[Therapeutic effect of the beta-adrenergic receptor blocker corgard (nadolol) and its effect on hemodynamics in hypertensive patients]. / Lechebnyi éffekt blokatora beta-adrenergicheskikh retseptorov korgarda (nadolola) i ego vliianie na gemodinamiku u bol'nykh gipertonicheskoi bolezn'iu.

The therapeutic effect of the non-cardioselective beta-blocker corgard (nadolol) was examined in 40 patients with stage II essential hypertension. In 22 of those, central, intracardiac and regional hemodynamics were measured echocardiographically and rheographically after 2 and 4 weeks of treatment. Blood pressure dropped significantly by days 8-13 of treatment, as a result of cardiac index reduction mainly due to decreased heart rate. At the same time, a moderate yet significant rise in total peripheral vascular resistance was noted. Intramyocardial tension decreased, as did the thickness of the left-ventricular posterior wall and interventricular septum, which caused a significant (6.74%) reduction in myocardial weight.

[Changes in central and regional hemodynamics during treatment of hypertension with hemiton]. / Izmeneniia tsentral'noi regionarnoi gemodinamiki pri lechenii bol'nykh gipertonicheskoi bolezn'iu gemitonom.

The indices of central hemodynamics were studied during hemiton therapy in 33 patients with stage IIA and IIB hypertensive disease by means of a noninvasive method--tetrapolar chest rheography. In patients with hypodynamic type of circulation the arterial pressure decreased already beginning with the first week of treatment due to a decrease in the arterial tonus and general peripheral resistance; the cardiac output practically did not change. During treatment cerebral and peripheral circulation improved significantly (according to the rheographic data) and the arterial tonus decreased. In 3-4 weeks of treatment, favourable shifts occurred in the reactions of general and regional hemodynamics in the orthostatic test. The overall changes were evidence that the compensatory-adaptational reactions of the arteries and veins had improved and the venous return had increased. In most patients treatment with hemiton led to lesser orthostatic decrease in arterial pressure and its greater lability during the day.

[Use of beta-adrenergic blockaders in the treatment of arterial hypertension]. / Primenenie beta-adrenergicheskikh blokatorov v lechenii arterial'noi gipertonii.

The results of treatment of over 300 patients suffering from hypertensive disease with beta-blocking agents Obsidan and Visken are analysed and the place of these agents among other hypotensive drugs is discussed. The therapeutic effect was most evident in patients with the early stages of the disease and hyperkinetic type of circulation. The daily doses were from 60 to 240 mg. The hemodynamic shifts were displayed by a decrease in the cardiac output and rate of cardiac contractions and reflex, ususlly moderate, increase in general peripheral resistance, as a result the arterial pressure decreased gradually. In 1 to 6 months general peripheral resistance diminished in half of the patients, evidently due to the gradual adaptation of the vascular tone to the chronic reduction of the cardiac output. Treatment with beta-blocking agents led to non-uniform changes in regional hemodynamics: the tone of the cerebral arteries significantly reduced, the tone of the arteries of the lower extremities had a tendency to increase. This gives rise to the conclusion that alpha-adrenergic receptors predominate in the vessels of the lower extremities. In the treatment of patients with high and stable hypertension, it is advisable to combine beta-blocking agents with saluretics, vasodilators, hemiton, and other hypotensive drugs.

[Effect of apressin and its combination with obzidan on central hemodynamic indices in the treatment of hypertension]. / Vliianie apressina i ego kombinatsii sobzidanom na pokazateli tsentral'noi gemodinamiki pri lechenii bol'nykh gipertonicheskoi bolezn'iu.

Apressine, obsidan and a combination of these two drugs were used for treating 44 patients suffering from hypertension, mainly stage IIB. When apressine was used to treat patients with the hypodynamic type of circulation, arterial pressure decreased due to considerable diminution of the arterial tone. Tachycardia developed simultaneously and the cardiac output increased, which restrained the hypotensive effect of apressine. The addition of the beta-blocking agent obsidan corrected, while its preliminary prescription prevented the development of the noted reflex stimulation of cardiac activity. This made it possible for the main valuable properties of apressine to become manifest, namely those which reduced the tone of the arteries and produced the hypotensive effect. Small doses of apressine and of the beta-blocking agent may be used and prolonged treatment applied with no side-effects.

[Regional and central hemodynamic changes during the treatment of hypertension with obsidan, apressin and their combination]. / Izmeneniia regionarnoi i tsental'noi gemodinamiki pri lechenii bol'nykh gipertonicheskoi bolezn'iu obzidanom, apressinom i ikh kombinatsiei.

