RU2398579C1 - Method of normalising functional responsiveness of cardiovascular system in arterial hypertension, impaired glucose tolerance and abdominal obesity and stage i impaired cardiac function - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to haematology, cardiology, endocrinology and can be used for normalising the functional responsiveness of cardiovascular system (CVS) in arterial hypertension, impaired glucose tolerance, abdominal obesity and stage I impaired cardiac function. That is ensured by estimating the state of functional responsiveness of the CVS in psychoemotional load. And systolic, diastolic, average dynamic pressure and heart rate (HR) are recorded. These data are used to evaluate a functional responsiveness index (FRI) before and after load by formula: FRI=(BPav.dyn. × HR)/100 (standard units). The FRI exceeding 20 standard units required a therapy to be prescribed. The therapy combines the individually prescribed hypocaloric diet, rationally graduated static and dynamic physical activity, and administration of lisinopril 10 mg once in the morning and metformin 500 mg twice a day. The length of treatment is at least 3 weeks.

EFFECT: method allows for well-timed diagnosis of the impaired functional responsiveness of CVS; and the combination of presented modalities ensures the effective correction, prevention of complications of arterial hypertension and impaired glucose tolerance, abdominal obesity and stage I impaired cardiac function.

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Description

The invention relates to medicine, to the field of cardiology, and can be used in therapeutic departments of clinics and hospitals. There are no analogues of the method for normalizing the functional reactivity of the cardiovascular system in case of arterial hypertension (AH) with impaired glucose tolerance (NTG), abdominal obesity (AO), and heart failure (stage I).

The aim of the invention is the effective correction of the functional reactivity of the cardiovascular system in hypertension with NTG, AO and CH I Art.

The essence of the proposed method for the correction of the functional activity of the cardiovascular system is to increase the tolerance of patients with hypertension with NTG, AO and HF I st. to psychoemotional stress and an increase in the functional reactivity of the cardiovascular system when they perform a dosed psychoemotional load and a decrease in the risk of cardiovascular complications during emotional stress, assessed after a dosed psychoemotional load with an ever-increasing speed for 18-20 minutes with a minute recording of central parameters hemodynamics: systolic blood pressure (BPA), diastolic blood pressure (BPD), arterial pressure of average dynamic pressure (BP avg. dyne) and heart rate (HR), determine the value of the functional reactivity index (PFR), which is a product of the average dynamic pressure BP on heart rate, calculate the relative increment of the PFR value when the load is performed compared to the value at rest and according to the value of PFR, the type of functional reactivity of the cardiovascular system is evaluated: with a PFR value of more than 20 conventional units reactivity is assessed as hyperfunctional (which occurs in hypertension in combination with NTG and AO), with a PFR value of less than 10 arb. the response to the load is assessed as hypofunctional and with PFR values from 10 to 20 conventional units type of functional reactivity is assessed as normal.

The time of the psycho-emotional load is no more than 20 minutes. To normalize the index of functional reactivity in patients with hypertension with NTG, AO and HF I st. a combination of an individually selected hypocaloric diet, rationally dosed static and dynamic physical activity, lisinopril and metformin for at least 3 months are used.

The inventive method is as follows. The value of the PFR indicator is determined by O. Lebedeva, S. A. Radzievsky, S. A. Bugaev A method for assessing the state of functional reactivity of the cardiovascular system RU 2207044. The patient is seated in front of a monitor screen. A cuff is placed on the patient’s left shoulder to measure systolic blood pressure, diastolic blood pressure, dynamic average blood pressure and heart rate before and during exercise. The patient is offered two sets of 4 letters: ANEU and RLOG, from which he must choose one to remember. After registering the hemodynamic parameters for 3 minutes and memorizing (30 s) the selected set of letters, the psychoemotional load begins, consisting in the fact that the test person presses the key marks the disparate letters from the selected set as the square frame moves randomly on the monitor located at random sequence of letters of the alphabet. The speed of moving the frame along the rows of letters during the sampling process increases from 3 letters in 1 s at the beginning of the load to 6 letters in 1 s from 6 minutes of the load, and this ensures the patient’s gradual engagement. Errors in marking letters from the selected set are accompanied by sound signals, according to which the subject can navigate the correct execution of the load and try to adjust its performance. After the end of the load, the average values of ADs, ADd, and ADsr are calculated. din and heart rate in periods: before the load and during the load. The average dynamic BP is calculated by the formula: BP cf.din = ADd + [0.42 (ADs-ADd)].

