Introduction. Some patients with stage 1 arterial hypertension often have symptoms originating from various anatomic and functional locations in the absence of organic changes associated with manifestations of psychosomatic autonomic dysfunction. Among the manifestations, patients have "respiratory", cardiovascular, abdominal symptoms, as well as the signs of anxiety-depressive syndrome. These signs indicate the presence of comorbid psychosomatic disorders in the patient, which can affect the course of hypertension and the nature of the treatment. Materials and methods. The screening was carried out in 125 patients with stage 1 AH. Hyperventilating syndrome was detected in 46.40% of them (n = 58) according to the Nijmegen questionnaire; these patients were included in the experimental group. At the same time, standard indicators of hemodynamics, state of anxiety as an additional marker of psychovegetative dysfunctions according to the Spielberger scale were evaluated. The control group consisted of 24 patients with stage 1 AH without signs of hyperventilating syndrome. By randomization, all patients of the experimental group were divided into 4 groups depending on the treatment: patients from 1st and 2nd group received perindopril and amlessa; 3rd and 4th group – medication in combination with systematic diaphragmatic breathing. The latter provides an anti-stressor effect, normalizes the breathing pattern, eliminates the consequences of hypocapnia and possibly reduces the effect of bradykinin on bronchial tone after taking ACE inhibitors. Results and discussion. A correlation was found (r = 0.72; p ˂ 0.05) between the severity of hyperventilating syndrome (41.63 ± 0.82) points and indicators of total peripheral vascular resistance (1476.13 ± 42.39) dyn•s•cm-5. The latter was significantly higher than the results obtained in the control group of patients – (1374.62 ± 36.11) dyn•s•cm-5 (р ˂ 0.05). At the same time, the signs of state anxiety comprised (42.96 ± 2.05) points vs. the result in the control group (22.36 ± 1.33) points (р ˂ 0.05). The evaluation of the results of the treatment after 2–3 months revealed a significant advantage of the combined effect of medications and systematic diaphragmatic breathing, which reduced hyperventilation in the 3rd and 4th groups by 12.92% and 15.37% (р ˂ 0.05); state anxiety by 16.73% and 20.31% (р ˂ 0.05), respectively, which was not significant in groups 1–2. In addition, diaphragmatic breathing increased the effect of amlessa. When treating patients with stage 1 hypertensive disease it is recommended to search for the signs of hyperventilating syndrome and prescribe combined therapy which includes diaphragmatic breathing and hypotensive medications.
The signs of hyperventilation syndrome are detected among hypertensive patients, but are notnoticed by doctors that in some way can complicate the progression of the hypertension. It was established during the research that for the hypertensive syndrome and its extent of reveal verification, besides standardized Nijmegen questionnairespirometry or diaphragm amplitude can be used. It was established, that among group of hypertensive patients (n=43) with the signs of hyperventilation syndrome, the decrease of lung ventilation figures in accordance to proper magnitude was revealed. Specifically, such figures as vital capacity, forced expiratory volume in 1 sec, inspiratory and expiratory reserve volume, peak expiratory flowwere accurately lower. The reveled changes increased after conducting of the hyperventilation probe among all patients of the main group. At the same moment only among 28,57 % of patients from control group (n=14), without signs of hyperventilation syndrome, according to the survey, the violation of lung ventilation from slight (21,43 %) to moderate (7,14 %) was revealed under the hyperventilation probe. Besides that, among patients from the main group the limitation of diaphragm amplitude was noticed in comparison to results gained in the control group which became stronger under the forced breathing. The revealed changes among hypertensive patients require on time diagnostic and correction.
Hypertensive disease is one of the urgent problems in the modern cardiology. It is known that a huge variety of comorbid states influence the development of hypertensive disease, i. e. neurogenic hyperventilating syndrome. It is the sign and the marker of suprasegmental vegetative structures disorders that destabilize homeostasis, initiate the development of specific pathological processes, which are the base of somatization of hyperventilating disorders, including heart disorders. It led to research of structural and functional characteristics of the ventricles with the help of echocardiology among hypertensive patients with neurogenic hyperventilating syndrome. Ventricular dilation of cavities, mostly of the right one without thickening of the walls, was found in the patients with stage 1 hypertension disease (43.59 %). Dilation of the ventricular cavities was also revealed in hypertensive patients with stage 2 hypertension disease in 37.88% of cases. The next variations of remodeling were registered: concentric – in 10.61% of cases; concentric hypertrophy – in 22.73%; asymmetric hypertrophy – in 12.12%; eccentric remodeling and eccentric hypertrophy of the left ventricle – in 4.55% and 9.09% of patients, respectively. Thickening of the right ventricle wall was observed in 13.64% of patients. In the control group of patients without hypertonic syndrome, the signs of concentric and asymmetric hypertrophy were noticed in 10% of patients, eccentric – in 20%; extension of the left ventricle – in 20%. The assessment of the condition of transmitral and tricuspid flows revealed a significant increase in the number of cases, disorders, relaxation of the heart ventricles among hypertensive patients with neurogenic hyperventilating syndrome. It can be a sign of specific role of permanent hyperventilation in ventricle remodeling and mandatory systematic echocardiological control of these patients.
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