ANTAGONISM IN SYSTEM REGULATION ARTERIAL PRESSURE And ITS CHANGE after THERAPY NICERGOLINE

By the method of fractional trends, when analyzing the dynamic series of blood pressure (АД), an antagonism between the cardiac output block (CB) and the peripheral vascular resistance block (СПС) was revealed in the patient, after 12 weeks of nicergoline therapy, at the 1-3 hierarchical level of systemic regulation. At the subordinate 4-6 levels of the hierarchy, the phenomenon of antagonism was also revealed. When regulating systolic (САД) and diastolic (ДАД) blood pressure, this method revealed that nicergoline has a greater effect on the regulation of ДАД.

COPD and preclinical cardiovascular disease

Objective: to assess cerebral blood flow and reveal early myocardial remodeling in COPD patients with varying degrees of airflow restriction. Materials and methods: the research included 105 patients with COPD from 1 to 4 degrees of severity, depending on the degree of restriction of FEV1 without CVD, diabetes mellitus, chronic kidney disease, obesity, other systemic and oncological diseases. Average age was 57.12 ± 0.68 years, men 45%. 5 groups were identified: mild severity of COPD (GOLD1, = 24), moderate (COLD2, n = 39), severe (GOLD3, n = 30), very severe (GOLD4, n = 12). Control group (n = 37) was tobacco free and CVD. Blood pressure and ultrasound tracranial dopplerography were performed in all groups. Transtoral echocardiography with assessment of global and local LV longitudinal deformation by the strain method and determination of left ventricular diastolic dysfunction (DDLV) was performed in GOLD1 and GOLD2 groups. Parameters of average values of deformation in basal, medial and apical segments are evaluated. Results were processed with Microsoft Excel 2016 and STATISTICA 10 (StatSoft, Inc., USA). Results: arterial hypertension (AH) was detected in 56.4% of patients in the COLD2 group; 56.7% of patients in the GOLD3 group and 100% of patients in the GOLD4. Сhanges in cerebral blood flow were not found in the GOLD1-3 groups. Significant increase of linear blood flow rate of middle cerebral arteries and index of peripheral vascular resistance were detected in group GOLD4 relative to control and GOLD1-3 groups (p < 0.05). DDLV of 1 type was revealed in 27.7% of patients of COPD and was higher at patients with COPD and AH - 62.5% (χ²=11.5, р =0.009). Pathological patterns were identified at the level of the basal and medial parts of the left ventricle in patients with COPD. Conclusion: preclinical signs of target organ involvement identified in COPD patients without cardiovascular disease. Changes in cerebral blood flow in the form of an increase in linear blood flow rate and peripheral vascular resistance index were detected in the GOLD4 group. DDLV of 1 type was detected in the GOLD1-2 groups and was found more frequently in the combination of COPD with AH. Pathological patterns were identified at the basal and medial left ventricular levels in a combination of COPD and AH. Changes in target organs indicate the need for an in-depth search to reclassify cardiovascular risk and identify an individual prevention plan.

The influence of plant saponins on the elasticity parameters of the great arteries in patients with multifocal atherosclerosis

Background. Among the goals of pathogenetic therapy in patients with multifocal atherosclerosis, not only control of the intensity of atherogenesis, but also the elastic properties of the arterial system is becoming increasingly important, which opens up additional ways to reduce overall and cardiovascular mortality in this category of patients. Aim. To evaluate effectiveness of medication Vazosponin (ZAO Vifitekh, Russia), which is a source of plant saponins in a dosage 400 mg per day, on the indicators of the elasticity of the great arteries. Materials and methods. The study included 100 patients with multifocal atherosclerosis: those who had had myocardial infarction or percutaneous coronary intervention during the previous 2 1 2 months and who had stenosing atherosclerosis of peripheral arteries brachiocephalic arteries and/or arteries of the lower extremities. The main group MG (n=50) consisted of patients who received combined hypolipidemic treatment: atorvastatin in dosage 40 mg/day + Vazosponin 400 mg/day along with baseline treatment. The control group (CG) included 50 patients who received only atorvastatin in dosage 40 mg/day along with baseline treatment. The observation period for each patient was 90 days with 3 control points (on the 1st, 10th and 90th days of therapy), in which were evaluated the elasticity indicators of the main arteries pulse wave velocity, linear blood flow velocity, total peripheral vascular resistance, actual specific vascular resistance. Results. There was a decrease in pulse wave velocity in both groups by the 90th day of the study, with a significant advantage in the group of patients who received Vazosponin: in the CG the indicator decreased by 7.3% (p0.05), in the MG by 19.3% (p0.05). The decrease in linear blood flow velocity was 14.3% (p0.05), in the CG the indicator decreased by 5.7% (p0.05). The dynamics of peripheral vascular resistance indicators showed an obvious advantage in the group of patients who received plant saponins: in the MG of patients, a decrease in total peripheral vascular resistance was detected by an average of 11.0% (p=0.006) and actual specific vascular resistance by 39.3% (p=0.0008), while in the CG by 4.5% and 5.0%, respectively. Conclusion. The addition of Vazosponin to the basic therapy of patients with multifocal atherosclerosis made it possible to achieve an additional increase in the elasticity of the arterial system, a significant decrease in peripheral vascular resistance, and the elimination of the escape effect of basic therapy. The data presented make it possible to consider the possibility of using preparations of plant saponins in combination therapy of patients with multifocal atherosclerosis who have instrumentally verified violations of the elastic properties of the arterial system.