Dynamic mean blood pressure is a complex result of all variables of blood pressure. When conducting a test with emotional stress in healthy individuals, the mean dynamic does not change significantly, and heart rate, as a rule, increases. According to studies, an increase in heart rate and blood pressure leads to an increase in myocardial oxygen demand and an increase in its energy expenditure. In conditions of pathology, for example, in hypertension with NTG, AO, and heart failure of the 1st century, vessels in a state of spasm are not able to provide the required increased amount of oxygen, as a result of which hypoxia may increase, transient disturbance of cerebral circulation may occur, etc.

Based on the data obtained, an indicator of functional reactivity is calculated, which allows integratively assessing the degree of increase in the hemodynamic load on the heart and, accordingly, the risk of developing cardiovascular complications, defined as follows:

PFR = (ADdr.din HR) × / 100 (conventional units)

The increment of PFR values during the transition from rest to load fulfillment is determined by the indicator:

PFR = PFR2-PFR1,

where PFR is the difference in the values of PFR before and under load,

PFR1 - the average value of the indicator to the load,

PFR2 - the average value of the indicator under load.

By the value of the relative increment of PFR values, the type of functional reactivity of the cardiovascular system is evaluated (conventional units are double digits).

In a second study in the dynamics of treatment, the patient is given to memorize a different set of letters in order to prevent addiction.

When the values of the increment after a metered psychoemotional load PFR from 10 to 20 srvc. units functional type of reactivity is assessed as normal. When PFR load more than 20 srvc. type of functional reactivity is assessed as hyperfunctional. In this case, the patient with hypertension with NTG, AO and CH I Art. it is necessary to prescribe for at least 3 months a combination of an individually selected hypocaloric diet, dosed static and dynamic physical activity, lisinopril 10 mg in the morning 1 time and metformin 500 mg 2 times a day.

To create a negative energy balance in the patient’s body, they may, as one of the options, recommend the following individually selected hypocaloric diet.

The calorie content of the daily diet for each patient individually is calculated in kcal according to the formula:

for women 18-30 years old (0.0621 × body weight, kg + 2.0357) × 240,

31 years-60 years (0.0342 × body weight, kg + 3.5377) × 240,

over 60 years old (0.0377 × body weight, kg + 2.7545) × 240,

for men 18-30 years old (0.0630 × body weight, kg + 2.8957) × 240,

31 years-60 years (0.0484 × body weight, kg + 3.6534) × 240,

over 60 years old (0.0491 × body weight, kg + 2.4587) × 240.

The coefficient obtained remains unchanged with minimal physical exertion, multiplied by 1.3 for moderate and 1.5 for high physical activity (as a rule, in patients with hypertension, NTG, AO, and CH I, the level of physical activity is low).

3 main meals and 2 intermediate meals are recommended. With the regular skipping of one of the main meals, the frequency of obesity increases significantly, a positive correlation between obesity and skipping breakfast is also revealed. The following daily calorie distribution is recommended: breakfast - 25%, 2nd breakfast -10%, lunch - 35%, afternoon tea - 10%, dinner - 20%.

To compile the patient’s menu, special tables are used that indicate the chemical composition and calorie content of the products, given that the main sources of energy are proteins (1 g contains 4 kcal), fats (9 kcal), carbohydrates (4 kcal) and alcohol (7 kcal).

The second component of the proposed method is feasible regular physical training, the use of which can be as one of the options in the form below.

In real life conditions, it is possible to carry out three forms of physical activity: 1) morning hygienic gymnastics (exercise); 2) therapeutic and preventive gymnastics; 3) fractional physical exercises throughout the day.

1. Morning hygienic gymnastics (exercise).

Morning exercises should be done after sleep before breakfast in a ventilated room. Under the influence of classes, the body is freed from the state of inhibition of physiological processes that occurs during sleep.

