Stages Of Hypertensive Disease Research Articles

The relationship of asymmetric dimethylarginine levels with uncontrolled arterial hypertension and hypertension disease stage

Background: Patients with treatment-resistant hypertension have a worse cardiovascular prognosis compared to those who achieve their target levels of blood pressure (BP). One of biochemical and clinical markers of a decreased response to antihypertensive therapy can be asymmetric dimethylarginine (ADMA), a molecule that reduces formation of nitric oxide and promotes endothelial dysfunction and vasoconstriction.
 Aim: To assess the status of the nitrogen oxide synthesis system and clinical and laboratory profile in patients, depending on the hypertensive disease stage, who achieved or not achieved their target BP levels during hospitalization.
 Materials and methods: We performed аn observational retrospective uncontrolled study in a consecutive sample of 192 patients aged 45–65 years who were admitted to the City Clinical Hospital No. 25 (city of Novosibirsk) with a diagnosis of uncomplicated hypertensive crisis. On the day of discharge, the patients were retrospectively divided into 2 groups. Group 1 included patients who achieved their target BP during hospitalization (target BP group, n = 116). Group 2 included patients with uncontrolled hypertension, in whom the administration of three antihypertensive drugs including a diuretic in optimal or maximal tolerated doses did not result in the achievement of the target BP below 140 and/or 90 mm Hg during hospitalization (non-target BP group, n = 76).
 The following parameters were measured: ADMA, symmetrical dimethylarginine (SDMA), N-monomethyl-L-arginine (NMMA), and total nitric oxide.
 Results: Serum ADMA concentrations (Me [Q25%; Q75%] were increasing with the stage of hypertension: stage I, 0.75 µmol/L [0.66; 0.78], stage II, 1.14 µmol/L [0.87; 1.39], stage III, 1.38 µmol/L [1.22; 1.49] (p 0.0001, Kruskal-Wallis test). In the pairwise comparison, the difference between all these subgroups was significant at p 0.01. In the patients with uncontrolled arterial hypertension ADMA levels were increased compared to those in the target BP group: 1.2 µmol/L [0.99; 1.47] vs 1.07 [0.79; 1.34] µmol/L (p = 0.002). The proportion of patients with type 2 diabetes mellitus among those with uncontrolled arterial hypertension was 31.2% (24/76), while in the target BP group there were only 3.5% of such patients (4/116) (odds ratio 12.57, 95% confidence interval 4.15–38.05; p = 0.00001).
 Conclusion: ADMA measurement may help identify patients with a potential poor response to antihypertensive therapy. This should be taken into account when choosing a treatment regimen and BP monitoring. In addition, ADMA seems to be a promising target for the development of new drug classes.

CARDIOVASCULAR RISK RECLASSIFICATION BY PULSE WAVE VELOCITY IN BRAZILIAN HYPERTENSIVE PATIENTS

Objective: Objetive: The number of asymptomatic hypertensive patients who already have subclinical injuries in the early stages of hypertensive disease is high and, generally, they are not identified by the traditional evaluation model. The use of Pulse Wave Velocity (PWV) in addition to traditional cardiovascular risk factors can improve risk stratification. The present study intends to perform the reclassification of cardiovascular risk according to the median Pulse Wave Velocity (PWV) and correlate PWV with the intima-media thickness, with the left ventricular (LV) mass indexed and with microalbuminuria. Design and method: Design and method: Multicenter analytical cross-sectional study of patients undergoing measurement of central and peripheral blood pressure parameters between October/2018 and March/2019. Intima-media thickness (IMT) and presence of carotid plaque, left ventricular mass indexed and microalbuminuria were also evaluated. Fisher’s test was applied to verify the association of cardiovascular risk reclassification by median PWV. Spearman’s correlation was used to correlate PWV with intima-media thickness, presence or absence of carotid plaque, microalbuminuria and indexed left ventricular mass. A significance level of 5% was adopted. Results: Results: 126 patients were evaluated, with a mean age of 60.58 ± 10.51 years and 87 (69.95%) are women. When reclassified, there was an increase in the frequency of patients who moved from medium to high risk (p<0.001). A weak and positive correlation was identified between PWV and LV mass indexed (r = 0.304, p < 0.001) and with IMT (r = 0.30, p < 0.001). Conclusions: Conclusions: The application of median PWV values is a simple and effective tool to reclassify intermediate-risk individuals to high-risk.

