动脉高血压患者的手部力量和耐力以及并发症水平和降压治疗方案

G. Usenko, D. Vasendin, N. P. Velichko, D. L. Kolodin
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To determine the level of oxygen utilization by tissues, strength and endurance of the hand, as well as the minute volume of blood and the level of complications in high- and low-anxiety patients with stage II hypertension (AH) with a predominance of excitatory or inhibitory processes in the central nervous system taking an empirical and personalized version of antihypertensive therapy, as well as to determine the most effective treatment approach. Material and methods. Design: outpatient, single-center, cohort, prospective, controlled, non-randomized, long-term clinical trial. From 2011 to 2018 patients with stage II AH, degree 2, risk 3 (n = 328) and healthy (n = 164) men (54.6 ± 0.6 years) were divided by type of higher nervous activity into equal groups with a predominance of excitatory (sympathicotonia) or inhibitory (parasympathicotonia and activation of the renin-angiotensin-aldosterone system in the central nervous system) processes with high and low anxiety. Reactive and personal anxiety, the coefficient of oxygen utilization by tissues, the coefficient of endurance and maximum hand strength, as well as the level of complications of hypertension were determined. Some groups of high- and low—anxiety patients took the empirical option, while others of the same groups of the corresponding activity of the central nervous system and departments of the autonomic nervous system took a personalized version of antihypertensive therapy. It included correction of sympathicotonia in people with a predominance of excitatory processes, and blockade of mineralocorticoid receptors in those with a predominance of inhibitory processes. Results and discussion. In contrast to the empirical one, against the background of personalized therapy, the value of the oxygen utilization coefficient by tissues, the coefficient of endurance of the hand and the maximum strength of the hand were higher, and the minute volume of blood fl ow was lower. 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引用次数: 0

摘要

尽管心血管疾病的治疗取得了成功,但与动脉高血压(AH)相关的并发症并没有减少。在高血压的背景下,中枢神经系统(CNS)的功能发生了变化,需要个性化和更积极的降压治疗来达到目标血压。研究目的确定中枢神经系统兴奋或抑制过程占主导地位的高焦虑和低焦虑 II 期高血压(AH)患者在接受经验性和个性化降压治疗时,组织对氧的利用水平、手的力量和耐力,以及分钟血容量和并发症水平,并确定最有效的治疗方法。材料与方法设计:门诊、单中心、队列、前瞻性、对照、非随机、长期临床试验。从 2011 年到 2018 年,按高级神经活动类型将 2 期 AH、2 度、风险 3 的患者(n = 328)和健康男性(n = 164)(54.6 ± 0.6 岁)分为兴奋型(交感神经张力)或抑制型(副交感神经张力和中枢神经系统中肾素-血管紧张素-醛固酮系统的激活)、高焦虑和低焦虑两组。测定了反应性焦虑和个人焦虑、组织氧利用系数、耐力和最大手部力量系数以及高血压并发症的程度。一些高焦虑和低焦虑患者组采用了经验疗法,而中枢神经系统和自主神经系统相应活动部门的同组患者则采用了个性化的降压疗法。其中包括对兴奋过程占主导地位的患者进行交感神经张力矫正,对抑制过程占主导地位的患者进行矿质皮质激素受体阻断治疗。结果与讨论。与经验疗法相比,在个性化疗法的背景下,组织氧利用系数、手部耐力系数和手部最大力量的数值较高,而分钟血流量较低。个性化降压治疗背景下的各项指标值与健康人相同,中枢神经系统和自主神经系统各部门具有相应的活性。采用个性化治疗方案的各组患者因急性脑血流障碍而引起的高血压并发症水平明显低于采用经验性治疗方案的各组患者。结论与经验治疗方案相比,在组织氧利用系数、手部耐力系数和手部最大力量方面与健康人的数值相同,而且高血压并发症的发生率较低,这表明高血压药物治疗的个性化方法是有效的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Strength and endurance of the hand and the level of complications in patients with arterial hypertension and options for antihypertensive therapy
Despite the success in the treatment of cardiovascular diseases, the number of complications associated with arterial hypertension (AH) does not decrease. Against the background of high blood pressure, the functioning of the central nervous system (CNS) changes and personalized and more active antihypertensive therapy is required to achieve the target blood pressure. Aim. To determine the level of oxygen utilization by tissues, strength and endurance of the hand, as well as the minute volume of blood and the level of complications in high- and low-anxiety patients with stage II hypertension (AH) with a predominance of excitatory or inhibitory processes in the central nervous system taking an empirical and personalized version of antihypertensive therapy, as well as to determine the most effective treatment approach. Material and methods. Design: outpatient, single-center, cohort, prospective, controlled, non-randomized, long-term clinical trial. From 2011 to 2018 patients with stage II AH, degree 2, risk 3 (n = 328) and healthy (n = 164) men (54.6 ± 0.6 years) were divided by type of higher nervous activity into equal groups with a predominance of excitatory (sympathicotonia) or inhibitory (parasympathicotonia and activation of the renin-angiotensin-aldosterone system in the central nervous system) processes with high and low anxiety. Reactive and personal anxiety, the coefficient of oxygen utilization by tissues, the coefficient of endurance and maximum hand strength, as well as the level of complications of hypertension were determined. Some groups of high- and low—anxiety patients took the empirical option, while others of the same groups of the corresponding activity of the central nervous system and departments of the autonomic nervous system took a personalized version of antihypertensive therapy. It included correction of sympathicotonia in people with a predominance of excitatory processes, and blockade of mineralocorticoid receptors in those with a predominance of inhibitory processes. Results and discussion. In contrast to the empirical one, against the background of personalized therapy, the value of the oxygen utilization coefficient by tissues, the coefficient of endurance of the hand and the maximum strength of the hand were higher, and the minute volume of blood fl ow was lower. The values of the indicators against the background of personalized antihypertensive therapy were the same as in healthy individuals with the corresponding activity of the central nervous system and departments of the autonomic nervous system. The level of hypertension complications due to acute cerebral blood f ow disorder in the groups of patients taking the personalized therapy option was significantly lower than in the groups taking the empirical option. Conclusion. The equality of values with healthy individuals in terms of the coeffi cient of oxygen utilization by tissues, the coefficient of endurance of the hand and the maximum strength of the hand, as well as the low level of complications of hypertension, compared with the empirical treatment option, indicate the effectiveness of a personalized approach to pharmacotherapy of hypertension.
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