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Humphys1204010pokrovskiilo.fm

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 Abstract—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.
Keywords: blood pressure, regulatory–adaptive abilities DOI: 10.1134/S036211971204010X
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 [3]; 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 < 0.001; 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 [11]. 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 [11]. 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 69.7% (p < 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 shaded columns).
Significant differences from the control values: * p < 0.05; It has been shown that a high BP decreases the reg ** p < 0.01; *** p < 0.001.
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 –0.70, p < 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).
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