The sequence of exercises involves alternating the load on various muscle groups (arms, legs, body). Exercises are performed with a gradually increasing excursion of breathing, stretching, limited use of force conditions. The breathing during exercises should be free, rhythmic, without delay, mainly through the nose; the exhalation should be longer than the inhalation (inhalation 2-3 s, exhale 3-5 s).

With good health, the load can be strengthened by the number of repetitions, speeding up the pace, increasing the amplitude of movements and reducing pauses between exercises.

With fatigue, you should reduce the load, increase the duration of pauses between exercises, fill them with calm breathing.

After gymnastics, you need to go to a wipe or take a shower.

Morning exercises should cause a sense of vitality, increased activity, better health and performance.

If you feel unwell, develop shortness of breath or pain in the heart and behind the sternum, you should temporarily interrupt classes and consult a doctor.

During the day, patients are recommended therapeutic and prophylactic gymnastics. Depending on the initial training, it is possible to use first a lightened version of physical activity, and then a strengthened version.

2. Complexes of therapeutic and prophylactic gymnastics for persons suffering from hypertension with NTG, AO and HF I Art.

2.1. A lightweight version of therapeutic gymnastics.

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. When performing the exercise, a gradual deepening of breathing.

Exercise 2. Circular movements in the shoulder joints. When breeding - inhale, while mixing - exhale with a slight tilt of the body and retraction of the abdominal wall - 6-8 times. Fingers touch shoulders, elbows pressed to the body.

Exercise 3. Standing, hands on the belt. Alternately transferring the severity of the body from one leg to the other with slight bending of the legs in the knee joint, without taking the feet off the floor. Do the exercise 10-16 times with muscle tension in the legs.

Exercise 4. Standing, legs spaced shoulder width apart, hands on the belt. Torso forward, touch left sock with your right hand. 4-6 times alternately. When the position is straightened, inhale; when tilted, exhale. Looking forward.

Exercise 5. Standing, arms along the torso. At the same time, take straight arms and one leg to the sides with alternating leg abductions. 4-6 times in each direction alternately. A wave of arms and legs, breathing free, do not hold.

Exercise 6. Standing, legs to the sides, hands in front of the chest, palms down. With the turn of the body, spread your arms to the sides with the turn of the palms up-inhale. Return to the starting position with a slight tilt of the body forward - exhale. 3-5 times in each direction alternately. Coordinate breathing with the movement of the body and hands. By the end of the exhale, retract the wall of the abdomen.

Exercise 7. Standing, hands free. Walking for free -1 min, then with high hip flexion - 10-20 movements, followed by a transition to a quiet walk - 1-2 minutes. Rhythmic breathing, medium depth.

Exercise 8. Sitting on the edge of the chair, hands on the waist. Bending back and bending forward of the body. Repeat 6-10 times. Do not hold your breath.

Exercise 9. Sitting on the edge of the chair, focus with tassels on the edge of the chair, and with your feet somewhat in front of the chair. Squats with an emphasis on the edge of the chair - 4-6 times. When squatting, exhale.

Exercise 10. Standing sideways to the back of the chair, hold on to it with one hand. Swing your free straight arm with your legs back. Return to starting position. Repeat 4-6 times with each hand and foot. Do not hold your breath.

Exercise 11. Standing, legs apart, arms at the waist. Turns the body to the right and left - 6-10 times alternately. Do not turn your head, look forward.

Exercise 12. Standing, legs together, arms down. To spread your arms to the sides - inhale, bend your leg at the knee and press your hands to your stomach - exhale. 3-5 times each leg in turn. Strive to maintain balance; as you exhale, draw in your stomach.

Exercise 13. Standing, legs together, hands down. Lateral inclinations of the body with bending of the opposite arm (“pump”). Do not hold your breath, strive for a greater excursion of movement.

Exercise 14. Standing. Walking is calm with uniform breathing of medium depth. 1-2 minutes

Exercise 15. Lying on a rug with a pillow placed under the head. Go to the half-sitting position and hug the bent hips - exhale, return to the starting position - inhale. Do not hold your breath. Strive in a half-sitting position to maintain balance. Run 4-6 times.

Exercise 16. Lying, arms to the sides, legs apart. Semicircular movements with the right straight leg to the left with the turn of the pelvis - exhale - return to the starting position - inhale. 3-5 times in each direction. Alternately left and right with the greatest possible excursion of the leg movement, while maintaining the emphasis of the hands on the floor.

