[Change in the Nature of the Course of Arterial Hypertension in Patients With Chronic Arterial Insufficiency of the Extremities in Acute Thrombotic Occlusion].

The article is devoted to the investigation of the mechanisms of the development of arterial hypertension (AH) in patients with atherosclerosis of the abdominal aorta and the formation of chronic lower limb ischemia (Lerish syndrome). With the development of thrombotic occlusion of arteries of the lower extremities, the nature of the course of hypertension worsens. The operational recovery of the main blood flow in the limbs positively influences the course of hypertension in the majority of patients.

[Level of nitrous oxide in peripheral blood serum in patients with various severity of arterial hypertension].

AIM: To elucidate the role of nitrous oxide (NO) in development of severe primary arterial hypertension (AH) including malignant hypertension and concomitant ischemic heart disease (IHD). MATERIAL AND METHOD: Patients with diagnosis of primary 1-3 degree AH (n=62, 21 men, 41 women aged 39-87 years, mean age 63.7+/-2.7 years) and 28 subjects with normal arterial pressure (AP) (n=28, 13 men, 15 women aged 30-85 years, mean age 57.5+/-7.8 years). Blood serum levels of NO stable metabolites (nitrates and nitrites) were measured by reaction of their reduction in the presence of vanadium chloride and by reaction of diazotization of sulfanilamide by generated nitrite (modification by R.M.Miranda et al., 2001). RESULTS: NO level (level of its stable metabolites) was substantially elevated in patients with various severity of AH compared with subjects with normal AP. Severe and malignant course of AH was not associated with substantial lowering of NO level in blood serum. Relation between NO level and age found in subjects with normal AP, was not observed in patients with labile and stable course of AH. In patients with AH, normal serum NO level and signs of chronic involvement of cardiovascular system the disease was several times more often associated with atrial fibrillation and class II-III angina than in patients with high NO levels. Patients with AH combined with IHD more often had signs of heart failure and history of myocardial infarction.

[Levels of sex hormones in obese women with hypertension during various periods of reproductive activity]. / Kharakter izmenenii urovnia polovykh gormonov u zhenshchin, bol'nykh arterial'noi gipertenziei, s ozhireniem v raznye periody generativnoi aktivnosti.

AIM: To assess effects of hypertension and obesity on blood plasma levels of sex hormones and gonadotropins in fertile and postmenopausal women. MATERIAL: We assessed endocrinological status and measured levels of sex hormones and gonadotropins in 228 women with grade I-III hypertension (WHO, 1999) and 114 normotensive women of fertile and postmenopausal ages (17 to 74 years). There was a definite relationship between obesity and levels of sex hormones which did not depend on blood pressure level. The authors regarded this relationship as an endocrinological consequence of obesity. Severity of hypertension was associated with elevation of luteinizing and follicle-stimulating hormones and lowering of progesterone level in fertile women and with elevated levels of sex hormones in blood plasma in menopausal women. The authors interpreted the latter phenomenon as a sign of adrenal gland hyperfunction.

[Role of imbalance of sex hormones and gonadotropins in the development and course of essential hypertension in women]. / Rol' narushenii balansa polovykh gormonov i gonadotropinov v razvitii i techenii éssentsial'noi gipertenzii u zhenshchin.

Overall 146 females suffering from essential hypertension (borderline, stage I and II according to WHO, 1980) were examined for basal concentrations of estradiol, estriol, progesterone, testosterone, cortisol, ACTH, prolactin in plasma, LH and FSH in blood and urine. The patients and 69 control normotensive females were reproductive, premenopausal, menopausal, postmenopausal, postcastration. Latent hypertension was elicited at bicycle exercise. It was found that relationships between sex hormones and gonadotropins both in hypertensive and normotensive women did not differ noticeably in reproductive period and in menopause. Hormone defects due to primary and secondary infertility, castration, menopause did not raise the risk of arterial hypertension onset. An-Unfavorable course of hypertension was observed in premenopause, following operative castration, in climacteric syndrome. The severity of AH at reproductive age was associated with hyposecretion of progesterone, estrogens and gonadotropins LH, FSH. This relationship was absent in menopausal women. A conclusion is proposed on miner significance of sex hormones imbalance and gonadotropins in the onset of arterial hypertension in females varying by generative activity.

[Potentiation of the hypotensive effect of labetalol in hypertensive patients treated to maintain sodium balance in the body]. / Potentsirovanie gipotenzivnogo éffekta labetaolola u bol'nykh gipertonicheskoi bolezn'iu pri vozdeistvii na balans natriia v organizme.

