RU2405422C1 - Method of cardiovascular system functional reactivity normalisation in patients with arterial hypertension and impaired glucose tolerance - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, to field of cardiology. In order to normalise cardiovascular system functional reactivity in patients with arterial hypertension and impaired glucose tolerance after determination of increment of value of circulatory system functional reactivity index to psychoemotional load while performing load in comparison with value of functional reactivity index at rest for more than 20 conv.units, administered are rationally dosed static and dynamic physical loads, lisinopril 10 mg in the morning 1 time and metformin 500 mg 2 times per day for not less than 3 months. ^ EFFECT: method normalises functional reactivity of cardiovascular system in patients with arterial hypertension and impaired glucose tolerance due to reduction of degree of risk to develop unfavourable vascular reactions in case of psychoemotional loads. ^ 1 ex

Description

The invention relates to medicine, to the field of cardiology and can be used in therapeutic departments of clinics and hospitals.

As the closest analogue of the claimed method, we can consider a method for choosing the tactics of conducting therapeutic measures in patients with metabolic syndrome (MS) on the background of arterial hypertension (AH), in which physical activity and metformin 500 mg 2 times a day for 3-6 months can be prescribed (RU 2337612 C1 (Mychka V.B. et al.) 10.11.2008). The known method can improve carbohydrate and lipid metabolism, lower blood pressure, improve vascular endothelial function, reduce the risk of developing atherosclerosis and cardiovascular disease.

However, the closest analogue is a metabolic syndrome with arterial hypertension, and this condition differs from the state of hypertension with impaired glucose tolerance (NTG), which is described in the claimed method with at least the presence of abdominal obesity and dyslipidemia (description and formula RU 2337612 ) Moreover, in the closest analogue, the degree of cardiovascular risk, body mass index, blood pressure, lipids, glucose, visceral obesity, the presence of NTG or type 2 diabetes mellitus are used as a criterion for the appointment of the treatment options, which significantly complicates the implementation of the method. At the same time, the approaches to the correction of the patient’s condition proposed in paragraph 1 of the claims of this method do not allow achieving 100% optimization of the considered criteria, which requires additional revision of the correction after 3-6 months (dependent claims 2-12), while maintaining the risk of complications (heart attacks, strokes, death), worsening the already disappointing prognosis in this category of patients.

In addition, the known method differs from the closest analogue in that in the claimed method, after the patient has established an increment of the value of the index of functional reactivity of the cardiovascular system to the psychoemotional load when the load is performed compared to a decrease in resting index of functional reactivity by more than 20 conventional units . rationally dosed static and dynamic physical activities are prescribed, lisinopril 10 mg in the morning 1 time. Moreover, the claimed method normalizes in 100% of cases the functional reactivity of the cardiovascular system in patients with arterial hypertension with impaired glucose tolerance for 3 months of treatment by reducing the risk of adverse vascular reactions during psycho-emotional stress.

The aim of the invention is to increase the efficiency of correction of the functional reactivity of the cardiovascular system in hypertension with NTG.

The essence of the proposed method for the correction of the functional activity of the cardiovascular system is to increase the tolerance of hypertensive patients with NTG to a psychoemotional load and to increase the functional reactivity of the cardiovascular system when they perform a dosed psychoemotional load and to reduce the risk of cardiovascular complications during emotional stress, assessed after conducting dosed psychoemotional load with an ever-increasing speed for 18-20 minutes with every minute using the parameters of central hemodynamics: systolic blood pressure (BPA), diastolic blood pressure (BPA), average dynamic blood pressure (BPA) and heart rate (HR), determine the value of the functional reactivity index (PFR), which is a product of the average dynamic BP at heart rate, calculate the relative increment of the PFR value when the load is performed compared to the value at rest and the type of functional reactivity dechno circulatory system: at a value of more than 20 FIU conv reactivity is assessed as hyperfunctional (which occurs in hypertension in combination with NTG), with a PFR value of less than 10 conventional units the response to the load is assessed as hypofunctional and with PFR values from 10 to 20 conventional units type of functional reactivity is assessed as normal. The time of the psycho-emotional load is no more than 20 minutes. To normalize the functional reactivity index in patients with hypertension with NTG, a combination of rationally dosed static and dynamic physical loads, lisinopril and metformin is used for at least 3 months.

