Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ - ΡΠΎΠ·Π΄Π°Π½ΠΈΠ΅ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ Π°Π½Π°Π»ΠΈΠ·Π° Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠ² ΡΠΈΡΡΠ΅ΠΌΡ ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ (ΠΠ) Π½ΠΎΠ²ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π° Π² ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π°Π½ΡΠΈΠ³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ. ΠΠ΅ΡΠΎΠ΄ΠΈΠΊΠ°. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ 277 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (136 ΠΌΡΠΆΡΠΈΠ½, 141 ΠΆΠ΅Π½ΡΠΈΠ½Π°) Ρ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ II ΡΡΠ°Π΄ΠΈΠΈ 1-2 ΡΡΠ΅ΠΏΠ΅Π½ΠΈ, ΡΠΈΡΠΊ II, III. ΠΠΎΠ·ΡΠ°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² 58,6Β±6,4 Π»Π΅Ρ, Π΄Π°Π²Π½ΠΎΡΡΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ 7,2Β±1,4 Π»Π΅Ρ. Π Π³ΡΡΠΏΠΏΡ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ Π²ΠΎΡΠ»ΠΈ 57 ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π΄ΠΎΡΠΎΠ²ΡΡ
Π»ΠΈΡ (25 ΠΆΠ΅Π½ΡΠΈΠ½, 32 ΠΌΡΠΆΡΠΈΠ½Ρ) Π² Π²ΠΎΠ·ΡΠ°ΡΡΠ΅ 52,1Β±4,4 Π³ΠΎΠ΄Π°. ΠΠΎΡΠ»Π΅ ΡΠΊΡΠΈΠ½ΠΈΠ½Π³Π° ΠΈ ΠΏΠΎΠ»ΡΡΠ΅Π½ΠΈΡ ΠΏΠΈΡΡΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΡΠΎΠ³Π»Π°ΡΠΈΡ Π² Π²ΠΈΠ΄Π΅ ΠΌΠΎΠ½ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π½Π°Π·Π½Π°ΡΠ΅Π½Ρ: Π½Π΅Π±ΠΈΠ²ΠΎΠ»ΠΎΠ», Π»ΠΈΠ·ΠΈΠ½ΠΎΠΏΡΠΈΠ», Π»ΠΎΠ·Π°ΡΡΠ°Π½, ΠΈΠ½Π΄Π°ΠΏΠ°ΠΌΠΈΠ΄, Π°ΠΌΠ»ΠΎΠ΄ΠΈΠΏΠΈΠ½, ΠΈ Π½Π΅ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ Π»ΠΈΠ·ΠΈΠ½ΠΎΠΏΡΠΈΠ»Π° ΠΈ ΠΈΠ½Π΄Π°ΠΏΠ°ΠΌΠΈΠ΄Π°. ΠΠ·ΡΡΠ΅Π½Ρ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΠ Π½Π° Π²ΡΠ΄Π΅Π»Π΅Π½Π½ΡΡ
ΡΡΠΎΠ²Π½ΡΡ
ΡΠΈΡΡΠ΅ΠΌΡ ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ ΠΠ ΠΏΠΎΡΠ»Π΅ 6 ΠΌΠ΅Ρ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠ΅Π½ΠΊΠ° ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΠΌΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΠΎΠΊΠ°Π·Π°Π»Π°, ΡΡΠΎ ΠΏΡΠΈ ΡΡΠ°Π±ΠΈΠ»ΠΈΠ·Π°ΡΠΈΠΈ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π²ΡΠ΅Ρ
6 Π³ΡΡΠΏΠΏ Π½Π° Π΄ΠΎΠ»ΠΆΠ½ΠΎΠΌ ΡΡΠΎΠ²Π½Π΅ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ ΡΠ°Π·Π»ΠΈΡΠΈΡ Π²ΡΡΠ²Π»Π΅Π½Ρ Π½Π° ΠΈΠ½ΡΠ΅Π³ΡΠ°ΡΠΈΠ²Π½ΠΎΠΌ ΡΡΠΎΠ²Π½Π΅ ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ. ΠΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ Π°ΠΌΠ»ΠΎΠ΄ΠΈΠΏΠΈΠ½Π°, Π»ΠΎΠ·Π°ΡΡΠ°Π½Π°, Π»ΠΈΠ·ΠΈΠ½ΠΎΠΏΡΠΈΠ»Π°, Π° ΡΠ°ΠΊΠΆΠ΅ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ Π»ΠΈΠ·ΠΈΠ½ΠΎΠΏΡΠΈΠ»Π° ΠΈ ΠΈΠ½Π΄Π°ΠΏΠ°ΠΌΠΈΠ΄Π° ΡΠ΅Π³ΡΠ»ΡΡΠΎΡΠ½ΠΎ-Π°Π΄Π°ΠΏΡΠΈΠ²Π½ΡΠ΅ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ° ΡΠ»ΡΡΡΠΈΠ»ΠΈΡΡ, ΠΏΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΈΠ½Π΄Π°ΠΏΠ°ΠΌΠΈΠ΄ΠΎΠΌ - Π½Π΅ ΠΈΠ·ΠΌΠ΅Π½ΠΈΠ»ΠΈΡΡ, ΠΏΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠΈ Π½Π΅Π±ΠΈΠ²ΠΎΠ»ΠΎΠ»Π° ΡΠ½ΠΈΠ·ΠΈΠ»ΠΈΡΡ. ΠΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Π° ΠΎΡΠΈΠ³ΠΈΠ½Π°Π»ΡΠ½Π°Ρ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΡ ΡΡΠΎΠ²Π½Π΅ΠΉ ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ (ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ) Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Ρ ΡΠ΅Π»ΠΎΠ²Π΅ΠΊΠ°, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½Π°Ρ Π½Π° ΠΎΠ±ΡΠ΅Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΏΡΠΈΠ½ΡΠΈΠΏΠ΅ ΠΈΠ΅ΡΠ°ΡΡ
ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ ΡΠ΅Π³ΡΠ»ΡΡΠΈΠΈ Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠ²Π½ΡΡ
