RU2301013C2 - Method for graphic depicting the data of daily arterial pressure monitoring, method for diagnostic survey of ah patients, method for choosing therapeutic tactics in ah patients and evaluating therapeutic efficiency in ah patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: the method deals with carrying out daily AP monitoring in AH patients followed by their processing and depicting the information obtained on a two-plane plot. The combination of SAP, DAP values should be process by the following formula: P% = Ki x 100% : N, where P% - the probability of occurrence of a certain AP value during the period if investigation, Ki - the quantity of values observed in one and the same range of the plot, N - total amount of relevant alterations per the period of investigation. The combination obtained of the probability of AH values occurrence should undergo spectral chromatic decomposition. The greater value corresponds to more intensive color, it should be plotted to obtain the geometrical figure of random shape and area. Its chromatic range corresponds to spectral density of the probability of AP values per the time of investigation. The innovation is of more information value, it enables to reveal the complexity of processes occurring in the body and reflects more accurately the AH picture being individual for only one concrete patient.

EFFECT: higher efficiency and accuracy.

4 cl, 21 dwg, 1 ex, 1 tbl

Description

The proposed group of inventions relates to medicine, namely to diagnostics, and can be used to assess the condition of a patient with arterial hypertension (AH), when choosing the tactics of his treatment and monitoring the correctness of the choice made.

Arterial hypertension is one of the leading causes of coronary heart disease (CHD) and the main cause of cerebrovascular complications. Despite the achievements of modern medicine, hypertension remains a poorly controlled disease and is in third place among the causes of disability in the population. In Russia, 20-30% of the population suffers from this pathology, with 60% of patients belonging to the working-age population. In 60% of cases, vascular complications of the brain develop against the background of mild hypertension. Thus, the problem of adequate, comprehensive diagnosis and treatment of hypertension remains relevant at the present time.

A known method of daily monitoring of blood pressure (BPM) (see Olbinskaya L.I., Martynov A.I., Hapaev B.A. Monitoring of blood pressure in cardiology. // Methodical manual, Moscow, 1998), during which the diagnostic information is displayed in the form of several numerical series, where each variable displays, respectively, the values of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure and heart rate, measured every 15 minutes in the afternoon and every 30 (60) minutes night. Based on these indicators, the mean arterial pressure, the variability of arterial pressure, the time index, the area index of arterial pressure for certain periods of time (day, night, day) and the degree of nighttime decrease in arterial pressure are automatically calculated, and a standard graph (Fig. 1) for displaying the results of ABPM, which represents a linear dependence of changes in SBP and DBP on the measurement time.

Analysis of the output of a standard study provides information on the circadian rhythm of blood pressure, the magnitude and speed of the morning rise in blood pressure; average blood pressure values are more reproducible during repeated studies, have a closer correlation with the frequency of target organ damage, and better reflect the effect of drugs.

However, the known method is not without a number of significant disadvantages. It is hardly possible to comprehensively evaluate the entire long series of digital indicators obtained after the Smad study, and the average values of blood pressure levels presented by automatic calculations can be the same in patients with different structures of hypertension.

The need for standardization of the graphical display of SMAD data is also emphasized by foreign authors.

Closest to the technical nature of the proposed group of inventions is a known method for graphically displaying ABPM data in a patient with hypertension, including conducting ABPM studies, receiving ABPM data, processing it, presenting the information on a two-plane graph and analyzing the data for diagnostic examinations of a patient with AH and choosing the tactics of his treatment. ((O'Brien E. Ambulatory blood pressure monitoring in the management of hypertension. // Heart 2003; 89: 571-576.)

The principle of visualization in the known method is based on the construction of a linear graph (Fig. 2) in the coordinate system, where the values of the measurement time (hours) are plotted on the abscissa axis, and blood pressure values (mmHg) are plotted on the ordinate axis.

As a result of the projection of the output of the ABPM onto the graph area, the subject of analysis is two curves. The graph displays the moments of sudden changes in blood pressure in the form of pronounced peaks. In contrast to the standard schedule, the author specifically selects on the chart a range of normal values of SBP and DBP, and also emphasizes day-night boundaries.

The advantage of this image is the successful presentation of the pattern of the daily profile of blood pressure - normal or perverted and fixing sharp changes in blood pressure in the form of dips or peaks.

However, both the method for graphically displaying SMAD data in the form of two curves and the mathematical apparatus used to process the obtained data do not allow us to evaluate such a phenomenon as the “complexity” described in nonlinear dynamics and underlying the behavior of biological systems. As a result, a large amount of valuable information about the object is lost and, using only linear methods of analysis, they get a simplified and sometimes distorted picture. In this graph, information on the variability of blood pressure can be obtained only by the degree of indentation of the curve, which is an extremely subjective characteristic and not least due to the inconvenient visual perception of this sign. Comparison of the results of the SMAD study to select treatment tactics for dynamic monitoring of the patient at different periods of treatment and evaluate its effectiveness by using standard graphic display is uninformative and therefore practically not carried out. Focused on stating gross and abrupt changes in the daily profile of blood pressure, this type of data presentation does not allow a subtle analysis of changes in blood pressure. It is difficult to assess which range of blood pressure values is most characteristic for a given patient, especially if the curve is not monotonous. Visual determination of the variability of blood pressure (VAD) by the type of curve in the absence of pronounced peaks or dips is difficult and is a subjective characteristic because of the complex visual perception of this symptom. When visually comparing the results of treatment, the doctor must mentally superimpose two pairs of similar curves on top of each other in order to conclude whether the degree of indentation of the curves has decreased and how the range of attraction of the most popular blood pressure values has changed. In this case, we can confidently conclude only the change in the daily profile of blood pressure, if any, and the success of treatment can be judged unconditionally only if both curves have moved to the selected range of optimal values, which in practice, unfortunately, is not so common. Thus, it is not possible to visually assess the adequacy, adequacy, and most importantly, the physiological effect of the prescribed therapy. The same applies to the quantitative assessment of the data obtained. Based on the foregoing, we can conclude that the accuracy, sensitivity, information content and specificity of the known method are insufficient, since the known diagnostic criteria are clearly insufficient to describe such a complex biological system as hypertension.

The objective of the proposed group of inventions is to provide new information about the structure and nature of hypertension, increase the accuracy, information content and reliability of a medical examination of a patient with hypertension, select treatment tactics and monitor its conduct, increase the convenience of visual assessment of SMAD information by obtaining a new graphic image , as well as a simplification of the method.

The problem in the known method of graphical display of data of 24-hour monitoring of arterial pressure (BPM) in a patient with hypertension, including BPM studies, obtaining BPM data, processing and presentation of the information on a two-plane graph, is solved by the fact that the dimension of the ordinate axis of the graph corresponds to the values systolic blood pressure (SBP), the abscissa axis corresponds to the values of diastolic blood pressure (DBP), the graph field is divided into four zones:

the normal zone, the zone of isolated systolic hypertension, the zone of isolated diastolic hypertension and the zone of systolic-diastolic hypertension, the zones are obtained by crossing two perpendiculars omitted from the values corresponding to 140 mm Hg y-axis and 90 mmHg the abscissa axis, while the division range of both axes corresponds to 10 mm Hg, and the zone of systolic-diastolic hypertension is further divided into 9 subzones corresponding to the first, second and third degrees of increase in blood pressure (BP), the entire set of SBP values is further processed and DBP according to the formula: P% = Ki × 100%: N, where P is the probability of occurrence of a certain blood pressure value during the measurement; Ki - the number of blood pressure values falling in the same range of the graph; N is the total number of relevant measurements during the study and the resulting set of probabilities of occurrence of certain blood pressure values during the measurement using a computer is subjected to spectral decomposition into colors so that a higher color intensity corresponds to a higher color intensity, put it on the graph field, receiving in as a result, a geometric figure of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure values during the measurement. Moreover, to obtain a three-dimensional image of a geometric figure of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure values during the measurement, the two-plane graph is additionally equipped with a third Z axis, on which the percentage of the blood pressure probabilities is plotted, where a higher frequency of recording the blood pressure values corresponds to a higher peak height.

