RU2330650C2 - Method of nitrogen oxide delivery normalisation in vessels of patient suffering from arterial hypertension associated with metabolic syndrome - Google Patents

Abstract

FIELD: medicine; cardiology.

SUBSTANCE: if nitrogen oxide level decrease is registered, patients suffering from arterial hypertension associated with metabolic syndrome are prescribed with six-months medical complex consisting of low-calorie diet, graduated statistical and dynamic physical activities, Metformin in dosage 500 mg 2 times a day after meal and Diroton in dosage 10 mg in the morning.

EFFECT: method provides normalised nitrogen oxide delivery in vessels of specified patients.

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Description

The invention relates to medicine, namely to hematology, cardiology and endocrinology.

Analogues of the proposed method for normalizing the production of nitric oxide in the vessels of patients with arterial hypertension (AH) with metabolic syndrome (MS) does not exist.

There are recommendations in the literature on the appointment of a hypocaloric diet for metabolic correction in the metabolic syndrome (Almazov V.A., Blagosklonnaya Y.V., Shlyakhto E.V., Krasilnikova E.I. Metabolic cardiovascular syndrome. St. Petersburg: Izd. St. Petersburg State Medical University. 1999. - 208 pp.) And reducing the degree of abdominal obesity, which is its component, using recommendations that are more focused on the use of a low-calorie diet (Savelyeva L. Modern approaches to the treatment of obesity. // Doctor, 2000, No. 12, - p. 12-14; Kadyrova R.Kh., Salkhanov B.A. for obesity. Alma-Ata "Kazakhstan", 1990) or physical training (Moshkov VN Physical education for obesity. M: "Medicine", 1976. - 56 p.).

Metformin is used to correct metabolic disorders in patients with metabolic syndrome and abdominal obesity (Dedov I.I., Butrova S.A., Mishchenko B.P., Dzgoeva F.Kh. Metformin (siofora) in patients with abdominal type of obesity. // Problems of endocrinology. 2000. - T.46, No. 5. - S.25-29).

The drug diroton is widely used at present for arterial hypertension and is one of the drugs of choice in patients with metabolic syndrome.

However, never before has a treatment complex consisting of a low-calorie diet, dosed physical exertion and drugs metformin and diroton been used in patients with arterial hypertension with metabolic syndrome in order to normalize the production of nitric oxide in the vessels.

The aim of the invention is to develop a method for normalizing the production of nitric oxide in the vessels of patients with arterial hypertension with metabolic syndrome.

The essence of the method is as follows. In patients with hypertension with MS, blood is taken for analysis and the level of synthesis of nitric oxide in the vascular wall is indirectly determined. Since nitric oxide is both a highly active compound (a vasodilator and a disaggregant) and extremely unstable, its production can be judged also by the content of nitrates and nitrites in the blood, which are the products of its transformation (Emchenko N.L., Tsiganenko O.I. , Kovalevskaya TV Universal method for the determination of nitrates in the biospheres of the body. // Clinical and laboratory diagnostics. 1994. - No. 6. - p.19-20). When registering a decrease in the level of nitric oxide (normal values for nitrates 5.9-7.1 mmol / L, nitrites 9.2-23.0 mmol / L), patients with hypertension and MS are prescribed for a long period of time (at least six months) a complex consisting of a low-calorie diet, dosed statistical and dynamic physical activity, the drug metformin at a dose of 500 mg 2 times a day after meals and the drug diroton 10 mg in the morning.

The method allows to normalize the production of nitric oxide in the vessels of patients with hypertension with MS for six months, translating it to a level characteristic of healthy people. If you follow the recommendations of the proposed method, it is possible to maintain the production of nitric oxide in the vessels in an optimal mode, which will significantly reduce the risk of thrombotic complications, reduce the number of cases of temporary disability, speed up and improve the quality of inpatient care, reduce disability, and also extend the life and reduce mortality of patients AH with MS from heart attack and stroke.

The inventive method is as follows.

To create a negative energy balance in the body of patients, they are recommended an individually selected hypocaloric diet.

