[Effect of diuretic agents on central and intracardiac hemodynamics in hypertension]. / Vliianie diureticheskikh sredstv na tsentral'nuiu i vnutriserdechnuiu gemodinamiku pri gipertonicheskoi bolezni.

Echocardiography and the method of dye dilution (Evans blue) were used to study parameters of the central and intracardiac haemodynamics in 28 men with uncomplicated essential hypertension during treatment with diuretics. Tests were undertaken thrice: after a 5-6 day control period, after a 3-day furosemide load (120 mg per 24 hrs), after 2-3 weeks course of treatment with hypothiazide (50-100 mg per 24 hrs). As a result there was a decrease of end-systolic, end-diastolic and stroke volumes of the left ventricle. In patients with hypotensive effect minute volume did not diminish. In the group without effect there was no significant decrease of arterial pressure, minute volume and general peripheral resistance but an increase in the heart rate. The initial volumes of the circulating blood and plasma in both groups were indistinguishable and decreased significantly as a result of treatment.

[Long-term use of prazosin alone and combined with propranolol in patients with essential hypertension]. / Dlitel'noe primenenie prazosina i ego sochetaniia s propranololom u bol'nykh gipertonicheskoi bolezn'iu.

Therapeutic efficiency and hemodynamic effects of prazosin were examined in 42 patients with essential hypertension in the course of prolonged treatment. Where the adrenoblocker showed low efficiency, the beta-blocker propranolol was added to the treatment scheme. The mechanism of the hypotensive effect was shown to be dependent on correlations between arteriolo- and venodilatation. In the presence of prevailing precapillary dilatation, BP dropped owing to reduced total and regional vascular resistance. If venodilatation was more pronounced, the hypotensive effect was due to reduced minute volume. The addition of propranolol eliminated the manifestations of sympathetic stimulation, enhanced the hypotensive effect and improved general condition of the patients. Combined treatment is indicated particularly in those cases of stable hypertension where prazosin alone has failed to produce an adequate effect.

[Integral indices of the automatically reproduced spatial QRS loop in the diagnosis of different forms of myocardial hypertrophy]. / Integral'nye pokazateli avtomaticheski vosproizvedennoi prostranstvennoi petli QRS v diagnostike raznykh form gipertrofii miokarda.

A total of 249 patients with arterial hypertension taking a variety of clinical forms, primary pulmonary hypertension, dilatation cardiomyopathy, congenital heart diseases with secondary pulmonary hypertension were examined and allocated to 3 groups: 125 patients with left-ventricular hypertrophy (LVH) (group 1); 44 patients with right-ventricular hypertrophy (RVH) (group 2), and 80 patients with combined hypertrophy of both ventricles (CH). Eighty-one normal subjects were taken as controls. New parameters of diagnostic significance were identified by automated reproduction of vectorcardiographic spatial QRSxyz loop (the Macfee-Parungao system) and computer analysis of vectorcardiographic parameters, that improve electrocardiographic diagnosis of cardiac hypertrophies, as compared to the conventional criteria, bringing its accuracy to 88.8% for LVH, 100% for RVH, and 45% for CH. Typical features of myocardial hypertrophy at large are increased area enclosed by the spatial loop (SQRS greater than 3.4 mV2) and/or increased mean vector (LQRSxyz greater than 0.76 mV), while Lx greater than 0.6 mV and/or Lz less than -0.4 mV were specific for LVH; Lx less than 0.05 mV was specific for RVH, and the H angle ranging from -70 degrees to -140 degrees or H of -60 degrees to -140 degrees at Lz less than 1.1 mV, or -50 degrees to -140 degrees at Lz less than 1.5 mV were specific for CH.

[Use of captopril (capoten) in arterial hypertension]. / Primenenie kaptoprila (Kapotena) pri arterial'noi gipertonii.

Capoten (captopril) treatment was conducted in 39 patients with essential hypertension of stage IIA-IIB and in 4 patients with idiopathic hyperplasia of the adrenals. In 35 patients the hypotensive effect was evaluated following a single administration of captopril in a dose of 12.5, 25 and 50 mg. Twelve patients were treated with this drug alone while in 23 patients it was combined with saluretics. Captopril monotherapy elicited a good and moderate hypotensive effect in 70% of patients with a high and stable hypertension. Both mono- and combined therapy was associated with a decrease in adrenaline and noradrenaline excretion and an increase in uterine kallikrein excretion. The examination of the regional circulation revealed a significant reduction in the resistance and tonus of the arterioles and an enhancement of the blood flow in the forearm as well as an increase in venous tensility. When captopril was combined with diuretics these changes were less marked.