The problem in the known method for the diagnostic examination of a patient with hypertension, including a comprehensive clinical examination, including the SMAD study and analysis of the SMAD data on a two-plane chart, is solved by the fact that the entire set of SBP and DBP values is additionally processed according to the formula: P% = Ki × 100%: N, where P is the probability of occurrence of a certain blood pressure value during the measurement, Ki is the number of blood pressure values falling in the same range of the graph, N is the total number of relevant measurements during the study, gender the set of probabilities of occurrence of certain blood pressure values for day, night and day using a computer is subjected to spectral decomposition into colors so that a higher color intensity corresponds to a higher probability of blood pressure, put it on the graph field, resulting in a geometric shape of arbitrary shape and area , the color gamut of which corresponds to the spectral probability density of the blood pressure values during the measurement, while the dimension of the ordinate axis of the graph field corresponds to the SBP values, B abscissa corresponds to the values of DBP, the chart comprises four zones: a zone rules zone isolated systolic hypertension, hypertension diastolic isolated zone and a zone of systolic-diastolic hypertension, which are obtained by intersection of the two perpendiculars dropped from values corresponding to 140 mm Hg y-axis and 90 mmHg the abscissa axis, while the division range of both axes corresponds to 10 mm Hg, and the zone of systolic-diastolic hypertension is additionally divided into 9 subzones corresponding to the first, second and third degrees of increase in blood pressure to obtain a three-dimensional image of a geometric shape of arbitrary shape and area , the color gamut of which corresponds to the spectral probability density of the blood pressure values during the measurement, the two-plane graph is provided with a third Z axis, on which the percentage of the blood pressure probabilities is plotted, where the greater frequency p a large peak height corresponds to the histogram, they compose a patient map containing the obtained two- and three-dimensional display of the SMAD data and conduct visual and quantitative analysis, while visual analysis of the geometric shape of an arbitrary shape and area or area of hypertension obtained on a two-plane graph separate the most intensively colored area of the figure, corresponding to a larger value of the probabilities of blood pressure during the measurement and constituting the core of the AG, and the least intensely colored area of the figure, having the lowest probability of blood pressure during the measurement and the peripheral component of hypertension, quantitatively determine the value of the most frequent blood pressure values during the measurement, having more than 8% of probabilities that correspond to the core index of hypertension, the value of the rarest blood pressure values during the measurement, which are less than 3% of probabilities, which correspond to the index of the periphery of the AH, as well as the value of the rarest values of blood pressure during the measurement, amounting to less than 3% of probabilities, excluding the normal zone, which correspond to the index of pathological periphery A , and the presence, differential diagnosis, assessment of the degree and shape of the AG is carried out by finding the obtained geometric shape or area of the AG in one or more zones and subzones of both graphs, the forecast of the AG course is carried out by the location and shape of the AG core in the zones and subzones of both graphs with high, the average or low value of blood pressure, as well as the area and location of the periphery in the zones and subzones of both graphs, and the course of hypertension are predicted to be favorable with a monolithic form of the core of hypertension and its presence in areas of the graph with low or a moderate level of blood pressure, while the periphery of the hypertension is concentrated around the core of the hypertension, has a small area and does not fall into the region of medium-high and high blood pressure, the course of hypertension is predicted as unfavorable in the presence of more than one hypertension core in the zones and subzones of the graphs, and / or the location of the hypertension in the areas of the graph corresponding to high degrees of hypertension, while the periphery occupies the main area of the graph, and / or is distant from the core of the AG and / or is in the zones and subzones of the graphs corresponding to high degrees of hypertension, simultaneously stratify the main risk of a patient with AH by quantitatively determining the AH core index, AH periphery index and pathological AH periphery index and predict an unfavorable course of AH with AH core index less than 50%, AH periphery more than 17% and AH pathological periphery more than 8% at normal, where the index AH core is 58-60%, periphery 14-16% and pathological periphery - 5.5-7.5%.

The task in the known method of choosing a treatment strategy for a patient with hypertension, including the appointment of drug therapy, taking into account the stage, form and degree of hypertension, as well as taking into account the total risk, concomitant diseases, individual indications and contraindications for a particular patient, is solved by the fact that an additional ABPM study is performed , process the entire set of values of SBP and DBP according to the formula:

P% = Ki × 100%: N, where

P is the probability of occurrence of a certain value of blood pressure during the measurement,

Ki - the number of blood pressure values falling into the same range of the graph,

N is the total number of relevant measurements during the study, the resulting set of probabilities of occurrence of certain blood pressure values for a day, night and day using a computer is subjected to spectral decomposition in color so that a higher color probability corresponds to a higher color intensity, put it on the graph field , resulting in a geometric shape of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the values of blood pressure during the measurement, while the ordinate axis of the graph field corresponds to the SBP values, the abscissa axis corresponds to the DBP values, the graph field contains 4 zones: the normal zone, the zone of isolated systolic hypertension, the zone of isolated diastolic hypertension and the zone of systolic-diastolic hypertension, which are obtained by crossing two perpendiculars omitted from the values corresponding to 140 mmHg y-axis and 90 mmHg the abscissa axis, while the division range of both axes corresponds to 10 mm Hg, and the zone of systolic-diastolic hypertension is further divided into 9 subzones corresponding to the first, second and third degrees of increase in blood pressure to obtain a three-dimensional image of a geometric shape of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure value during the measurement, the two-plane graph is equipped with the third Z axis, on which the percentage of the blood pressure probability value is plotted, where the greater frequency p Hysteria of arterial pressure corresponds to a high peak height, they compose a patient map containing the obtained two- and three-dimensional displays of the ABPM data and conduct visual and quantitative analysis, while visual analysis of the geometric shape of an arbitrary shape and area or the area of hypertension obtained on a two-plane graph separate the most intensively colored area of the figure, corresponding to a larger value of the probabilities of blood pressure during the measurement and constituting the core of the AG and the least intensely colored area of the figure, having the smallest probability of blood pressure during the measurement and the peripheral component of hypertension, quantitatively determine the value of the most frequent blood pressure values during the measurement, having more than 8% of probabilities that correspond to the core index of hypertension, the value of the rarest blood pressure values during the measurement, which are less than 3% of probabilities, which correspond to the index of the periphery of the AH, as well as the value of the rarest blood pressure values during the measurement, amounting to less than 3% of probabilities, excluding the normal zone, which correspond to the index of pathological periphery AH, and the presence, differential diagnosis, assessment of the degree and shape of AH is carried out by finding the obtained geometric shape, or area of AH, in one or more zones and subzones of both graphs, and the prognosis of AH is carried out by the location and shape of the AH core in the zones and subzones of both graphs with high, medium or low blood pressure, as well as the area and location of the periphery in the zones and subzones of both graphs, and the course of hypertension is predicted to be favorable with a monolithic form of the core of hypertension and its presence in areas of the graph with a low or an average level of blood pressure, while the periphery of the hypertension is concentrated around the core of the hypertension, has a small area and does not fall into the region of medium-high and high blood pressure, the course of hypertension is predicted as unfavorable in the presence of more than one hypertension core in the zones and subzones of the graphs, and / or the location of the core AG in the areas of the graph corresponding to high degrees of AG, while the periphery occupies the main area of the graph, and / or is distant from the core of the AG and / or located in the zones and subzones of the graphs corresponding to high degrees of AG, simultaneously carry out stratification June of the main risk of a patient with AH by quantitatively determining the AH core index, AH periphery index and pathological AH periphery index and predict an unfavorable course of AH with AH core index less than 50%, AH periphery more than 17% and AH pathological periphery more than 8% at normal, where the hypertension core index is 58-60%, the periphery is 14-16% and the pathological periphery is 5.5-7.5%, in addition, the percentage distribution of all the obtained blood pressure values during the measurement over the biplane zones is determined and presented as a histogram Afica and the choice of treatment tactics are carried out taking into account the location of the obtained geometric shape or area of AH in certain zones and sub-zones of the schedules, while the need and choice of dose are carried out by the location of the AH core, the need for combination therapy is carried out by the area of the periphery of AH in high and medium-high levels Blood pressure and the fragmented nature of the nucleus, with an unfavorable course of hypertension in a patient, the selection of drugs with a certain mechanism of action is carried out taking into account the histogram. To assess the effectiveness of therapy for a patient with hypertension, at the end of the course of treatment, an additional BPM study is performed, a map of the patient with hypertension is made containing two "and a three-dimensional display of BPM - data for day, night and day, and the location and shape of the geometric shape or area of hypertension are visually analyzed. in the zones and subzones of the graphs, the obtained map is compared with the first patient’s map and the therapy is recognized to be effective in reducing the entire area of the figure, shifting it to the normal zone and normalizing the indices of the AH core and periphery AH, therapy is recognized as ineffective in the absence of a change in the shape and area of the figure, and / or its shift to the region of lower blood pressure values, while maintaining a large periphery in area and its location in areas with high blood pressure, as well as the absence of quantitative changes in the indices of the nucleus and periphery AH.

The proposed group of inventions meets the criterion of "novelty", since in the process of conducting patent information research, no sources were found that discredited the novelty of the proposed methods. The proposed group of inventions meets the criterion of "inventive step", since the search did not reveal technical solutions with essential features of the proposed methods.

