ISSN 0362 1197, Human Physiology, 2012, Vol. 38, No. 5, pp. 541–544. Pleiades Publishing, Inc., 2012.
Original Russian Text V.M. Pokrovskii, O.G. Kompaniets, 2012, published in Fiziologiya Cheloveka, 2012, Vol. 38, No. 5, pp. 102–107.
Influence of the Level of Blood Pressure
on the Regulatory–Adaptive State
V. M. Pokrovskii and O. G. Kompaniets
Kuban State Medical University, Krasnodar, Russia
—Subjects with an increased blood pressure have a decreased regulatory–adaptive potential. The
degree of its decrease increases in individuals with higher blood pressure values. The achievement of the target
blood pressure level with antihypertensive drugs normalizes the regulatory–adaptive potential. However, only
those patients whose blood pressure values did not exceed 160/90 (systolic/diastolic) mm Hg attained the
level of adaptation of healthy individuals.
: blood pressure, regulatory–adaptive abilities
The levels f systolic (BP ) and diastolic (BP ) blood
tory–adaptive reactions of the body, ensures maxi
pressure serve as a criterion for the verification of arte
mum integration in the assessment of the regulatory–
rial hypertension (AH), the basic parameters charac
adaptive potential [9, 10]. At present, a considerable
terizing its severity, and the conventional parameters
number of works describing in detail the state of adapt
of the efficacy of antihypertensive therapy [1, 2].
ability under different conditions in health [11–14]
However, it is evident that the usual BP recording
and in pathology [11, 15–17] using CRS are available.
using Korotkoff’s method or under 24 h monitoring
The regulatory–adaptive state of individuals with
conditions does not include the evaluation of the indi
an increased BP was assessed in this work.
vidual’s state of regulatory–adaptive potentialitieswhose level determines the capacity for an adequateresponse to endogenous and exogenous factors. The
evaluation of the regulatory–adaptive state of the body
Subjects with different BP levels (n
= 168) were
is connected with certain methodical difficulties. Dif
enrolled in the study. The average age of patients in the
ferent authors have already made an attempt to reach
study group was 56.7 ± 6.6 years; the gender distribu
a conclusion about the adaptive state in health and in
tion was 97 women and 71 men; the duration of AH
pathology with the characteristics of the functioning
was 8.9 ± 2.1 years. The control group included
of individual organs and systems. Note that the esti
healthy subjects (n
= 34) with optimal BP and BP
mate of the functional state was carried out on the
values of 120–139 and 70–89 mm Hg, respectively.
basis of ultrasonic dopplerography ; the models of
The study group was divided into separate groups
evaluation of the autonomic tone, predominantly
according to the degree of the BP increase: group 1,
based on the dynamics of heart rate variability and the
with grade I BP increase (BP , 140–159 mm Hg; BP ,
daily excretion values of adrenaline, noradrenaline,
90–99 mm Hg); group 2, with grade II BP increase
17 ketosteroids, and 17 oxycorticosteroids, are used
(BP 160–179, mm Hg; BP , 100–109 mm Hg); and
[4–8]. The structures and/or functions of several
group 3, with grade III BP increase (BP is higher than
dominant parameters and target organs are disturbed
179 mm Hg; BP is higher than 109 mm Hg). The
during the formation of hypertension. In this context,
patients received one of the following medications as
the methods providing the quantitative characteristic
monotherapy: lisinopril at an initial dose of 10 mg/day,
of intersystem interaction between several autonomic
losartan at an initial dose of 25 mg/day, corinfar (nife
functions are of special importance in the assessment
dipine) retard at an initial dose of 20 mg/day. No phys
of the influence of the BP level. The method of car
iotherapeutic methods of treatment were used. The
diac–respiratory synchronization (CRS), whose
drug dose was titrated for the target BP values to be
resultant parameter values are formed with the partic
attained, with the parameters studied repeatedly
ipation of several sensory inputs, the central and auto
recorded subsequently. The CRS method whose key
nomic systems, as well as the respiratory and the car
parameters were compared with the blood pressure
diovascular systems, whose coordinated work may be
level was used for the assessment of the regulatory–
an important guarantor of adequacy of the regula
adaptive status. The electrocardiogram (ECG) in the
Cardiorespiratory synchronization parameters in individuals with a different BP level (M ± s)
Note: See the text for decoding the abbreviations. Significant differences from the control values: * p
< 0.05; ** p
< 0.01; *** p
second classical lead according to Einthoven, the
(e) The duration of CRS development within the
pneumogram (PG), and the markers of the photo
minimal and maximal limits of the synchronization
stimulator lamp flashes whose frequency was regulated
range was determined by the number of cardiac cycles
by the experimenter were recorded synchronously.