Hypotensive activity of labetalol therapy alone or in combination with the diuretic agent oxodolin or with low-sodium diet (about 110 mmol/day) and potassium cooking salt substitute "Sanasol" (60% sodium chloride, ammonium chloride, calcium gluconate, magnesium asparaginate, etc.) was studied in 67 patients with second- or third-stage essential hypertension and 14 patients with nephrogenic hypertension. Central hemodynamic changes were assessed by means of radiocardiography and tetrapolar rheography. Combined treatment had better hypotensive effect in moderate and severe hypertension (diastolic arterial BP above 110 mm Hg). The diuretic-labetalol combination made possible a 25-45% reduction in the adrenoblocker dose. The effect of combined hypotensive treatment was similar in patients with different central hemodynamic types. Low-sodium diet with potassium substitute was well tolerated by the patients.

[Urinary sodium excretion in women with hypertension and various indicators of hemodynamics and pressor hormone levels]. / Ekskretsiia natriia s mochoi u zhenshchin, bol'nykh gipertonicheskoi bolezn'iu, s razlichnymi pokazateliami gemodinamiki i urovnem pressornykh gormonov.

Urinary sodium excretion was assessed in women with essential hypertension as an indicator of dietary sodium consumption. Groups of individuals with low (below 120 mmol/day), medium and high (above 180 mmol/day) excretion were identified. Patients with high sodium excretion levels showed slower withdrawal rates, as well as high total peripheral resistance and low cardiac output values. At the labile hypertension stage, these patients demonstrated an increase in total metabolic sodium owing to its growing residual fraction, and expanded interstitial fluid volume. Changes in renin-angiotensin-aldosterone activity showed close correlation with changes in sodium balance. Urinary adrenaline and noradrenaline excretion decreased in patients with labile hypertension who had the highest sodium excretion levels, and increased considerably in stable hypertension. Hypertension was particularly severe in patients who excreted over 180 mmol sodium daily whereas patients who excreted less than 120 mmol in the presence of stable hypertension had normal values of total metabolic sodium and cardiac output, and moderately elevated peripheral vascular resistance.

[Changes in water-electrolyte balance and central hemodynamics in hypertensive crises]. / Izmeneniia vodno-elektrolitnogo obmena i tsentral'noi gemodinamiki pri krizovom techenii gipertonicheskoi bolezni.

Sodium, potassium and water distribution, central hemodynamic parameters, and plasma renin activity and aldosterone levels were examined in 48 patients with stable essential hypertension, including 10 males and 11 females with hypertensive crises aggravating the course of the disease, and in 18 controls. The individuals showing signs of heart and renal failure were excluded from the analysis. In female patients, the crise pattern of the disease was associated with marked changes of sodium metabolism, namely, raised extracellular fluid and plasma sodium levels, the patients with the crises having a more severe course of the disease, with higher, as compared to those of crises-free patients, total peripheral resistance and lower cardiac output values. In female patients with the crises, plasma renin activity was reduced 3.3-fold, while aldosterone levels remained unchanged, as compared to the levels of crises-free women. A direct correlation was demonstrated between the recurrence of the crises and total peripheral resistance. Causes of sodium retention in female patients with the crises are discussed.

[Central hemodynamic function and the metabolic electrolyte ratio of patients with hypertension and hereditary disposition]. / Sostoianie tsentral'noi gemodinamiki i sootnosheniia obmennykh élektrolitov u bol'nykh gipertonicheskoi bolezn'iu s nasledstvennoi otiagoshchennost'iu.

A study was made of the pecularities of a course of arterial hypertension and the efficacy of hypotensive therapy in 69 hypertension patients with hereditary aggravation and 92 hypertension patients without hereditary aggravation. In 91 the content and distribution of sodium, potassium and water were studied using radionuclides; indices of the central and renal hemodynamics, plasma renin activity, aldosterone concentration and catecholamine excretion with urine were also studied. A natriuretic reaction to i.v. injection of lasix was measured in 12 of 42 patients. In hereditary aggravation hypertension was characterized by a higher level of systolic and diastolic AP which was more pronounced in men. Higher doses of hemiton and beta-adrenoblocking agents were required for its return to normal. In the authors' opinion, a more severe course of hypertension in such patients was associated with a raised sensitivity of resistant vessels to angiotensin which was confirmed by a significant elevation of the sodium/renin index. Changes in the values of the ratio extra/intracellular content of sodium and potassium in the patients with and without hereditary aggravation were not noticeable. Response to lasix was excessive as compared to normotonics in both groups.

[Use of Albetol for treating hypertension patients]. / Primenenie albetola dlia lecheniia bol'nykh gipertonicheskoi bolezn'iu.

The drug albetol (labetalol) was used in 97 patients with stage I-III essential hypertension (according to the WHO classification) and 13 patients with stable arterial hypertension of renal genesis. Albetol exerted a marked hypotensive effect beginning from the 2-3d day of the treatment and peaking on the 6-8th day of the treatment. To normalize the blood pressure, the patients with labile hypertension were given the drug in a dose of 200-400 mg/day whilst in the patients with a stable course the dose used was 600-2200 mg/day (858 mg/day on the average). In patients with the hyperkinetic type of the hemodynamics the blood pressure decreased following albetol administration at the expense of a reduction in the cardiac index and the heart rate whereas in patients with the hypokinetic type it was achieved mostly at the expense of a decreased vascular resistance to the blood flow. The drug was effective in 69% of the patients, it was well tolerated and induced no side effects.