A known method of processing and displaying cardiological information for the functional state of the body (RF p.2218862, IPC АВВ 5/0452, published in BI No. 35 dated 12/20/2003). However, the above method is based on the analysis of changes in heart rate associated with respiration and requires for its implementation the presence of every second recorded parameters. The known method is unsuitable for the analysis of SMAD data due to the large time intervals between adjacent measurements, excluding the causal relationship between the act of breathing and the value of blood pressure.

In a method for graphically displaying SMAD data, a new dimension of the graph axes is proposed for the first time - the dimension of the ordinate axis corresponds to SBP values, the dimension of the abscissa axis to DBP values. The division range of both axes corresponds to 10 mm Hg. The width of the ranges into which the total interval of physiological fluctuations in blood pressure in humans is divided is 10 mm Hg, based on the existing error of modern blood pressure monitors. Range width over 10 mmHg inexpedient, since the information obtained in this case will be crude and approximate. As a result, the number of ranges with a width of 10 mm Hg it is equal for GARDEN - 18 in the general range from 100 to 240 mm Hg, for DBP - 11 in the general range from 50 to 140 mm Hg.

The proposed group of inventions is illustrated by graphs, patient cards, histograms and other graphical materials that help in revealing the essence of the proposed methods and links to which are given in the implementation section of the methods.

Figure 1 shows a graph of the SMAD data obtained by the method-analogue.

Figure 2 shows a graph of SMAD data obtained by the prototype method.

Figure 3 shows the graph field of the SMAD data according to the proposed method.

Figure 3 shows: 1 - the ordinate axis; 2 - abscissa axis, 3 - normal zone; 4 - zone of isolated systolic hypertension; 5 - zone of isolated diastolic hypertension; 6 - zone of systolic-diastolic hypertension; 7-9 subzones of the first, second and third degree of increase in blood pressure.

Figure 4 shows the geometric shape obtained by the proposed method for displaying data from the ABPM of a certain shape and area on a two-plane graph.

In figure 4 is indicated:

10 is a geometric figure.

Figure 5 shows a graph field for a three-dimensional image of the ABPM data.

Figure 5 marked: 11 - axis Z.

Figure 6 shows the geometric figure obtained by the proposed method for graphically displaying the ABPM data on a three-plane graph.

Figure 7 shows the proposed map of a patient with hypertension.

On Fig shows a histogram of a patient with hypertension.

Figure 9 shows a graph of SMAD healthy person.

Figure 9 shows: 12 - core AG; 13 - the periphery of the AG.

Figure 10 shows the visualization of the SMAD data of a patient having systolic-diastolic hypertension.

Figure 11 shows the visualization of the BPM data of a patient having isolated diastolic hypertension.

12 shows a visualization of the BPM data of a patient having isolated systolic hypertension.

In Fig.13 shows the receipt of the core AG.

On Fig shows the receipt of the periphery of the AG.

On Fig depicts the classification of types of antihypertensive effect.

On Fig shows an example of a favorable antihypertensive effect according to the results of the analysis of patient cards before and after treatment.

On Fig shows an example of an adverse hypotensive effect according to the analysis of patient records before and after treatment.

In the proposed group of inventions, new information obtained, as well as new diagnostic criteria for hypertension, required the introduction of a new terminology for arterial hypertension (although these terms are widely used in everyday life). These terms, according to the Dahl dictionary, correspond to their direct meanings.

For the first time, the authors of the proposed group of inventions received on a two- and three-plane graphs a geometric figure of a certain shape and area corresponding to the area of the AG, the shape and area of which depend on the values of blood pressure during the measurement. The location of the area of hypertension on the graph and its shape are new diagnostic criteria for the nature of hypertension in the patient. So, in the method of diagnostic examination of a patient with hypertension, a large area of distribution of the area, its fuzziness, tearing into several subregions indicates a high variability of blood pressure in this patient and, therefore, a violation of the regulation of blood pressure, which indicates an unfavorable course of the disease. On the contrary, the compact location of the area of hypertension, the location of the area in areas of low pressure indicates a favorable course of hypertension.

In the obtained area of hypertension, the core of hypertension, the periphery of hypertension and pathological periphery are distinguished.

So, the AG core is the most intensely colored part of the AG area, which includes the aggregate of blood pressure values with the highest probability of recording during the measurement, and it also corresponds to the highest peaks on a three-plane graph. Studies conducted by the authors of the application, it was found that the core of hypertension, i.e. blood pressure values having the highest percentage of probability per day of measurement and, accordingly, the highest spectral distribution density on the graph, really determines the presence, shape and degree of hypertension. The location of the AG core is usually either consistent with the average daily blood pressure or significantly refines it. When comparing the ABPM data on the proposed method and the "range" of the hypertension with the indicators of the traditional assessment of the ABPM results, it was revealed that the "core" of the hypertension really determines the degree of hypertension in a particular patient based on a real state of things. A comparative analysis with the known method for the diagnostic examination of a patient with hypertension revealed that in 34% of cases (in 34 patients) the interpretation of the degree of hypertension based on the average daily blood pressure values turned out to be false. When the AG core is isolated, an action target for therapy is obtained (claim 4 of the claims), the values of which are exempted from the influence of artifacts and random emissions and can serve as a guide for choosing the dose of drugs.

AG periphery - on a two-plane graph, this is the least intensely colored part of the area of the obtained geometric figure, or the area of the AG, which includes a set of blood pressure values with the least probability of recording during the measurement and on a three-plane graph these are also the rarest blood pressure values displayed as the lowest peaks. Since on the graph they are located in the areas farthest from the AG core, they were called the "periphery" of the AG. The periphery of hypertension is a graphic embodiment of the degree of blood pressure variability, a sign of instability and dysregulation of the blood pressure maintenance system. The periphery of hypertension can be near if it is not far from the nucleus, and far if it occupies areas remote from the nucleus. The periphery can be non-aggressive if it falls into the normal zone or nearby areas, and aggressive if it is found in the marginal areas of the graph, that is, it corresponds to high blood pressure values. Visual registration on graphs of pronounced distant and / or aggressive periphery of hypertension indicates poor control over the course of the disease in this patient, warns the doctor about the need to take into account all possible risk factors, the appointment of complex and, most likely, combination therapy. Thus, the specific location of the area of hypertension in areas of low pressure in the absence of distant aggressive periphery indicates a favorable course of the disease for this patient. On the contrary, a large area of the figure and / or pronounced distant aggressive peripheral arterial hypertension, often in combination with a fragmented nucleus, indicates a serious condition of the patient and a prognostically poor course of the disease, reflecting a high degree of blood pressure dysregulation and the imbalance of the systems controlling it.

The obtained new graphical display of the SMAD analysis (the method according to claim 1) and the new diagnostic criteria (the method according to claim 2) allow us to talk about the internal structure of arterial hypertension in a particular patient, which could not be done by focusing only on the average values of blood pressure obtained using prototype method. The average blood pressure values may be the same in patients with different hypertension structures. To eliminate errors associated with the analysis of the areas of the graph having a non-uniform color gamut, and at the same time with the aim of most accurately characterizing the internal structure of AH in a particular patient, the AH formula was developed. The formula AH is the percentage of the distribution of all blood pressure values in a patient per day of measurement over the zones on the graph, or, in other words, according to the degree of hypertension of a certain form.

The prerequisite for the selection of certain layers in virtual tomography of a three-plane graph (the method according to claim 2) was the following. Considering the literature data that 62% of the daily variability of blood pressure is explained by the physical and psychoemotional activity of the subject, it is logical to assume that the examined patient has a certain number of “random” episodes of blood pressure increase that are not associated with the hypertension picture as a whole, but due to a significant difference with the main percentage the probabilities of blood pressure values that introduce a dissonance into the understanding of the disease, both in assessing average values and in interpreting graphic images. Therefore, it is necessary to consider separately the totality of the most typical BP values for an individual patient.