The caloric content of the daily diet individually for each patient with MS is calculated in kcal according to the formula:

for women 18-30 years old (0.0621 × body weight, kg + 2.0357) × 240,

31-60 years (0.0342 × body weight, kg + 3.5377) × 240,

over 60 years old (0.0377 × body weight, kg + 2.7545) × 240,

for men 18-30 years old (0.0630 × body weight, kg + 2.8957) × 240,

31-60 years (0.0484 × body weight, kg + 3.6534) × 240,

over 60 years old (0.0491 × body weight, kg + 2.4587) × 240.

The coefficient obtained remains unchanged with minimal physical activity, multiplied by 1.3 for moderate and 1.5 for high physical activity (as a rule, in patients with MS the level of physical activity is low).

3 main meals and 2 intermediate meals are recommended. With the regular skipping of one of the main meals, the frequency of obesity increases significantly, a positive correlation between obesity and skipping breakfast is also revealed. The following daily calorie distribution is recommended: breakfast - 25%, 2nd breakfast - 10%, lunch - 35%, afternoon tea - 10%, dinner - 20%.

To compile the patient’s menu, special tables are used with indications of the chemical composition and calorie content of the products, given that the main sources of energy are proteins (1 g contains 4 kcal), fats (9 kcal), carbohydrates (4 kcal) and alcohol (7 kcal).

The second component of the proposed method is feasible regular physical training.

In real life conditions, it is possible to carry out three forms of physical activity: 1) morning hygienic gymnastics (exercise); 2) therapeutic and preventive gymnastics; 3) fractional physical exercises throughout the day.

1. Morning hygienic gymnastics (exercise)

Morning exercises should be done after sleep before breakfast in a ventilated room. Under the influence of classes, the body is freed from the state of inhibition of physiological processes that occurs during sleep.

The sequence of exercises involves alternating the load on various muscle groups (arms, legs, body). Exercises are performed with a gradually increasing excursion of breathing, stretching, limited use of force conditions. The breathing during exercises should be free, rhythmic, without delay, mainly through the nose; the exhalation should be longer than the inhalation (inhalation 2-3 s, exhale 3-5 s).

With good health, the load can be strengthened by the number of repetitions, speeding up the pace, increasing the amplitude of movements and reducing pauses between exercises.

With fatigue, you should reduce the load, increase the duration of pauses between exercises, fill them with calm breathing.

After gymnastics, you need to go to a wipe or take a shower.

Morning exercises should cause a sense of vitality, increased activity, better health and performance.

If you feel unwell, develop shortness of breath or pain in the heart and behind the sternum, you should temporarily interrupt classes and consult a doctor.

During the day, patients with MS are recommended preventive gymnastics. Depending on the initial training, it is possible to use a lightened version of physical activity at the beginning, and in the subsequent - a strengthened version.

2. Complexes of therapeutic and preventive gymnastics for persons suffering from MS

2.1. Lightweight version of therapeutic gymnastics

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. During the exercise, a gradual deepening of breathing.

Exercise 2. Circular movements in the shoulder joints. When breeding - inhale, while mixing - exhale with a slight tilt of the body and retraction of the abdominal wall - 6-8 times. Fingers touch shoulders, elbows pressed to the body.

Exercise 3. Standing, hands on the belt. Alternately transferring the severity of the body from one leg to the other with slight bending of the legs in the knee joint, without taking the feet off the floor. Do the exercise 10-16 times with muscle tension in the legs.

Exercise 4. Standing, legs spaced shoulder width apart, hands on the belt. Torso forward, touch left sock with your right hand. 4-6 times alternately. When the position is straightened, inhale; when tilted, exhale. Looking forward.

Exercise 5. Standing, arms along the torso. At the same time, take straight arms and one leg to the sides with alternating leg abductions. 4-6 times in each direction alternately. A wave of arms and legs, breathing free, do not hold.

Exercise 6. Standing, legs to the sides, hands in front of the chest, palms down. With the turn of the body, spread your arms to the sides with the turn of the palms up - inhale.

Return to the starting position with a slight tilt of the body forward - exhale. 3-5 times in each direction alternately. Coordinate breathing with the movement of the body and hands. By the end of the exhalation, retract the wall of the abdomen.

Exercise 7. Standing, hands free. Walking freely - 1 min, then with high flexion of the hips - 10-20 movements, followed by a transition to a quiet walk - 1-2 minutes. Rhythmic breathing, medium depth.

