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Aim: to improve the results of treatment of uncomplicated hypertensive crises at the prehospital stage by studying the state of systemic hemodynamics, determining the balance of the autonomic nervous system, in patients with hypertension in uncomplicated hypertensive crises. A study of 206 patients with documented stage II hypertension, 75 people who had a stable course of the disease and were examined on an outpatient basis. Almost healthy 31 people the indicators of heart rate variability in the examined persons were analyzed. For diagnosis were recorded according to the standard method “Cardiolab” (KhAI-Medika, Kharkіv). Assessment of the initial vegetative status in patients with hypertension and the direction of its changes after taking antihypertensive drugs, conducted within the framework of acute drug tests, suggests the possibility of differentiated choice of drug therapy and to predict its effectiveness. Reducing blood pressure significantly reduced the % risk, as on a SCORE scale of 5.83 [3.68; 8.66] % to 3.39 [1.87; 6.65] %, (p < 0.05) and Framingham Risk Score with 31.93 [22.72; 43.25] % to 21.74 [15.35; 31.43] %, (p < 0.05). The provision of EMD to patients with GC was generally effective and was accompanied by a significant decrease in CAT by – 3.93 % and DBP by – 12.5 %. Effective reduction of blood pressure led to a reduction in cardiovascular risk, both on the SCORE scale and the Framingham Risk Score. Assignment of differentiated EMD to patients with HA depending on the balance of the (autonomic nervous system) ANS was effective and was accompanied by normalization of total peripheral vascular resistance.

Purpose of the study. Improve the outcomes of treatment for uncomplicated hypertensive crises at the prehospital stage by studying the state of systemic hemodynamic, determining the balance of the autonomic nervous system and markers associated with the systemic inflammatory response in arterial hypertension patients in uncomplicated cases of hypertensive crisis. Materials and methods. During the 2017–2019 period, an open, prospective and comparative study was conducted and consisted of 206 patients with documented second-stage hypertension, of which 131 patients sought emergency medical attention in the «Municipal Institution Zaporizhzhya Station of Emergency (Ambulance) Medical Assistance» and 75 people who had a stable course of the disease and were examined on an out patiently on the basis of the «Primary health care Centre No 10». Practically healthy 31 people were examined on the basis of the MI «Regional medical exercises dispensary». The indices of heart rate variability in the examined persons were analyzed. All patients were examined physically, used generally clinical, instrumental and laboratory methods for ECG diagnosis were recorded according to the standard method, on a 12-channel computer-cardiographic complex «Cardiolab» (KhAI-Medika, Kharkov). The examinations were performed before the  start of emergency care and after HC relief. For the analysis of heart rate variability, a 5-minute ECG interval recorded at rest was used, and the signal was recorded in the supine position, with calm breathing. The obtained data were analyzed with the help of the Cardiolab-HRV software complex, followed by the analysis of the cardiorhythmogram according to the generally accepted method. Results. The analysis of the obtained evidence showed that the total HRV (by all indicators was significantly reduced in patients with hypertonic disease compared with healthy individuals), and with the development of hypertensive crisis in patients with hypertonic disease was even lower. In the hypertonic disease group with hypertensive crisis, activation of the sympathetic division of the autonomic nervous system (with increasing LF/HF ratio) was detected, but despite a higher LF/HF index of 2,21 (0,86–3,94) there was no significant difference against level 1,85 (1,56–2,03) in the hypertonic disease group without hypertensive crisis and a value of 1,81 (1,66–1,89) among healthy persons (p > 0,05). Conclusions. The results obtained indicate that the decrease in compensatory capacity in all HRV indicators is more pronounced in patients with hypertonic disease in the development of hypertensive crisis. Assessment of heart rate variability indicators may be a useful component of cardiovascular risk stratification, requiring further statistical analysis. Keywords: hypertension, uncomplicated hypertensive crisis, heart rate variability.

Актуальность. Артериальная гипертензия — один из основных факторов риска развития ишемической болезни сердца и цереброваскулярной патологии, что на 88,1 % определяет уровень смертности от сердечно-сосудистых заболеваний. Сердечно-сосудистые заболевания являются основной причиной инвалидизации населения во всех развитых странах мира, а также в Украине. Цель: улучшить результаты лечения неосложненных гипертонических кризов на догоспитальном этапе путем изучения состояния системной гемодинамики, определения баланса вегетативной нервной системы, маркеров системного воспалительного ответа у больных артериальной гипертензией при неосложненных гипертонических кризах. Материалы и методы. Проведено исследование 206 больных с документированной гипертонической болезнью II стадии, среди них — 75 человек, которые имели стабильное течение заболевания и были обследованы амбулаторно; практически здоровых — 31 человек. Проанализированы показатели вариабельности сердечного ритма у исследованных лиц. Все больные обследованы физикально, для чего были использованы общеклинические, инструментальные и лабораторные методы диагностики; электрокардиограмму регистрировали по общепринятой методике на 12-канальном компьютерном электрокардиографическом комплексе «Кардиолаб» («ХАИ-Медика», Харьков). Обследование проводили до начала оказания экстренной медицинской помощи (ЭМП) и после купирования гипертонического криза. Результаты. Оценка исходного вегетативного статуса больных артериальной гипертензией и направленности его изменений после приема антигипертензивных препаратов, проведенная в рамках острых медикаментозных проб, позволяет говорить о возможности дифференцированного выбора медикаментозной терапии и прогнозировать ее эффективность. Снижение артериального давления (АД) достоверно уменьшало риск как по шкале Systematic COronary Risk Evaluation (SCORE) — с 5,83 [3,68; 8,66] % до 3,39 [1,87; 6,65] % (p < 0,05), так и по шкале Framingham Risk Score (FRS) — с 31,93 [22,72; 43,25] % до 21,74 [15,35; 31,43] % (p < 0,05). Выводы. Оказание ЭМП больным с гипертонической болезнью было в целом эффективным и сопровождалось достоверным снижением систолического АД на –63,93 % и диастолического АД на –12,5 %. Эффективное снижение АД способствовало уменьшению кардиоваскулярного риска как по шкале SCORE, так и по шкале FRS. Назначение дифференцированной ЭМП пациентам с гипертоническим кризом в зависимости от баланса вегетативной нервной системы было эффективным и сопровождалось нормализацией общего периферического сопротивления сосудов.

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