Aim. To reveal the role of a “youth protein” GDF11 in regulation of lipid metabolism and cardiovascular system work in essential hypertension (EH) in women taking antihypertension medications and regularly involved in moderate physical exercises (kinesitherapy).Material and methods. In all participants, the level of GDF11 was measured by immune enzyme assay, and levels of lipids; registration was done of blood pressure, echocardiography and circulation condition with a novel sensor of dynamic light scattering (mDLS).Results. In women with AH taking antihypertension medications, the level of GDF11 was lower more than 3 times. In EH patients the deviations found, in a shear flow velocity with significant increase of rapid velocity processes. Correlations found for GDF11 level with the age, blood pressure, condition of the heart work, hemodynamical and oscillatory indexes. In the EH group patients regularly doing exercises (kinesitherapy), the level of GDF11, blood pressure, lipid profile and all parameters of heart work and hemodynamics are close to normal.Conclusion. The “youth protein” CDF11 is a factor of prevention of AH. Kinesitherapy in EH patients normalizes GDF11, lipid profile, and significantly increases the work of cardiovascular system.
Цель исследования - выявление взаимосвязи между показателями вариабельности сердечного ритма (ВСР), кровяным давлением и гемодинамическими функциями у женщин, страдающих гипертонической болезнью (ГБ) и находящихся на медикаментозной терапии (ГБ-1), либо в дополнение к этому, проходящих регулярные курсы кинезитерапии (ГБ-2). Методика. Наблюдения проведены на 72 женщинах, страдающих артериальной гипертензией II стадии. В группу ГБ-1 вошли 37 женщин с ГБ, находящихся на медикаментозной терапии, в группу ГБ-2 - 35 женщин с ГБ, которые, помимо медикаментозной терапии, регулярно проходили на протяжении 2-3 лет по 3-4 полуторамесячных курса кинезитерапии (управляемые умеренные физические нагрузки). Для изучения гемодинамики был использован датчик динамического рассеяния света (miniature Dynamic Light Scattering - mDLS) от Elfi-Tech (Rehovot, Israel), измеряющий сигналы, инициированные кожным кровотоком, и использующий методику разложения сигнала на частотные компоненты, связанные с разными гемодинамическими источниками. Из пульсовой компоненты mDLS сигнала извлекалась информация о вариабельности RR-интервалов и рассчитывались индикаторы вариабельности сердечного ритма. Введен показатель «гемодинамический индекс» (Hemodynamic Index - HI). Зависимость HI от скорости сдвига интерпретируется путем сопоставления каждой полосе частот определенной скорости сдвига (HI1 - низкочастотный, HI2 - промежуточный, HI3 - высокочастотный). Использованы следующие относительные (RHI, Relative Hemodynamic Index) и осцилляторные (OHI, Oscillatory Hemodynamic Indexes) гемодинамические индексы: нейрологический (NEUR), Майера (MAYER), дыхательный (RESP) и пульсовой (PULSE). ВСР показатели включали: HR (Heart Rate), PWR (Power) - общую мощность колебаний, LF (Low Frequency), HF (High Frequency), SDNN (Standard Deviation of the Normal-to-Normal), RMSSD (Root Mean Square of the Successive Differences), а также индексы: CVI (Cardiac Vagal Index) и CSI (Cardiac Sympathetic Index). Результаты. У женщин, находящихся исключительно на медикаментозной терапии (ГБ-1), выявляются отрицательные взаимосвязи LF и LF/HF с систолическим, средним и пульсовым давлением. При ГБ-2 проявляются отрицательные связи PWR, LF, HF с пульсовым давлением. При ГБ-1 обнаружены положительные взаимосвязи между HR и гемодинамическими индексами HI1, RHI2 и отрицательная взаимосвязь с RHI3, а также между RMSSD и RHI3 и между HF и HI1/HI3. У пациенток ГБ-2 обнаружена отрицательная корреляция SDNN и RHI1, а также PWR и RHI1; положительные взаимосвязи между PWR и HI2, HI3, RHI2, HF и RHI3 и LF/HF с HI1/HI3; отрицательные связи HF c HI1/HI3 и с RHI1, а также между LF/HF и RHI3, CSI и RHI3. У больных ГБ-1 имеются прямые связи между SDNN, PWR, LF, HF, CVI и NEUR_HI1, что свидетельствует о действии этих факторов на эндотелиальный кровоток (HI1). В группе ГБ-2 установлено наличие лишь положительных связей между LF, HF и NEUR_HI3. У больных ГБ-1 на уровень АД влияют все без исключения осцилляторные ритмы, которые могут оказывать как отрицательное (с MAYER_HI1, PULSE_HI2), так и положительное (MAYER_HI2, RESP_HI3) влияние. У больных ГБ-2 взаимосвязи АД с осцилляторными индексами не обнаружены. Заключение. Уменьшение в группе ГБ-2 по сравнению с больными группы ГБ-1 числа факторов, влияющих на АД и гемодинамику, носит более совершенный и благоприятный характер, что и обеспечивает более быструю и устойчивую нормализацию артериального давления. Aim. To study the relationship between heart rate variability (HRV), blood pressure and hemodynamic functions in women with essential hypertension (EH) receiving a drug therapy alone (EH-1) or in combination