Exercise 8. Sitting on the edge of the chair, hands on the waist. Bending back and bending forward of the body. Repeat 6-10 times. Do not hold your breath.

Exercise 9. Sitting on the edge of the chair, focus with tassels on the edge of the chair, and with your feet somewhat in front of the chair. Squats with an emphasis on the edge of the chair - 4-6 times. When squatting, exhale.

Exercise 10. Standing sideways to the back of the chair, hold on to it with one hand. Swing your free straight arm with your legs back. Return to starting position. Repeat 4-6 times with each hand and foot. Do not hold your breath.

Exercise 11. Standing, legs apart, arms at the waist. Turns the body to the right and left - 6-10 times alternately. Do not turn your head, look forward.

Exercise 12. Standing, legs together, arms down. To spread your arms to the sides - inhale, bend your leg at the knee and press your hands to your stomach - exhale. 3-5 times each leg in turn. Strive to maintain balance; as you exhale, draw in your stomach.

Exercise 13. Standing, legs together, hands down. Lateral slopes of the body with bending of the opposite arm ("pump"). Do not hold your breath, strive for a greater excursion of movement.

Exercise 14. Standing. Walking is calm with uniform breathing of medium depth. 1-2 minutes

Exercise 15. Lying on a rug with a pillow placed under the head. Go to the half-sitting position and hug the bent hips - exhale, return to the starting position - inhale. Do not hold your breath. Strive in a half-sitting position to maintain balance. Run 4-6 times.

Exercise 16. Lying, arms to the sides, legs apart. Semicircular movements with the right straight leg to the left with the turn of the pelvis - exhale - return to the starting position - inhale. 3-5 times in each direction. Alternately left and right with the greatest possible excursion of the leg movement, while maintaining the emphasis of the hands on the floor.

Exercise 17. Sitting on the floor; a) get on all fours; b) move to a kneeling position; c) raise your hands up - inhale, tilt the body, and take your hands back - exhale. When tilting, belly retract. Repeat 4-6 times; e) move to a standing position, and the son-in-law to a lying position; f) self-massage of the abdomen with small semicircular movements in a clockwise direction - 1-2 minutes. Rest 2 min; g) calm breathing; h) exercise in protruding (calm) and retracting (active) the abdominal wall. Combine abdominal retraction with expiration through the mouth. Repeat 4-6 times.

Exercise 18. Standing, arms bent. Vigorous walking on the spot or in a room with high flexion of the hips and waved arms - 20-30 steps. Do not hold your breath.

Exercise 19. Sitting on a chair, legs apart, hands on the waist or rest against the edge of the chair. Circular movements of the pelvis with retraction of the abdomen when the pelvis is brought back. 4-6 times in each direction.

Exercise 20. Standing. Calm walking with breathing of an average depth of 2-3 minutes.

With the initial sufficient training or exercise tolerance arising during classes, it is possible to use the following set of exercises.

2.2. Reinforced version of therapeutic gymnastics

Exercise 1. Standing. Walking calm with rubbing the palms of the chest, abdomen, lower back. It takes 1-2 minutes.

Exercise 2. Standing, arms down. Simultaneous bending with tension and free “throwing” of arms forward, to the sides and up 12-16 times. When bending, exhale; when leveling, inhale.

Exercise 3. Standing, arms at the waist, legs shoulder width apart. Lateral movements of the pelvis to the right and left, back and forth. It is performed 6-10 times alternately. Breathing is free.

Exercise 4. Standing, feet shoulder width apart, arms down. Circular movements of straight arms in the shoulder joints, 6-10 times with maximum excursion, do not hold your breath.

Exercise 5. Standing, arms in front of the chest, bent at the elbows. Walking with high flexion of the hips, with the touch of hands. 6-10 times each leg in turn. The movements are vigorous, while flexing the thigh - exhale through the mouth.

Exercise 6. Walking calm 1-2 minutes.

Exercise 7. Sitting on the edge of the chair, hands on the waist. Bending and bending of the body. The exercise is performed 8-10 times. The movements are energetic. When straightening, inhale; when bent, exhale.