When measuring blood pressure values, the doctor cannot say with certainty whether the obtained blood pressure value is stochastic or significant in the structure of hypertension in this patient. Based on the foregoing, the authors sequentially excluded from the analysis the values of blood pressure, having respectively 3%, 5% and less than 8% probability in assessing the complex of daily values, assuming a relatively small contribution of blood pressure values of this probability to the general structure of hypertension and their uselessness as application points for selection of a dose of drug therapy. Using virtual tomography, three “tomographic” slices of a three-plane graphical image are obtained. As the percentage of probabilities of rejected blood pressure values increases, the image becomes compact, representing the core of hypertension, which is the leading manifestation of the symptoms of the disease (Fig. 13). However, based on the installation, to conduct a comprehensive analysis that takes into account all the features of the behavior of the system under study, one cannot limit oneself to analyzing only a part, even the main one, of its indicators. It is well known that about 60% of cerebrovascular complications develop against the background of hypertension of the 1st degree. In other words, the last straw is the rise in blood pressure to a level not characteristic of this patient. The imbalance and inadequacy of the dynamic control of blood pressure leads to its excessive variability, which is clinically expressed by the presence of drops in blood pressure. Values of blood pressure against the background of such differences will have a low percentage of probability over a long measurement time. However, they are the result of the pathological state of blood pressure regulation systems, reflecting impaired stability and adaptability of the behavior of the cardiovascular system. Therefore, taking into account the proportion of such values in each patient becomes extremely important in diagnostic and prognostic terms. In order to be able to analyze the internal structure of hypertension in a particular patient from the position of accounting for the number of rare blood pressure values, a tomographic section of the studied object is performed, cutting off the patient-specific values. As a result, an image is obtained on a three-plane graph, which is a projection of the state of the cardiovascular system in terms of the physiological regulation of blood pressure. It reflects the variability of blood pressure in graphical form, just one that is easily interpreted and remembered. Therefore, for a more in-depth analysis of the internal structure of hypertension, it is necessary to use the principle of virtual tomography, obtaining for analysis two sets of blood pressure values: the rarest and most frequent for the patient being examined. The terms AG core and AG periphery are also used to describe these values, since, as already mentioned, on the graph, blood pressure values are most likely located in the center of the obtained geometric figure, and the rarest blood pressure values occupy the marginal and / or marginal zones. Thus, the essence of virtual tomography is that the study includes only the most frequent blood pressure values that have more than 8% probability during the measurement (AG core) and only the rarest blood pressure values that have less than 3% probability during the measurement (AG periphery ) When the AH core is isolated, an action target for therapy is obtained, the values of which are exempted from the influence of artifacts and random emissions and can serve as a guide for choosing the dose of drugs. The specific probability value was chosen empirically. When conducting an ABP analysis with an interval of 15 minutes during the day and 30 (60) minutes at night, less than 100 blood pressure values were obtained at the output. Thus, one value already has a probability of more than 1%. When analyzing a layer containing blood pressure with a probability of less than 2%, it was found that it is filled in a very small number of patients and registers only a few high rises and decreases in blood pressure. Therefore, to determine the number of rare blood pressure values, the optimal probability level is 3%. In the same way, the limit was set when obtaining the AG core. With further discarding layers containing blood pressure values of more than 8% probability, the graphic image either did not change at all or disappeared in 75% of the subjects. Therefore, the level of blood pressure values of 8% was found to be adequate to determine the most typical blood pressure values for the patient. Thus, the use of virtual tomography makes it possible to obtain a more accurate assessment of the patient's condition, since the AG core determines the degree of stability and organization of the state of the cardiovascular system, and the periphery of the AG determines the degree of its plasticity and adaptability, being a projection of the outcome of the interaction of regulatory blood pressure systems. The presence of a nucleus in a certain area of the graph unambiguously determines the real degree of hypertension in a particular patient, being also the basis for choosing the dose of the drug. Since tomography graphs are to some extent a projection of blood pressure variability in an individual patient, in contrast to the standard blood pressure variability indices, calculated as its standard deviation, the authors obtained indices, which they called modified variability indices and, in addition to their visual representation, also performed quantitative analysis. It was made using a computer program. As a result, it was calculated: Hypertension peripheral index — the number (in% of the total) of rare blood pressure values having a probability of less than 3%, pathological periphery index — blood pressure values with a probability of less than 3% falling within the normal range were excluded from the analysis; AG core index - the number (in% of the total) of frequent values having a probability of more than 8%. In the group of healthy individuals, the “periphery” index is 15.6%, the pathological “periphery” index is 7.02%, and the “core” index is 57.9%. In the group of hypertensive patients, these indices are 22.1%, 15.1% and 43.2%, respectively. The indices of the “periphery”, “pathological periphery” and “nucleus” exceed the norm by 41.8%, 114.4% and 34%, respectively, while the difference in the STD of SBP and DBP between the groups was only 19% and 18%, respectively. which allows us to consider additional VAD indices as more sensitive indicators in terms of assessing the reactivity of the cardiovascular system.

Characteristic of a two-plane plot, i.e. the spectral probability density of all blood pressure values obtained during the day of measurement and analysis of the location of the AH nucleus and AH periphery, as well as clarifying the location of the AH nucleus and AH periphery on tomographic sections obtained using virtual tomography, together create a picture of the area of AH in an individual patient. Approximately the same picture was observed when assessing the variability of blood pressure. In most cases, increased standard variability indices correspond to the graphs obtained by the authors, which have a large area of the periphery of the antigens and, often, a high degree of fragmentation. However, in 29 patients (29%), the form of the presented data on the proposed method of displaying information gave a more accurate description of the variability of blood pressure in a particular patient. Thus, a comparison of the standard and the proposed graphs among themselves confirms the diagnostic value of the method for displaying SMAD information.

To assess the effectiveness of the prescribed antihypertensive therapy, an analysis is made of the nature of changes in the area of hypertension during the course of treatment. Studies of the authors identified the following types of changes in the "range" of AH:

Collaboration

Expansion,

Fragmentation,

Bias,

moreover, the first 3 species can be combined with the latter, or they can be registered independently. Collaboration means a decrease in the total area of the arterial hypertension during treatment. Expansion is an increase in the area of the AG range on the graph. Fragmentation — fragmentation of an entire figure into several subregions. The offset is the transition of the AG core from one zone of the graph to another or movement within 1 zone (Fig. 15).

After analyzing the change in the total area of the AH area, the dynamics of the indices of the AH core and the periphery of AH of this patient is evaluated after a course of therapy. For this, the graphs obtained after virtual tomography are compared. The periphery of hypertension can shift, decrease, disappear and appear (activate). The AG core can be fragmented, consolidated, collaborated and expanded.

The change in the area of a figure by zones on a graph corresponding to certain degrees and forms of hypertension is quantified. The analysis is performed by constructing the "formulas of the hypertension range" before and after treatment and calculating the change in the number of blood pressure values in each zone during treatment. In this case, to register the number of blood pressure values falling into each zone of the graph, the corresponding designation is introduced:

S1 (from the English Square-area) - the number of blood pressure values falling into the normal zone;

S2 - the number of blood pressure values falling into the zone of isolated systolic hypertension;

S3 - the number of blood pressure values falling into the zone of isolated diastolic hypertension;

S4 - the number of blood pressure values falling into the zone of systolic-diastolic hypertension, which are divided into:

I st is the number of blood pressure values falling into the zone of systolic-diastolic hypertension of the first degree;

II st - the number of blood pressure values falling into the zone of systolic-diastolic hypertension of the II degree;

III st is the number of blood pressure values falling into the zone of systolic-diastolic hypertension of the III degree.

To assess the change in these indicators during therapy, the indicated indices with the prefix d (dS1, dS2, etc.) are calculated, which are equal to the difference between the indices of the first and repeated BPM. Therefore, positive values of the indicators correspond to their decrease during therapy, and negative values to the increase.

The following is a quantitative analysis of changes in the modified indices of VAD: the periphery of hypertension, pathological periphery and the nucleus of hypertension. The change is recorded, both the total value of these indices and their values specifically for the areas of the graph. It is desirable to change these indicators to values characteristic of the control group: AG periphery - 15.9%, pathological AG periphery - 7.02%, AG core - 58%.

A decrease in blood pressure and / or achievement of the target level established for a particular patient on the patient’s cards is recorded as a movement of the zone of the main blood pressure values - the AG core - towards the normal zone. Ideally, the core of the area of hypertension after a course of prescribed therapy on the graph is entirely in the normal zone. In this case, the total area of the AG area should also decrease due to the concentration of other blood pressure values around the AG core. The nature of the periphery of the AH should be changed so that it all falls under the definition of "non-aggressive" and "neighbor".

When conducting virtual tomography, the transition of the AG core to the zones of reduced, compared with the initial, blood pressure is confirmed. The AG core should acquire or maintain a monolithic character. On the graph, the AG periphery occupies a smaller area compared to the initial one and is located in zones close to the AG core and in the zone of normal blood pressure values.

When conducting a quantitative analysis, virtual tomography indices should decrease or tend to decrease to the developed standards. The calculation of the change in the number of blood pressure values in the areas of the graph should show negative values in the high pressure zones and positive in the normal zone and, as an intermediate stage, in areas of low blood pressure.

According to the working classification of the hypotensive effect developed in the framework of the visualization method of the ABPM data, the beneficial effect is collocation and collocation with bias (Fig. 16).

The above changes reflect the expected decrease in the main range of blood pressure values, combined with the general stabilization of blood pressure maintenance systems within the physiological range.