The inventive method is as follows. The value of the PFR indicator is determined by O. Lebedeva, S. A. Radzievsky, S. A. Bugaev A method for assessing the state of functional reactivity of the cardiovascular system RU 2207044. The patient is seated in front of a monitor screen. A cuff is placed on the patient’s left shoulder to measure systolic blood pressure, diastolic blood pressure, dynamic average blood pressure and heart rate before and during exercise. The patient is offered two sets of 4 letters: ANEU and RLOG, from which he must choose one to remember. After registering the hemodynamic parameters for 3 minutes and remembering (30 s) the selected set of letters, the psychoemotional load begins, which consists in the fact that the test person presses the key marks the scattered letters from the set he chooses as he moves on the monitor screen a square frame in random order the letters of the alphabet. The speed of advancement of the frame along the rows of letters during the sampling process increases from 3 letters in 1 s at the beginning of the load to 6 letters in 1 s, starting from 6 min of the load, and this ensures the patient’s gradual development. Errors in marking letters from the selected set are accompanied by sound signals, according to which the subject can navigate the correct execution of the load and try to adjust its performance. After the end of the load, the average values of ADs, ADd, and ADsr are calculated. din and heart rate in periods: before the load and during the load. Dynamic mean blood pressure is calculated by the formula: ADsr.din = ADd + [0.42 (ADs-ADd)].

Dynamic mean blood pressure is a complex result of all variables of blood pressure. When conducting a test with emotional stress in healthy individuals, the mean dynamic does not change significantly, and heart rate, as a rule, increases. According to studies, an increase in heart rate and blood pressure leads to an increase in myocardial oxygen demand and an increase in its energy expenditure. Under pathological conditions, for example, in hypertension with NTG, vessels that are in a state of spasm are not able to provide the required increased amount of oxygen, as a result of which hypoxia can build up, a disturbance of cerebral circulation can occur, etc.

Based on the data obtained, an indicator of functional reactivity is calculated, which allows integratively assessing the degree of increase in the hemodynamic load on the heart and, accordingly, the risk of developing cardiovascular complications, defined as follows:

PFR = (ADdr.din HR) * / 100 (conventional units).

The increment of PFR values during the transition from rest to load fulfillment is determined by the indicator:

PFR = PFR2-PFR1,

where PFR is the difference in the values of PFR before and under load,

PFR1 - the average value of the indicator to the load,

PFR2 - the average value of the indicator under load.

According to the value of the relative increment of PFR values, the type of functional reactivity of the cardiovascular system is evaluated: if the value is *, then it is divided by 100 to obtain arbitrary units (conventional units are two-digit numbers).

In a second study in the dynamics of treatment, the patient is given to memorize a different set of letters in order to prevent addiction.

When the values of the increment after dosed psychoemotional load PFR from 10 to 20 srvc. functional type of reactivity is assessed as normal. When PFR load more than 20 srvc. type of functional reactivity is assessed as hyperfunctional. In this case, a patient with hypertension with NTG should be prescribed for at least 3 months a combination of dosed static and dynamic physical activity, lisinopril 10 mg in the morning 1 time and metformin 500 mg 2 times a day.

The inventive method includes feasible regular physical training, the use of which can be as one of the options in the form below.

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 increased by the number of repetitions, acceleration of the pace, an increase in the amplitude of movements and a reduction in 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 are recommended therapeutic and prophylactic gymnastics. Depending on the initial training, it is possible to use at the beginning of a lightened version of physical activity, and subsequently a strengthened version.

2. Complexes of therapeutic and preventive gymnastics for people suffering from hypertension with NTG

2.1. Lightweight version of therapeutic gymnastics

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. When performing 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 exhale, 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 inclinations 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 the classes, the following set of exercises can be used.

