[Structure of risk factors, damages of target organs, and metabolic changes in patients with arterial hypertension of various age groups].

UNLABELLED: AIM of the study consisted in investigation of structure of risk factors and pathological changes of morphological and functional parameters of cardiovascular system, parameters of carbohydrate and lipid metabolism and their relationship with arterial hypertension (AH) in age groups younger than 35 years, 35 - 55, and older than 55 years. We examined 91 patients with AH and 158 subjects with normal blood pressure (BP). Both groups were divided into 3 age groups: < 35, 35 - 55, > 55 years. Examination included study of anamnesis, investigation of anthropometric parameters, indices of lipid and carbohydrate metabolism, determination of signs of involvement of large vessels and the heart, assessment of parameters of left ventricular diastolic function. Genotyping of a row of polymorphisms of renin angiotensin aldosterone system was also carried out. Association of each pathological sign with the presence of AH was calculated according to value of odds ratio. RESULTS: Presence of AH in all selected age groups was significantly associated with signs of metabolic syndrome (except hypercholesterolemia for subjects before 35 years) and symptoms of involvement of large vessels and the heart (except diastolic left ventricular dysfunction according to IVRT criterion for subjects younger than 35 and older than 55 years). Contrary to persons with normal BP detection of heredity burdened with cardiovascular diseases was significantly associated with presence of AH in patients aged 35 - 55 years. Hypertriglyceridemia, lowering of low density lipoprotein cholesterol level, increased thickness of intima media complex of common carotid artery, as well as elevation of rate of propagation of pulse wave along elastic arteries were characterized by about equal degree of association with the presence of AH in all three age groups. Variants of polymorphisms of genes encoding elements of renin angiotensin aldosterone system (AGTT174M, ACE, AGTR1) were associated with presence of AH in younger and middle age groups.

[Physical training at ambulatory-polyclinical stage in complex rehabilitation and secondary prevention of patients with ischemic heart disease after acute incidents. Effect on physical working capacity, hemodynamics, blood lipids, clinical course and prognosis (Russian cooperative study)].

AIM: To investigate efficacy of early and long term physical training (PT) of moderate intensity in conditions of practical health care in Russia in patients with ischemic heart disease (IHD) of able to work age - survivors of acute coronary events. MATERIAL AND METHODS: Three hundred ninety two patients were enrolled in this study. They were randomized into intervention group " O" (n=197) and control group " C" (n=195). Inclusion period was 3- 8 weeks from onset of myocardial infarction (MI), unstable angina (UA), or intervention on coronary arteries. Patients were followed up for 1 year and efficacy of intervention was assessed by results of laboratory (levels of lipids), instrumental (ECG, exercise test on veloergometer, echocardiography), and clinical examination. In the group " O" regimen of PT with work loads of moderate intensity (50-60% of power achieved during exercise test) was used. Duration of FT was 45 - 60 min, frequency - 3 times a week. All patients received standard therapy for IHD and a lipid lowering drug when indicated. RESULTS: Proofs of efficacy of PT in the given contingent of patients were obtained. This was manifested by significant increase of physical working capacity: prolongation of exercise time (+31.7%, p<0.001), increases of volume of work performed (+74.3%, p<0.001) and efficiency of cardiac work according to results of exercise tests. All parameters were significantly different from those in the group " C" . Structural functional parameters of the heart also improved in the group " O" : left ventricular (LV) stroke volume increased 4.5% (p<0.005), ejection fraction increased 7.2% (p<0.001), diastolic LV volume decreased 2.5% (p<0.05), systolic LV volume decreased 8.1% (p<0.001). In the group " C" stroke volume and LV ejection fraction rose to a lesser degree - by 5.5% (p<0.01) and 2.9% (p<0.05), respectively. Differences between groups in dynamics of these parameters turned out to be significant (p<0.05). Moreover in group " C" LV diastolic volume increased 2.3% (p<0.05) and systolic volume did not change, while left atrium increased 3.4% (p<0.002). At intergroup comparison differences in dynamics of these parameters were significant (p<0.005). Analysis of lipid profile after 1 year showed no changes in patients of group " C" , while in group " O" it revealed significant (3.6%) lowering of total (T) cholesterol (CH) (p<0.05 compared with baseline and change in group " C" ) and elevation of high density lipoprotein (HDL) CH (+12.3%, p<0.001; compared with group " C" p<0.005). Atherogeneity index TCH/HDLCH decreased 8.5% in the group " O" (p<0.01), and increased 12% (p<0.02) in the group " C" , difference between groups was statistically significant (p<0.001). In the group " O" body mass index decreased 2.8% (p<0.001), and frequency of attacks of angina decreased 50.8% (p<0.001; compared with group " C" p<0.001). Statistically significant differences were registered between the following parameters of composite end point and surrogate points: total number of cardiovascular events - 26 (14.8%) vs 47 (27%), p<0.01; number of cardiovascular catastrophes - 5 (3%) vs 15 (8.7%), p<0.05; number of days out of work because of exacerbation of IHD per 1 person/year - 2.4 vs 4.2, p<0.05 in groups " O" and " C" , respectively. Thus in the group " O" positive effect of PT on the course and outcomes of the disease was registered compared with the group " C" . CONCLUSION: The data obtained are indicative of sufficient efficacy of the used program of PT and feasibility of its application in practice of ambulatory rehabilitation of patients with IHD - survivors of acute coronary events. It also can be looked upon as a method of secondary prevention as results of the study showed its positive impact on risk factors and outcomes of the disease.