The criteria for an adverse hypotensive effect, with the exception of its absence, are:

- fragmentation or fragmentation of the core of the hypertension area of arterial hypertension;

- an increase in the total area of the range, even when the AG core is shifted towards the normal zone;

- maintaining the severity of the distant, aggressive periphery of the hypertension or the emergence of new areas of blood pressure releases in the previously free zones of the graph related to medium-high and high levels of blood pressure

When conducting a quantitative analysis, negative values of the indicators of changes in areas in areas of high pressure are recorded, and positive values in the normal zone. Indices of the periphery or pathological periphery of the hypertension remain at the same level or increase. The AG core index decreases and / or is recorded in more than one area of the graph.

According to the classification, such changes relate to expansion, fragmentation, and displacement of the AG core, while maintaining the initial level of increased blood pressure (Fig. 17).

The above signs correspond to the inadequate effect of the prescribed drug on the pathogenetic mechanisms of maintaining high blood pressure and its pathological fluctuations due to the mismatch of the mechanism of action of the selected drug with the proposed hemodynamic variant of AH or an erroneous interpretation of the clinical and pathogenetic variant of the disease.

Particular attention in this regard deserves the clinical cases of a false positive result of the course of therapy, when as a result of the prescribed treatment, a decrease in the average blood pressure is recorded, confirmed by the shift of the "core" to the normal zone. However, an increase in the aggressive and distant "periphery" and / or fragmentation of the nucleus indicates the instability of the hypotensive effect caused, and therefore, the imminent and almost inevitable slipping of hypertension out of control. Such cases are not uncommon in clinical practice. And a patient requiring a review of therapy receives recommendations to continue it unchanged for a long time.

Therefore, the use of new methods for the qualitative and quantitative assessment of the hypotensive effect of drugs allows individualizing the appointment of therapy to a particular patient from the perspective of a subtle analysis of the nature of the disease occurring under the action of the prescribed therapy, as well as identifying the distinctive features of patients, which are potentially the most suitable application point for a particular drug .

A method for graphically displaying data of daily monitoring of blood pressure in a patient with hypertension according to claim 1 is as follows. Pre-build the field of the two-plane graph, the dimension of the ordinate axis (1) of which corresponds to the values of the GARDEN (figure 3) and the abscissa axis (2) corresponds to the values of DBP. Mark the axes in increments of 10 mm Hg. For the ordinate axis (CAD), 18 intervals from 100 to 240 mm Hg are obtained. and for the abscissa axis, (DBP) - 11 intervals from 50 to 140 mm Hg. Thus, they get a working grid or a field of the future chart. By crossing two perpendiculars omitted from the values corresponding to 140 mmHg y-axis and 90 mmHg the abscissa axis, the graph field is divided into four zones: the normal zone (3), the zone of isolated systolic hypertension (4), the zone of isolated diastolic hypertension (5) and the zone of systolic-diastolic hypertension (6). The zone of systolic-diastolic hypertension (6) is additionally divided into 9 subzones (7-9), corresponding to the first, second and third degree of increase in blood pressure. The patient undergoes an ABPM study, the information obtained is processed first in a routine way, then the entire set of SBP and DBP values is further processed according to the formula: P% = Ki × 100%: N, where P is the probability of occurrence of a certain blood pressure value during the measurement; Ki - the number of blood pressure values falling in the same range of the graph; N is the total number of relevant measurements during the study. The resulting set of probabilities of occurrence of certain blood pressure values during the measurement is subjected to spectral decomposition in color using computer technology so that a higher color intensity corresponds to a higher probability value. Put the data on the graph field and get a geometric figure (10) (figure 4) of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure values during the measurement. To obtain a three-dimensional image of a geometric shape of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure value during the measurement, the two-plane graph is additionally equipped with the Z axis (11) (figure 5), on which the percentage of the blood pressure probability value is plotted, where the higher frequency registration of blood pressure values corresponds to a high peak height (Fig.6).

The method for the diagnostic examination of a patient with hypertension according to claim 3 is as follows.

A patient with hypertension undergoes a comprehensive clinical examination, including an ABPM study. The entire set of SBP and DBP values is processed according to the formula: P% = Ki × 100%: N, where P is the probability of occurrence of a certain blood pressure value during the measurement, Ki is the number of blood pressure values falling in the same range of the graph, N is the total the number of relevant measurements during the study. The resulting set of probabilities of occurrence of certain blood pressure values for day, night and day using a computer is subjected to spectral decomposition into colors so that a higher color probability corresponds to a higher color intensity, put it on the graph field. The dimension of the ordinate axis of the graph field corresponds to the SBP values, the abscissa axis corresponds to the DBP values. The graph field contains 4 zones: the normal zone, the zone of isolated systolic hypertension, the zone of isolated diastolic hypertension and the zone of systolic-diastolic hypertension, which are obtained by crossing two perpendiculars omitted from the values corresponding to 140 mm Hg. y-axis and 90 mmHg the abscissa axis, while the division range of both axes corresponds to 10 mm Hg The systolic-diastolic hypertension zone additionally contains 9 subzones corresponding to the first, second and third degrees of increase in blood pressure (BP). Thus, they obtain a geometric figure, or area of the AG of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the ABP values during the measurement. To obtain a three-dimensional image of a geometric figure (Fig.6) of arbitrary shape and area, or the area of AG, a two-plane graph is provided with a third Z axis, on which the percentage of the values of the AB probabilities is plotted, where a higher peak height corresponds to a higher recording frequency. Map the patient (7). The patient card contains the resulting two - and three-dimensional display of the ABPM data. According to the data obtained, a visual and quantitative analysis is carried out. When visual analysis of a geometric figure or area of AH, arbitrary shape and area obtained on a two-plane graph, of arbitrary shape and area, the most intensely colored area of the figure (12) (Fig. 9), corresponding to a higher value of the AB probabilities during the measurement and constituting the AG core, is separately distinguished. The least intensely colored area of the figure (13) is distinguished, which has the least probability of blood pressure during the measurement and constitutes the periphery of the hypertension. Thus, the method allows to obtain the area of hypertension of a particular patient during the measurement. Figure 9 shows a graph of SMAD healthy person. Figure 10, 11, 12 shows the area of AG of different forms of AG. Quantify the magnitude of the most frequent blood pressure values during the measurement, having more than 8% of the probabilities that correspond to the core index of the hypertension (Fig.13). The value of the rarest blood pressure values during the measurement, comprising less than 3% of probabilities that correspond to the index of the AH periphery, as well as the value of the rarest blood pressure values during the measurement, constituting less than 3% of the probabilities, excluding the normal range, which correspond to the index of the pathological periphery of the AH ( Fig.14). Thus, quantitative data on the structure of AG are obtained. The presence, differential diagnosis, assessment of the degree and form of hypertension is carried out by finding the area of hypertension in one or more zones and subzones of both graphs. The prognosis of the AG course is carried out by the location and shape of the AG core in the zones and subzones of both graphs with high, medium or low blood pressure values, as well as by the area and location of the periphery in the zones and subzones of both graphs. The course of AH is predicted to be favorable with the monolithic form of the AH core and its presence in areas of the graph with a low or medium level of blood pressure, while the periphery of the AH is concentrated around the AH core, has a small area and does not fall into the region of medium-high and high levels of blood pressure. The course of AG is predicted as unfavorable if there is more than one AG core in the zones and subzones of the graphs, and / or the AG core is in the graph zones corresponding to high degrees of AG, while the periphery occupies the main area of the graph, and / or is distant from the AG core and / or located in the zones and subzones of the graphs corresponding to high degrees of hypertension. At the same time, the main risk of the patient with AH is stratified by quantitative determination of the AH core index, AH periphery index and pathological AH periphery index and an unfavorable course of AH is predicted with AH core index less than 50%, AH periphery more than 17% and AH pathological periphery more than 8% at normal where the AH core index is 58-60%, the periphery is 14-16% and the pathological periphery is 5.5-7.5%. As a result, the patient card contains two-plane graphs of the distribution of blood pressure values per day, day, and night, as well as tomographic sections of the core of the AH and the periphery of the AH. Quantitatively contribute all the indices of the standard method of ABPM, as well as indices of the periphery of AH, the nucleus of AH and pathological periphery of AH.