Oxygen deficiency in hypertension

The book is intended for a wide range of practitioners. The description of specific data on oxygen deficiency at various stages of hypertensive disease is preceded by a presentation of general information about the physiology of respiration, its impairments and methods for studying the functional state of the respiratory apparatus

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

Bayesian Joint Modeling of Longitudinal and Survival Time Measurement of Hypertension Patients.

BackgroundHigh blood pressure is a health risk for all populations, worldwide. Globally the number of people with uncontrolled hypertension rose by 70% between 1980 and 2008.ObjectiveThis paper aims to investigate the association of survival time and fasting blood sugar levels of hypertension patients and identify the risk factors that affect the survival time of the patient.MethodsWe considered a total of 430 random samples of hypertension patients who were followed-up at Yekatit-12 Hospital in Ethiopia from January 2013 to January 2019. A linear mixed effects model was used for the longitudinal outcomes (fasting blood sugar) with normality assumption, although four parametric accelerated failure time distributions: exponential, Weibull, lognormal and loglogistic are studied for the time-to-event data. The Bayesian joint models were defined through latent variables and association parameters and with specified noninformative prior distributions for the model parameters. Simulations are conducted using Gibbs sampler algorithm implemented in the WinBUGS software. The model selection criteria DIC is employed to identify the model with best fit to the data.ResultsThe findings from Bayesian joint models are consistent. The association parameter in each Bayesian joint model is significant. This implies that there is dependence between the two processes: longitudinal fasting blood sugar level and the time-to-death event under joint models. With investigation of the model comparison criteria, the Bayesian–Weibull model was preferred to analysize the current data sets. Based on joint analysis the baseline age, place of residence, family history of hypertension, khat intake, blood cholesterol level of the patient, hypertension disease stage, adherence to the treatment and related disease were associated factors that affect the survival time of hypertension patients.ConclusionThe analysis suggests that there is strong association between longitudinal process (fasting blood sugar) and time-to-event data. The researcher recommends that all stakeholders should be aware of the consequences of these factors which can influence the survival time of hypertension patients in the study area.

A clinical case of a patient with liver cirrhosis in non-alcoholic fatty liver disease and pregnancy

Introduction: Non-alcoholic fatty liver disease (NAFLD) is a significant health problem in society and it affects around a billion people on a global scale. NAFLD is the most common reason for liver damage worldwide and is considered the hepatic manifestation of the metabolic syndrome. NAFLD could be classified into two categories: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), which can progress to liver cirrhosis. There is limited literature on the occurrence of NAFLD in pregnant women and its effect on pregnancy. It is presumed that there is an increase in the frequency of gestational diabetes, premature birth, low birth weight, preeclampsia, more frequent delivery with Caesarean section, and more frequent occurrence of intrahepatic cholestasis. There is no data on the course of pregnancy in patients with NAFLD and cirrhosis, which is already formed. Clinical case: We present the clinical case of a 30-year-old woman, who is pregnant in the VIII lunar month and was brought to the hospital due to heaviness, feeling of bloating, and swelling in the legs. Laboratory examination conducted a month before hospitalization revealed that: AST - 460 U/L, ALT - 980 U/L, GGT - 28.3 U/L, total bilirubin – 20.2, Hb - 138 g/L. The patient informed that she had had two miscarriages in the past. After the second miscarriage three years ago, she was hospitalized for the first time due to icterus and fever. For the first time, she was diagnosed with: liver cirrhosis caused by non-alcoholic steatohepatitis, active, decompensated, child stage B; portal hypertension; metabolic syndrome; hypertension; obesity class III. Autoimmune and viral etiology of cirrhosis was excluded. Hepatoprotective treatment was conducted. Following the first hospitalization at the Endocrinology Clinic, the patient was diagnosed with: impaired fasting glycemia; decreased glucose tolerance; metabolic syndrome; hypertensive disease stage II, moderate degree; obesity class III; dyslipidemia; Hashimoto's thyroiditis. Glucobay therapy, diet, and hypocaloric and exercise regimen were prescribed. The last hospitalization at the Endocrinology Clinic was during the VI lunar month of the current pregnancy. Insulin treatment was started. The results of the laboratory tests conducted during the last hospitalization in the Clinic are shown in Table 1. Ultrasound examination showed cirrhotic transformation of the liver, moderate ascites, splenomegaly, and pregnancy with coexisting live fetus. The presence of acute infection with hepatotropic and non-hepatotropic viruses was excluded. After consulting with a cardiologist and an echocardiography, the presence of heart failure was rejected. Hepatoprotective treatment and diuretics were carried out, which resulted in normalization of liver parameters and a slight reduction of ascites. The patient was discharged and referred for planned delivery by Caesarean section when the fetus reaches maturity. Conclusion: The clinical case presents a patient with underlying hepatic cirrhosis in NAFLD and pregnancy, who developed transient hepatocytolysis and decompensation of cirrhosis with ascites during pregnancy, as well as diabetes mellitus on the background of previous impaired glucose tolerance. NAFLD is a disease, which could affect young patients in childbearing age. The presence of an advanced stage of NAFLD is associated with many complications during pregnancy, which requires follow-up by a gastroenterologist.