[Rehabilitation of patients with ischemic heart disease at outpatient stage.].

The article is assigned to general practitioners and devoted to the outpatient combined rehabilitation of coronary heart disease patients, including those after myocardial infarction. In the part concerning the physical rehabilitation there is given the classification of patients by functional classes, the exercise programs of middle intensity for sport and home training. The formula of selection of the walking training temp according to the results of exercise stress test is given. There are presented the psychodiagnostic methods that evaluate the psychological reactions of patients on the disease, and the methods of psychological rehabilitation with use of psychopharmacotherapy. Special part is devoted to the educational program for patients.

[Isometric exercise tolerance in healthy women and in those with myocardial infarction]. / Tolerantnost' k izometricheskoi nagruzke u zdorovykh i bol'nykh infarktom miokarda zhenshchin.

Isometric stress tolerance was examined in 40 normal females and 40 female patients with subacute myocardial infarction (MI). Normal females exhibited smaller hand grip force, as compared to normal males with similar static stress tolerance. Female MI patients, like their male counterparts, showed uncompromised hand grip force, while their static stress tolerance was reduced, being approximately similar in both male and female patients. In normal females and female MI patients, changes in heart rate, systolic and diastolic arterial blood pressure and the double product were similar to those observed in males, but were induced by smaller static stress.

[Physical work capacity in isometric and dynamic regimens in patients with stenocardia and cardiac-type neurocirculatory dystonia]. / Fizicheskaia rabotosposobnost' v izometricheskom i dinamicheskom rezhimakh u bol'nykh stenokardiei i neirotsirkuliatornoi distoniei po kardial'nomu tipu.

It is established that the strength of both hands is much weaker in patients with angina pectoris than in healthy individuals. Development of an atypical cardiac pain syndrome leads to a significant diminution in the strength of the left hand of patients with angina pectoris and to a considerable reduction in endurance. In patients with cardiac-type neurocirculatory dystonia, the strength in the left hand and the endurance of isometric exertion are diminished. The endurance of dynamic exertion is sharply reduced in patients with chronic coronary insufficiency. Physical working capacity is substantially higher in patients with cardiac-type neurocirculatory dystonia than in those with angina pectoris and lower than in practically health individuals.

[Isometric load tolerance in patients with postinfarct cardiosclerosis]. / Tolerantnost' k izometricheskoi nagruzke u bol'nykh postinfarktnym kardiosklerozom.

The work deals with the comparative study of the tolerance of 80 patients with post-infarction cardiosclerosis with a different clinical picture of the disease to isometric and dynamic loads. It was established that the strength of the hands was weaker in patients with the cardiac pain syndrome than in healthy individuals. In addition to this in patients with cardialgia, the tolerance to isometric load was diminished. In isometric loading the systolic arterial pressure in all patients increases much more than in individuals of the control group, and in patients with severe post-infarction angina pectoris there are also changes in the pulse. Cardialgia has a determining effect on the tolerance to isometric load, whereas the dynamic test tolerance is mainly limited by the severity of chronic coronary insufficiency.