[MORPHOFUNCTIONAL MYOCARDIAL CHARACTERISTICS IN PATIENTS WITH MASKED ARTERIAL HYPERTENSION AND WHITE COAT HYPERTENSION].

The aim of this work was to study morpho-functional myocardial characteristics in patients with masked arterial hypertension (AH) and white coat hypertension (WCH) given antihypertensive therapy (AHT) and without it. This cross-sectional cohort study included employees of a large industrial enterprise who annually underwent routine medical examination supplemented by 24 hr AP monitoring and echocardiography carried out at specified time of the working day. The participants of the study were divided into 6 groups based on the relationship between clinical AP and mean AP during work. Group I comprised 20 (7%) subjects with normal AP, group 2--20 (7%) with masked AH, group 3--40 (14%) with WCH, group 4--81 (28.3%) with optimal A HT effect, group 5--64 (22.4%) with unmanifest inefficiency of AHT, group 6--40 (14%) with WCH during AHT. Criteria for masked AH and unmanifest AHT inefficiency were clinical AP below 140 and 90 mm Hg in combination with mean AP during work 135 and/or 85 mm Hg and higher. Echocardiography was performed in a standard positions in M- and B-modes as well as in three Doppler regimes. One-factor ANOVA was used to analyze differences between the groups and Pearson's Chi-square test to determine the relationship between categorical variables. 206 (72%) of the 286 employees of the large industrial enterprise had a diagnosis of AH. It was shown that ambulatory AP values obtained by 24 hr monitoring better characterized the patient's condition than clinical AP since they correlated with the frequency of disorders in the target organs and the risk of cardiovascular complications in patients with AH. Patients with masked AH more frequently developed left ventricular hypertrophy and diastolic dysfunction than those having normal clinical and ambulatory AP. The mean width of the left ventricle wall and left ventricular isovolumic relaxation time (therefore, the degree of LV hypertrophy and diastolic dysfunction) in the patients with unmanifest inefficiency of AHT were greater than in those with optimal AHT effect. The occurrence of WCH was comparable in the two groups. These data were used to determine intensity of preventive AHT at the workplace with a view to improving medical and occupational prognosis.

[The influence of psychological factors on the integral health characteristic (data from a prospective population study)].

AIM: To develop integral assessment of the health status based on the examination of representative samples from different regions of Russia (Veliky Novgorod, Nizhni-Novgorod, Vologda, Omsk and Nalchik) with the use of special questionnaires and simple anthropometric and functional methods in the framework of a prospective 3-year population study of organized groups. METHODS: The above questionnaires allowed to elucidate the socio-economic status of the patients, their somatic and psychological conditions (lifestyle index or psychological protection mechanisms (PPM), social adaptation, sanogenic reflexia; also used were Eysenck's psychotism scale, hospital anxiety and depression scale, the perceived stress scale (PSS), and moral potential of personality development scale. RESULTS: It was shown that the profile of psychological protection mechanisms is dominated by primitive reactions, such as projection, protection, and negation. Most subjects from the sample formed the pathogenic type of reflexia (inability to resolve a problem situation based on the cognitive components of the patient's mental state). Mathematical treatment of the so-called "simple cross-tabulation" with unification of all negative PPM revealed the highly significant relationship of LSI (not norm) with most previous somatic diseases (p<0.001), i.e. the history of myocardial infarction, angina of effort, cardiovascular syndromes, diabetes, hypertension, chronic broncho-pulmonary, hepatic, gastrointestinal, urogynecological, oncological, and psychic diseases. (p<0.007). CONCLUSION: Pyschological changes have greater influence than somatic ones on physiological parameters determining the population health status which suggests the necessity of taking them into account when planning health promotion measures.

[Relationships between arterial hypertension, metabolic disturbances and uric acid nephropathy].

