Research  objective.  Evaluation  of the influence  of 6-month  antihypertensive  therapy  with  drugs  of different  classes on hemodynamic parameters of the circulatory system in patients with comorbid hypertension and rheumatoid arthritis. Materials and methods. Patients who met age criteria (58.6 ± 6.4 years), duration of hypertension (11.2 ± 1.6 years), onset (aged 45–64 years), and duration (7.2 ± 2.1 years) of rheumatoid arthritis were divided into groups: Group I (136 men, 141 women) — 277 patients  with stage II hypertension;  Group II (28 men, 114 women)  — 142 patients  with stage II  hypertension  and rheumatoid arthritis (in clinical-laboratory remission); Group III (20 men, 92 women) — 112 patients with stage II hypertension and rheumatoid arthritis (in clinical-laboratory  exacerbation). Antihypertensive  monotherapy was prescribed by polyclinic doctors: nebivolol, lisinopril, losartan, amlodipine, indapamide, and a combination of lisinopril and indapamide. Observation was carried out for 6 months. Results. The influence of antihypertensive therapy (6 months) on hemodynamic parameters of the circulatory system in patients of groups I and II was presented by positive dynamics of morphometric and speed parameters, while in group III patients the indicators were less significant and more distant. Conclusion.  The presence of rheumatoid arthritis introduces additional changes in the dynamics of hemodynamic effects of prescribed antihypertensive therapy and is determined by the degree of disease activity and adequacy of basic anti-inflammatory therapy.

Кубанский государственный медицинский университет, Краснодар, Российская Федерация mulTileVel analYsis of regulaTorY mechanism DisorDers as a principle of choice for inDiViDual anTihYperTensiVe TherapY in paTienTs WiTh hYperTension (parT ii). opTimiZaTion of anTihYperTensiVe TherapY choice TaKing inTo accounT The mulTileVel analYsis of ViolaTions in regulaTorY mechanisms of arTerial BlooD pressure eliseeva l. n., samorodskaya n. a. Kuban state medical university, Krasnodar, russian federation Цель: оптимизация выбора индивидуальной антигипертензивной терапии (АГТ) у пациентов с гипертонической болезнью (ГБ) с учетом анализа нарушений механизмов системы регуляции артериального давления (АД). Включены 277 пациентов с ГБ II стадии в возрасте 58,6±6,4 лет. В виде монотерапии назначено: небиволол, лизиноприл, лозартан, индапамид, амлодипин и нефиксированная комбинация лизиноприла и индапамида. Изучены изменения показателей на интегративном, вегетативном, органном и периферическом уровнях системы регуляции АД через 6 месяцев АГТ. Изменения на периферическом и органном уровнях носили разнонаправленный и отсроченный характер от 3 до 6 месяцев, что не позволяет использовать их как для выбора стартовой терапии, так и для оперативной экспресс-коррекции; на интегративном и вегетативном уровнях отмечены признаки коррекции регуляторно-адаптивного статуса (РАС) при симпатикотоническом (Ст) типе вегетативной регуляции на фоне терапии небивололом, лизиноприлом, лозартаном; парасимпатикотоническом (Пс) типе-на фоне терапии амлодипином, индапамидом; смешанном (См) типе-на фоне комбинированной терапии индапамидом и лизиноприлом. Интегративный и вегетативный уровни системы регуляции АД дают объективно количественную оценку функционального состояния организма, позволяя оптимизировать выбор АГТ. Ключевые слова: артериальное давление, оценка эффективности лечения первичной артериальной гипертензии Aim: optimization of the individual antihypertensive therapy (AHT) choice in patients with hypertension (H) taking into account the violation analysis of arterial blood pressure (AP) regulation system. This study has included 277 patients with hypertension degree II at the age of 58.6±6.4 years. As a form of monotherapy it was administered: nebivolol, lisinopril, losartan, indapamid, amlodipin, and non-fixed combination of lisinopril and indapamid. Changes of indicators were studied at the allocated levels: integrative, vegetative support, organ, initially peripheral levels in 6 months of AGT. Changes at peripheral and organ levels were quite various and postponed, from 3 to 6 months. And this fact demonstrated that it was impossible to apply them as a chosen initial therapy and as an operative express correction; at integrative and vegetative levels: we noticed some signs of regulative and adaptive status (RAS) in sympathicotonic (St) type of vegetative regulation on treatment with nebivolol, lisinopril, losartan, in parasympatheticotonic(Ps) type in treatment with amlodipin, indapamide; in mixed (Mi) type in mixed therapy with indapamide and...

Introduction. There are almost no studies characterizing the integrative level of blood pressure (BP) regulation. Materials and methods. 277 people of both genders aged 58.6±6.4 with stage II hypertension disease were randomized into six groups. The monotherapy of hypertension disease was conducted in five groups, using nebivolol, lisinopril, indapamide, amlodipine, and losartan. The sixth group had a combined therapy (lisinopril/indapamide). The therapy effectiveness was assessed at four levels of blood pressure regulation, using the following methods: 1) laser Doppler flowmetry, determination of the level of tumor necrosis factor-α and interleukin-10; 2) echocardiography and Doppler sonography, ultrasound examination of the renal blood flow, ECG, Holter monitoring of ECG; 3) an examination of the heart rate variability level and a quantitative assessment of beta-adrenoreception of erythrocyte cell membranes; 4) the regulatory and adaptive status was assessed, using the method of cardio-respiratory synchronism. Results and discussion. A more significant BP decrease was revealed during a combination therapy (by 20.4% of the baseline daily value). At the integrative level, an index of the regulatory and adaptive status (iRAS) increased in the treatment with lisinopril/indapamide combination (by 40.5%), amlodipine (by 40.5%), losartan (by 35.3%), and lisinopril (by 30.2%). Nebivolol administration resulted in a 13.5% decrease in iRAS. Indapamide therapy had no significant effect on iRAS. Conclusion. A comprehensive assessment of the blood pressure regulation system makes it possible to control the effectiveness of the therapy not only on a target organ or function, but also on the condition of the organism as an integral system.

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