[Therapeutic value of pratsiol and its effect on indicators of central and peripheral hemodynamics in patients with hypertension]. / Lechebnyi effekt pratsiola i ego vliianie na pokazateli tsentral'noi i perifericheskoi gemodinamiki u bol'nykh gipertonicheskoi bolezn'iu.

Thirty-eight patients with stage IIB essential hypertension have been studied to determine the therapeutic activity of prazosine (pratsiol, "Orion" company, Finland) and its influence on the parameters of the central and peripheral hemodynamics. It has been established that following the oral administration of the drug, a hypotensive effect develops in 90-120 min and lasts for about six h. After a three-week course of treatment, the arterial pressure in the majority of patients decreased due to a reduction in the total peripheral resistance and the tone of the resistant vessels (arterioles). Simultaneously, there was an increase in the heart rate, end diastolic and stroke volumes and in the cardiac output. In a smaller portion of patients, the arterial pressure decreased due to the predominant reduction in the venous tone; the elasticity of the veins increased sharply, the end diastolic stroke and minute volumes diminished. The heart rate and total peripheral resistance showed no statistically significant changes. It has been established that pratsiol acts as an arterial and venous vasodilator and that it is advisable to use the drug in combination with beta-blockers and diuretics.

[Treatment of hypertension with the calcium antagonist korinfar and its combination with obzidan]. / Lechenie gipertonicheskoi bolezni antagonistom kal'tsiia korinfarom i ego sochetaniem s obzidanom.

A hypotensive effect of corinfar and its effect on the indices of the central and peripheral hemodynamics were studied in 50 patients with stage II hypertension. In 3 weeks BP was lowered at the expense of a considerable decrease in the total peripheral vascular resistance (TPVR) (by 29.6%) and regional vascular resistance (by 48%). It was accompanied by an increase in the peripheral blood flow (by 61%), a reflex activation of the sympathetic-adrenal system with an increase in heart rate and cardiac output (by 22%, p less than 0.001). An index of vein distensibility remained unchanged. The addition of propranolol removed signs of the sympathetic stimulation of the cardiac activity, improved vasodilatator tolerance, enhanced a hypotensive effect of corinfar causing a transient increase in TPVR and tension of the resistive vessels only. By the end of the 4th month of therapy these indices significantly decreased. A prolonged combined therapy with corinfar and propranolol resulted in a significant decrease in the resistance of resistive vessels in maximum vasodilatation characterizing the regression of arteriole structural changes. Besides there was a decrease in the wall thickness (p less than 0.01) and left ventricular myocardial mass (by 7.88 +/- 2.66 g, p less than 0.05) that was interpreted as a tendency to a decrease in a degree of hypertrophy of the left ventricle. The efficacy of corinfar therapy was higher in the patients with hypertension with a high initial tension of the peripheral vessels.

[Results of the treatment of hypertension by autogenic training (data of 5 years' catamnestic observation)]. / Rezul'taty lecheniia gipertonicheskoi bolezni s ispol'zovaniem autogennoi trenirovki (po dannym 5-letnego katamnesticheskogo nabliudeniia).

A total of 90 patients with hypertension were examined after a 5-year interval using echocardiography and the psychological MMPI test. During the first study all the patients were randomized into 2 groups: the study group of 44 patients who were given autogenic training and the control group of 46 patients without psychological intervention. An analysis of the patients' status over 5 yrs. showed that in a labile course of disease a less pronounced progression of disease, more favorable changes of hemodynamics indices (absence of an increase in the myocardium left ventricular mass), a reduced level of neurotization and a reduced number of days of temporary disability were observed in the study group as compared to the control group. In Stage IIB hypertension psychological intervention resulted in improved psychological status, increasing the patient's motivation to treatment and working capacity.

[The effect of obzidan monotherapy on the beta 2-adrenoreceptors of the lymphocyte adenylate cyclase system in hypertension patients]. / Vliianie monoterapii obzidanom na beta 2-adrenoretseptornuiu adenilattsiklaznuiu sistemu limfotsitov bol'nykh gipertonicheskoi bolezn'iu.

