RU2277847C1 - Method for choosing therapy in case of severe arterial hypertension - Google Patents

Abstract

FIELD: medicine, cardiology.

SUBSTANCE: the present innovation deals with optimizing therapy in patients at severe arterial hypertension. Before the onset of antihypertensive therapy it is necessary to conduct electrocardiography to detect the value of myocardial functional tension X according to the formula by taking into account QT interval. Then comes therapy including capoten, furosemid, atenolol or capoten and hypothiazid based upon X value being higher, lower or equal to 0.127. The innovation enables to choose adequate scope of procedures in patients with chronic arterial hypertension by taking into consideration possible body reaction to antihypertensive therapy even at primary inspection.

EFFECT: higher efficiency.

1 ex

Description

The invention relates to medicine, in particular to cardiology, and can be used to optimize therapy in patients with severe arterial hypertension.

A known method of choosing antihypertensive therapy based on the presence or absence of certain concomitant conditions (M. Fried and S. Greens (eds.). Cardiology in tables and diagrams - Moscow, "Practice", 1996, pp. 23-31).

The disadvantage of this method is the lack of accuracy, which does not allow at the initial examination to determine the necessary volume of therapeutic measures.

There is a method of choosing antihypertensive therapy in patients with arterial hypertension, taking into account individual fluctuations in blood pressure (BP) in a patient during the day according to the results of daily monitoring of blood pressure (E.E. Gogin. Hypertension. - Moscow, 1997, p.325).

The disadvantages of the method taken as a prototype are its technical complexity, including the availability of expensive equipment for daily monitoring of blood pressure, as well as underestimation of the functional state of the myocardium and the possible reaction of the body to antihypertensive therapy.

The essence of the claimed invention lies in the fact that according to the method of choosing therapy for severe arterial hypertension, which includes determining a physiological indicator before starting a course of treatment, an indicator of myocardial functional tension is used as a physiological indicator, which is determined by the formula:

X = (QT _AND -QT _P ) / QT _P,

Where

X is an indicator of the functional tension of the myocardium,

QT _AND - QT interval, measured in lead V _5,

QT _P - QT interval calculated by the Bazetta formula,

and with an X value greater than 0.127, a therapy comprising more than three components is selected, and with an X value less than or equal to 0.127, a therapy comprising no more than three components is selected.

The proposed method of choosing therapy for severe arterial hypertension does not require the use of complex equipment, takes into account the functional state of the myocardium of patients and allows you to choose an adequate amount of therapeutic measures in patients with severe arterial hypertension, taking into account the possible reaction of the body to antihypertensive therapy already during the initial examination, which reduces the time required for stabilization of the condition of patients, and prevents the irrational prescription of drugs.

The method is as follows: before the start of antihypertensive therapy, directly during the initial examination, the patient undergoes electrocardiography according to the standard method, during which the duration of the QT interval in lead V ₅ is measured and the due duration of the QT interval is calculated according to the well-known Bazetta formula (Cardiology Guide in 4 volumes / under the editorship of E.I. Chazov, M., 1982, volume 2, p. 214), after which the indicator of the functional tension of the myocardium is determined by the formula:

X = (QT _AND -QT _P ) / QT _P,

Where

X is an indicator of the functional tension of the myocardium,

QT _AND - QT interval, measured in lead V _5,

QT _P - QT interval calculated by the Bazetta formula,

and with an X value greater than 0.127, a therapy comprising more than three components is selected, and with an X value less than or equal to 0.127, a therapy comprising no more than three components is selected.

Examples of specific implementation of the method.

Example 1. Patient U., 51 years old, diagnosis: Hypertension, III stage, severe, H _II-A . QT _I - 0.43 s, QT _P - 0.36 s, X = 0.194. Given the degree of lengthening of the QT interval, complex therapy was prescribed (capoten 75 mg / day + furosemide 10 mg / day + atenolol 50 mg / day + vitamin E 600 mg / day), the treatment is effective.

Example 2. Patient A., 39 years old, diagnosis: Hypertension, stage II, severe, H _I. QT _I - 0.39 s, QT _P - 0.36 s, X = 0.083. Given the degree of lengthening of the QT interval, therapy has been prescribed (capoten 75 mg / day + hypothiazide 12.5 mg / day), the treatment is effective.

Claims (1)

The method of choosing therapy for severe arterial hypertension, which includes determining a physiological indicator before starting a course of treatment, characterized in that the indicator of myocardial functional tension is used as a physiological indicator, which is determined by the formula X = (QT _and -QT _p ) / QT _p , where X is an indicator of the functional tension of the myocardium, QT _and - the QT interval measured in assignment of V ₅ , QT _p - QT interval calculated by the Bazetta formula, and with a value of X greater than 0.127, capoten, furosemide, atenolol is prescribed, and with a value of X less than or equal to 0.127, capoten and hypothiazide are prescribed.