Exercise 17. Sitting on the floor; a) get on all fours; b) move to a kneeling position; c) raise your hands up - inhale, tilt the body, and take your hands back - exhale. When tilting, belly retract. Repeat 4-6 times; e) move to a standing position, and the son-in-law to a lying position; f) self-massage of the abdomen with small semicircular movements in a clockwise direction -1-2 min. Rest 2 min; g) calm breathing; h) exercise in protruding (calm) and retracting (active) the abdominal wall. Combine abdominal retraction with expiration through the mouth. Repeat 4-6 times.

Exercise 18. Standing, arms bent. Vigorous walking on the spot or in a room with high flexion of the hips and waved arms - 20-30 steps. Do not hold your breath.

Exercise 19. Sitting on a chair, legs apart, hands on the waist or rest against the edge of the chair. Circular movements of the pelvis with retraction of the abdomen when the pelvis is brought back. 4-6 times in each direction.

Exercise 20. Standing. Calm walking with breathing of an average depth of 2-3 minutes.

With the initial sufficient training or exercise tolerance arising during classes, the use of the following set of exercises is possible.

2.2. A reinforced version of therapeutic gymnastics.

Exercise 1. Standing. Walking calm with rubbing the palms of the chest, abdomen, lower back. It takes 1-2 minutes.

Exercise 2. Standing, arms down. Simultaneous bending with tension and free “throwing” of arms forward, to the sides and upwards 12-16 times. When bending, exhale, while leveling, inhale.

Exercise 3. Standing, arms at the waist, legs shoulder width apart. Lateral movements of the pelvis to the right and left, back and forth. It is performed 6-10 times alternately. Breathing is free.

Exercise 4. Standing, feet shoulder width apart, arms down. Circular movements of straight arms in the shoulder joints, 6-10 times with maximum excursion, do not hold your breath.

Exercise 5. Standing, arms in front of the chest, bent at the elbows. Walking with high flexion of the hips, with the touch of hands. 6-10 times each leg in turn. The movements are vigorous, while flexing the thigh - exhale through the mouth.

Exercise 6. Walking calm 1-2 minutes.

Exercise 7. Sitting on the edge of the chair, hands on the waist. Bending and bending of the body. The exercise is performed 8-10 times. The movements are energetic. When straightening, inhale; when bent, exhale.

Exercise 8. Standing sideways to a chair, hold on to the back, the other hand at the waist. Alternating swings with a straight leg forward with the greatest possible excursion. Leg sweep combined with exhalation. It is carried out 4-6 times.

Exercise 9. Standing, legs apart, arms to the sides. Tilts the body forward with a touch of the right brush of the left toe of the foot, the other hand is pulled up. Return to starting position. Combine the slope with the exhale, while straightening, inhale 4-6 times.

Exercise 10. Walking calm with breathing of medium depth. 1-2 minutes Exercise 11. Standing, hands in a fist and lowered: a) bending the arms at the elbows with force and unbending them with the back, with the greatest possible straightening and tension and a delay in tension for 2-3 seconds. Standing, hands on the waist; b) half-squats, followed by lifting on toes and straining the legs. The exercise is performed 4-6 times with the greatest possible rectification and tension, and a delay in the stress state for 2-3 seconds.

Exercise 12. Sitting on the edge of a chair. In the position of the leg raised and bent at the knee joint, alternately shake the tibia and thigh muscles with the hands. Reduce muscle tension. 1-2 minutes

Exercise 13. Sitting on the edge of the chair, straight legs divorced. Breeding and mixing straight arms and legs. When breeding, inhale, while mixing, exhale. It is carried out 4-8 times.

Exercise 14. Standing. Walking is calm with the transition to a rhythmic calm run (jogging) in place or with movement. If tired, go for a walk with moderate breathing. 2-5 minutes

Exercise 15. Lying on the mat. Simultaneous lifting of the body and legs as you exhale. 4-6 times. Arms and legs straightened, keep balance.

Exercise 16. Lying on the mat, emphasis with brushes on the floor. Cross movement with straight legs - “scissors.” 4-8 times. Do not hold your breath.