The method of choosing a treatment strategy for a patient with hypertension according to claim 4 is as follows. Drug therapy is prescribed taking into account the stage, form and degree of hypertension, as well as taking into account the total risk, concomitant diseases, individual indications and contraindications of the patient. The SMAD study at this stage is usually not performed at all. In the proposed method, daily monitoring of blood pressure is additionally carried out, the whole set of SBP and DBP values is processed according to the formula: P% = Ki × 100%: N, where P is the probability of occurrence of a certain blood pressure value during the measurement, Ki is the number of blood pressure values falling into the same range of the graph, N - the total number of relevant measurements during the study. The resulting set of probabilities of occurrence of certain blood pressure values for a day, night and day using a computer is subjected to spectral decomposition into colors so that a higher color probability corresponds to a higher color probability. The data is plotted on the graph field, resulting in a geometric figure of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure values during the measurement. In this case, the dimension of the ordinate axis of the graph field corresponds to the SBP values, the abscissa axis corresponds to the DBP values. The graph field contains 4 zones: the normal zone, the zone of isolated systolic hypertension, the zone of isolated diastolic hypertension and the zone of systolic-diastolic hypertension, which are obtained by crossing two perpendiculars omitted from the values corresponding to 140 mm Hg. y-axis and 90 mmHg abscissa axis. The division range of both axes corresponds to 10 mm Hg. The zone of systolic-diastolic hypertension is additionally divided into 9 subzones corresponding to the first, second and third degree of increase in blood pressure. To obtain a three-dimensional image of a geometric shape of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure values during the measurement, a two-plane graph is provided with a third Z axis, on which the percentage of the blood pressure probabilities is plotted, where a higher peak height corresponds to a higher recording frequency.

A patient map is compiled containing the obtained two- and three-dimensional display of the ABPM data and a visual and quantitative analysis is performed. When visual analysis of a geometric shape of arbitrary shape and area or area of AH obtained on a two-plane graph, the most intensely colored area of AH area corresponding to a higher value of blood pressure probabilities during measurement and constituting the core of AH is separately distinguished. Allocate the least intensely colored area of the AG range, which has the least probability of blood pressure during the measurement and constitutes the periphery of the AG. Quantify the magnitude of the most common blood pressure values during the measurement, having more than 8% of the probabilities that correspond to the core index of the hypertension. The value of the rarest blood pressure values for the measurement time, constituting less than 3% of probabilities that correspond to the index of the AH periphery, as well as the value of the rarest blood pressure values for the measurement time, constituting less than 3% of the probabilities, excluding the normal range, which correspond to the index of the pathological periphery of the AH, is determined. The presence, differential diagnosis, assessment of the degree and form of hypertension is carried out by finding the area of hypertension in one or more zones and subzones of both graphs. The prognosis of the AG course is carried out by the location and shape of the AG core in the zones and subzones of both graphs with high, medium or low blood pressure values, as well as by the area and location of the periphery in the zones and subzones of both graphs. Take into account the favorable and unfavorable course of hypertension. Moreover, the course of AG is predicted to be favorable with the monolithic form of the AG nucleus and its presence in the areas of the graph with a low or medium level of blood pressure, while the periphery of the AG is concentrated around the AG core, has a small area and does not fall into the region of medium-high and high blood pressure. The course of AG is predicted as unfavorable if there is more than one AG core in the zones and subzones of the graphs, and / or the AG core is in the graph zones corresponding to high degrees of AG, while the periphery occupies the main area of the graph, and / or is distant from the AG core and / or located in the zones and subzones of the graphs corresponding to high degrees of hypertension. At the same time, the main risk of a patient with hypertension is stratified by quantitatively determining the hypertension core index, hypertension peripheral index and pathological hypertension peripheral index. An unfavorable course of AH is predicted when the AH core index is less than 50%, AH periphery is more than 17% and AH pathological periphery is more than 8% at normal, where AH core index is 58-60%, periphery 14-16% and pathological periphery 5.5 -7.5%. The patient card contains two-plane graphs of the distribution of blood pressure values per day, day, and night, as well as tomographic sections of the nucleus of hypertension and the periphery of hypertension. Quantitatively contribute all the indices of the standard method of ABPM, as well as indices of the periphery of AH, the nucleus of AH and pathological periphery of AH. Quantitatively, according to the AG formula, the percentage distribution of all the obtained blood pressure values during the measurement over the zones of the two-plane graph is determined and presented as a histogram. The choice of treatment tactics is carried out taking into account the location of the area of hypertension in certain areas and subzones of the schedules, while the need and choice of dose are carried out at the location of the core of hypertension. The need for combination therapy is carried out according to the area of the periphery of hypertension in areas of high and medium-high blood pressure and the fragmented nature of the nucleus. With an unfavorable course of AH in a patient, the selection of drugs with a certain mechanism of action is carried out taking into account the histogram data. To evaluate the effectiveness of the therapy for a patient with hypertension, upon completion of the course of treatment, an additional BPM study is carried out, a second card of the patient with hypertension is compiled, containing new two- and three-dimensional graphs of the BPM data for day, night and day, as well as quantitative indices of the structure of hypertension. that is, the nucleus of hypertension, the periphery of hypertension and the pathological periphery of hypertension. Enter routine SMAD data. Visually analyze the location and shape of the geometric shape, or area of the AG, in the zones and subzones of the graphs. The resulting card is compared with the first card of a patient with AH, and therapy is recognized to be effective in reducing the entire area of the figure, or the area of AH, and its shift to the normal zone and in normalizing the indices of the AH core and the periphery of AH. Therapy is recognized as ineffective in the absence of changes in the shape and area of the arterial hypertension, and / or its displacement to the region of lower blood pressure values, while maintaining a large peripheral area and its location in areas with high blood pressure. An unfavorable sign is the absence of quantitative changes in the indices of the nucleus and periphery of the hypertension and the distribution of histogram data over the zones of the two-plane graph.

The proposed group of inventions allows using the following positive effect.

As a result of this study, a new form of graphical presentation of the ABPM data was created, focused on visualization of the internal structure of arterial hypertension, which qualitatively improves the diagnosis of the real degree of arterial hypertension and allows to obtain new data on dysregulation of blood pressure in a particular patient, to optimize the selection and monitoring of the effectiveness of the prescribed antihypertensive therapy.

To test the practical significance of the proposed group of inventions, a study was conducted, which included 100 patients (61 men and 39 women) suffering from essential arterial hypertension. The inclusion criteria were a documented diagnosis of arterial hypertension, the exclusion of symptomatic arterial hypertension, and the absence of severe concomitant diseases and associated clinical conditions. The average age of the patients was 48.2 ± 10.4 years (18-65 years). Of these, 76 people had hypertension of the I degree, 18 - II degree and 6 - III degree. As a control group, 30 practically healthy individuals were examined. Both groups are comparable in gender and age. All patients underwent routine examinations and BPM. The BPMS data for each patient were processed using standard methods and proposed methods.

In the group of healthy individuals, the peripheral index was 15.6%, the pathological peripheral hypertension index was 7.02%, and the core index was 57.9%. In the group of hypertensive patients, these indices are 22.1%, 15.1% and 43.2%, respectively.

The indices of the periphery of the hypertension, the atopic periphery of the hypertension and the nucleus of the hypertension exceed the norm by 41.8%, 114.4% and 34%, respectively, while the difference between the standard deviations of the SBP and DBP between the groups was only 19% and 18%, respectively, which allows consider additional variability indices as more sensitive indicators in terms of assessing the state of balance and reactivity of the cardiovascular system.

Further in our study, all patients were subjected to cluster analysis, first using standard BPMS indicators, then the described indices were included in the analysis. As a result of a comprehensive analysis, the high-risk group, which had the most unfavorable indicators of instability of arterial hypertension (the highest values of the indices of the periphery, pathological periphery of the AH and the lowest values of the index of the AH core) increased by 19 people from the low-risk group (the most favorable values of the average daily SBP and DBP, as well as STD GARDEN and STD DAD), formed after stage I of the analysis.

Thus, based on the foregoing, it can be noted that the use of the proposed group of inventions allows us to obtain new information about the structure, course, presumptive prognosis of the behavior of AH and the possibilities of selecting therapy for the study of patients with AH.

When comparing the obtained graphic information and the formula of the area of hypertension with indicators of a traditional assessment of the results of ABPM, it was found that the core of hypertension really determines the degree of hypertension in a particular patient based on a real state of things. The location of the nucleus is usually either consistent with the value of ADsr, or significantly refines it. In our study, in 34% of cases (in 34 patients), the interpretation of the degree of AH only on the basis of ADSr turned out to be false.

