[Mechanisms of the hypotensive effect of psychorelaxation therapy in hypertension]. / Mekhanizmy gipotenzivnogo deistviia psikhorelaksatsionnoi terapii pri gipertonicheskoi bolezni.

An evaluation of the effect of mental relaxation treatment on endogenous opioid activity and vascular reactivity in 20 patients with labile essential hypertension has demonstrated that mental relaxation treatment results in a significantly greater drop in arterial BP, as compared to pharmacologic placebo, and is associated with the improvement of the patients' psychological status, lesser psychophysiologic and vascular reactivity, and a smaller beta-endorphin increment under emotional stress.

[Characteristics of water-electrolyte balance in patients with labile essential hypertension and various approaches to the optimal therapy with diuretics and low-sodium diet]. / Osobennosti vodno-élektrolitnogo obmena u bo'lnykh gipertonicheskoi bolez'niu s labi'lnoi gipertenziei i nekotorye podkhody k optimi- zatsii terapii diuretikami i dietami s nizkim soderzhaniem natriia.

A study of 56 males, aged 22 to 56 years, with uncomplicated essential hypertension, stages IB-IIA, where pretreatment examination was followed by repeat investigation after 4 or 5 weeks of treatment with diuretics or low-sodium diets with strict (less than 2 g), moderate (up to 3 g), or mild (4-4.5 g) restriction of sodium uptake, demonstrated a tendency to sodium retention with fluid redistribution from the interstitium to intravascular space in the presence of diuretic treatment. Where dietary sodium was reduced, extracellular sodium was increased owing to increased residual sodium, while total metabolic sodium dropped, and extracellular fluid increased owing to the increase in interstitial fluid. All three variants of the low-sodium diet produced changes in sodium metabolism, with a drop in systemic residual sodium and arterial blood pressure. It is proposed to use strict limitation of dietary sodium for a limited period of time, to be followed by a transition to mildly limited sodium uptake after arterial BP is brought down and stabilized.

[Study of the relation of various genetic and pathophysiologic factors participating in the regulation of blood pressure in patients with hypertension]. / Izuchenie vzaimosviazi mezhdu nekotorymi geneticheskimi i patofiziologicheskimi faktorami, uchastvuiushchimi v reguliatsii arterial'nogo davleniia u bol'nykh gipertonicheskoi bolezn'iu.

A study of 35 patients with uncomplicated essential hypertension (EH) (labile hypertension, stages IB-IIA or stable hypertension, stage IIB) demonstrated a higher rate of Na+-Li+ countertransport in patients with hypertensive hereditary predisposition to EH (group 1), as compared to those with unaggravated heredity (group 2). A suppression of plasma renin activity (53%), and a higher rate of hyperlipoproteinemia (55%) were observed in group 1, as opposed to group 2 where Na+-Li+ countertransport was lower, plasma renin activity was normal, and hyperlipoproteinemia occurred in 33%. There was a direct correlation between Na+-Li+ countertransport and renin-angiotensin-aldosterone components in group 2. A conclusion is made that aggravated heredity, RAAS components and hyperlipoproteinemia should be taken into account in the assessment of Na+-Li+ countertransport in hypertensive patients.

[Disorders of humoral immunity in hypertension]. / Narushenie gumoral'nogo immuniteta pri gipertonicheskoi bolezni.

Examination included 51 patients with essential hypertension (EH) of an uncomplicated course, labile (IB-IIA stage, according to A. L. Myasnikov's classification) and stable (IIB stage) hypertension. Clinical characteristics were given to the stages and duration of EH, body weight of the patients, arterial hypertension (AH) heredity and the AP level. Immunological examination included determination of the concentration of the basic classes of immunoglobulins IgG, IgA, IgM, circulating immune complexes (CIC), concentration of IgE and beta 2-microglobulins. It was revealed that EH development is attended by an increased concentration of immunoglobulins, primarily of IgA (23 per cent), IgE (31 per cent) and CIC (21 per cent), which is associated, to a certain degree, with a factor of AH hereditary aggravation.

[Genetic markers and susceptibility to hypertension]. / Geneticheskie markery i predraspolozhennost' h gipertonicheskoi bolezni.

Genetic markers Hp, Gc, EstD and phosphoglucomutase (PGM) were studied in patients with essential hypertension (EH). The authors proved relationship between GcI-I-genotype and predisposition to EH. Heterozygote type 1-2 of the Gc-system was more resistant to the disease. The authors conclude that genetics markers may make the basis for studying the EH etiology and determining its more etiologically similar forms.

[The interrelation of the sodium-excretory function of the kidneys and vascular reactivity in hypertension patients]. / Vzaimosviaz' natriivydelitel'noi funktsii pochek i sosudistoi reaktivnosti u bol'nykh gipertonicheskoi bolezn'iu.