AIM: To study effects of uric acid disbolism in combination with other metabolic disturbances on prevalence and clinical symptoms of arterial hypertension; contribution of uric acid nephropathy to its development. MATERIAL AND METHODS: A cohort of 243 representatives from a general population (107 males, 136 females, age 19-59 years) was studied in 1986 and 15 years later. At the beginning and end of the trial the participants were examined for arterial hypertension, microalbuminuria, uric acid nephropathy, blood biochemical tests were made. RESULTS: For 15-year follow-up prevalence of arterial hypertension doubled, incidence of hyperuricemia and hyperuricosuria, hypertriglyceridemia increased considerably. The number of hypertensive subjects was maximal in the group with the greatest number of signs of uric acid nephropathy. CONCLUSION: The population studied exhibited increasing frequency of some risk factors, especially of uric acid metabolism, contributing to formation of arterial hypertension.

Nonlinear relationship between erythrocyte sodium-lithium countertransport and blood pressure in man.

A relationship between erythrocyte Na+/Li(+)-countertransport activity and blood pressure was studied in a randomly selected sample (95 subjects) with full range of blood pressure, from a representative group of inhabitants of one of Moscow's districts. The mean rate of erythrocyte Na+/Li(+)- countertransport activity was higher (p < 0.01 or less) in the groups of subjects with both borderline (BH) and moderate essential hypertension (EH) as compared with the group of normotensives (NT). A positive correlation was found between the erythrocyte Na+/Li(+)- countertransport rate and age and body weight in the entire selected group. The total contribution of these confounding parameters is responsible for 20.4% of the interindividual variability of the Na+/Li(+)- countertransport activity. The individual Na+/Li(+)- countertransport values remained unchanged during at least 2 years of follow-up. A nonlinear relationship between erythrocyte Na+/Li(+)- countertransport activity and blood pressure was established in the entire group. No significant association between blood pressure and Na+/Li(+)- countertransport was seen at high and low values of these two parameters. A pronounced change in the erythrocyte Na+/Li(+)- countertransport values occurred within a narrow borderline blood pressure range.

[New guidelines of the Joint National Committee (USA) on Prevention, Diagnosis and Management of Hypertension. From JNC VI to JNC VII]. / Novye rekomendatsii Ob"edinennogo natsional'nogo komiteta po preduprezhdeniiu, diagnostike i lecheniiu arterial'noi gipertonii (SShA): ot JNC VI k JNC VII.

Need for update of guidelines of the Joint National Committee (USA) on Prevention, Diagnosis and Management of Hypertension was based on necessity to adopt changes based on results of recent studies as well as creation of more simple and convenient variant for practical physicians. Compared with JNC VI most important changes concerned classification of blood pressure (BP) levels and approaches to drug therapy. New category "prehypertension" was introduced and 2 stages of hypertension distinguished: stage I - systolic BP 140-159 mm Hg or diastolic 90-99 mm Hg, stage II - systolic BP 160 mm Hg or higher, diastolic BP 100 mm Hg or higher. Diuretics were recommended as drugs of first choice and wider use of drug combinations encouraged. Some statements of JNC VII report have been criticized by some hypertension authorities.

[Blood pressure changes induced by various exercise regimes in patients with "mild" arterial hypertension]. / Dinamika AD pod vliianiem razlichnykh rezhimov fizicheskoi trenirovki u lits s "miagkoi" arterial'noi gipertenziei.

How two regimes of exercise training affect blood pressure changes was examined in 70 individuals with mild arterial hypertension. Prolonged controlled exercise training were shown to be an effective tool of non-drug correction of elevated blood pressure, the exercises aimed at developing aerobic tolerance being more beneficial. The magnitude of changes (increase) of working capacity may be an indicator for the effectiveness of exercise training programmes.

[Integral assessment of cerebral hemodynamics normally, at a borderline level of arterial pressure and in arterial hypertension]. / Integral'naia otsenka mozgovoi gemodinamiki v norme, pri pogranichnom urovne arterial'nogo davleniia i arterial'noi gipertonii.

Cerebral circulation in relation to central hemodynamics was examined by means of rheoencephalography and chest rheography in 667 individuals with normal and elevated arterial blood pressure. Cardio-cerebral mechanisms are shown to be pathogenetically engaged since early stages of arterial hypertension. They are manifested as decreased cerebral stroke volume, smaller pulse inflow to cerebral arteries and increased vascular tonicity. Cerebral circulatory disorders grew more severe as the disease progressed.