Survival Time Analysis of Hypertension Patients Using Parametric Models

Background: Hypertension is a worldwide public-health challenge and one of a leading modifiable risk factor for cardiovascular disease and death.&#x0D; Aims: The aim of this study was compare parameter estimations using both Bayesian and classical approaches and to detect out potential factors that affects survival probability of hypertension patient’s under follow up.&#x0D; Materials and Methods: A simple random sampling technique was used to select 430 patients among a total of 2126 hypertension patients who had been under follow up at Yekatit-12 Hospital in Ethiopia from January 2013 to January 2019. Parametric distributions: Exponential, Weibull, Lognormal and loglogistic are studied to analysis survival probabilities of the patients in both Bayesian and classical approaches. The model selection criteria are employed to identify the model with best fit to the data. Bayesian estimation approach was smaller deviance information criteria as compare to classical estimation approaches for the current data set.&#x0D; Results and Conclusion: The analysis Bayesian Weibull results indicate that the baseline age of the patient, gender, family history of hypertension, tobacco use, alcohol use, khat intake, blood cholesterol level of the patient, hypertension disease stage, adherence to the treatment and related disease were significantly associated with survival time of hypertension patients. Patients with raised blood Cholesterol level at baseline tend to have shorter survival time as compare to one with normal blood cholesterol level at baseline. Society and all stakeholders should be aware of the consequences of these factors which can influence the survival time of hypertension patients.

Survival Analysis of Factor Affects Survival Time of Hypertension Patients

Hypertension is a major long-term health condition and a leading modifiable risk factor for cardiovascular disease and death. The aim of this study was to examine major factors that affect survival time of hypertension patients under follow-up. We considered a total of 430 random samples of hypertension patients who had been under follow up at Yekatit-12 Hospital in Ethiopia from January 2013 to January 2019. Four parametric accelerated failure time distributions: Exponential, Weibull, Lognormal and loglogistic are used to analyse survival probabilities of the patients. The Kaplan-Meierestimation method and log-rank tests were used to compare the survival experience of patients with respect to different covariates. The Weibull model is selected to best fit to the data sets. The results indicate that the baseline age of the patient, place of residence, family history of hypertension, khat intake, blood cholesterol level of the patient, hypertension disease stage, adherence to the treatment and related disease were significantly associated with survival time of hypertension patients. But factor like gender, tobacco use, alcohol use, diabetes mellitus status and fasting blood sugar were not significantly associated factors. Society and all stakeholders should be aware of the consequences of these factors which can influence the survival time of hypertension patients.

Structural and functional properties of erythrocytes in patients with chronic cerebral ischemia.

