[PERIOPERATIVE CARE FOR PATIENTS WITH UNDERLYING ARTERIAL HYPERTENSION (CLINICAL GUIDELINES)].

These clinical guidelines apply to the implementation of health care for all patients with concomitant hypertension in the perioperative period in a hospital. The guidelines specify the method of stratifying the risk of perioperative cardiac complications. We described methods for the treatment of urgent conditions with hypertension and hypertensive crises and identified the main features of the preoperative evaluation and preparation of patients with concomitant hypertension. The clinical guidelines contain recommendations on the management of intra- and postoperative period

[The rare case of Bland-White-Garland syndrome in adult patient].

We present analysis of a case history of a patient with rare congenital heart disorder - Bland-White-Garland syndrome. The 25 years old women was first diagnosed with this disorder during an examination in the cardiological department of the Moscow clinical hospital No83. The paper contains discussion of difficulties of diagnosis and peculiarities of management of adults with this pathology as well as of a problem of the choice of further therapeutic approaches.

[The effect of intermittent normobaric hypoxia on oxygen metabolism in hypertonic pilots]. / Vliianie preryvistoi normobaricheskoi gipoksii na kislorodnyi metabolizm u pilotov s gipertonicheskoi bolezn'iu.

Oxygen tissue metabolism was evaluated in hypertonic pilots in order to draw up an optimal treatment plan. Oxygen metabolism kinetics was determined with the help of transcutaneous polarography and the local ischemic extremity test was applied to measure the O2 utilization efficiency. Breathing mixture of 90% nitrogen and 10% oxygen (GGS-10) was used in therapeutic sessions of intermittent normobaric hypoxia. Results point to the reduced tissue breathing intensity and cell functional energy reserve in hypertonic patients. However, O2 metabolism is much closer to normal in pilots as compared with non-flyers. In pilots, O2 utilization is more intensive, energy supply of cells is higher, O2 transport and utilization are well-balanced, and tissue breathing is less reactive to the hypoxic factor. Dynamic kinetics of O2 metabolism tested post treatment suggested activation of O2 tissue metabolism in the hypertonic pilots rather than O2 transport which was stimulated in non-flyers. In addition, by the end of treatment the pilots were advised to extend the period of breathing GGS-10 leaving the period of air breathing unchanged. Consequently, the pilots were more adaptable to hypoxia than the non-flyers and, therefore, improved O2 tissue metabolism more rapidly.

[Hypoxic therapy of arterial hypertension in patients with different variability of arterial pressure]. / Gipoksicheskaia terapiia arterial'noi gipertonii u bol'nykh s razlichnym urovnem variabel'nosti arterial'nogo davleniia.

Sixty two patients with essential hypertension stage II were divided into two groups. 32 patients of group 1 received combined therapy including a course of inhalations of gas hypoxic mixture containing 10% oxygen and conventional medication (ACE inhibitors, beta-blockers, calcium antagonists, diuretics). 30 patients of group 2 (controls) were given medication alone. 24-h monitoring of arterial pressure (AP) and echocardiography suggested that high AP variability (APV) in hypertensive subjects leads to more significant changes in left ventricular and atrial structure and function typical for hypertensive heart. In high VAP, its night values are subnormal while daytime values are high in patients on combined medication and hypoxic therapy. The patients on standard medication had significantly low VAP at night while their daytime VAP tended to decrease. VAP positively correlated with hypertensive load. In high VAP hypoxic and drug therapies are less effective.

[Hemodynamics of the minor circulation in patients with gastroduodenal ulcer on hypoxic therapy]. / Gemokinamika malogo kruga krovoobrashcheniia u bol'nykh iazvennoi bolezn'iu zheludka i dvenadtsatiperstnoi kishki na fone gipoksicheskoi terapii.

Adaptation of patients with gastroduodenal ulcer (GDU) to intermittent normobaric hypoxia is effective in the treatment of this disease. Some GDU patients have functional pulmonary hypertension. Single procedure and a course of normobaric hypoxic therapy have no negative effect on pulmonary hemodynamics. Overloading of the right heart in GDU patients does not contraindicate a course of breathing gas hypoxic mixture created by Strelkov's apparatus.

[The possibilities of using intermittent normobaric hypoxia for treating hypertension patients]. / Vozmozhnosti ispol'zovaniia preryvistoi normobaricheskoi gipoksii dlia lecheniia bol'nykh gipertonicheskoi bolezn'iu.

The response to intermittent normobaric hypoxia (INH) created in breathing gas hypoxia mixture (10% oxygen, 90% nitrogen) was evaluated in 123 patients with essential hypertension stage I and II. Hypoxia adaptation effects on central hemodynamics, physical performance, kinetics of oxygen exchange were studied. A pronounced response to INH persistent for 6 months was demonstrated in 80.5% of the patients. The reduction of the arterial pressure resulted from different mechanisms depending on hemodynamic type. Physical performance of the patients rose, oxygen consumption and transport normalized.

[The evaluation of the efficacy of adaptation to intermittent normobaric hypoxia as a method for treating hypertension]. / Otsenka éffektivnosti adaptatsii k preryvistoi normobaricheskoi gipoksii kak metodu lecheniia gipertonicheskoi bolezni.

Clinical and functional condition was examined for 75 patients with essential hypertension stage I and II who had developed adaptation to normobaric cyclic-fractionated hypoxia. The latter was produced by gas hypoxic mixture (10% oxygen, 90% nitrogen) in its inhalation. A pronounced positive effect of such treatment modality was registered in 86.7% of the patients and persisted for 6 months and more in 84.3%. A normal correlation was achieved of cardiac ejection to peripheral vascular resistance, this reducing arterial pressure. An optimal hemodynamic response arose to the hypoxic effects which also improved psychoemotional status of the patients.

[Mechanisms of therapeutic and preventive effects of adaptation to hypoxia in arterial hypertension]. / Mekhanizmy lechebno-profilakticheskogo éffecta adaptatsii k gipoksii pri arterialnoi gipertenzii.

Data on the effect of adaptation to hypoxia on the cardio-vascular system responses and arterial pressure regulation have been considered. The role of sympathoadrenal system rearrangement in regulation of cardiac output and vascular tension has been analyzed. The data on the possible role of water-salt metabolism changes in a decrease of arterial pressure after long-term effect of hypoxia are presented. It is concluded that hypoxic training is a promising trend of prevention and treatment of arterial hypertension.

[Effect of intermittent normobaric hypoxia on dynamics of disease state in patients with hypertension]. / Vliianie preryvistoi normobaricheskoi gipoksii na dinamiku sostoianiia bolnykh gipertonicheskoi bolezníu.

Curative effect of intermittent normobaric hypoxia created when breathing in gaseous hypoxic mixture containing 10% of oxygen and 90% of nitrogen has been examined in 41 patients with hypertonic disease. Adaptation to hypoxia has been studied for its effect on the central hemodynamics psychoemotional state and kinetics of oxygen supply of the skin. The pronounced positive effect of treatment was achieved in 70.7% of patients, the arterial pressure decreasing at the expense of different mechanisms depending on the type of blood circulation. Besides, a decrease in the emotional tension of patients and normalization of oxygen consumption and transport were observed.