The values of central and regional hemodynamics were studied in 80 patients with hypertensive disease mainly of stage IIB by means of tetra- and bipolar rheography in different periods of treatment with obsidan, apressin and their combination. It was established that obsidan reduces the cardiac output and increases by reflex peripheral vascular resistance, while apressin reduces the vascular tonus and stimulates by reflex cardiac activity. Apressin caused a significant improvement in cerebral and peripheral circulation, but the asymmetry of cerebral and leg rheograms increased in these instances. In obsidan therapy the tonus of cerebral arteries diminished to a lesser degree while the tonus of the leg arteries was often increased, but the inter-hemispheric asymmetry of the rheoencephalogram and the limb rheograms diminished. The combined use of these drugs corrects undesirable effects in regard to the haemodynamic structure and potentiates the hypotensive effect.

[Therapeutic effect of the cardioselective beta-blocking agent tenormin and its action on the indices of systemic, intracardiac and regional hemodynamics in patients with hypertension]. / Lechebnyi éffekt kardioselektivnogo beta-blokatora tenormina i ego vliianie na pokazateli tsentral'noi, vnutriserdechnoi i regionarnoi gemodinamiki u bol'nykh gipertonicheskoi bolezn'iu.

Cardioselective beta-blocking agent tenormin (atenolol) was used in 55 patients with essential hypertension, Stage II; in 20 of those, central, intracardiac and regional hemodynamics were assessed echocardiographically and rheographically. Tenormin produced a pronounced hypotensive effect within 2-4 weeks of treatment (BP decreasing by 26.8/22.8%). A significant decrease was noted in cardiac index (by 26.8%), heart rate (by 24%), intramyocardial tension (by 21.9%), the myocardial circular fibre shortening rate (by 6.5%), left-ventricular myocardial wall thickness and weight (by 4.5%). Total vascular peripheral resistance did not change significantly (it dropped in half of the patients). Stroke index, output fraction and left-ventricular size remained unchanged. Cerebral and femoral arterial tone also decreased. Tenormin was effective in 5 patients with hypertension combined with bronchial asthma. Owing to its prolonged action, tenormin can be administered once or twice daily, a factor that facilitates considerably prolonged out-patient treatment.

[Venous distensibility in essential hypertension]. / Izuchenie rastiazhimosti ven u bol'nykh gipertonicheskoi bolezn'iu.

Using venous occlusive plethysmography, venous distensibility was examined in 85 hypertensive patients and in 21 normal men. Venous distensibility in the hypertensive versus normal subjects was significantly lower, being inversely depended on the blood pressure level. Venous distensibility depended directly on the blood flow in the forearm and inversely on the resistance of the resistive vessels at rest. This may indicate that the reduction of venous distensibility was caused by both functional and structural changes characteristic of both resistive and capacitance vessels. It appears that functional and structural alterations in the system of low pressure, along with an elevated resistance of the arterioles, were actively involved in changes of the peripheral resistance and the development of a hypertensive state.

[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.

[Certain aspects of the pathogenesis and prophylactic treatment of hypertensive crises]. / Nekotorye aspekty patogeneza i profilakticheskogo lecheniia gipertonicheskikh krizov

The paper analyses the results of a study of the clinical peculiarities of the course of essential hypertension with crises, of the changes in the functional state of the central nervous system, and of some neuro-humoral systems of the human body. In most of the patients tending to develope frequent crises distinct changes were noted in the EEG that indicate dysfunction of the hypothalamic zone and of the reticular formation of the brain stem, their clinical course being characterized by significant astheno-neurotic disorders with autonomous dysfunction and cerebral angiodistonic disturbances. For the prevention of crises it is essential to conduct a pathogenetically substantiated and highly differentiated systematic therapy, as well as special measures aimed at increasing the endurance of the central nervous system, improving the circulation and metabolic processes in the brain, decreasing tnd hypothalamic structures of the brain, and correcting the dishormonal disorders.

[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.

[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.

[Condition of the tissue oxygen regime of patients with essential hypertension with different types of hemodynamics]. / Sostoianie kislorodnogo rezhima tkanei u bol'nykh gipertonicheskoi bolezn'iu s razlichnymi tipami gemodinamiki.

Systemic and regional hemodynamic parameters were investigated using echocardiography, venous-occlusion plethysomography, and tissue oxygen regimen was studied polargraphically, in 51 patients with essential hypertension. Tissue oxygen supply becomes increasingly inadequate as the disease progresses, as reflected in limited oxygen delivery to tissues, its reduced utilization, and smaller reserve capacities of oxygen transport at the microcirculatory level. In patients with hyperkinetic circulation, increased blood stroke volume was combined with a significant increase in baseline tissue oxygen tension and the capillary-to-tissue oxygen diffusion rate, while changes in the resistive vascular element were basically functional. Changes in regional hemodynamics and tissue oxygen supply were particularly severe in patients with hypokinetic circulation.