Treatment of chronic cerebral ischemia is still an important problem, because in most cases you cannot influence the constantly progressive character of the disease. Particularly relevant is the search for relationships between laboratory parameters and clinical manifestations of chronic cerebral ischemia with a subsequent search of the most informative indicators for timely assessment of disease severity and prediction of outcome. The aim of the study was to determine the relationships between neurological and cognitive disorders with representativeness in the membrane of red blood cells proteins and lipids in patients with chronic cerebral ischemia stage I and II treatment. Under constant observation there were 44 patients with a diagnosis of chronic cerebral ischemia stage I or II on the background of hypertensive disease stage II. Already in the early stages of the development of chronic cerebral ischemia are significant changes in the content of proteins that form the structure of erythrocyte membrane, shape and flexibility of the membrane, provide intracellular metabolism. Revealed violations in the content and ratio of lipids in the membrane. Primarily, this refers to the content of membrane glycerophospholipids and sphingomyelins, which are the basis of the double lipid layer of cell membrane and play a major role in regulating protein macromolecules and to the normal metabolism of erythrocytes. There is a relatively large number of significant relationships between laboratory parameters and parameters of the neuropsychiatric status in patients with chronic cerebral ischemia stage I or II before and after treatment.

The detection of cortisol level in blood plasma of patients with arterial hypertension at resistance to stress impacts of various degree.

The analysis was applied to the results of detection of level of cortisol in pre-operational period before planned arthroscopy in 63 patients (aged from 45 to 50 years) with hypertension disease stage I and II with different stress resistance. The stress resistance was detected using such tests as Perceived Stress Scale (PSS) and the Depression, Anxiety and Stress Scale (DASS). In most of patients, the analysis of results of testing demonstrated an average level of stress and and average anxiety before the operation. 20 stress resistant patients and 43 stress non-resistant patients were picked out. The level of cortisol in pre-operational period turned out reliably higher in patients with low stress resistance. The data analysis according results of day monitoring of blood pressure prior to implementation of arthroscopy established that in stress non-resistant patients a more expressed increasing of velocity of morning rising of systolic and diastolic blood pressure as compared to stress resistant patients. After surgical intervention, velocities of morning rising of systolic and diastolic blood pressure also were higher in stress non-resistant patients. They also had lower values of day index of systolic blood pressure (non-dipper). In stress resistant patients, day index of systolic blood pressure before and after was within the limits of standard values. The average values of systolic and diastolic blood pressure registered within limits of on standard values. However, they were higher in pre- and post-operational periods among patients with low stress resistance. The received results reflect alteration of function of cardio-vascular system in response to psychological stress that is more expressed in patients with low stress resistance.

Multilevel convergence of interoceptive impairments in hypertension: New evidence of disrupted body-brain interactions.

Interoception, the sensing of visceral body signals, involves an interplay between neural and autonomic mechanisms. Clinical studies into this domain have focused on patients with neurological and psychiatric disorders, showing that damage to relevant brain mechanisms can variously alter interoceptive functions. However, the association between peripheral cardiac-system alterations and neurocognitive markers of interoception remains poorly understood. To bridge this gap, we examined multidimensional neural markers of interoception in patients with early stage of hypertensive disease (HTD) and healthy controls. Strategically, we recruited only HTD patients without cognitive impairment (as shown by neuropsychological tests), brain atrophy (as assessed with voxel-based morphometry), or white matter abnormalities (as evidenced by diffusion tensor imaging analysis). Interoceptive domains were assessed through (a) a behavioral heartbeat detection task; (b) measures of the heart-evoked potential (HEP), an electrophysiological cortical signature of attention to cardiac signals; and (c) neuroimaging recordings (MRI and fMRI) to evaluate anatomical and functional connectivity properties of key interoceptive regions (namely, the insula and the anterior cingulate cortex). Relative to controls, patients exhibited poorer interoceptive performance and reduced HEP modulations, alongside an abnormal association between interoceptive performance and both the volume and functional connectivity of the above regions. Such results suggest that peripheral cardiac-system impairments can be associated with abnormal behavioral and neurocognitive signatures of interoception. More generally, our findings indicate that interoceptive processes entail bidirectional influences between the cardiovascular and the central nervous systems.

