[Criteria for selecting patients with resistant hypertension for a renal sympathetic denervation]. / Kriterii otbora bol'nykh s rezistentnoi arterial'noi gipertoniei dlya simpaticheskoi denervatsiya pochek.

AIM: to define and develop a procedure that can select patients with resistant hypertension (RH) for a renal sympathetic denervation (RSD) procedure, by being orienting to the specific initial values of ß-adrenoreactivity (ß-AR) and systolic blood pressure (SBP). SUBJECTS AND METHODS: The analysis included 23 RH patients receiving the maximally tolerable doses of 4 antihypertensive drugs. The investigations involving BP control and a Russian spectrophotometric procedure for determining ß-AR in terms of the change in the osmoresistance of erythrocyte membranes (EM) were performed at baseline and 4 and 24 weeks. RSD was carried out using endovascular radiofrequency ablation of the renal arteries. The therapy was not changed during the observation. RESULTS: If SBP was >170 mm Hg and ß-AR of EM >40 conditional units (CUs) at baseline, ΔSBP was 17.68±3.24 mm Hg and the efficiency of RSD was 100%. When SBP was <170 mm Hg and ß-AR of EM <40 CUs at baseline, ΔSBP was 0.97±4.21 mm Hg (p>0.05) and the efficiency of RSD was low. CONCLUSION: The overall estimate of baseline SBP and ß-AR of EM in patients with RH could determine the expediency of the RSD procedure in order to lower BP. The proposed procedure can optimize the selection of patients and enhance the efficiency of RSD in the treatment of RH.

[Correlation between indices of 24-h monitoring of blood pressure and disturbed venous cerebral outflow in hypertensive patients].

AIM: To study relations between disturbances of cerebral venous circulation and parameters of 24-h blood pressure monitoring in hypertensive patients. MATERIAL AND METHODS: A total of 72 patients aged 28 to 60 years with essential hypertension of stage II have undergone 24-h blood pressure monitoring and MR-venography of the brachiocephalic veins on a low-field MR-tomograph using 2D TOF angiography. RESULTS: Symptoms of disturbed cerebral venous circulation were found in 60% patients. Major venous collectors were asymmetric in 79.2% patients, 40.3% had marked asymmetry, 14% had severe asymmetry. Disturbances of venous outflow significantly more frequently occurred in non-dippers and night-peakers as well as in high variability of blood pressure. Patients with marked asymmetry of venous collectors had elevated nocturnal systolic and diastolic blood pressure, high load indices of nocturnal systolic and diastolic pressure, a low degree of nocturnal fall of blood pressure. CONCLUSION: Disturbance of venous cerebral outflow in hypertensive patients is closely related with alterations of a circadian profile of blood pressure: circadian index of blood pressure, variability of blood pressure.

[Structural-functional manifestations of cerebrovascular pathology in patients with essential hypertension].

AIM: To study functional activity of the brain in hypertensive patients by computer EEG and topographic mapping versus MR-tomography of the brain. MATERIAL AND METHODS: Computed EEG and MR-tomography (MRT) of the brain were made in 162 patients (age 28-56, mean age 43 +/- 2.4 years) with essential hypertension (EH) stage II. RESULTS: Four types of maps reflecting stages of forming defects of electric activity of the brain in patients with hypertension without neurological deficiency were identified. There is evidence about correlation between spectral rhythm power of EEG and severity of structural changes of the brain in hypertensive patients. CONCLUSION: Progression of vascular hypertensive encephalopathy by MRT in hypertensive patients is accompanied with changes in EEG rhythm power: alpha-rhythm index reduction, leveling of its interhemispheric differences, a rise of the low activity index in all the cerebral regions. The latter and alpha-rhythm index reduction may be regarded as markers of cerebral structural changes, primarily, disordered liquorodynamics and periventricular leukoaraiosis in relevant brain regions.

[Correlation between the parameters of 24-hour monitoring of arterial pressure and changes in arterial wall structure based on the results of a prospective trial].