Exercise 17. With a quick straightening of the legs, move to a sitting position, then lie down. You can help with a wave, 4-6 times.

Exercise 18. Lying on your back, legs bent. Calm breath 4-6 times.

Exercise 19. Lying on your back, arms spread apart with the emphasis of the hands on the floor. With the pelvis turning to the left, bend the legs, turn the pelvis with the legs crossed to the right and stretch the legs. Repeat such circular movements with legs 3-6 times in each direction alternately. Do not tear your hands off the floor. Do not hold your breath.

Exercise 20. Lying on your back, arms and legs apart. Alternate turns of the body to the right and left with the laying of one hand on the other. Do not move your legs. With arms apart, inhale, while turning, exhale. It is carried out 3-6 times.

Exercise 21. Lying on your back, arms along the body: a) turn on your left side; b) turn on the right side; c) go to the supine position; d) get on your knees; e) move to a standing position; f) walking in a place with high hip flexion and arm movement - 20-30 steps; g) sit on the mat;

h) lie on your back, calm breathing. Repeat the whole complex 3-4 times.

Exercise 22. Standing. Walking calm with breathing of medium depth - 1-2 minutes.

Exercise 23. Standing, legs spaced the width of the foot, hands on the waist. Circular motion of the pelvis, right and left 6-8 times. Do not hold your breath.

Exercise 24. Standing with legs wide apart, hands in front of the chest. Alternately bending the leg with the transfer of body weight to it with stretching the arms to the toe of the bent leg. 4-6 times in each direction. The other leg is straight. When straightening - inhale, while tilting - exhale.

Exercise 25. Standing, legs spaced shoulder width apart, arms at the waist. Circular head movements 4-10 times in each direction.

Exercise 26. Standing, legs spaced shoulder-width apart, arms at the waist. Tilt the body to the right, pulling the left hand up - inhale. Return to starting position - exhale. 4-6 times alternately.

Exercise 27. The same, arms to shoulders. Circular movements of the hands with the maximum excursion in the shoulder joints, when breeding - inhale, while reducing and retracting the walls of the abdomen - exhale. The breath is deep.

Exercise 28. Standing. Calm walking and breathing of medium depth. Reduced overall load. 1-2 minutes

3. Fractional exercise throughout the day. A patient with hypertension, NTG, AO and CH I st. - this is a patient with a number of concomitant disorders and, above all, the cardiovascular system. This circumstance limits the simultaneous use of great physical activity in the process of morning gymnastics, as well as in the main occupation of therapeutic and prophylactic gymnastics. That is why an increase in the physical activity of people suffering from hypertension with NTG, AO, and HF of the 1st stage should be achieved by distributing physical activity in small doses throughout the day. This method of increasing the physical activity of patients should be considered as a fractional load method.

Depending on the real-life conditions of patients suffering from varying degrees of abdominal obesity, various exemplary fractional exercise options can be recommended to increase physical (motor) activity throughout the day.

Option 1.

Exercise 1. Sitting - spread your elbows to the sides - inhale, stretch your arms forward with tension - exhale, 4-6 times.

Exercise 2. Sitting - stand up with the deflection of the body and sit down - 8-10 times.

Exercise 3. Sitting - an imitation of the movements of a boxer with a possibly large rotation of the body - 10-12 times.

Option 2

Exercise 1. Standing - walking with high flexion of the hips -16-30 times.

Exercise 2. Standing - circular movements of the head to the right and left - 3-8 times in each direction.

Exercise 3. Standing - legs spread wide - imitation of the movement of a scythe - 10-12 times.

Exercise 4. Sitting - transition to a standing position - 10-12 times.

Option 3

Exercise 1. Walking is calm - 1 min.

Exercise 2. Walking accelerated - 1 min.

Exercise 3. Walking with a high flexion of the hips and alternate wave of hands 20-30 times.

Exercise 4. Walking calm with breathing - 1-2 minutes; the run is calm on the spot or with movement around the room - 2-5 minutes.

Option 4

Walking walk of various extent.

Option 5

Physical labor in various versions and of various durations depending on the conditions (cleaning the premises, home maintenance, work on cleaning the territory, garden works, etc.).

