RU2307577C1 - Method for predicting hypertension disease development in native southern kuzbass teleute population - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves determining testee sex, body mass and height. Somatic index is calculated using Ris-Isenk formula. Chest circumference, abdominal circumference and thigh circumference are measured in addition. High risk of hypertension disease is predicted in male cases, if height is less than 161 cm, Ris-Isenk index is less than 86, chest cross-section diameter is equal to or greater than 31 cm, chest circumference is equal to or greater than 93 cm, abdominal circumference is equal to or greater than 83 cm, thigh circumference is equal to or greater than 97 cm, body mass is equal to or greater than 69 kg; in female cases, if height is less than 144 cm, Ris-Isenk index is less than 90, chest cross-section diameter is equal to or greater than 27 cm, chest circumference is equal to or greater than 97 cm, abdominal circumference is equal to or greater than 85 cm, thigh circumference is equal to or greater than 106 cm and body mass is equal to or greater than 69 kg.

EFFECT: high accuracy of prognosis.

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Description

The invention relates to medicine, in particular to cardiology and clinical anthropology.

Arterial hypertension (AH), the prevalence of which among adults is about 20%, is a serious public health problem [Report of the WHO Expert Committee “Fighting Arterial Hypertension", 1997]. Hypertension, represented by hypertension (GB) in more than 95% of cases, is one of the leading factors in mortality from major cardiovascular diseases, whose share in the structure of total mortality is 20-50% [ibid.]. The annual cost of treating patients with cardiovascular diseases is $ 21 billion, with 9 of them in Europe [Widimsky J., 1990]; the total material damage caused by the cost of treatment and labor losses is more than a dozen times. Therefore, the prevention of the disease has not only a humanistic, but also a socio-economic justification. Materials for the prevention of hypertension are many, they are extensive, but too unspecific; start most correctly with the identification of children - future hypertensive patients [Shulutko BI, Perov Yu.L., 1993]. The latter possibility is extremely small, since the sensitivity and specificity of existing methods are at a low level, and only very few specialized laboratories can carry out genetic research today.

Recent studies have shown a high relationship between the constitutional features of premorbid background and clinical manifestations of various diseases. The introduction into practice of methods based on the results of constitutional-clinical research allows you to expand the capabilities of prognosis and prevention [Nikityuk BA, Kornetov NA, 1998].

Currently, in cardiology, the main one is the proposed by the US ONC (1977) and supplemented by the WHO expert committee (1997), a method for predicting the possibility of developing hypertension and cardiovascular complications, based on the identification of risk factors (burdened heredity, dyslipoproteinemia, smoking, diabetes mellitus, nutrition , obesity, degree of physical activity, the patient’s personality, his environment) and target organ damage [Report of the WHO Expert Committee “Fighting Arterial Hypertension", // Trans. from English, State Center for Preventive Medicine of the Ministry of Health of the Russian Federation. - M. - 1997. S.7-8, 12-18, 27, 31-32, 33-40, 52-54].

The disadvantages of this method are:

1. Limited individuality of the clinical approach: expressed only by the presence or absence of a particular risk factor in a particular person;

2. Late identification of the risk of hypertension, as a rule, after a patient visits a doctor with appropriate complaints, when the primary prevention of the disease is insufficient and drug therapy is required;

3. A superficial account of constitutional features: gender (male or female in the postmenopausal period), age (over 60 years), the presence or absence of excess body weight.

A known method for predicting the possibility of GB development (Patent RU No. 2181260, IPC 7 АВВ 5/107, Bull. No. 11, 04/20/2002. Authors Smirnov N.V., Podkhomutnikov V.M.), based on the analysis of individual constitutional features in the absence clinical signs of hypertension. The length, body weight are measured in the subjects, the Quetelet index (IR), the Rhys-Eisenck index (IRA) are calculated for men with growth over 165, IR 29 and more, IRA less than 105, for women with growth less than 156 cm, IR 29 and more, an IRA less than 106 - predict an increased risk of developing GB.