[Relationship of physical work capacity, blood pressure and other hypertension risk factors with the rate of erythrocyte Na/Li countertransport]. / Sviaz' fizicheskoi rabotosposobnosti, arterial'nogo davleniia i drugikh faktorov riska arterial'noi gipertenzii so skorost'iu Na/Li-protivotransporta éritrotsitov.

The relationship of physical working capacity (PWC), blood pressure and other arterial hypertension risk factors to the rate of red blood cell Na+/Li+ countertransport was examined in a representative sample comprising 60 individuals (22 males and 38 females) whose age was 35-54 years. Regression analyses demonstrated that there was no significant relationship between PWC and the rate of red blood cell Na+/Li+ countertransport, but a significant correlation was found between the rate of Na+/Li+ countertransport and "double product" (DP) as an indirect indicator of PWC and heart rate. Thus, there is a heart rate- and DP-mediated correlation between the rate of red blood cell Na+/Li+ countertransport and the level of PWC. The magnitude of a decrease in the rate of red blood cell Na+/Li+ countertransport depends inversely on the dynamics of heart rate in males and females and directly on the dynamics of DP in females. Hence, there is a direct relationship between the magnitude of a reduction in the rate of red blood cell Na+/Li+ countertransport and that of PWC increment during exercise.

[Testing of arterial hypertension with physical exercise PWCx ]. / Proba s fizicheskoi nagruzkoi PWCx pri arterialnoi gipertonii.

The relation of physical fitness (PF) to blood pressure (BP) and arterial hypertension risk factors was studied in a representative sample by PWCX exercise testing. The relations were studied at the initial stage, during exercise and recovery by using the multivariance stepwise regression analysis. This complex approach allowed the independent relation of PF to BP to be found. In normotensive males, systolic BP determined 4% PF variability after the first exercise, while in hypertensive males, the second exercise heart rate and age determined 27 and 9% PF variability, respectively. In normotensive females, the first exercise heart rate determined 62% PF variability, in hypertensive females, the second exercise systolic BP and age determined 4 and 2% PF variability, respectively. The value x shows the relation of PF to heart rate and BP in the restorative period and is an additional significant parameter of PF and the functional status of the cardiovascular system.

[Value of the analysis of new cases of arterial hypertension in an organized population for the purpose of planning primary prevention programs]. / Znachenie analiza vozniknoveniia novykh sluchaev arterial'noi gipertonii v organizovannoi populiatsii dlia planirovaniia programm pervichnoi profilaktiki etogo zabolevaniia sredi neseleniia.

Within the framework of the 5-year program for the control of arterial hypertension, "detriment" to the population program caused by the lack of preventive work among the so-called healthy portion of the population was estimated at a Moscow machine-building plant. The proportion of patients in whom arterial hypertension was successfully reduced or controlled was matched against the proportion of those whose arterial BP went up above the normal or marginal level during the same period. The study demonstrated the possibility of identifying high-risk individuals in need of primary preventive care within a population, and timely and purposive planning of preventive programs.

[Differential approach to the development of physiologic standards and its significance for preventive cardiology]. / Differentsirovannyi podkhod k razrabotke fiziologicheskikh normativov i ego znachenie dlia profilakticheskoi kardiologii.

A new approach to the assessment of physiological standards involving the specification in health of three groups of parameters, namely constant, variant and unique is described. A statistical analysis of variant parameters is to be conducted considering their division into types (strata) which are normally characterized by the typical mean values. It is recommended that in carrying out programmes of the prevention of cardiovascular diseases, the susceptibility of different physiological types to the development of corresponding diseases be identified and taken into account.

[A new approach to evaluating the prevalence of electro- cardiographic high-amplitude R and S waves during mass screening]. / Novyi podkhod k otsenke rasprostranennosti vysokoamplitudnykh zubtsov R i S EKG pri massovykh obsledovaniiakh.