Exercise 8. Standing sideways to a chair, hold on to the back, the other hand at the waist. Alternating swings with a straight leg forward with the greatest possible excursion. Leg sweep combined with exhalation. It is carried out 4-6 times.

Exercise 9. Standing, legs apart, arms to the sides. The body tilts forward with the right hand touching the left toe of the foot, the other hand is pulled up. Return to starting position. Combine the slope with the exhale, while straightening, inhale 4-6 times.

Exercise 10. Walking calm with breathing of medium depth, 1-2 minutes.

Exercise 11. Standing, hands clenched and lowered: a) bending the arms at the elbows with force and unbending them with the back, with the greatest possible straightening and tension and a delay in tension for 2-3 seconds. Standing, hands on the waist; b) half-squats, followed by lifting on toes and straining the legs. The exercise is performed 4-6 times with the greatest possible rectification and tension and a delay in the stress state for 2-3 seconds.

Exercise 12. Sitting on the edge of a chair. In the position of the leg raised and bent at the knee joint, alternately shake the tibia and thigh muscles with the hands. Reduce muscle tension, 1-2 minutes.

Exercise 13. Sitting on the edge of the chair, straight legs divorced. Breeding and mixing straight arms and legs. When breeding, inhale, while mixing, exhale. It is carried out 4-8 times.

Exercise 14. Standing. Walking is calm with the transition to a rhythmic calm run (jogging) in place or with movement. If tired, go for a quiet walk with breathing medium depth of 2-5 minutes.

Exercise 15. Lying on the mat. Simultaneous lifting of the body and legs on the exhale 4-6 times. Arms and legs straightened, keep balance.

Exercise 16. Lying on the mat, emphasis with brushes on the floor. Cross movement with straight legs - “scissors” 4-8 times. Do not hold your breath.

Exercise 17. With a quick straightening of the legs, move to a sitting position, then lie down. You can help with a wave, 4-6 times.

Exercise 18. Lying on your back, legs bent. Calm breath 4-6 times.

Exercise 19. Lying on your back, arms spread apart with the emphasis of the hands on the floor. With the turn of the pelvis to the left, bend the legs, turn the pelvis with the legs crossed to the right and stretch the legs. Repeat such circular movements with legs 3-6 times in each direction alternately. Do not tear your hands off the floor. Do not hold your breath.

Exercise 20. Lying on your back, arms and legs apart. Alternate turns of the body to the right and left with the laying of one hand on the other. Do not move your legs. With arms apart, inhale, while turning, exhale. It is carried out 3-6 times.

Exercise 21. Lying on your back, arms along the body: a) turn on your left side; b) turn on the right side; c) go to the supine position; d) get on your knees; e) move to a standing position; f) walking in a place with high hip flexion and arm movement - 20-30 steps; g) sit on the mat; h) lie on your back, calm breathing. Repeat the whole complex 3-4 times.

Exercise 22. Standing. Walking calm with breathing of medium depth - 1-2 minutes.

Exercise 23. Standing, legs spaced the width of the foot, hands on the waist. Circular motion of the pelvis, right and left 6-8 times. Do not hold your breath.

Exercise 24. Standing with legs wide apart, hands in front of the chest. Alternately bending the leg with the transfer of body weight to it with stretching the arms to the toe of the bent leg. 4-6 times in each direction. The other leg is straight. When straightening - inhale, while tilting - exhale.

Exercise 25. Standing, legs spaced shoulder width apart, arms at the waist. Circular head movements 4-10 times in each direction.

Exercise 26. Standing, legs spaced shoulder-width apart, arms at the waist. Tilt the body to the right, pulling the left hand up - inhale. Return to starting position - exhale. 4-6 times alternately.

Exercise 27. The same, arms to shoulders. Circular movements of the hands with a maximum excursion in the shoulder joints, when breeding - inhale, while reducing and retracting the walls of the abdomen - exhale. The breath is deep.

Exercise 28. Standing. Calm walking and breathing of medium depth. Reduced overall load. 1-2 minutes

3. Fractional exercise throughout the day.

A patient with MS is a patient with a number of concomitant disorders, and especially the cardiovascular system. This circumstance limits the simultaneous use of great physical activity in the process of morning gymnastics, as well as in the main occupation of therapeutic and prophylactic gymnastics. That is why the increase in physical activity of people with MS should be carried out by distributing physical activity in small doses throughout the day. This method of increasing the physical activity of patients with MS should be considered as a fractional load method.