The disadvantages of this method are:

1. Application of the given anthropometric borders for the alien population of Western Siberia living in a large industrial city without taking into account its ethnicity;

2. Limited individual somatic assessment: the circumference of the chest, the circumference of the waist, and the circumference of the hips are not taken into account (that is, the external examination is not complete).

The objective of the present invention is to improve the accuracy of predicting the possibility of developing hypertension by including individual constitutional indicators in the analyzed data — gender, height and body weight, transverse diameter of the chest, chest circumference, waist circumference, hip circumference, constitutional morphological type (CMT) - s the purpose of early identification of a group of people in need of mandatory treatment and preventive measures in relation to GB.

The task is achieved in that in the absence of clinical signs of GB in the subjects determine gender, body weight, and height. The somatic index is calculated using the Rhys-Eysenck formula (IRA). Additionally measure chest circumference, waist circumference, hip circumference. In men, with growth less than 161 cm, the Rhys-Eysenck index value is less than 86, the transverse diameter of the chest is 31 cm or more, the chest circumference is 93 cm or more, the waist circumference is 83 cm or more, the thigh circumference is 97 cm or more, body weight 69 kg and more, in women with growth less than 144 cm, Rhys-Eysenck index value less than 90, chest transverse diameter 27 cm or more, chest circumference 97 cm or more, waist circumference 85 cm or more, hip circumference 106 cm or more, weight bodies of 69 kg or more predict an increased risk of developing hypertension in indigenous rural Teleuts residents of the south of Kuzbass.

The novelty of the method:

1. An assessment of anthropometric indicators for rural Teleut indigenous inhabitants of the South of Kuzbass was carried out.

2. Additionally measure the chest circumference, waist circumference, hip circumference.

3. The critical values of anthropometric indicators are determined, at which the risk of developing GB for men and women increases significantly, 4-6 times.

The new result of using the method.

1. Early detection of an increased risk of GB development allows timely primary prevention of the disease in this category of people.

2. Determination of clear discrete values of growth, body weight, transverse diameter of the chest, chest circumference, waist circumference, hip circumference, and IRA for men and women allows us to predict an individual risk of developing GB regardless of age and outside of clinical signs of GB.

The essence of the method is as follows: the subjects are questioned for the presence of risk factors for hypertension (WHO recommendations), instrumental studies, a clinical examination with a 2-fold measurement of blood pressure (BP) are performed (blood pressure levels of 140/90 mm Hg are taken for hypertension and moreover, the degree of hypertension is evaluated according to the WHO / MTF classification of 1999), electrocardiography is recorded and an anthropometric study is carried out according to the method of V.V. Bunak adopted at the Institute of Anthropology. D.N. Anuchin, Moscow State University MV Lomonosov, including measuring the transverse diameter of the chest, chest circumference, waist circumference, hip circumference, height and body weight. Perhaps the screening application of the proposed method without extensive objective and laboratory examinations and history, but with mandatory preliminary tonometry (for example, in young people).

The growth is determined by a Martin anthropometer, a reference height meter or other measuring instruments, the permissible errors are not more than 4-5 mm.

Determination of body weight. The mass index is recorded to the nearest gram on a medical scale.

Measurement of the transverse diameter of the chest is carried out by a large calico compass, obstetric-gynecological tazomer or other measuring instruments with an accuracy of 2-3 mm.

Measurement of the circumference of the chest, waist, hips is made with a millimeter tape with an accuracy of 3 mm.

Definition of the constitutional-morphological type. The somatic type is determined by the following formula (Rhys-Eysenck index):

The index values obtained in this way (IRA) must be correlated with discrete groups whose boundaries are calculated by the principle of dividing the set of the control array by quadratic deviation with an accuracy of 0.6 sigma (Table 1).

To assess the effectiveness of the developed method for predicting the possibility of developing hypertension in indigenous rural Teleuts of the South Kuzbass, a relative risk (RR) criterion was calculated for all external somatic characteristics

This indicator reflects how many times more often the disease develops in people with the presence of this factor compared with those who do not have it, and is calculated by the formula:

where fn is the fraction of the carriers of the trait among patients, fk is the fraction of carriers of the trait among healthy individuals. A relative risk score of more than one indicates a positive association with the disease; with a value equal to two, its value is considered significant.