with regular courses of kinesitherapy (EH-2). Methods. The study included 72 women with EH. The EH-1 group consisted of 37 women with stage II arterial hypertension. The EH-2 group consisted of 35 women with stage II arterial hypertension who underwent 3-4 1.5-month courses of kinesitherapy (controlled moderate physical activity) on a regular basis for 2-3 years. Hemodynamics was studied with a miniature Dynamic Light Scattering (mDLS) sensor from Elfi-Tech (Rehovot, Israel), which measures signals initiated by the skin blood flow by decomposing the signal into frequency components associated with different hemodynamic sources. Information on the RR interval variability was extracted from the pulse component of mDLS signal, and indicators of heart rate variability were calculated. A Hemodynamic Index (HI) was introduced. The HI dependence on shear rate was interpreted by matching each frequency band with a specific shear rate (HI1, low-frequency; HI2, intermediate; HI3, high-frequency). The following relative (RHI, Relative Hemodynamic Index) and oscillatory (OHI, Oscillatory Hemodynamic Indexes) indexes were used: neurological (NEUR), Mayer (MAYER), respiratory (RESP), and pulse (PULSE) ones. The HRV indexes included HR (Heart Rate), PWR (Power, total oscillation power), LF (Low Frequency), HF (High Frequency), SDNN (Standard Deviation of the Normal-to-Normal), RMSSD (Root Mean Square of the Successive Differences). CVI (Cardiac Vagal Index), and CSI (Cardiac Sympathetic Index). Results. In women who were on drug therapy alone (EH-1), negative relationships were found for LF and LF/HF with systolic, mean and pulse pressure. For EH-2, PWR, LF, and HF negatively correlated with pulse pressure. For EH-1, HR positively correlated with the hemodynamic indices HI1 and RHI2 and negatively correlated with RHI3; RMSSD negatively correlated with RHI3; and HF negatively correlated with HI1/HI3. For patients with EH-2, negative correlations were observed for SDNN and RHI1, PWR and RHI1; positive correlations were found between PWR and HI2; HI3, RHI2, HF and RHI3; and between LF/HF and HI1/HI3. HF negatively correlated with HI1/HI3 and with RHI1. LF/HF negatively correlated with RHI3, and CSI negatively correlated with RHI3. In patients with EH-1, SDNN, PWR, LF, HF, CVI, and NEUR_HI1 were directly related, which indicated an effect of these factors on the endothelial blood flow (HI1). In the EH-2 group, only positive correlations were found between LF, HF, and NEUR_HI3. In EH-1 patients, all oscillatory rhythms influenced BP; this influence could be both negative (for MAYER_HI1, PULSE_HI2) and positive (for MAYER_HI2, RESP_HI3). In EH-2 patients, no relationship was found between blood pressure and oscillatory indices. Conclusion. The smaller number of factors influencing blood pressure and hemodynamics in the EH-2 group compared to the EH-1 group was more beneficial and favorable, which ensured faster and steadier normalization of blood pressure.
The task of the study was to elucidate the effect of moderate exercise on heart rate variability (HRV) in women who regularly take kinesitherapy courses. Materials and methods. Studies were conducted on 72 women with essential hypertension (EH), divided into 2 subgroups: first (EH-1) included 37 women suffering from stage II EH and under medical therapy, the second (EH-2) consisted of patients who underwent along with medication treatment, regular courses of kinesitherapy. To evaluate the characteristics of HRV, a photoplethysmography method was used. The following indicators were used: SDRR is the standard deviation of all cardiointervals, RMSSD is the square root of the average sum of squares of cardiointerval differences, LF - is the oscillation power in the low frequency range, due to the activity of the sympathetic section, HF - is the power in the high frequency range, associated with respiratory movements and caused by vagal activity, LF/HF - is the power ratio, reflecting sympathetic balance, CVI - nonlinear parasympathetic index, CSI - nonlinear sympathetic index. Results. It was established that the average heart rate in women of both groups is approximately the same, while all other indicators (with the exception of LF/HF and CSI) were significantly higher in patients EH-2 group. In patients EH-2 group, there is a significantly larger value of SDRR, RMSSD, LF, HF. In the frequency analysis, no increase in the total power of cardiointerval oscillations and autonomic balance (LF/HF) was detected. A pronounced increase in the nonlinear parasympathetic index (CVI) has been shown, while the sympathetic index (CSI) remained unchanged. Conclusion. Regular use of kinesitherapy courses helps to increase the tone of the parasympathetic division of the autonomic nervous system, which is significantly depressed in EH.
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