THE REGULATORY ADAPTIVE STATUS IN TESTING EFFICIENCY OF THERAPY WITH BISOPROSOL AND NEBIVOLOL IN PATIENTS WITH PAROXYSMAL SUPRA-VENTRICULAR TACHYCARDIA AND HYPERTENSION DISEASE

The purpose. To compare efficiency of application of Bisoprosol and Nebivolol in patients with paroxysmal supra-ventricular tachycardia against the background of hypertension disease considering their effect on regulatory adaptive status.Materials and method. The sampling consisted of 50 patients with paroxysmal supra-ventricular tachycardia against the background of hypertension disease stage I-II randomized to two groups for treatment with Bisoprosol (3,9±1,3 mg per day, n=25) or Nebivolol (3,8±1,2 mg per day, n=25). The combined therapy provided Lisinopril (7,5±2,5 and 7,4±2,4 mg per day)and in case of indications - Atorvastatin (15,4±3,8 mg per day, n=9 и 15,9±4,1 mg per day, n=9) and acetylsalicylic acid (91,5±14,7 mg per day, n=12 и 93,1±16,2 mg per day, n=14) correspondingly. Initially and after 6 months quantitative evaluation of regulatory adaptive status (by means of testing cardio-respiratory synchronism), echocardiography, triplex scanning of brachiocephalic arteries, six minutes walk testing, tredmilmetry, day monitoring of arterial pressure and electrocardiograms, subjective evaluation of life quality were implemented.Results. It is established that both schemes of combined therapy had comparable effect, controlled arterial hypertension, ameliorated functional and structural condition of heart. The application of Nebivolol positively effected regulatory adaptive status and in a greater degree increases tolerance to physical load and ameliorated life quality.Conclusion. The application of Nebivolol as compared with Bisoprosol in combined therapy is more preferable in patients with paroxysmal supra-ventricular tachycardia against the background of hypertension disease stage II-III due to positive effect of regulatory adaptive status.

The influence of Cytoflavin therapy on the cerebral hemodynamics in patients with various stages of hypertensive disease

To study an influence of cytoflavin therapy on the cerebral hemodynamics in patients with various stages of hypertensive disease (HD). One hundred and forty patients with HD, I-III stages, were randomized into 2 groups: patients of group 1 received complex treatment (antihypertensive therapy and cytoflavin), patients of group 2 were treated with antihypertensive therapy. The control group consisted of 30 healthy people. The changes in cerebral hemodynamics using the algorithm of the complex ultrasound study of cerebral vascular system were assessed. Disturbances of hemodynamics at all structural/functional levels of cerebral vascular system were found in all HD stages. There were a decrease in the blood flow through the common carotid, inner carotid, spinal and middle cerebral arteries, reactivity of veins of Rosenthal, blood flow through veins of Rosenthal and inner jugular veins and an increase of blood flow through spinal veins. The hemodynamic study showed that in group 1 there was the increase of blood flow through common carotid, inner carotid, middle cerebral arteries in stage I and through spinal arteries in stage I-II of HD; improvement of the reactivity of veins of Rosenthal, restoration of blood flow parameters through the veins of Rosenthal and inner jugular veins to control values, the decrease in blood flow velocity through the spinal veins in all HD stages. HD is accompanied by the damage of all structural/functional levels of cerebral vascular system. The use of cytoflavin in the complex therapy of HD exerts a positive influence on the cerebral hemodynamics reducing the severity of arterial insufficiency in the initial stages of disease, improving microcirculation and venous hemodynamics in all HD stages.

The Influence of Cytoflavin Therapy on the Cerebral Hemodynamics Condition in Patients with Various Stages of Hypertensive Disease

The Influence of Cytoflavin Therapy on the Cerebral Hemodynamics Condition in Patients with Various Stages of Hypertensive Disease

Psychological Characteristics of Patients With Stress-induced Arterial Hypertension: a Violation of the Regulation of Emotions as a Central Link of Pathogenesis