CHANGES IN GAUSSIAN MODELING PARAMETERS OF PPG PULSE DURING HEALTHY PREGNANCY

We used Gaussian modeling to depict the changes in finger photoplethysmographic (PPG) pulse during pregnancy in healthy women. We enrolled 70 healthy pregnant women and recorded their PPG pulses in 11–13 gestational weeks, 20–22 gestational weeks, and 37–39 gestational weeks. Three independent positive Gaussian functions were utilized to decompose the pulses, and each Gaussian function extracted three key parameters: the peak amplitude ([Formula: see text]), the peak position ([Formula: see text]), and the half-width ([Formula: see text]). The method of ANOVA and post-hoc multiple comparisons of mathematical statistics were utilized to study the differences of these parameters between the three trimesters. We found that in the first trimester [Formula: see text] increased significantly ([Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]). [Formula: see text] and [Formula: see text] increased in the first trimester ([Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]; [Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]), then decreased significantly ([Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]: [Formula: see text] versus [Formula: see text], [Formula: see text]). [Formula: see text] is associated with cardiac output, and [Formula: see text] and [Formula: see text] are associated with peripheral vascular resistance. The results of this study were consistent with the conclusion that healthy pregnant women exhibited high flow state of the cardiovascular system and their peripheral vascular resistance decreased first and then gradually recovered during pregnancy. This study indicated that PPG pulse could also reflect the changes in the maternal cardiovascular system during pregnancy.

FEATURES OF CEREBRAL CIRCULATION UNDER CONDITIONS OF MOTOR AND SENSOR DEPRIVATION

The features of cerebral circulation in children with motor and sensory deprivation were studied. Children with impaired motor activity had reduced blood supply in all leads (except for the frontomastoidal left hemisphere) and peripheral vascular resistance. The tone of the postcapillary type vessels more often decreased in comparison with the values in young men with sensorineural hearing loss. Girls with impaired motor activity had reduced peripheral vascular resistance in all leads and blood circulation in the brain (except for the left carotid artery basin). The tone of the postcapillary vessels in them was more often below the standard values of similar indicators in female students with sensorineural hearing loss. Changes in the cerebral hemodynamics of children reflect the redistribution of the blood supply to the brain. This is due to the peculiarities of the effects of the studied deprivations and the role of motor activity in cerebral hemodynamics.

Differentiated approach to treatment of arterial hypertension in patients, suffering ischemic cerebral stroke

Objective. To raise the efficacy of treatment of arterial hypertension in patients, suffering ischemic cerebral stroke of the middle grade of severity on background of determination of hemodynamic variant of arterial hypertension. Materials and methods. Prospective nonrandomized investigation concerning 42 patients, suffering ischemic cerebral stroke of middle severity in accordance to the insult severity scale of National Institute of Health (National Institutes of Health Stroke Scale - NIHSS), was conducted. The patients’ middle age have constituted (69.4 ± 1.4) yrs. There were the central hemodynamic indices measured, the arterial hypertension hemodynamic variant determined, the oxygen and hemodynamic status estimated, and in accordance to the results obtained - the differentiated antihypertensive therapy was administered. All the patients were divided into three groups, depending on hemodynamical variant of arterial hypertension: the first group – patients with eukinetic variant, the second group – patients with hypokinetic variant, the third group – patients with hyperkinetic variant. Hemodynamical variant of arterial hypertension was determined in accordance to the referent level of cardiac index. The groups were representative in accordance to age, height, the body mass, the main and concurrent pathology and the cerebral affection degree. Results. In the patients, suffering initial eukinetic hemodynamical variant of arterial hypertension, the cardiac index have fluctuated from 2.88 to 4.67 l × min-1 × m-2, general peripheral vascular resistance have rested in the norm borders, the oxygen saturation level of arterial blood did not demand the oxygen therapy, index of the oxygen delivery have exceeded the appropriate values and fluctuated in borders from 541 to 903 l × min-1 × m-2. In complex of differentiated antihypertensive therapy there was applied a constant intravenous injection of magnesium sulfate in a daily dose 2500 - 5000 mg. For patients with initial hypokinetic hemodynamic variant of arterial hypertension following signs are characteristic: low cardiac index - from 1.65 to 2.08 l × min-1 × m-2, the enhanced general peripheral vascular resistance - 2813 (from 2393 to 3403) dyne × s-1 × cm-5 and the lowered index of the oxygen delivery - from 306 to 412 l × min-1 × m-2. Differentiated antihypertensive therapy was conducted, using urapidyl: intravenous boluses 1.25 – 2.5 mg with further infusion 5 - 40 mg × h-1. For hyperkinetic hemodynamic variant of arterial hypertension the raised cardiac index is characteristic – 3.75 l × min-1 × m-2 (fluctuated in borders from 3.62 to 4.10 l × min-1 × m-2), as well as normal general peripheral vascular resistance - 1189 (from 1055 to 1449) dyne × s-1 × cm-5 and raised index of the oxygen delivery - 762 (from 725 to 828) l × min-1 × m-2. Differentiated antihypertensive therapy was conducted, using labetalol: intravenous infusion with velocity 2 - 8 mg × min-1. Conclusion. In the patients with ischemic cerebral stroke of the middle grade of severity the conduction of differentiated antihypertensive therapy, taking into account hemodynamic type of arterial hypertension and the oxygen-hemodynamic stabilization of the blood circulation system, improved the results of treatment and accelerated the rehabilitation duration.