ΡΡΠ½ΠΊΡΠΈΠΉ. ΠΡΠ΄Π΅Π»Π΅Π½Ρ ΡΡΠΎΠ²Π½ΠΈ: ΠΈΠ½ΡΠ΅Π³ΡΠ°ΡΠΈΠ²Π½ΡΠΉ, Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ (ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΠ΅ΠΌΡΠΉ Π°Π²ΡΠΎΠ½ΠΎΠΌΠ½ΠΎΠΉ Π½Π΅ΡΠ²Π½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΠΎΠΉ), ΠΎΡΠ³Π°Π½Π½ΡΠΉ, ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ (ΡΠ½Π΄ΠΎΡΠ΅Π»ΠΈΠ°Π»ΡΠ½ΠΎ-ΠΌΠΈΠΊΡΠΎΡΠΈΡΠΊΡΠ»ΡΡΠΎΡΠ½ΡΠΉ). ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½Π°Ρ ΠΎΡΠ΅Π½ΠΊΠ° Π½Π° ΠΈΠ½ΡΠ΅Π³ΡΠ°ΡΠΈΠ²Π½ΠΎΠΌ ΡΡΠΎΠ²Π½Π΅ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ½ΠΈΠ²Π΅ΡΡΠ°Π»ΡΠ½ΡΠΌ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΌ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ, ΡΡΠΎ ΠΎΡΠΊΡΡΠ²Π°Π΅Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΡΠΎΠ·Π΄Π°Π½ΠΈΡ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π°, ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ Π½Π° ΠΎΡΠ΅Π½ΠΊΠ΅ Π²Π»ΠΈΡΠ½ΠΈΡ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π²ΠΎΠ·Π΄Π΅ΠΉΡΡΠ²ΠΈΠΉ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π½Π° ΠΎΡΠ³Π°Π½- ΠΈΠ»ΠΈ ΡΡΠ½ΠΊΡΠΈΡ-ΠΌΠΈΡΠ΅Π½Ρ, Π½ΠΎ ΠΈ Π½Π° ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ° ΠΊΠ°ΠΊ ΡΠ΅Π»ΠΎΡΡΠ½ΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ.
Aim. To create a new methodological approach for determining the effectiveness of antihypertensive therapy in patients with arterial hypertension based on the analysis of violation of mechanisms in the blood pressure (BP) regulation system. Methods. This study included 277 patients (136 males, 141 females) with stage II, grade 1-2 hypertension, risk II, III, aged 58.6Β±6.4 yrs, with disease duration 7.2Β±1.4 yrs. The control group included 57 essentially healthy individuals (25 females, 32 males) aged 52.1Β±4.4 yrs. After screening and obtaining written informed consent, the following monotherapy was prescribed: nebivolol, lisinopril, losartan, indapamide, and amlodipine, plus an unfixed combination of lisinopril and indapamide. Changes in BP indexes at the predetermined levels of the BP regulation system were studied after 6 mos. of treatment. Results. Evaluation of the therapy effectiveness showed that, when BP was stabilized in all six groups at proper values, significant differences were revealed at the integrative regulatory level. When patients were treated with amlodipine, losartan, lisinopril, as well as a combination of lisinopril and indapamide, the regulatory and adaptive capabilities of the body improved. When treated with indapamide, these capabilities were unchanged, and when treated with nebivolol, these capabilities decreased. A new classification of the regulatory levels of BP control in humans is proposed. This classification is based on the general biological principle of hierarchical organization for the regulation of autonomic functions. The following levels are distinguished: integrative, autonomic support, i.e., carried out by the autonomic nervous system, organ, and peripheral, i.e., endothelial-microcirculatory. Conclusion. Quantitative assessment at the integrative level is a universal indicator of the treatment effectiveness. It makes it possible to create a methodological approach to determine possible effectiveness of treatment based on the assessed impact not only on the target organ or function, but also on the status of the body as a whole system.