Approximately the same picture is observed when evaluating VAD. In most cases, the increased standard VAD indices correspond to the obtained graphs, which have a large area of the AG area and, often, a high degree of fragmentation. However, in 29 patients (29%), visual presentation of the BPM data gave a more accurate characterization of blood pressure variability in a particular patient

A new graphical representation of the ABPM information is supplemented by the calculation of the formula for the area of hypertension, which increases the accuracy of diagnosis and provides the opportunity to individualize the prescribed treatment, as well as increase the accuracy of evaluating the effectiveness of the treatment. Visual and quantitative signs of a favorable and unfavorable course of the disease make it possible to individualize the assessment of the condition of a patient with hypertension as much as possible. The developed diagnostic criteria and the method for displaying the ABPM information allows one to construct a probabilistic prognosis of the course of the disease in a patient. Visual registration on the graph of the hypertension nucleus in areas of high blood pressure along with the large area and / or fragmentation of the area of hypertension and pathological values of the modified indices of hypertension, which is closely associated with target organ damage and the risk of complications, suggests poor control over the course of the disease in this patient, warns the doctor about the need to take into account all possible risk factors, the appointment of complex and, most likely, combination therapy. On the contrary, the compact location of the area of hypertension in areas of low pressure in the absence of a pronounced "periphery" indicates a favorable course of the disease in this patient.

Thus, the proposed group of inventions allows:

- accurately establish the degree and form of hypertension by finding the "core" of hypertension in a specific area of the graph;

- assess the degree of VAD and, consequently, the imbalance of its regulatory systems in the form of the area of hypertension and the severity of the "periphery" on the graph;

- establish a probabilistic prognosis of the course of the disease in a particular patient based on the above symptoms.

The proposed group of inventions allows you to visually and quantitatively evaluate the components of the internal structure of the AG core and periphery, which make it possible, on the one hand, to reasonably determine the degree of hypertension by finding the AG core in a certain area of the graph, on the other hand, to judge the degree of disregulation and maladaptation of the blood pressure system by the severity of the aggressive periphery of the hypertension, the standards are calculated for the proposed indicators for the assessment of VAD and their higher sensitivity is proved in comparison with the standard ones, which at the initial Agnostic can improve the risk stratification of patients with hypertension using the following criteria: the index of the periphery of> 17%, the index of abnormal peripheral> 8%, the core index of <50%. Thus, the application of the principle of virtual tomography allows you to get a more accurate assessment of the patient’s condition, since the “core” determines the degree of stability, organization of the state of the cardiovascular system, and the “periphery” determines the degree of its plasticity and adaptability, being a projection of the outcome of the interaction of regulatory blood pressure systems. In addition, the location of the "core" in a certain area of the graph uniquely determines the real degree of arterial hypertension in a particular patient.

Visual presentation and quantitative assessment of the ABPM data allows to optimize the selection and assessment of the effectiveness of therapy in patients with EAG. The dose of the drug is selected based on the degree of hypertension, estimated by the location of the core of hypertension in a certain area of the schedule, the state of the excretory systems and the age of the patient. The type of drug and the need for combined treatment is determined by the severity of the aggressive periphery of the AH, the number of nuclei in the area of the AH and the estimated predominant pathogenetic variant of the development of the disease in an individual patient, taking into account the total risk of complications, individual contraindications, intolerance to drugs and the presence of treatment for the treatment of concomitant diseases.

To evaluate the effectiveness of treatment, a working classification of the hypotensive effect was developed, qualitative and quantitative criteria for a favorable and unfavorable hypotensive effect were identified, their advantage was proved compared to the traditional comparison of the BPMD data during therapy. An example of a specific performance is given in the form of an extract from a medical history.

Patient K., a 45-year-old man complaining of a periodic increase in blood pressure to 140-145 / 90 mm Hg, was examined at a consultative outpatient appointment. for 5 years. The episodes of increasing blood pressure either did not have clinical symptoms and were detected by chance, but not constantly, at professional examinations, or were accompanied by moderate intensity headaches. The patient was observed in the clinic at the place of work with a diagnosis of Vegetative-vascular dystonia of the hypertonic type, where he was recommended to take atenolol periodically for stopping blood pressure rises.

From the anamnesis it was found that the heredity of arterial hypertension is burdened by the mother, the patient smokes. The patient does not have any concomitant diseases; he does not suffer from increased weight. The patient underwent the necessary minimum examination for arterial hypertension and daily monitoring of blood pressure. Target organ damage was not identified.

The main risk of cardiovascular disease according to standard recommendations is rated as average, the prognosis is favorable.

Data ABPM (day) are as follows: GARDEN / DBP = 132/89 mm Hg, STD GARDEN / DBP = 21 / 12.8 mm Hg, the patient is a dipper.

The standard image of the ABPM data (Fig. 18) in this case does not allow us to confidently judge the most typical BP values for the patient, although it does make it possible to register four pronounced elevations in the SBP during the day to high blood pressure levels. Otherwise, the curve is difficult to visualize.

At the next stage of the examination, the ABP data of patient K. were processed using the data visualization method and a patient map was compiled (Figs. 19, 20).

As a result of examination using the VOPD method, the ABPM assesses the internal structure of high blood pressure in a patient during the day.

Indeed, both visually (according to the location of the nucleus) and quantitatively (according to the formula for the area of arterial hypertension), they state that 50% of all daily and 100% of all nighttime blood pressure values in a patient fall into the normal zone, 25% of blood pressure values fall in the zone of isolated diastolic arterial hypertension of the I degree, 17% fall into the zone of systolic-diastolic hypertension. These data, excluding their greater clarity and accuracy, as a whole do not contradict the results of a standard analysis of the ABPM data.

However, when conducting virtual tomography, the “classical” “aggressive” periphery is recorded: on the graph it has a large area, is fragmented, removed from the nucleus and occupies zones of high blood pressure levels. When determining the indices of the nucleus and periphery, it was found that the periphery index is 2.3 times and the pathological periphery index 3.75 times higher than normal, while the standard deviation of SBP is 1.4 normal values, and STD DBP does not differ at all from the norm.

Thus, an in-depth analysis of the results of the ABPM indicated an unfavorable and unstable nature of the course of the disease, the presence of significantly impaired blood pressure regulation processes.

Given the data obtained, the patient was immediately prescribed combination therapy with an ACE inhibitor and a diuretic.

The unfavorable nature of the course of the disease was confirmed during the first control one month after the treatment was prescribed: the area of arterial hypertension occupied almost the same area as on the initial chart, although a slight decrease in the area of the “aggressive” periphery was visually observed. The patient was assigned more frequent follow-up visits to the doctor, at which compliance with measures to change his lifestyle was checked and additionally discussed: smoking cessation, regular moderate physical activity, mandatory inclusion of auto-training techniques. Against the background of "aggressive" therapeutic tactics, due to unfavorable results of the analysis of the patient's initial data, after 4 months from the start of treatment, stabilization of blood pressure in the normal zone was achieved.

A visual assessment of the antihypertensive effect (Fig. 21) is accompanied by an analysis of changes in the range formula of AH and indices of the nucleus and periphery during the course of therapy (table 1).

Table 1 Quantitative analysis of the BPM data of patient K. during therapy. The results of a quantitative analysis of the ABPM data Initial data I control of BPM (1 month) II control of ABPM (4 months) Formula of the range of hypertension (% of total) Normal zone fifty% 59% 89% ISAG Zone 7% one% 2% IDAG Zone 25% 33% 5% SDAG zone I, II, III
degree of increase in blood pressure 17% 7% four% 6% -4% -7% 6% -1% -0% 4% -0% -0% Peripheral Index 37% 32% 12% Index of "pathological periphery" 23% fifteen% four% Kernel Index 36% 31% 61% GARDEN / DBP (mmHg) 132/89 124/83 120/74 STD GARDEN / DBP (mmHg) 21 / 12.8 15/13 14.8 / 9 ISAG - isolated systolic hypertension IDAG - isolated diastolic hypertension SDAG - systolic-diastolic arterial hypertension

An in-depth analysis of the results of the first control of ABPM shows that although according to standard data there is a decrease to the norm of average daily blood pressure values and standard indicators of blood pressure variability, confirmed to some extent by a redistribution of blood pressure values within the AG range formula, the preservation of 2–2.5 times increased peripheral indices warns about the instability and inferiority of the achieved hypotensive effect. Intensive measures taken to control blood pressure, carried out in accordance with international recommendations, allowed 4 months to achieve the normalization of all indicators. This example is especially important, since it shows how it is possible to prevent cardiovascular complications of hypertension in young, actively working people, who, with the external well-being of standard indicators of blood pressure dynamics, are a hidden potential for the sad statistics of the course of hypertension complications that we have in Of Russia.