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 upwards 12-16 times. When bending, exhale, while 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. Tilts the body forward with a touch of the right brush of 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 in a fist 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. Exercise is performed 4-6 times with the greatest possible rectification, tension and delay in tension 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 walk with moderate breathing. 2-5 minutes

Exercise 15. Lying on the mat. Simultaneous lifting of the body and legs as you 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 a turn of the pelvis to the left, bend the legs, turn the pelvis with crossed legs 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 the 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 hypertension and NTG is a patient with a number of concomitant disorders and, above all, 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 an increase in the physical activity of individuals suffering from hypertension with NTG should be carried out by distributing physical activity in small doses throughout the day. This method of increasing the physical activity of patients should be considered as a fractional load method.

Depending on the real life conditions of patients suffering from various degrees of abdominal obesity, various exemplary fractional exercise options 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.).

Timely and effective correction of PFR in hypertensive patients with NTG will allow them to quickly normalize the functional reactivity of the cardiovascular system, which will shorten the period of temporary disability in these patients, prevent strokes and heart attacks, reduce the number of disability exits and reduce mortality among hypertensive patients with NTG.

Example. Patient S., 42 years old, suffering from AH of the II degree, II stage with NTG for 7 years was examined. In the study of hemodynamics in the initial state before the psychoemotional load, the blood pressure was 144 mmHg, blood pressure was 90 mmHg, blood pressure was 112.7 mmHg and heart rate was 74 beats. in 1 min. PFR before the start of the psychoemotional load was 83.4 srvc. During the psychoemotional load, blood pressure increased to 170 mmHg, blood pressure - 102 mmHg, blood pressure to 130.5 mmHg, heart rate - up to 90 beats. in 1 min, the PFR value increased to 117 conventional units, that is, the increment of the PFR at the load or, which is the same as the PFR, amounted to 33.6 conventional units. (from 83.4 conventional units to 117 conventional units), which can be regarded as a manifestation of hyperfunction of the cardiovascular system. The patient was prescribed a combination of rationally dosed static and dynamic physical activity, lisinopril 10 mg in the morning and metformin 500 mg 2 times a day. After 3 months of treatment, the PFR value decreased before the start of the load compared with the same before treatment: BPA - up to 125 mmHg, BPA - up to 78 mmHg, BPAdin - up to 97.7 mmHg. , Heart rate - up to 64 beats. in 1 min, PFR - up to 62.5 conventional units When performing the load, a decrease compared to the state before treatment, the degree of increase in blood pressure values - up to 140 mm Hg, blood pressure - up to 84 mm Hg, blood pressure - up to 107.5 mm Hg, heart rate - up to 72 beats in 1 min, PFR - up to 77.4 conventional units, that is, an increase in the values of PFR, or PFR, by 14.9 conventional units was noted. (before treatment - by 33.6 conventional units), which may indicate an increase in the tolerance of the cardiovascular system to psychoemotional stress, a decrease in the hyperfunction of the cardiovascular system and, consequently, an increase in cardiac activity.

As a result of the application of the proposed method for correcting the state of the functional reactivity of the cardiovascular system in patients with hypertension with NTG, normalization of the functional reactivity of the cardiovascular system to a dosed psychoemotional load is achieved, which allows you to use the method to normalize the tolerance of patients with hypertension with NTG to psychoemotional stresses, and reduce the degree of hemodynamic stress exposure, reducing the risk of development during psycho-emotional stress unfavorable with sudistyh reactions (angina attack, myocardial infarction, cerebrovascular disease and others.).

Claims (1)

A method of normalizing the functional reactivity of the cardiovascular system in patients with arterial hypertension and impaired glucose tolerance, characterized in that after the patient has established an increment in the value of the index of functional reactivity of the cardiovascular system to the psychoemotional load when the load is performed compared to the resting value of the functional reactivity index more than 20 conventional units rationally dosed static and dynamic physical activities are prescribed, lisinopril 10 mg in the morning 1 time and metformin 500 mg 2 times a day for at least 3 months.