Obsidan (propranolol) monotherapy was investigated for the effect on the density of lymphocytic beta2-adrenoreceptors (B max), the activity of lymphocytic homogenates adenylate cyclase (AC), plasma renin activity (PRA), aldosterone concentration (A) and plasma catecholamines (CA). Obsidan treatment brought about a 40% increase in B max without a significant changes in AC activity. Contrary to a significant fall in PRA, A and norepinephrine in plasma reduced insignificantly. Changes in B max correlated with its baseline level (r = -0.56, p < 0.01), PRA (r = 0.57, p < 0.01) and A level in plasma (r = 0.62, p < 0.01). No significant correlations appeared between hypotensive effect of the drug and drug-related changes in B max and AC activity, while PRA and A concentrations showed such dependence. B max and before treatment mass of the left ventricular myocardium correlated significantly (r = = 0.595, p < 0.01). A small decrease in the myocardial mass followed obsidan administration, being related to B max (r = = 0.497, p < 0.05). It is concluded that obsidan-induced changes in lymphocytic beta 2-adrenoreceptors correlate with alterations in the activity of renin-angiotensin-aldosterone system and myocardial hypertrophy dynamics.

[Density of lymphocyte beta-2 adrenoreceptors in the course of hypertension]. / Plotnost' limfotsitarnykh beta2-adrenoretseptorov v techenie gipertonicheskoi bolezni.

Baseline density of intact lymphocyte beta2 adrenoreceptors (B max., 3H-DHA) was compared to dynamics of left ventricular hypertrophy (LVH) and frequency of essential hypertension (EH) complications within 7-9-year follow-up in 27 patients with EH stage II. No significant correlation was noted between B max and LVH changes. In a subgroup of 9 patients with initially very high B max overall number of complications reached 77.8% against 27.5%) (p<0.05) in control. These patients also developed acute myocardial infarctions more frequently (33.3% versus 0%, p<0.05). Such complications as strokes, coronary failure occurred with the same frequency. More extended trials are needed to infer on prognostic value of lymphocytic beta2-adrenoreceptor density.

[Hemodynamic mechanism of the hypotensive action of diuretics and their effect on myocardial hypertrophy in the process of long-term treatment of hypertension]. / O gemodinamicheskom mekhanizme gipotenzivnogo deistviia diuretikov i ikh vliianii na gipertrofiiu miokarda v protsesse dlitel'nogo lecheniia bol'nykh gipertonicheskoi bolezn'iu.

During 12-week hydrochlorothiazide treatment 16 men suffering from uncomplicated essential hypertension were examined. Hemodynamic parameters were controlled by means of echocardiography. The volume of the circulating plasma was determined by the dye dilution method. There was noted a significant decrease of systolic, diastolic, and the mean BP. During the first days of treatment there was observed a significant reduction of left ventricular end-diastolic and stroke volumes (EDV and SV) as well as minute volume (MV). Heart rate and indices of myocardial pump function did not change. On the 12th week of treatment there was noted a significant increase of EDV, SV, and MV, and total peripheral vascular resistance decreased as compared with the initial level. In 9 (56%) out of 16 patients 15.6 g decrease was observed in left ventricular myocardial mass (LVMM) on the average for the group during the 12th week of treatment. The decrease in LVMM was preceded by the decrease in the maximum intracardiac tension on the 3rd week of treatment which, probably, may serve a prognostic criterion of changes in LVMM in the prolonged treatment with diuretics.

[Comparative aspects of the structural and functional status of the myocardium in left-ventricular asymmetrical myocardial hypertrophy in patients with hypertension and cardiomyopathy]. / Sravnitel'nye aspekty strukturno-funktsional'nogo sostoianiia miokarda pri asimmetricheskoi gipertrofii miokarda levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu i gipertroficheskoi kardiomiopatiei.

23 patients with hypertrophic cardiomyopathy (HCMP) and 19 patients with stage II of essential hypertension (EH) with left ventricular asymmetric hypertrophy (ASH) were examined. Echocardiography demonstrated significantly more manifest hypertrophy of interventricular septum and higher coefficient of asymmetry in patients with HCMP compared to those with EH while left ventricular myocardium mass was equal in both groups. Phase-volumetric analysis exhibited in all the patients deterioration of myocardial relaxation processes. EKG-monitoring showed a significant increase in frequency of supraventricular rhythm disturbances in patients with HCMP while no reliable differences in total frequency of rhythm and conduction disturbances were registered. Regular adequate antihypertensive therapy resulted in patients with EH in decrease of ASH degree caused by regression of interventricular septum hypertrophy. In natural course of EH the ASH degree also decreased, but in this case because of increased hypertrophy of left ventricular posterior wall. The patients with HCMP were followed for 1-1.5 years. Drug therapy produced no significant changes in left ventricular myocardium mass as well as character of degree of ASH.