The inventive method was tested during the year at periodic medical examinations of rural Teleuts in the south of Kuzbass, during which 591 people of average age 47.18 ± 0.71 years were examined. At the same time, in 288 (49%) individuals who did not have previous GB, as evidenced by recordings on outpatient maps (the last tonometry was performed more than 1 year ago), signs (GB, hypertrophy and / or systolic overload of the left ventricular myocardium) were revealed, confirming persistent or transient episodes of GB. Comparative data are given in table 4.

Thus, with a simple anthropometric examination of individuals without signs of hypertension, including measuring body length, body weight, transverse diameter of the chest, chest circumference, waist circumference, hip circumference, followed by the calculation of IRA for them, we obtain reliable indicators of body weight and length and somatic differentiation which, taking into account gender, indicate the possibility of predicting the development of GB in this category of subjects and the need for therapeutic and preventive measures in relation to GB. For men, this growth value is less than 161 cm, an IRA less than 86, a transverse diameter of the chest 31 cm or more, a chest circumference 93 cm or more, a waist circumference 83 cm or more, a hip circumference 97 cm or more, body weight 69 kg or more; for women - body length less than 144 cm, IRA less than 90, transverse diameter of the chest 27 cm or more, chest circumference 97 cm or more, waist circumference 85 cm or more, hip circumference 106 cm or more, body weight 69 kg or more.

The reliability of the findings is confirmed by Tables 2-4, including anthropometric data of 74 men and 214 women aged 15-80 (51.31 ± 1.59) years and older and (56.42 ± 0.97), respectively, suffering from hypertension , and 107 men and 187 women of the same age without clinical signs of cardiovascular disease and musculoskeletal deformities. All surveyed were indigenous rural Teleuts in the south of Kuzbass villages: Bekovo, Shanda, Ulus, Teleutskaya Devil, Novo-Bachaty and Bachaty, Belovsky and Guryevsky districts (their compact habitats), not differing in social and ethnic characteristics.

Thus, among men and women suffering from arterial hypertension, faces of hypersthenic CMT are found almost 2 times more often than patients with normal blood pressure, and asthenic, on the contrary, are more than 2 times less likely. In order to identify critical indicators of anthropometry as risk factors for the development of GB, we calculated the risk coefficient (RR), taking as a basis the values of the indicator of a healthy individual (M ± 0.6σ). Considered anthropometric indicators (height, body weight, chest circumference, waist circumference, hip circumference) for men and women with respect to GB are pathognomonic signs (RR≥2), Table 2.

For both men and women, the risk of developing GB directly depends on the severity of the revealed anthropometric indicators: the probability of occurrence of GB is the lower, the higher the growth, less body weight (low-grade obesity or its absence), the higher the IRA value (more asthenic somatic differentiation ), smaller transverse diameter of the chest, chest circumference, waist circumference, hip circumference - for persons of both sexes.

Example 1. Patient Ch., 42 years old. For the first time at a cardiologist's appointment, he complained of episodic headaches. An objective and paraclinical examination of the patient showed no damage to the target organs, revealed: HELL 140/90 mm RT. Art., heart rate - 76 beats. in minutes Among the risk factors for GB are noted: burdened heredity for both parents, smoking, episodes of alcohol abuse, frequent psycho-emotional experiences associated with work, increased consumption of sodium chloride in food, and an inactive lifestyle. The anthropometric study established the following values: height - 160 cm, body weight 85 kg, transverse diameter of the chest 32 cm, IRA - 83, chest circumference 100 cm, waist circumference 88 cm, hip circumference 98 cm.

Conclusion: the patient has a high risk of developing GB.

In this example, early identification of the risk of developing GB using the proposed method allows for earlier preventive measures against GB (to reduce weight, increase physical activity, a diet with a limited intake of fats and sodium salt) before target organ damage and the formation of persistent GB , psychocorrection, etc.).

