[Influence of physical therapy on intestinal microbiota, blood pressure control and systemic inflammation level: a randomized controlled study of 84 patients with arterial hypertension].

Objective: To analyze the clinical and organ-protective effects of different 12-month therapeutic intervention schemes, including a balanced diet enriched with dietary fibers, course application of prebiotics, PT courses, in presence of basic antihypertensive therapy in patients with arterial hypertension (AH) of the 1st-3rd degree.

Material and methods: The study included 84 patients with AH of the 1st-3rd degree, randomized to 4 groups. Basic antihypertensive pharmacological therapy was prescribed in the 1st group (control; 22 patients with AH; mean age 51.82±11.89 years); balanced diet with dietary fibers in addition to antihypertensive therapy - in the 2nd group (21 patients; mean age 52.90±9.97 years; balanced diet with dietary fibers and prebiotic (Plantago ovata Forssk) in addition to antihypertensive therapy - in the 3rd group (20 patients; mean age 47.65±11.56 years); pharmacological therapy and balanced diet with dietary fibers and PT course - in the 4th group (21 patients; mean age 53.52±9.50 years). The groups were comparable in age, degree of AH, pharmacological therapy and presence of concomitant pathology. We conducted a laboratory study of the biosamples of blood and faeces at the time of hospitalization. The following parameters were evaluated: metabolites of intestinal microbiota - short-chain fatty acids (SCFA) in the faeces (gas chromatography (GC) with mass spectrometry /GC with plasma ionization detection), endotoxin (chromogenic method based on enzymatic reaction, LAL test set); level of proinflammatory markers - proinflammatory cytokines (interleukin (IL)-1β, IL-6, IL-8, FNO-α (enzyme-linked immunoassay, «sandwich»-method, IMMULITE 2000 (USA)), hsCRP, homocysteine (Stat Fax 4200, USA). We performed: 24-hour monitoring of blood pressure (BP) (BPLaB apparatus, OOO «Petr Telegin», Russia) according to the standard protocol; study of elastic properties of the vascular wall by sphygmography (Vasera VS-1000 Series apparatus, Fukuda Denishi, Japan) with assessment of the following indicators: PWV - pulse wave velocity and CAVI - parameter of the vascular wall rigidity stiffness by the arteries of elastic type.

Results: Analysis of the obtained data has shown that there was a significant reduction in waist and hips volume in patients of the 2nd, 3rd and 4th groups (p=0.049, p=0.001, p=0.025 and p=0.007, p=0.001, p=0.051, respectively). The following changes have been registered: significant reduction of endotoxin levels in all groups; increase in C3 and C4 (propionic and butyric acid) SCFA levels in the group with prebiotic (p=0.001 and p=0.025, respectively) and in the group with PT (p=0.036 and p=0.008, respectively); significant reduction of IL-1β (p=0.038), hsCRP (p=0.013) levels in the group with PT; mean daily heart rate decrease (p=0.052), variability of systolic BP(24) in the group with prebiotic and systolic BP(24) (p=0.043) and diastolic BP(24) (p=0.028) in the group with PT; as well as significant reduction of PWV and CAVI only in the group with PT.

Conclusion: Reduction of endotoxemia and proinflammatory markers levels, increase in SCFA level, normalization of individual parameters of BP profile and tendencies towards improvement of the vascular wall elasticity indicate that there is a positive effect of all schemes of additional intervention to therapy in all study groups, more pronounced in the group of patients undergoing PT. Positive synergistic impact of balanced diet with dietary fibers and PT course on intestinal microbiota correction, systemic inflammation level and stiffness of the arteries in AH has been proven.