no such change of the relation. Conclusion . In young females with idiopathic arterial hypotension the test with reactive hyperemia, as a model of acute hypoxia, is followed by isolated diastolic dysfunction of myocardium. Probably, it is related to the increase of the rate of already existing hypernitricoxidemia, which is a key factors for arterial hypotension pathogenesis.

Диастолическая функция левого желудочка при психоэмоциональной нагрузке у молодых женщин с идиопатической артериальной гипотензией

A comparative analysis of the structural and functional parameters of echocardiography between the two groups of women aged 18-22 years. Test group - 16 women with idiopathic arterial hypotension (systolic 94-98 mm Hg). The control - 10 women with normal blood pressure (SBP 120-123 mm Hg). Echocardiography was performed at rest and after emotional load by the method of E. Kraepelin. If hypotension an infringement diastolic function at rest and during exercise (increased ratio Ve/Va alone, lack of speed dynamics of transmitral blood flow under load). Diastolic dysfunction recorded on a background of heart malnutrition, which indicates a decrease in cardiac hemodynamic reserve adaptation physiological effects.

THE USE OF BETA-BLOCKER BISOPROLOL FOR THE PREVENTION OF HIGH BLOOD PRESSURE IN WOMEN WITH IDIOPATHIC ARTERIAL HYPOTENSION

This study is devoted to the problem of arterial hypertension (AH), developing with age in women with idiopathic arterial hypotension (IAH).In the survey of 650 women doctors revealed the high frequency of AHI (up to 24,8% ), accompanied by every second or third case of periodic increase in blood pressure with clinical vascular symptoms. An important role in the prevention of hypertension on the background of IAG given to therapy with beta blockers, in particular, bisoprolol. Conducted in 27 women daily monitoring of blood pressure showed that, to revent the increase in BP in the background of the IAG, it is advisable to choose the starting dose of bisoprolol 2.5 mg, increasing it as needed under the control of blood pressure, heart rate and clinical symptoms. The most pronounced hemodynamic changes have occurred in patients receiving bisoprolol dose of 5 mg. however, almost a threefold increase in episodes of hypotension (hypotonic index) and is probably associated with increasing variability of systolic, AP, was regarded as unwanted excessive effect of the drug. Reducing the dosage of bisoprolol to 2.5 mg/day was accompanied by an almost threefold decrease in hypotonic index and two-time decrease in BP variability. These changes occurred against the backdrop of milder antihypertensive effects and pulseraduction without any negative influence on positive clinical dynamics. . A reduction in the dose of bisoprolol during the titration of therapeutic effect lowered the risk of side reactions and improves the adherence of women with labile AD to treatment.

Syncope as a health risk for soldiers- influence of medical history and clinical findings on the sensitivity of head-up tilt table testing.

BackgroundSyncope is a relevant health problem in military environments. Reliable diagnosis is challenging. Tilt table testing is an important tool for syncope diagnosis. The aim of this study was to determine whether signs such as prodromal symptoms, co-morbidity, frequency of syncopal events, body length, body mass index, and electrocardiography abnormalities can be used to predict the success of tilt table testing at diagnosing syncope.MethodsData from 100 patients with histories of syncope or pre-syncope, who were diagnosed using head-up tilt table testing, were retrospectively analyzed in a cross-sectional analysis. The diagnostic procedure was based upon a modified version of the Westminster protocol without any pharmacological provocation.ResultsPatients showing pathological reaction patterns during tilt table testing suffered from prodromal symptoms, such as dizziness and sweating, significantly more often. The patients reported more injuries resulting from syncopal events and more previous syncopal events, and the prevalence of co-morbidity was greater among patients presenting negative findings during tilt testing. An asthenic-leptosomal physique was not confirmed as a risk factor for syncopal events as is the case for idiopathic arterial hypotension. However, patients with pathological reaction patterns during tilt table testing were significantly taller. This finding was detected for both females and males. No significant predictors were found in the electrocardiogram (ECG) patterns of patients showing syncope during tilt table testing.ConclusionsFrequency of prior syncope and prodromal symptoms, and increased body length with an otherwise good state of health influence the predictive value of tilt table testing for syncope diagnosis. In particular, if these factors are present, tilt table testing should be considered part of the diagnostic algorithm for soldiers with recurrent syncope.

Cerebral circulation, neurological and neuropsychological disorders in idiopathic arterial hypotension

Objective: to evaluate the cerebral circulation in idiopathic arterial hypotension (IAH) in relation to neurological and neuropsychological disorders. Patients and methods. Sixty-five patients (mean age 40.2 [8, 14] years) with prolonged IAH were examined. Neuropsychological examination was made using the procedure adapted by A.R. Luria; different psychic functions (memory, speech, gnosis, praxis, thinking, attention, counting, writing, and reading) were studied. Cerebral hemodynamics was investigated using duplex scanning of the brachiocephalic arteries (BCA), middle cerebral arteries (MCA), internal jugular (IJV) and vertebral veins (VV). The patients were assigned to 2 groups: 1) 19 (29%) patients with somatoform disorders, 2) 46 (71%) patients with signs of the initial manifestations of chronic cerebrovascular insufficiency. Group 2 patients were older and had a longer history of IAH. Results. In all the patients, cerebral blood supply in the carotid system showed moderately lower arterial blood inflow with a compensatory vascular resistance decrease and balanced venous outflow reduction with increased vascular resistance. Group 2 patients had a substantial (to the lower normal range) blood flow decline in the vertebral artery along with increased peripheral resistance in the VV. The degree of neuropsychological derangement was inversely proportional to blood flow velocity in BCA and MCA and to blood outflow in IJV and VV.

Idiopathic arterial hypotension: neurological abnormalities and cerebral and central hemodynamics

To study abnormalities of central and cerebral hemodynamics in chronic cerebrovascular pathology, 65 patients were examined with long-term stable idiopathic arterial hypotension (IAH), mean age of 40.2 (8.1) years. According to neurologic examination, all patients were distributed into two groups. The first group comprised 19 (29%) patients with somatoform disturbances, and the second group comprised 46 (71%) patients with cerebrovascular pathology: early signs of cerebral blood supply impairment and dyscirculatory encephalopathy, stage I. Patients from the second group were older and had longer hypotension anamnesis. Cerebral and central hemodynamics was examined with duplex ultrasonography of internal carotid arteries (ICA), vertebral arteries (VA) and medial cerebral arteries and with transthoracic echocardiography. In all patients ICA ultrasound showed moderate slowness of blood velocity and compensatory reduction of vascular resistance. There was no compensatory vasodilatation in VA, which resulted in considerable blood flow reduction, most expressed in the second group. The cardiac index was increased in both groups: in the first group due to increase in the left ventricular contractility and in the second group due to increase in the cardiac rate. Cerebrovascular disorders in patients with IAH are associated with age, duration of arterial hypotension, predominant deterioration of blood supply in the vertebral-basilar system and hyperkinetic state of central hemodynamics.