Relationships between the prevalence of electrocardiographic high-amplitude R and S waves, the stroke index, mean hemodynamic arterial BP and left-ventricular myocardial thickness (MT) were examined in a population of 411 individuals, aged 35-64 years. The prevalence of those waves is shown to have independent functional relationships with the stroke index and mean hemodynamic BP, irrespective of left-ventricular myocardial morphology. This functional approach is used to explain the causes of low sensitivity of electrocardiographic signs of left-ventricular myocardial hypertrophy when used for diagnostic purposes at population screenings.

[Evaluation of the effectiveness of the program of primary prevention of arterial hypertension at an industrial plant based on a prospective epidemiological study]. / Effektivnost' programmy pervichnoi profilaktiki arterial'noi gipertonii na promyshlennom predpriiatii po dannym prospektivnogo épidemiologicheskogo issledovaniia.

Whether the primary arterial hypertension prevention programme can be applied among employees of a Novosibirsk industrial enterprise within the framework of the second stage of the USSR Cooperative Study of Arterial Hypertension Control, is studied. For this, the authors used sodium-restricted diet concurrent with non-drug therapy (physio-, balneo-, reflexotherapy and acupuncture), and active sanitary education. The 2-year prospective follow-up showed a sufficiently high efficiency of health measures: the incidence of borderline hypertension was reduced by 10.5% at the end of the study, blood pressures could be maintained at the level of the borderline and subnormal values in most patients with persistent hypertension, the patients at risk developed no persistent hypertension, cases. In a 20% blind sample from the matched population, the changes in the frequency of various blood pressures were insignificant during this period.

[ECG in arterial hypertension in 15 and 16-year-old adolescents]. / EKG pri arterial'noi gipertenzii u podrostkov 15--16 let.

The ECG data are analyzed in the adolescents, aged 15-16, with arterial hypertension, revealed during the prospective examination. Th main group consisted of 238 adolescents with arterial hypertension, and the control group of 172 healthy adolescents. ECG recording was done in 12 conventional leads. ECG was assessed according to the Minnesota code. The data were compared with the criteria of the clinical electrocardiography. 1/3 of the adolescents had normal ECG. The duration of RQ interval, P wave, QRS complex and internal deviation time were within normal, as in the adults. The signs of the left ventricular hypertrophy were revealed in 11.3% of the adolescents of the main group. The sign RV5,6 + SV1 greater than 35 mm was the most typical one. The left ventricular electric prevalence by the position of the transitional zone was observed in 44.1% of the adolescents of the main group. Sinus tachycardia was detected in 14.7% of the cases.

[Role of health education in the secondary prevention of hypertension]. / Rol' sanitarnogo prosveshcheniia vo vtorichnoi profilaktike gipertonicheskoi bolezni.

Questionnaires were used to examine the extent of hypertensive patients' knowledge of the measures needed to prevent crises and complications of essential hypertension (EH), attitudes to physicians' prescriptions and recommendations and certain elements of hygienic behavior. Male EH patients below 40-50 years of age were found to follow the "I-know-it-is-needed-but-don't-do-it" principle with respect to their health. Many of the older men and the majority of women with EH demonstrated a different health credo: "It is needed, so I am doing it", or "It is needed, so I am trying to do it". Young and middle-aged male hypertensive patients were shown to require medical education to be of convincing or, at some points, even threatening modality, with short and clear-cut health recommendations, while hypertensive females and older males would benefit more from explanatory aids with detailed recommendations on diets, exercise, daily routines, etc.

[Dynamics of rates of fatal and nonfatal complications of hypertension in a population of workers subjected to occupational vibration (15-year follow-up)]. / Dinamika chastoty fatal'nykh i nefatal'nykh oslozhnenii arterial'noi gipertonii v populiatsii rabochikh vibroopasnykh professii pri 15-letnem nabliudenii.

Prospective monitoring of fatal and nonfatal myocardial infarctions and strokes was carried out in a population of workers with professional exposure to vibration. Duration of monitoring was 15 years. In the end of this period implementation of a program of preventive intervention was associated with lowering of rates of cerebral and coronary events (3.0 vs. 5.2% among nonparticipants in this program). In 5 years after cessation of the program an increase of risk of cardiovascular complications especially that of strokes occurred. Changes of rates of events in a group of workers not subjected to special intervention were less pronounced. Negative dynamics of event rates in the group of active prevention could be attributed to continuing action of unfavorable occupational factor.