Vascular reactivity was evaluated by a modified photoplethysmographic method in 20 patients with essential hypertension before and after an acute volumetric salt load. A relationship was demonstrated between vascular reactivity and renal sodium excretion pattern under stress. Patients with "excessive" natriuresis 24 h after the test showed reduced vascular reactivity, and slow sodium and water excretion was associated with increased vascular response. A study of membrane Ca2+ transport 24 h after the test showed an increase in receptor-dependent Ca2+ uptake in response to all inductors (platelet aggregation factor, vasopressin, ADP), as compared to the baseline.

[Receptor-dependent regulation of the concentration of Ca2+ in the cytoplasm of thrombocytes in hypertensive patients]. / Retseptorzavisimaia reguliatsiia kontsentratsii Ca2+ v tsitoplazme trombotsitov bol'nykh gipertonicheskoi bolezn'iu.

Platelet activation factor (PAF)-, ADP and vasopressin-induced increments of platelet Ca2+ concentration were measured by quin-2 in 64 patients with essential hypertension and 16 normal donors. Basal concentration of free Ca2+ was 87 +/- 4 nM in donors, 106 +/- 5 nM in patients with labile hypertension (LH) and 122 +/- 6 nM in those with stable hypertension (SH) (p less than 0.01). PAF, ADP and vasopressin, added to platelets, increased [Ca]in by 448 +/- 58, 397 +/- 66, and 277 +/- 50 nM, respectively, in the donors, by 473 +/- 57, 479 +/- 54 and 195 +/- 32 nM, in LH patients, and by 607 +/- 85, 584 +/- 73 and 245 +/- 41 nM in SH patients. There were no significant variations between the three samples, using the ANOVA test. In 20 patients, whose both parents had essential hypertension, [Ca]in increment was 738 +/- 8 nM for PAF, 682 +/- 90 nM for ADP, and 320 +/- 61 nM for vasopressin. In 19 patients, who admitted to no essential hypertension in the family, these parameters were significantly lower: 310 +/- 40 nM for PAF, 389 +/- 61 nM for ADP, and 147 +/- 26 nM for vasopressin. The demonstrated changes may be making an important contribution to the maintenance of elevated vascular tone and provide an evidence in favor of a genetically-predetermined EH variety.

[Various immunological aspects of essential and symptomatic hypertension]. / Nekotorye aspekty immunologii gipertonicheskoi bolezni i simptomaticheskikh gipertonii.

131 patients with essential hypertension (EH) and 30 patients with secondary hypertension (SH) of renal genesis were examined, all of them Russian inhabitants of Moscow, aged 20-56. In patients with EH increased rate of HLA-B13 and B22 antigens was determined. The highest rate of HLA-B13 antigen in this group was registered in patients without IHD, while patients with IHD had the highest rate of HLA-B22 antigen compared to controls. Patients with SH demonstrated no significant difference in HLA antigens distribution from that in controls. Besides, patients with EH had significantly increased serum concentration of circulating immune complexes (CIC), of IgA and beta 2-microglobulins as well as of three complement components (C3c, C4 and B factor). Similar changes were observed in patients with SH, excluding CIC and C3c, concentration of which did not differ from that in the control group. No strict dependence between the level of immunity humoral factors and presence of HLA-B13 and -B22 antigens was observed. The data gained suggest possible association of HLA system with EH development.

[Effect of hypotensive therapy on a receptor-dependent increase in Ca2+ in the thrombocytes of patients with hypertension]. / Vliianie gipotenzivnoi terapii na retseptorzavisimoe povyshenie soderzhaniia Ca2+ v trombotsitakh bol'nykh gipertonicheskoi bolezn'iu.

The effect of antihypertensive drugs on receptor-dependent increase in Ca2+ basal level and its changes under stimulators action (thrombocytes activating factor, ADP and vasopressin) were studied by means of a fluorescent calcium probe "quin-2". Nifedipine blocked receptor-dependent increase of Ca2+ in thrombocytes in vitro as well as by oral administration, which was accompanied by decrease in vascular tone and BP. The degree of BP decrease correlated with that of depression of receptor-dependent increase of Ca2+ in thrombocytes. Combined therapy including nifedipine, propranolol and a diuretic resulted in more manifest inhibition of receptor-dependent calcium channels than monotherapy with nifedipine. Effect of antihypertensive drugs evidently depends on their influence on receptor-dependent Ca2+ cellular entrance.

[Origin of the pain syndrome in asymmetric myocardial hypertrophy in patients with stable hypertension]. / O geneze bolevogo sindroma pri asimmetricheskoi gipertrofii miokarda u bol'nykh stabil'noi gipertonicheskoi bolezn'iu.