AIM: To evaluate prognostic value of 24-h monitoring of blood pressure (BPM-24) for assessment of structural changes in arterial walls in patients with essential hypertension living in West Siberia. MATERIAL AND METHODS: In the course of 5-year prospective study we made two extended clinical and device examinations with use of BPM-24 and ultrasonic measurements of arterial intima-media complex (IMC) in 160 patients (mean age 48.97+/-8.18 years). RESULTS: An independent significant correlation was found between initial drop of the circadian index (CI) of blood pressure, systolic blood pressure (SBP)/diastolic blood pressure (DBP) at night (r = 0.24/0.22, p = 0.012/0.024) and thickness of IMC in 5 years (r = -0.28/-0.30, p = 0.004/ 0.002). The risk of increased thickness of arterial wall in the group with abnormal CI was 1:4. There was no relationships between IMC increase and baseline office blood pressure (r = 0. 18/0.12, p = 0. 057/0.188). In evaluation of office BP effects on progression of arterial atherosclerosis insignificant correlation coefficients for SBP/DBP were obtained (r = 0. 18/0.18, p = 0. 150/0.149) contrary to BPM-24 parameters: mean circadian SBP (r = 0.22, p = 0.046) and heart rate (r = 0.23, p = 0.038), SBP temporal index for 24 hours (r = 0.24, p = 0.035). CONCLUSION: . BPM-24 parameters are more significant predictors of structural changes in arterial wall than standard office blood pressure. This allows calculations of possible risk of such changes.

[Recognition of actual periods of nocturnal rest from 24-hour heart rate profile].

UNLABELLED: Inability to delineate exactly periods of nocturnal sleep and diurnal wakefulness during 24-hour blood pressure (BP) monitoring causes reporting of erroneous BP values for these periods. We suggested a simple mathematical algorithm for detection of periods of nocturnal rest determined as period of low values of cardiac rhythm using data of BP monitoring itself. AIM: To compare novel method of recognition of periods of sleep with 2 standard techniques: use of fixed time interval between 23 and 7 hours (1), or period of sleep according to patient's diaries (2). Reproducibility of nocturnal BP lowering between two 24-hour intervals during 48-hour blood pressure monitoring was used as a measure of precision of determination of diurnal/nocturnal BP. METHODS: Ambulatory 48-hour BP monitoring was carried out in 33 patients with uncomplicated stage II hypertensive disease. Automatic analysis of BP monitoring data was performed with the use of specially designed computer application. Standard deviation (SD) of differences (SDD) between pairs of nocturnal BP lowering during 48 hours was used as a measure of reproducibility. RESULTS: Reproducibility of values obtained with novel algorithm (SDD for systolic/diastolic BP 6.7/8.2 mm Hg) was substantially better than those obtained with standard methods (1) and (2) (SDD 13.0/14.8 and 13.5/18.3 mm Hg, respectively). CONCLUSION: The proposed method of recognition of the period of nocturnal rest substantially improved precision of automatic analysis of 24-hour BP monitoring.

[Effect of the vertebral syndrome in cervical osteochondrosis on the course of I-IIA stage hypertension and cerebral electrical activity and hemodynamics]. / Vliianie vertebra'lnogo sindroma pri sheinom osteokhondroze na techenie gipertonicheskoi bolezni I-IIA stadii, bioélektri- cheskuiu aktivnos't i gemodinamiku mozga.

Examination included two groups of patients with I-IIA stage essential hypertension combined with cervical osteochondrosis: with and without the vertebral syndrome. It revealed significant polymorphism of clinical symptoms, more severe course of vascular pathology, disorders of cerebral hemodynamics with decreased pulse blood filling, increased tone of arterioles, venules and veins, signs of disturbances of venous outflow and features of bioelectric brain activity indicating dysfunction of the middle structures in patients with the vertebral syndrome of cervical osteochondrosis. Since the pathogenic significance of cervical osteochondrosis is mostly realized in the presence of the vertebral syndrome, therapeutic policy should involve both antihypertensive agents and measures that control vertebrogenic pathology as well as medicamentous correction of hemodynamic cerebral disturbances.