The study of emotional and personality characteristics of patients with hypertension in the workplace (HW) and comparative assessment of the effectiveness of antihypertensive therapy in these patients. The study included 170 patients c hypertensive disease stage II, 1-2-th degree, aged 32-52 years, including 85 patients with and 85 patients without WAH, and 82 healthy subjects matched for age and sex. To carry out simulation of the situation of emotional intensity (level of claims assessment process - UE) and a modified version of the test Rosenzweig. Patients with WAH were randomized into 2 groups: patients of group 1 received bisoprolol, 2nd group -eprosartan. If target blood pressure (BP) in 2 weeks, all patients were added indapamide retard. At baseline and after 16 weeks of treatment was carried out daily monitoring of blood pressure and the working day. When modeling a situation of emotional intensity in patients with WAP become, compared with patients without a healthy and WAH, revealed (1) marked increase in systolic blood pressure - 16.1, 4.1 and 3.0 mmHg, respectively (p <0,001 ), (2) the dominance of motivation "avoid failure" (UP underestimated in 34.1% of cases, unformed UP - in 21.2% of cases, healthy - 14.6% and 3.7% of cases, cootvetstvenno, p<0,001 in patients without WAH - 20% and 11.8%, respectively, p<0,05). Patients with WAP become different from normal was significantly (p<0.05) the number of the selected blshim emotionally meaningful situations (9.7 and 7.8, respectively) and emotional descriptors (11 and 7, respectively). Patients with WAH differ significantly (p<0,05) more frequent than in healthy, the use of ineffective strategies of emotion regulation in an emotionally meaningful situations: the suppression of the expression of emotions (38.3 and 20.3%, respectively), rumination and disasterization (19 and 11.8%, respectively) and more rare - high performance: sequential actualization of new meanings (25.7 and 31.7%, respectively) and the strategy of interactive subject-subject transformations (12.6 and 25.2%, respectively). After 16 weeks of treatment showed a significant (p<0,001) reduction of blood pressure in the 1st and 2nd groups. The number of patients achieving target blood pressure, at 2, 4 and 6 weeks, respectively, was as follows: 14 in the bisoprolol group and 93 (100%), in the eprosartan group - 0, 52 (100%). Both groups showed significant (p <0,001) reduction in mean daytime and nighttime blood pressure in the weekdays and weekends. In the group of bisoprolol showed a significant (p <0,01) higher average daily decrease in systolic blood pressure in the working day, compared with eprosartan group (26.2 and 19.3 mm Hg, respectively). Patients with WAP become emotionally meaningful situations frequently resorted to repression of emotions, choose the inefficient strategies of emotion regulation, they noted the expressed reaction of BP in response to the emotional burden. Antihypertensive therapy based on bisoprolol, is highly effective and has advantages over circuit-based therapy with eprosartan.

Effect of cytoflavin on the clinical and autonomic-psychological manifestations of hypertensive disease

To evaluate the impact of incorporating cytoflavin in a treatment regimen for patients with different stages of hypertensive disease (HD). The results of treatment were analyzed in 140 patients with HD (53 with Stage I, 50 with Stage II, and 37 with Stage III). According to the treatment regimen, the patients were divided into 2 groups. A study group (n=74) received combination treatment involving antihypertensive therapy and cytoflavin intravenously dropwisely in a single dose of 200 ml of 5% glucose solution for 10 days, then 2 tablets twice daily for 60 days, with a total cycle time being 70 days. A comparison group (n=66) had antihypertensive therapy only. Thirty apparently healthy individuals (a control group) were examined to have reference values. All the patients were examined using conventional clinical and laboratory studies. The patients' complaints and neurological status were assessed using respective questionnaires over time - before and after treatment. The incorporation of cytoflavin in a treatment regimen was ascertained to reduce the degree of anxiety, depressive, dissomnic, and cognitive disorders, improves quality of life in patients with Stage I HD, and lowers the degree of asthenic and autonomic disorders in all disease stages. The found efficacy and safety of the drug may recommend its incorporation in combination therapy regimens for Stages I-III HD.