Depending on the real life conditions of patients with MS suffering from various degrees of abdominal obesity, various exemplary fractions of various loads can be recommended to increase physical (motor) activity throughout the day.

Option 1

Exercise 1. Sitting - spread your elbows to the sides - inhale, stretch your arms forward with tension - exhale, 4-6 times.

Exercise 2. Sitting - stand up with the deflection of the body and sit down - 8-10 times.

Exercise 3. Sitting - an imitation of the movements of a boxer with a possibly large rotation of the body - 10-12 times.

Option 2

Exercise 1. Standing - walking with high hip flexion - 16-30 times.

Exercise 2. Standing - circular movements of the head to the right and left - 3-8 times in each direction.

Exercise 3. Standing - legs spread apart - imitation of the movement of the pigtail - 10-12 times.

Exercise 4. Sitting - transition to a standing position - 10-12 times.

Option 3

Exercise 1. Walking is calm - 1 min.

Exercise 2. Walking accelerated - 1 min.

Exercise 3. Walking with a high flexion of the hips and alternate wave of hands 20-30 times.

Exercise 4. Walking calm with breathing - 1-2 minutes; the run is calm on the spot or with movement around the room - 2-5 minutes.

Option 4

Walking walk of various extent.

Option 5

Physical labor in various versions and of various durations depending on the conditions (cleaning the premises, home maintenance, work on cleaning the territory, garden works, etc.).

In addition to individually selected non-drug treatment, patients with hypertension with MS on the background of stable antihypertensive therapy should be prescribed metformin at a dose of 500 mg 2 times a day after meals and diroton 10 mg in the morning every day.

The proposed complex is able to weaken insulin resistance, normalize the blood lipid spectrum, lipid peroxidation and the production of nitric oxide in the vessels of patients. This is the basis for the effective prevention of vascular complications, improving the quality and prolonging the life of patients with hypertension with MS.

Example 1. Patient A., 65 years old, with hypertension and MS, was examined in a clinic for 10 years. Blood was taken and examined from the patient. A decrease in the synthesis of nitric oxide by depression in the blood content of the products of its conversion, nitrates and nitrites, was revealed to be 3.12 mmol / L and 12.0 mmol / L, respectively. The patient was prescribed a complex of individually selected hypocaloric diet, dosed physical activity, metformin 500 mg 2 times a day and diroton 10 mg in the morning for six months, which allowed normalizing nitric oxide synthesis after 6 months - the level of nitrates and nitrites in the blood was normalized, amounting to 6.0 mmol / L and 21.7 mmol / L, respectively.

In the future, the patient was recommended to comply with these recommendations, which allowed to maintain the level of synthesis of nitric oxide in her vessels during the entire observation period within normal limits.

Example 2. Patient S., 62 years old, with hypertension and MS, was examined in a clinic for 8 years. Blood was taken and examined from the patient. A decrease in the synthesis of nitric oxide by depression of the content of its conversion products in the blood — nitrates and nitrites — of 3.00 mmol / L and 11.0 mmol / L, respectively, was revealed. The patient was prescribed a complex of individually selected hypocaloric diet, dosed physical activity, metformin 500 mg 2 times a day and diroton 10 mg in the morning for six months, which allowed normalizing nitric oxide synthesis in 5 months - the level of nitrates and nitrites in the blood was normalized, amounting to 6.2 mmol / L and 23.0 mmol / L, respectively.

In the future, the patient was recommended to follow these recommendations, which allowed to maintain the level of nitric oxide in her vessels during the entire observation period.

Using the proposed method for normalizing the production of nitric oxide in the vessels of hypertensive patients with MS observed by cardiologists and endocrinologists will help them to avoid many vascular complications, reduce the number of cases of temporary disability, reduce the duration of hospitalization, reduce disability and mortality in this category of patients.

Claims (1)

A method for normalizing the production of nitric oxide in the vessels of patients with arterial hypertension with metabolic syndrome, including the use of an individually selected hypocaloric diet, rationally dosed static and dynamic physical activity, metformin 500 mg 2 times a day and diroton 10 mg in the morning.