Timely and effective correction of PFR in patients with hypertension with NTG, AO and HF I st. they will allow them to quickly normalize the functional reactivity of the cardiovascular system, which will shorten the period of temporary disability in these patients, prevent strokes and heart attacks, reduce the number of disability exits and reduce mortality among patients with hypertension with NTG, AO and CH I st.

Example. A 49-year-old patient, suffering from AH of the II degree, II stage with NTG, AO, and HF of the 1st stage, was examined. for 7 years. In the study of hemodynamics in the initial state before the psychoemotional load, the blood pressure was 142 mmHg, blood pressure - 94 mmHg, blood pressure. din - 114.2 mm Hg, heart rate - 76 beats. in 1 min. PFR before the start of the psychoemotional load was 86.7 conv. units During the psychoemotional load, blood pressure increased to 166 mm Hg, blood pressure - 106 mm Hg, blood pressure. dyne up to 131.2 mm Hg, heart rate - up to 90 beats. in 1 min, the PFR value increased to 118.1 conventional units, that is, the increment of PFR at the load, or the same as PFR, amounted to 31.4 conventional units. (from 86.7 conventional units to 118.1 conventional units), which can be regarded as a manifestation of hyperfunction of the cardiovascular system. The patient was prescribed a combination of an individually selected hypocaloric diet, rationally dosed static and dynamic physical activity, lisinopril 10 mg in the morning, and metformin 500 mg 2 times a day. After 3 months of treatment, the value of PFR decreased before the start of the load compared with the same before treatment: BPA - up to 128 mmHg, BPA - up to 80 mmHg, BPAdin - up to 100.2 mmHg. , Heart rate - up to 70 beats. in 1 min, PFR - up to 70.1 conv. units When performing the load, there was a decrease compared to the state before treatment, the degree of increase in blood pressure values - up to 148 mm Hg, blood pressure - up to 88 mm Hg, blood pressure. din - up to 109.8 mm Hg, heart rate - up to 78 beats. in 1 min, PFR - up to 85.6 conv. units, that is, an increase in the values of PFR, or PFR, by 17 srvc. (before treatment - by 31.4 srvc. units), which may indicate an increase in the tolerance of the cardiovascular system to psychoemotional stress, a decrease in the hyperfunction of the cardiovascular system and, consequently, the economization of cardiac activity.

As a result of the application of the proposed method for correcting the state of the functional reactivity of the cardiovascular system in patients with hypertension with NTG, AO and HF I st. normalization of the functional reactivity of the cardiovascular system to a dosed psychoemotional load is achieved, which allows the use of a method to normalize the tolerance of patients with hypertension with NTG, AO and CH I art. to psychoemotional stresses, reduce the degree of hemodynamic stress when exposed to stress, reducing the risk of developing unfavorable vascular reactions (attack of angina pectoris, myocardial infarction, cerebrovascular accident, etc.) during psychoemotional stresses.

Claims (1)

A method of normalizing the functional reactivity of the cardiovascular system (CVS) in patients with arterial hypertension with impaired glucose tolerance, abdominal obesity and heart failure stage I, including assessing the state of functional reactivity of CVS with psycho-emotional stress, for which systolic, diastolic, and mean dynamic are recorded (ADs. dyn.) pressure, heart rate (HR), on the basis of these data determine the indicator of functional reactivity (PFR) before and after heating dressings using formula RPF = (ADsr.din. × HR) / 100 (conv) and increment values PFR more than 20 conv prescribe a combination of an individually selected hypocaloric diet calculated in kcal according to the formula:
for women: 18-30 years old (0.0621 × body weight, kg + 2.0357) × 240;
31 years-60 years (0.0342 × body weight, kg + 3.5377) × 240;
over 60 years old (0.0377 × body weight, kg + 2.7545) × 240;
for men: 18-30 years old (0.0630 × body weight, kg + 2.8957) × 240;
31 years-60 years (0.0484 × body weight, kg + 3.6534) × 240;
over 60 years old (0.0491 × body weight, kg + 2.4587) × 240,
rationally dosed static and dynamic physical activity, lisinopril 10 mg in the morning 1 time and metformin 500 mg 2 times for at least 3 months.