CEREBRO-VASCULAR CIRCULATION IN YOUNG PATIENTS AT THE EARLY STAGES OF HYPERTENSION DISEASE

Purpose. To assess arterial circulation inflow and venous outflow in extra and intracranial vessels in young patients with initially diagnosed hypertension with or without consistent hypertensive therapy in correlation to degree and stage of hypertensive disease (HD). Materials and methods. We have examined 82 patients (mean age 36,9±1,5), with HD of the 1-st degree, 63,4 % and 2-nd degree – 36,6 %, HD of the 1-st degree – 61 % and 2-nd degree – 39 %. He control group included – 28 healthy patients of the same age and having normal blood pressure. Circulation in extra and intracranial arteries and veins was studied by ultrasound apparatus Logiq 9 (GEHealthcare,USA). Results. Patients with hypertension disease reliably demonstrated blood flow decrease in carotid and cerebral arteries depending on the degree and stage of HD compared to healthy people with a normal blood pressure. Venous outflow in patients with AH of the 1-st degree and HD of the first stage was increasing objectively in relevance to the patients with AH of the 2-nd degree and HD of the 20nd stage and healthy patients. Later in patients with AH of the 2-nd degree and HD of the 2-nd stage internal jugular vein elasticity decrease was observed accompanied by diminishing of blood stream velocity. Conclusion. Patients with HD of 1-st and 20-nd stage and AH of 1-st and 2-nd degree demonstrate blood stream autoregulation in extra and intracranial arteries of the brain. Changes in venous outflow in AH and HD of the 1-st degree and stage are compensatory. Severity of AH and HD results in cerebral venous congestion confirmed by ultrasound signs.

LASER AND ACUPUNCTURE IN COMBINED TREATMENT OF HYPERTENSIVE DISEASE

368 patients with hypertensive disease stage I and II were examined and treated either with laser puncture or acupuncture. Laser puncture was effective at stage I of hypertensive disease while acupuncture had a more potent hypotensive effect and can be used both in hypertensive disease stage I and II. Action on the acupuncture points and zones normalizes also parameters of the central and peripheral hemodynamics in hypertensive patients.

Drugs acting on imidazoline receptors: a review of their pharmacology, their use in blood pressure control and their potential interest in cardioprotection.

Drugs acting within the autonomic nervous system are of particular interest when autonomic abnormalities are implicated in the development and maintenance of various cardiovascular pathologies. For example, it has been documented that in the early stages of hypertensive disease, i.e. hyperkinetic borderline hypertension, a sympathetic hyperactivity associated with a decreased parasympathetic activity results in increased cardiac output and heart rate. Several classes of drugs acting within the central, as well as the peripheral, autonomic nervous system are very efficient in treating hypertensive disease. One class - the second generation of a group of centrally acting drugs selective for imidazoline receptors - has proved beneficial in this respect, because drugs in this class are well tolerated and have interesting additional effects such as their antiarrhythmic action. Rilmenidine and moxonidine are the lead compounds of this class of drugs. Rilmenidine and moxonidine both proved more selective for cerebral imidazoline receptors than the reference drug, clonidine. It was suggested that this selectivity, attributable to their lower affinity for alpha2-adrenoceptors, explains the low incidence of adverse effects (including sedation) associated with these drugs. In addition, potentially beneficial actions on cardiac dysrythmias and congestive heart failure enlarge the therapeutic potential of the second generation of imidazoline-related drugs. This review focuses on the main pharmacological and clinical properties of rilmenidine and moxonidine, paying particular attention not only to their efficacy in hypertension but also to other potential cardiovascular indications.

Autonomic nervous system as a target for cardiovascular drugs.

1. Drugs acting within the autonomic nervous system (ANS) are of particular interest when autonomic abnormalities are implicated in the development and maintenance of various cardiovascular pathologies. For example, it has been documented that in the early stages of hypertensive disease (i.e. hyperkinetic borderline hypertension) a sympathetic hyperactivity associated with a decreased parasympathetic activity results in increased cardiac output and heart rate. 2. Several classes of drugs acting within the central, as well as the peripheral ANS, are very efficient in treating hypertensive disease. One of these classes of drugs, the second generation of centrally acting drugs, has proved beneficial in this respect because, in addition to their therapeutic efficacy, these drugs are well tolerated. 3. The central nervous system may also be the target for drugs with the potential to treat other cardiovascular diseases. Some recent experimental and clinical data supporting such new perspectives concerning idiopathic dysrhythmias, angina pectoris and congestive heart failure will be summarized.