[Methodological problems of evaluation of electrolyte intake in the clinical and population studies]. / Metodologicheskie problemy otsenki potrebleniia élektrolitov v klinicheskikh i populiatsionnykh issledovaniiakh.

The paper deals with methodological problems of electrolyte intake in clinical and population-based studies. Marked inter- and intraindividual fluctuations were found to substantially affect the reliability of assessing the intake of electrolytes, which should be borne in mind in practice. Specifically, individual-based reliable characteristics of electrolyte intake (excretion) may be obtained after examining at least 8 daily urinary collections. The adequate validity of group electrolyte intake may be attained when a group consists of at least 8 persons. It is shown that it is feasible to employ the definite urine amounts to gain an insight into electrolyte intake.

[Erythrocyte sodium-lithium countertransporter level as a risk factor of hypertension (prospective study data)]. / Velichina Na+/Li+ protivotransporta éritrotsitov kak faktor riska gipertonicheskoi bolezni (dannye prospektivnogo issledovaniia).

A 3-year prospective study was undertaken to evaluate the relation of red blood cell Na+/Li+ countertransport rates to the incidence of arterial hypertension. A total of 227 subjects (males and females aged 24-54 years)--a 20% representative sample of organized population--was followed up. The annual incidence of arterial hypertension was 4.3 among males and 2.7 among females. The baseline blood pressures and obesity in males and rates of Na+/Li+ countertransport in females were demonstrated to be factors associated with the incidence of arterial hypertension. The rate of red blood cell Na+/Li+ countertransport can be regarded as an independent biological risk factor for arterial hypertension.

[Erythrocyte Na+/Li+ countertransport and arterial hypertension: data of a cross-sectional population study]. / Skorost' Na+/Li+-protivotransporta éritrotsitov i arterial'naia gipertoniia: dannye odnomomentnogo populiatsionnogo issledovaniia.

The relation of red blood cell Na+/Li+ countertransport rate to the prevalence of arterial hypertension (AH) and blood pressure was evaluated in 720 individuals aged 23-60 years. In all age groups, the rate of red blood cell Na+/Li+ countertransport was significantly higher in males than in females. Age, alcohol use, obesity in males and age, obesity, and Na+/Li+ countertransport rate in females are factors that predispose to AH, as evidenced by multivariate logistic analysis. The latter parameter is associated with obesity and diastolic blood pressure and unassociated with age, alcohol use, and smoke, as suggested by regression analysis. The distribution of Na+/Li+ countertransport rate values in the population after standardization for ruling out the impact of obesity is erroneous and shifted to the right. This allows it to be presented as a sum of two normal distributions. However, their analysis has failed to reveal statistically significant differences in blood pressure values of AH incidence. The rate of Na+/Li+ countertransport may be regarded as a biological population risk factor for AH, which is, however, less than such factors as age, obesity, and excessive alcohol use.

[Physical activity and physical work capacity of patients with initial manifestations of cerebrovascular disorders in arterial hypertension]. / Fizicheskaia aktivnost' i fizicheskaia rabotosposobnost' bol'nykh s nachal'nymi proiavleniiami nedostatochnosti krovoobrashheniia mozga pri arterial'noi gipertonii.

The routine protocol of general and neurological examinations and some special questionnaires were used to examine physical activity (FA) and physical working capacity (FWC) in a random population from one of the Moscow districts which included 1200 persons (males and females aged 30-64 years). The majority of the examinees were those who had slight and moderate exercises, mainly sitting work, did few or no physical exercises. The proportion of persons with low physical activity increased with age both among males and females. The ratios generally remained despite the presence of early signs of abnormal blood supply. Bicycle ergometer testings showed a significant reduction in the physical working capacity of the patients with abnormal brain blood supply, in a greater extent, in arterial hypertension. Decreased functional activity and functional working capacity may regarded as one of the risk factors for cerebrovascular disorders, in arterial hypertension in particular, and should be borne in mind in implementing preventive measures.