A study of 20 patients with essential hypertension, stage IIB, asymmetrical myocardial hypertrophy and chest pains has suggested that the pain syndrome, presenting as "possible angina", positive functional tests and reduced label accumulation around the ventricular septum may be indicative of coronary insufficiency.

[Evaluation of the hypotensive effect of unilateral adrenalectomy in patients with low-renin hyperaldosteronism]. / Otsenka gipotenzivnogo éffekta odnostoronnei adrenlaéktomii u bol'nykh s nizkoreninovym giperal'dosteronizmom.

The antihypertensive effect of unilateral adrenalectomy was analyzed in 19 patients with arterial hypertension and primary hyperaldosteronism diagnosed by way comparing clinical findings, a degree of hypokalemia, activity of plasma renin and aldosterone concentration and CT data. A follow-up period after operation was 8-14 mos. Clinical and biochemical findings were compared with the results of morphological investigation of the adrenal glands and kidneys. An antihypertensive postoperative effect was observed in 12 patients: good in 6, moderate in 6, the absence of an antihypertensive effect in 7. Different forms of adrenocortical hyperplasia revealed during histomorphological investigation, endocrine nephropathy of various degree and vascular changes of hypertensive genesis in the renal parenchyma were discussed as causes of residual hypertension.

[Lesions of target organs in arterial hypertension]. / Porazhenie organov-myshenei pri arterial'noi gipertonii.

A total of 530 patients with a variety of hypertensive conditions, including 476 patients with labile and stable essential hypertension, 40 with hypertensive chronic diffuse glomerulonephritis and hypertensive chronic pyelonephritis, and 14 with vasorenal hypertension, were investigated. Structure and function of target organs (the heart and the kidneys) were assessed by means of echocardiography (530) and intravital morphologic studies of renal biopsy specimens (89). A heterogeneous nature of hypertrophic developments associated with essential hypertension was demonstrated, with adequate, inadequate, disproportionate and excessive hypertrophy identified, while no correlation could be found between the kind of hypertension and the degree and nature of hypertrophy. Renal morphologic changes were also shown to be heterogeneous in labile and stable arterial hypertension, and early involvement of the renal mechanism presenting as structural changes was found to be possible.

[Regression of left-ventricular myocardial hypertrophy in patients with hypertension during long-term treatment with beta-adrenergic blockaders]. / Regressiia gipertrofii miokarda levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu v protesesse dlitel'nogo lecheniia beta-adrenergicheskimi blokatorami.

Thirty-nine patients with second-stage essential hypertension were treated with Beta-adrenoblockers of different classes for 2.5 to 3 years. Two groups of patients were distinguished: 23 patients showing a regression of left-ventricular myocardial weight (group 1) and 16 patients without such developments (group 2). A significant decrease in arterial blood pressure (by 20-24%) and heart rate (by 15 to 18%) was recorded in both groups. Total peripheral resistance was changed insignificantly in group 1 and by 9.7% (p less than 0.05) in group 2. The end diastolic volume decreased by 5.4% (p less than 0.05) in group 1, and increased by 4.7% (p less than 0.05) in group 2. The end systolic volume decreased by 10.6% (p less than 0.05) in group 1 and increased by 5% (p greater than 0.1) in group 2. Myocardial contractility declined significantly in both groups (by 9.5% and 10.6%, respectively). Intramyocardial tension dropped by 13-20% (p less than 0.001) in both groups. Therefore, the regression of left-ventricular myocardial hypertrophy was shown to have a favorable effect on cardiac function.

[Reactivity of the cardiovascular system and of the pressor neurohumoral systems in hypertension patients]. / Reaktivnost' serdechno-sosudistoi sistemy i nekotorykh pressornykh neirogumoral'nykh sistem u bol'nykh gipertonicheskoi bolezn'iu.

Correlations between sympathoadrenal, renin-angiotensin and cardiovascular (BP and heart rate) response to psychoemotional and physical stress and antebrachial skin vascular response to noradrenaline were examined in patients with essential hypertension. Four groups of patients were identified on the basis of the magnitude of variation in the examined parameters. The progress of the disease over the past two years was assessed in all patients. The prognosis was particularly unfavorable in the "hyperreactive" group which showed a set of distinctive features: increased vascular response to noradrenaline, a greater BP rise in response to stress, greater sympathoadrenal activation, increased neuroticism, as well as significantly older age of the patients and greater severity and duration of the disease. No intergroup differences in plasma renin activity could be demonstrated. Possible use of vascular response to noradrenaline, and BP and plasma catecholamine variation in response to psychoemotional stress as criteria for the assessment of the severity and outcome of essential hypertension is discussed.