Example 2. Patient M. 50 years. Periodically notes an increase in blood pressure from 45 years. In connection with the deterioration of health, I began to see a doctor. The symptomatic nature of GB is not confirmed. An objective and paraclinical examination of the patient showed no damage to the target organs, revealed: HELL 150/90 mm RT. Art., heart rate - 80 beats. in minutes Among the risk factors for hypertension, weighed down by heredity for both parents, several (at least 5) traumatic events of a personal nature, prolonged work in conditions with increased noise, abuse of salt, a sedentary lifestyle were identified. When conducting an anthropometric study, the following data were obtained: height - 143 cm, body weight 75 kg, transverse diameter of the chest 29 cm, IRA - 82, chest circumference 110 cm, waist circumference 92 cm, hip circumference 107 cm. Conclusion: the patient had a high risk of developing GB.

In this example, early identification of the risk of developing GB using the proposed method allows for earlier preventive measures against GB (to reduce weight, increase physical activity, a diet with a limited intake of fats and sodium salt) before target organ damage and the formation of persistent GB , psychocorrection, etc.).

Considering the fact that the process of age-related constitutional-morphological modification is slow, the proposed method expands the possibilities of early prediction of the risk of developing GB and allows, on the basis of an individual approach, to identify groups of people in need of therapeutic and preventive measures.

Table 1
The boundaries of discrete groups for different types of constitution according to the value of the Rhys-Eisenck index of the indigenous rural Teleuts in the South of Kuzbass. Constitution type For men For women Hypersthenic ≤90.71 94.83 Normosthenic 90.71-107.13 94.83-111.53 Asthenic ≥107.13 ≥111.53

table 2
Critical values of anthropometric indicators of indigenous rural Teleuts in the South of Kuzbass, exceeding which leads to a high risk of developing GB. No. p / p Indicators Men Women Values of the indicator (M ± 0.6σ) Rr Values of the indicator (M ± 0.6σ) Rr one IRA ≤86 7.26 ≤90 8.30 2 Height, cm ≤161 6.53 ≤144 3.78 3 Transverse doctor of the chest, cm ≥31 2.90 ≥27 2.28 four Waist circumference, cm ≥83 2.29 ≥85 2.13 5 Thigh circumference, cm ≥97 2.22 ≥106 2.03 6 Body weight ≥69 2.16 ≥69 2.22 7 Chest circumference, cm ≥93 2.07 ≥97 2.03

Table 3
The distribution of the examined by type of constitution. KMT Men Women Total: sick healthy sick healthy sick healthy Hypersthenic 17 (23%) 23 (21%) 44 (21%) 11 (6%) 61 (21%) 34 (12%) Normosthenic 53 (72%) 75 (70%) 153 (9%) 139 (74%) 206 (71%) 214 (73%) Asthenic 4 (5%) 9 (8%) 17 (8%) 37 (20%) 21 (7%) 46 (16%) All: 74 107 214 187 288 294

Claims (1)

A method for predicting the possibility of developing hypertension for indigenous rural Teleuts of the south of Kuzbass, based on the analysis of individual constitutional features: body weight, height, calculation of the somatic index according to the Ries-Eysenck formula (IRA), characterized in that the subjects in the absence of clinical signs of hypertension diseases are additionally measured: chest circumference, waist circumference, hip circumference, and in men with growth less than 161 cm, the Rhys-Eysenck index value is less than 86, the transverse diameter of the chest cells 31 cm or more, chest circumference 93 cm or more, waist circumference 83 cm or more, hips 97 cm or more, body weight 69 kg or more, in women with growth less than 144 cm, Rhys-Eysenck index value less than 90 , a transverse diameter of the chest of 27 cm or more, a chest circumference of 97 cm or more, a waist circumference of 85 cm or more, a hip circumference of 106 cm or more, and a body weight of 69 kg or more predict an increased risk of developing hypertension in the indigenous rural Teleuts of the south Kuzbass.