[Clinical use of chloranolol (tobanum) in essential hypertension patients]. / Klinicheskoe primenenie khloranolola (tobanuma) u bol'nykh gipertonicheskoi bolezn'iu.

A clinical study of the efficiency of a new beta-blocker, chloranolol (Tobanum, Hungary), was carried out in 24 patients with second-stage essential hypertension. Central and intracardiac hemodynamics, left-ventricular myocardial function (echocardiography) and regional hemodynamics (occlusion plethysmography) were assessed in 14 patients before treatment and on days 10-15 and 25-30 of chloranolol administration. During the fourth or fifth week of chloranolol treatment, arterial BP diminished by 12/10% (p less than 0.01) owing to an 11.5% reduction in the cardiac index and a 15.7% reduction in heart rate (p less than 0.001), while the stroke index and total peripheral resistance showed no significant change. No basic changes in end diastolic and systolic left-ventricular size and volume, nor in the ejection fraction were seen during treatment. Myocardial contractility dropped by 9.8% (p less than 0.05), and intramyocardial tension, by 14% (p less than 0.001), while the thickness of the interventricular septum declined by 7% (p less than 0.001), and that of left-ventricular posterior wall, by 4.2% (p less than 0.005). Chloranolol treatment was particularly efficient in moderately hypertensive patients and also in some highly-hypertensive ones that had not responded to propranolol.

[Change in the central and regional (brain) hemodynamics in the treatment of hypertension using beta-adrenergic blockaders]. / Izmenenie tsentral'noi i regionarnoi (mozgovoi) gemodinamiki pri lechenii bol'nykh gipertonicheskoi bolezn'iu beta-adrenergicheskimi

The haemodynamic parameters were studied dynamically by way of noninvasive techniques--tetrapolar thoracic rheography in the course of treatment of 48 patients with essential hypertension Stage IB and IIA urth beta-blocking agents Obsidan and Visken. It was found that as early as by the 5th day of therapy the stroke volume and heart rate decreased, the maximum fall being noted after 2-3 weeks of treatment. The reflex elevation of the total peripheral resistance was moderate, as a result of which a gradual reduction of the arterial pressure developed. The state of the cerebral circulation significantly improved in the course of the treatment (as shown by rheoencephalography) and the tone of the cerebral arteries decreased. After 2-3 weeks of beta-blockers therapy favourable shifts were observed in the response of the general and cerebral haemodynamics to the orthostatic test.

[Theoretical basis of the search of individual limits of fluctuations and the maximum long-term maintainance of arterial pressure within the maximum permissible limits in hypotensive therapy]. / Teoreticheskie osnovy poiska individual'nykh granits kolebanii i dlitel'nogo podderzhaniia arterial'nogo davleniia v dopustimykh predelakh pri gipotenzivnoi terapii

The methods of determining the maximum permissible and functionally justifiable (upper and lower) limits of arterial pressure fluctuations limiting the zones of individual "comfort" "caution" and "alarm" for every patient are described. The mathematical method of the least squares was used for long-term control of the maintenance of arterial pressure within the limits individually pre-set for those treated on an out-patient basis. The above methods permit to decrease the duration of therapy with a minimal drug expenditure and to ensure a mass control of the efficacy of hypotensive therapy.

[Use of Visken-15 for treating hypertension]. / Primenenie Viskena-15 dlia lecheniia bol'nykh gipertonicheskoi bolezn'iu.

The hypotensive effect of visken-15, a blocking agent of the beta-adrenergic receptors, was studied in 7 patients with stage IB hypertensive disease, in 18 with stage IIA, and in 8 patients with stage IIB under conditions of in- and out-patient establishments. A favourable effect was produced in 81.5% of patients who were given one tablet of the drug once or twice a day. Treatment with visken-15 led to a decrease in systolic, diastolic and mean arterial pressure, in the rate of cardiac contractions, and in the blood minute volume at rest, in the orthostatic position, and during physical load. Visken-15 is marked by low toxicity, it is tolerated well and seldom causes side effects. The drug is recommended for the treatment of patients with early stages of hypertensive disease.

[Comprehensive study of central and regional hemodynamics in hypertension using bloodless research methods]. / Kompleksnoe izuchenie tsentral'noi i regionarnoi gemodinamiki u bol'nykh gipertonicheskoi bolezn'iu s pomoshch'iu beskrovnykh metodov issledovaniia.