[Salt and water loads and water-sodium metabolism in patients with hypertension]. / Solevye, vodnye nagruzki i vodno-natrievyi obmen u bol'nykh gipertonicheskoi bolezn'iu.

Thirty-seven subjects including 29 patients with essential hypertension (8 with labile and 21 with stable disease patterns) and 8 controls received salt and water loads. Sodium chloride was administered per os at a rate of 0.12-0.22 g bw, water at a rate of 20 ml bw. Before loads the measurements were taken of the total water content in the body and of the total metabolic sodium. Radiocardiography was employed to study the central hemodynamics. After sodium chloride load BP measurements were taken over 2 h, within the first 45 min every other 5 to 10 min. Sodium excretion with urine was measured hourly, whereas the changes in the central hemodynamics were evaluated every other 5 to 10 min. After water load BP measurements were taken for 1.5 h. Urine excretions were evaluated too. It was demonstrated that patients with labile and stable hypertension responded differently to salt and water loads. In the first case the increment of BP was similar to that seen in the controls, being measured by increases in the cardiac and stroke indices. In the second case BP rises were more prolonged and more significant than in the controls and occurred primarily at the expense of the high total peripheral resistance of the blood flow. There were two types of the response to salt load: the first one involved a rapid BP elevation (after 1 to 5 min) accompanied by the violent vegetative symptomatology and BP returning to normal after 20 to 30 min.(ABSTRACT TRUNCATED AT 250 WORDS)

[Water-electrolyte and hemodynamic aspects of the lasix test in patients with various courses of hypertension]. / Vodno-élektrolitnye i gemodinamicheskie aspekty proby s laziksom u bol'nykh s razlichnym techeniem gipertonicheskoi bolezni.

Forty-two hypertensive patients and seven controls were subjected to the lasix test (20 mg intravenously) followed by the assessment of the time-course of water and electrolytes excretion as well as by arterial pressure measurements. Prior to the test the authors, using isotopic and non-isotopic dilutions, determined the indices of central hemodynamics and sodium, potassium and water distribution in the body. In more than 60% of the patients, the diuretic, sodium- and potassiumuretic response to the administration of lasix was higher than in control. In the patients with essential hypertension, the nature of this response did not depend on the initial level of the arterial pressure, cardiac index, rate of glomerular filtration, content of the total metabolic sodium and potassium, or on the amount and distribution of water in the extracellular and intracellular spaces of the body. The patients with an excessive response to lasix had a significantly lower baseline urine excretion of stable sodium, a higher sodium concentration in the red blood cells and, in cases of stable hypertension, a higher activity of plasma renin as well. Modifications in hypotensive therapy are proposed in relation to the response to lasix administration.

[Changes in water-sodium balance in patients with hypertension subjected to different types of hypotensive therapy]. / Kharakter vodno-natrievykh izmenenii v organizme bol'nykh gipertonicheskoi bolezn'iu pod vliianiem razlichnykh vidov gipotenzivnoi terapii.

The parameters of water-electrolyte metabolism and central hemodynamics were studied in 44 patients with essential hypertension (stage II-III) after 3-week treatment with sympatholytics and diuretics. Patients with hyperkinetic type of hemocirculation had a sodium lack at the stage of stable hypertension, therefore the diuretic treatment is not indicated for such patients. The treatment with the diuretic oxodolin was accompanied by the decrease in the peripheral resistance of blood vessels, in sodium metabolism and its extracellular fraction, and by the increase of the deposit sodium fraction. The elevation of the renin-angiotensin system activity due to the diuretic therapy did not influence the blood pressure level and the central hemodynamics parameters.

[Potassium metabolism and content of the body in hypertension]. / Obmen i soderzhanie kaliia v organizme bol'nykh gipertonicheskoi bolezn'iu.

Potassium metabolism was studied with the use of 42K nuclide in 68 patients with hypertensive disease, stage I-III (WHO classification) without signs of cardiac and renal insufficiency and in 13 persons of the control group, total body volume with tritium oxide dilution and central haemodynamics with radiocardiography were also recorded. Patients with the stable course of arterial hypertension show decreased potassium metabolism in the body, apparently with deterioration of the tissue metabolism. Decrease of the total metabolised potassium was seen in patients with hypertensive disease only in the sclerotic stage of illness, it is more marked in men than in women. Decrease of potassium content in the body did not depend on the duration and severity of arterial hypertension and on the changes in central haemodynamics. It is concluded that more information on total potassium content in the body is gained with calculated percentage to the predicted normal values in milliequivalents per liter of total water in the body.