[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.

[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.

[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.

[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.

[Monitoring arterial hypertension in workers in professions exposed to vibration hazards (results of a 15-year study)]. / Monitoring arterial'noi gipertonii u rabochikh vibroopasnykh professii (rezul'taty 15-letnego nabliudeniia).

AIM: To follow up for 15 years prevalence of arterial hypertension (AH) in workers exposed to vibration, to study AH course and possible correction in long-term vibration exposure. MATERIAL AND METHODS: The survey covered 1232 males aged 25-59 years exposed to vibration at their working places for 1 to 30 years (test group) and 1163 males matched for age but not exposed to vibration (control group). Active primary and secondary prevention of AH and annual population control for 10 years were performed in the test group. The control group was followed up outpatiently without active intervention. Final screening was conducted 5 years after completion of the program of AH prophylaxis. RESULTS: Among workers exposed to vibration AH prevalence was similar to that in the controls and tended to reduction in the process of preventive treatment. However, after the end of prophylactic measures AH incidence rate returned to the baseline level. In workers at risk of vibration aftereffects conversion of normal arterial pressure to hypertension was observed more frequently than in unexposed patients. This requires active prophylactic intervention. CONCLUSION: Long-term exposure to moderate and high frequency vibration is an AH risk factor. Incidence rate of AH increases with longer exposure to vibration. Compared to controls, aged workers exposed to vibration have AH much more frequently.

[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.

[Control of arterial hypertension in stroke prevention]. / Kontrol' arterial'noi gipertonii v profilaktike insul'tov.

According to epidemiological surveys arterial hypertension increases the risk of death of coronary heart disease 3-hold, of hemorrhagic and ischemic strokes--6-fold. Treatment of arterial hypertension leads to a significant fall in the risk of strokes and ischemic heart disease. The PROGRESS trial demonstrates that antihypertensive therapy of patients with the history of acute cerebral circulation disorder with ACE inhibitor perindopril is effective in secondary prophylaxis in such patients.

[ACE-dependent and sympathetic components of blood pressure regulation in patients with essential hypertension]. / APF-zavisimyi i simpaticheskii komponenty reguliatsii arterial'nogo davleniia u patsientov s éssentsial'noi gipertoniei.

UNLABELLED: The development of arterial hypertension is accompanied by impairment of the normal ratio of the "ACE-depending" and of the sympathetic nervous system, correlates with the action on the main pharmacological "targets": I-I-imidazoline receptors (moxonidine) or the ACE activity (enalapril). The aim of the present investigation was to determine the hypotensive and metabolic effects of moxonidine and enalapril depending on the basal ACE activity in patients with arterial hypertension, complicated with the metabolic syndrome. Effectiveness of moxonidine and enalapril administration (during 24 weeks) depended on the basal ACE activity in the hypertensive patients: (a) in the group of patients with low basal ACE activity moxonidine very effectively decreased systolic and diastolic blood pressure, compared with the group of patients with high basal ACE activity; (b) influence of enalapril on the level of arterial blood pressure was more pronounced with high basal ACE activity. IN CONCLUSION: choosing a hypotensive treatment for patients with the metabolic syndrome, it is advisable to take into account the basal ACE activity levels.

[Hormone replacement therapy in women with arterial hypertension in peri- and postmenopause: hemodynamic effects]. / Zamestitel'naia gormonoterapiia u zhenshchin s arterial'noi gipertoniei v peri- i postmenopauze: gemodinamicheskie éffekty.

AIM: To study hemodynamic effects of replacement hormone therapy (RHT) with trisecvens, beta-blocker betaksolol and their combination in perimenopausal and menopausal women with hypertension. MATERIAL AND METHODS: The study was made of 60 menopausal women aged 45-60 with mild and moderate arterial hypertension (AH). The women had no contraindications to either RHT or beta-blockers. They were randomized into three groups: group 1 received trisekvens, group 2--trisekvens plus betaksolol in a dose 10-20 mg/day, group 3--betaksolol. Arterial pressure (AP) and heart rate (HR) were measured before the treatment, in one month and each three months for a year. ECG and echo-CG were registered before treatment and each 3 months of the therapy. AP monitoring covered 50% of the patients of each group before the treatment and after 1 and 3 months of it. The data were analysed according to SAS system. RESULTS: Group 1 patients showed no significant changes in AP and HR. Group 2 and 3 patients' AP lowered, in group 2 the fall of systolic AP being more pronounced. 12-month therapy brought about a 10.3% decrease in left ventricular myocardial mass index in group 2. CONCLUSION: RHT with trisekvens in combination with beta-blocker in long-term use potentiates the effect on systolic AP and reduced hypertrophy of the left ventricle. RHT does not produce a significant effect on AP in women with AH recorded before the menopause.

[Betaxolol treatment of hypertension in postmenopausal women]. / Primenenie betaksolola u zhenshchin s arterial'noi gipertoniei v postmenopauze.

AIM: The study of hypotensive efficacy of high-cardioselective beta-blocker betaxolol, its effects on lipid and carbohydrate metabolism, menopausal syndrome in females with mild and moderate arterial hypertension. MATERIALS AND METHODS: 20 postmenopausal 45-59-year-old women entered the trial of betaxolol. They had diastolic blood pressure 90-114 mm Hg. Beta-blockers were not contraindicated. Arterial pressure, heart rate, body mass, blood lipid spectrum, glucose and insulin levels were evaluated before the treatment, 1, 3 and 6 months after it. RESULTS: Betaxolol safely and effectively lowered blood pressure. Blood lipid spectrum remained unchanged. A transitory rise in fasting insulin levels did not worsen glucose tolerance despite a small gain in body mass. Menopausal syndrome relieved due to good effect of betaxolol on vasomotor disorders. CONCLUSION: Betaxolol has a good hypotensive effect in the absence of adverse effects on lipid and carbohydrate metabolism. A reduction of menopausal syndrome was also achieved.

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.

[Arterial pressure, physical activity and physical work capacity]. / Arterial'noe davlenie, fizicheskaia aktivnost' i fizicheskaia rabotosposobnost'.

A representative population sample was studied to elucidate relationships of arterial pressure (AR) with muscular performance (MP) and arterial hypertension risk factors. Power working capacity (PWCx) was measured by means of exercise tolerance test at rest, under physical loading and after the exercise. The findings were processed using a multivariate step-by-step regression analysis which established independent relations between exercise and postexercise MP and arterial hypertension. In normal and hypertensive males a rise in systolic pressure (SP) after the initial exercise (load 1) was dependent on PWC1 after more intensive exercise (load 2) on relations of MP with heart rate, SP and diastolic pressure (DP). In hypertensive males the SP elevation depended also on the age, B. W. index and heart rate. In normal AP males a DP rise depended on PWC2 and MP, the increment being limited by relationships between MP, DP, heart rate and SP. In hypertensive males the influence of PWC1 is defined through a SP rise after load 1. In normal AP and hypertensive females PWC1 is decisive for a SP rise. In normal AP females growth of DP after load 2 was dependent on PWC2 in relation to heart rate growth after load 2, while in hypertensive females PWC1 resulted in DP elevation after load 1. On comparison of the groups with normal and high AP the degree of AP increment under exercise depended on the relations of MP with heart rate, SP and DP.