Claims (4)

1. A method for graphically displaying 24-hour blood pressure monitoring data (BPM) in a patient with arterial hypertension (AH), including conducting a BPM study, receiving BPM data, processing and presenting the information on a two-plane graph containing the abscissa axis and the ordinate axis, which differs the fact that the dimension of the ordinate axis of the graph corresponds to the values of systolic blood pressure (SBP), the abscissa axis corresponds to the values of diastolic blood pressure (DBP), produce p marking the axes of the graph with a step of 10 mm Hg, getting the graph field, which is divided into 4 zones: the normal zone, the isolated systolic hypertension zone, the isolated diastolic hypertension zone and the systolic-diastolic hypertension zone, the zones are obtained by crossing two perpendiculars omitted from values corresponding to the ordinate axis 140 mm Hg and the abscissa axis - 90 mm Hg, and the zone of systolic-diastolic hypertension is further divided into 9 subzones corresponding to the first, second and third degrees of increase in blood pressure (BP), the entire set of values of SBP and DBP is processed by the formula: P% = K _i · 100%: N, where P% - the probability of occurrence of a certain value of blood pressure during the measurement, K _i - the number of blood pressure values falling into the same range of the graph, N is the total number of relevant measurements during the study, and the resulting set of probabilities of occurrence of certain blood pressure values during the measurement using a computer is subjected to spectral decomposition into colors so that a higher color intensity corresponds to a higher probability of blood pressure, put it on the graph field and get a geometric shape of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of blood pressure values during the measurement. 2. The method according to claim 1, characterized in that to obtain a three-dimensional image of a geometric shape of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of the blood pressure value during the measurement, the two-plane graph is additionally equipped with a third Z axis, on which the percentage of the blood pressure probability value is laid and moreover, the greater the frequency of the probability of blood pressure corresponds to a high peak height of the blood pressure value. 3. A method for the diagnosis of hypertension, including a comprehensive examination of the patient, including 24-hour monitoring of blood pressure of the BPM, receiving BPM data, processing it, presenting the information on a two-plane graph containing the abscissa axis and the ordinate axis and subsequent visual and quantitative assessment of the results of the BPM and diagnosis based on the aggregate data for hypertension, characterized in that the dimension of the ordinate axis of the graph corresponds to the values of systolic blood pressure SBP, abscissa axis corresponds to the values of diastolic blood pressure DBP, mark the axes of the graph with a step of 10 mm Hg, producing a graph field that is divided into 4 zones: normal zone, zone of isolated systolic hypertension, zone of isolated diastolic hypertension and zone of systolic-diastolic hypertension, zone obtained by the intersection of two perpendiculars omitted from the values corresponding to 140 mm Hg the ordinate axis and the abscissa axis are 90 mm Hg, and the zone of systolic-diastolic hypertension is further divided into 9 subzones corresponding to the first, second and third degrees of increase in blood pressure, the entire set of values of SBP and DBP is processed by the formula: P% = K _i · 100%: N, where P is the probability of occurrence of a certain value of blood pressure during the measurement, K _i - the number of blood pressure values falling into the same range of the graph, N is the total number of relevant measurements during the study, and the resulting set of probabilities of occurrence of certain blood pressure values during the measurement using a computer is subjected to spectral decomposition into colors so that a higher color intensity corresponds to a higher probability of blood pressure, put it on the graph field and get a geometric shape of arbitrary shape and area, the color gamut of which corresponds to the spectral probability density of blood pressure values during the measurement, to obtain a three-dimensional image of a shape of arbitrary shape and area, c the gamma of which corresponds to the spectral probability density of blood pressure values during the measurement, the two-plane graph is additionally equipped with a third Z axis, on which the percentage of blood pressure probabilities is plotted, and the higher the probability frequency of blood pressure corresponds to a higher peak height of blood pressure values, then a patient map containing two - and three-dimensional images of the ABPM data, and conduct visual and quantitative analysis, while visual analysis of a geometric shape of arbitrary shape and the areas separately highlight the most intensely colored area of the figure, corresponding to a larger value of the probabilities of blood pressure during the measurement and constituting the core of AH, and the least intensely colored area of the figure, which has the least probability of blood pressure during the measurement and making up the periphery of the AH, visual diagnosis of blood pressure, differential diagnosis of the type of hypertension , assessment of its degree and shape is carried out by the location of the obtained geometric shape of the AG area in one or more zones and subzones of both graphs, excluding the zone norms, the prognosis of the course of hypertension is carried out according to the location and shape of the intensively colored area of the figure corresponding to a higher value of the probabilities of blood pressure during the measurement - the core of the hypertension in the areas and subzones of the graphs with high, medium or low blood pressure values, as well as the area and location of the least intensely colored area figures that have the least probability of blood pressure values during the measurement, i.e. along the periphery of the AH in the zones and subzones of both graphs, and the course of the AH is predicted to be favorable with a monolithic form of the AH nucleus, the presence of the AH core in the areas of the graphs with low or medium blood pressure, while the AH periphery is concentrated around the AH core, has a small area and does not fall in areas of high and medium high blood pressure, the course of hypertension is predicted as unfavorable if there is more than one hypertension core in the areas and subzones of the graphs, and / or the presence of the hypertension core in the zones and subzones of the graph corresponding to high blood pressure values, while AH occupies the main area of the graph, and / or is distant from the core, and / or is located in the zones and subzones of the graph corresponding to high blood pressure values, at the same time a quantitative analysis of the obtained geometric figure is carried out, for this the magnitude of the most frequent blood pressure values for the measurement time, having more 8% of the probabilities that correspond to the hypertension core index, the value of the rarest blood pressure values during the measurement, amounting to less than 3% of the probabilities, including the normal range, which correspond to the peripheral hypertension index, the largest its rare blood pressure values during the measurement, constituting less than 3% of probabilities, excluding the normal range, which correspond to the index of the pathological periphery of the AH, and predict an unfavorable course of hypertension with the AH core index less than 50%, the AH periphery index more than 17% and the AH pathological periphery index more than 8%, while the norm corresponds to: AH core index 58-60%, AH peripheral index 14-16% and AH pathological peripheral index 5.5-7.5%. 4. A method for choosing the treatment strategy for a patient with hypertension, including the appointment of drug therapy, taking into account the stage, form and degree of hypertension, as well as taking into account the total risk of complications, concomitant diseases, individual indications and contraindications for a particular patient, characterized in that they also conduct daily monitoring blood pressure and represent the data obtained by the ABPM on a two-plane graph, the dimension of the ordinate axis of which corresponds to the values of systolic blood pressure SA , The abscissa corresponds to the values of diastolic blood pressure DBP, produce markup axes in increments of 10 mm Hg getting the graph field, which is divided into 4 zones: the normal zone, the zone of isolated systolic hypertension, the zone of isolated diastolic hypertension and the zone of systolic-diastolic hypertension, the zones are obtained by the intersection of two perpendiculars omitted from the values corresponding to 140 mm Hg. the ordinate axis and the abscissa axis are 90 mm Hg, and the zone of systolic-diastolic hypertension is additionally divided into 9 subzones corresponding to the first, second and third degrees of increase in blood pressure, the entire set of values of SBP and DBP is processed according to the formula: P% = K _i · 100%: N, where P is the probability of occurrence of a certain value of blood pressure during the measurement, K _i - the number of blood pressure values falling into the same range of the graph, N is the total number of relevant measurements during the study, the resulting set of probabilities of occurrence of certain blood pressure values during the measurement using a computer is subjected to spectral decomposition into colors so that a higher color intensity corresponds to a higher probability of blood pressure, put it on the graph field and get a geometric shape of arbitrary shape and area, the color gamut of which corresponds the spectral probability density of blood pressure values during the measurement, to obtain a three-dimensional image of an arbitrary shape and area, color the gamma scale of which corresponds to the spectral probability density of blood pressure values during the measurement, the two-plane graph is additionally equipped with a third Z axis, on which the percentage of blood pressure probabilities is plotted, and the higher the probability frequency of blood pressure corresponds to a higher peak height of blood pressure values, then a patient map containing two - and three-dimensional images of the ABPM data, and conduct visual and quantitative analysis, while visual analysis of a geometric shape of arbitrary shape the areas separately distinguish the most intensely colored area of the figure, corresponding to a higher value of the AB probabilities during the measurement and constituting the AG core, and the least intensely colored area of the figure, which has the least probability of blood pressure during the measurement and making the periphery of the AG, quantitatively determine and present the percentage distribution as a histogram of all the obtained blood pressure values during the measurement in the areas of the two-plane graph and the choice of treatment tactics is carried out by placing geometric figures or the areola of hypertension in one or several zones and sub-zones of the schedules, while the need and the choice of dose are carried out by the location of the core of the hypertension in the zones and sub-zones of the graphs with high, medium or low blood pressure, the need for combination therapy is carried out visually at the location of the periphery of the hypertension and medium-high values of blood pressure, its area and fragmented nature of the core of hypertension, and quantitatively by exceeding the normative values for the index of the periphery of hypertension, which is normally 14-16%, the selection of drugs a specific mechanism of action is carried out taking into account the histogram.

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