Tetrapolar chest rheography is a convenient, noninvasive method for determining the stroke and minute blood volumes. Its application made it possible to reveal various types of hemodynamics in patients with hypertensive disease and apply differentiated treatment with due account for these peculiarities. Study of regional hemodynamics showed a significant increase in the tonus of the arteries of the brain and crura and diminished tonus of the veins. The method is most valuable in a follow-up during treatment and particularly for recording rapid shifts in hemodynamics in functional loads. Assessment of the reactions of patients with hypertensive disease during the orthostatic test revealed various degrees of disorders of the circulatory system adaptation mechanisms; with the progression of the disease these disorders become more intense.

[Administration of the catecholamine precursor, L-DOPA, for evaluating their in vivo biosynthesis in hypertension]. / Vvedenie predshestvennika katekholaminov L-DOFA dlia otsenki ikh biosintez in vivo pri gipertonicheskoi bolezni.

The activity of the sympathetico-adrenal system was studied in 19 healthy individuals and in 40 patients with grade IB and IIA hypertensive disease. The excretion of free and conjugated forms of catetcholamines (adrenalin, noradrenalin and dopamine) and the precursor of their synthesis DOPA was determined. Comparison of these values in the control period and after per os administration of L-DOPA (levodopa) showed that administration of the precursor makes it possible to appraise catecholamine biosynthesis in vivo on the level of the intact organism. The results indicate that in patients with hypertensive disease of the early stages the production of dopamine is increased, whereas that of noradrenaline is reduced.

[Evaluation of the effectiveness of the long-term treatment of hypertension patients. I. Changes in hemodynamics and myocardial function]. / Otsenka éffektivnosti dlitel'nogo lecheniia bol'nykh gipertonicheskoi bolezn'iu. I. Izmeneniia gemodinamiki i funktsional'nogo sostoianiia miokarda.

Altogether 106 patients with stage II essential hypertension (EH) were treated for a long time (up to 3 years) with beta-blockers belonging to different classes. In some cases beta-blockers were administered in combination with vasodilators and/or a diuretic. In 66 patients, prolonged continuous treatment led to an appreciable drop in blood pressure (BP) due to the reduction of both the cardiac index and the total peripheral vascular resistance (TPVR), particularly in patients with stage IIB essential hypertension treated with a cardioselective beta-blocker tenormine or an alpha- and beta-blocker trandate. These patients showed a significant decrease in intramyocardial tension, in the thickness of the walls and mass of the myocardium. Regression of left ventricle hypertrophy depended not only on the hemodynamic factors that determine the decrease in the load of the myocardium by the volume or pressure but also on the neurohumoral effects (mainly due to the reduced adrenergic stimulation during treatment with beta-blockers). In 40 patients with stage IIB EH treated occasionally, BP appeared to approach the initial level after 2.5-3 years. Furthermore, these patients manifested an increase in the TPVR. The myocardial mass significantly rose, mainly at the expense of the thickening of the ventricular septum.

[Prolonged use of beta-blockers in patients with essential hypertension and different degrees of severity of left ventricular hypertrophy]. / Dlitel'noe primenenie beta-blokatorov u bol'nykh gipertonicheskoi bolezn'iu s razlichnoi stepen'iu vyrazhennosti gipertrofii levogo zheludochka.

The paper is concerned with analysis of the results of therapy with beta-blockers of different classes of 56 patients (over 2.5-3 yrs) with essential hypertension and analysis of the time course of the structural-functional states of the left ventricular myocardium with various degree of expression of left ventricular hypertrophy (LVH). The patients were divided into 3 groups: the 1st group--14 persons (the left ventricular myocardial mass/LVMM/up to 150 g); the 2nd group--19 persons (the LVMM up to 200 g); the 3rd group--23 persons (the LVMM over 200 g). Patients in all the groups showed a significant decrease in BP from 19/15 up to 26/22% (p less than 0.001), the cardiac index (CI) from 14.4 up to 18.5% (p less than 0.001), and HR from 16.5 to 19.1% (p less than 0.001). The stroke index (SI) did not change significantly. The total peripheral vascular resistance (TPVR) in all the groups showed a tendency to a decrease, in the 3rd group only it decreased significantly. In the patients of the 1st and 2nd groups end-systolic sizes (ESS) increased by 4.1 and 3.1% (p less than 0.05) and volumes (ESV) by 9.7 and 7.4% (p less than 0.05), and in the 3rd group a tendency to a decrease was observed. End-diastolic sizes and volumes in all the groups did not change significantly. The myocardial contractility index (VCF) decreased significantly in the 1st and 2nd groups of patients. The value of intramyocardial tension ("sigma max") decreased in all the groups from 15 to 20% (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)