(cc) from the beginning of the trial to the stable CRS
The subject synchronized his breathing with predeter
formation within the minimal and maximal limits of
mined photostimulator flashes; the appearance of
CRS was determined by comparison in the synchro
Earlier, the most informative role of the range
nous ECG, PG, and the photostimulaltor marker
width and the duration of CRS development within
recording. The duration of each trial was 30–60 s. In
the minimal limit of the CRS range were repeatedly
the first trial, the predetermined frequency of the pho
proven . This allowed us to introduce the integral
tostimulator lamp flashes was 5–7% lower than that of
index, the index of the regulatory–adaptive state
the baseline rhythm. After the completion of the first
(IRAS), which represents the synchronization range
trial, the patients relaxed for several minutes to recover
(SR) value to the duration of synchronization devel
their heart and respiratory rates to the initial level, the
opment within the minimal limit (DuD min lim) ratio
trials were repeated with a subsequent 5% increase in
multiplied by 100 . The regulatory–adaptive state
the photostimulator flash frequency. The trials were
is assessed by the IRAS value: the regulatory–adaptive
performed until the CRS, the state when one heart
potential is high at IRAS > 100; good at 95–50; satis
contraction corresponds to each respiratory cycle, had
factory at 49–25; low at 24–10; and unsatisfactory at
been attained. The following CRS parameters were
The results obtained were statistically processed
(a) The minimal limit (min lim) of the synchroni
using the EXCEL 2000 software package and the
zation range, i.e., the minimal frequency of the photo
STATISTICA 6.0 applied software package using sta
stimulator lamp flashes and, correspondingly, the res
tistical tests for comparison between independent
piratory rate synchronous with them at which CRS
(b) The maximal limit (max lim) of the synchroni
zation range, i.e., the maximal respiratory rhythm inresponse to photostimulation at which CRS was still
In group 1, the average BP value exceeded this
manifest but was lost if the rhythm was exceeded. The
value in the control group by 19.2%; and BP , by
minimal and maximal limits of the synchronization
19.8%; in group 2, by 36.5 and 25.0%, respectively;
range were expressed in the number of cardiorespira
and in group 3, by 54.9 and 32.0%, respectively. The
comparison between the regulatory–adaptive states inindividuals with different BP levels revealed the most
(c) The synchronization range, which is the differ
significant differences of groups 2 and 3 from the con
ence between the synchronized heart and respiratory
rates within the maximal and minimal CRS limits.
Note that SR in group 2 was lower by 48.5% (p
The range was expressed by the number of synchro
0.001) than in the control group; DuD min lim was
nous cardiorespiratory cycles per minute.
lower by 65.6% (p
< 0.01); and in group 3 patients, by
(d) The difference between the CRS minimal limit
< 0.0001) and 106.9% (p
< 0.0001), respec
and the initial heart rate (HR) (in cardiac cycles).
tively. In group 3, the average BP value exceeded the
INFLUENCE OF THE LEVEL OF BLOOD PRESSURE
organs. In order to identify the mechanisms of recov
ery of the regulatory–adaptive state, additional pro
spective investigations are required. Regrettably, the
results of the studies do not provide an unambiguous
answer as to what is primary: the influence of the level
of blood pressure on the state of the regulatory systems
or vice versa. This requires long term prospective
investigations with the determination of the regula
tory–adaptive potential of healthy individuals during a
number of years to determine whether maladaptationor hypertension appears first.
Index of the regulatory–adaptive state (IRAS) at differentlevels of arterial hypertension initially (dark shaded columns) and after normalization of blood pressure (light
Significant differences from the control values: * p
It has been shown that a high BP decreases the reg
< 0.01; *** p
ulatory–adaptive capacity. The higher the blood pressure the lower the regulatory–adaptive potential of thebody. Normalization of the BP level with pharmaco
control group values by 54.9%; and BP , by 32.0%.
therapy restores the regulatory–adaptive potential in
The IRAS dynamics were correlated with the BP (R =
individuals with BP increased to 160/90 mm Hg. The
< 0.01) and BP (R = –0.53, p
< 0.01) values.
regulatory–adaptive capacity is not restored com
In group 1, the SR decrease was 40.9% (p
< 0.05); the
pletely in individuals with high BP and/or BP values,
DuD min lim decrease was 41.8% with a tendency to
even against the background of the normalization of
increase. The figure shows the IRAS values. Negative
IRAS dynamics were observed with increasing BP,from satisfactory in group 1 to low in group 3 (see thefigure).
When antihypertensive pharmacological therapy
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The past year has been another busy and productive year for our breast cancer research programme. Particular highlights over the year include the first major presentations and publication from our Waikato Breast Care (Cancer) Register (WBCR); the completion of two major local projects (one evaluating a Waikato incidence of lymphoedema and the other wound infiltration with local anaesthetic after
ISMP’s List of Error-Prone Abbreviations, Symbols, and Dose Designations he abbreviations, symbols, and dose designations found in this tableThe Joint Commission (TJC) has established a National Patient T have been reported to ISMP through the USP-ISMP Medication Safety Goal that specifies that certain abbreviations must appear onError Reporting Program as being frequently misinterpr