Strength and endurance of the hand and the level of complications in patients with arterial hypertension and options for antihypertensive therapy

Abstract

Despite the success in the treatment of cardiovascular diseases, the number of complications associated with arterial hypertension (AH) does not decrease. Against the background of high blood pressure, the functioning of the central nervous system (CNS) changes and personalized and more active antihypertensive therapy is required to achieve the target blood pressure. Aim. To determine the level of oxygen utilization by tissues, strength and endurance of the hand, as well as the minute volume of blood and the level of complications in high- and low-anxiety patients with stage II hypertension (AH) with a predominance of excitatory or inhibitory processes in the central nervous system taking an empirical and personalized version of antihypertensive therapy, as well as to determine the most effective treatment approach. Material and methods. Design: outpatient, single-center, cohort, prospective, controlled, non-randomized, long-term clinical trial. From 2011 to 2018 patients with stage II AH, degree 2, risk 3 (n = 328) and healthy (n = 164) men (54.6 ± 0.6 years) were divided by type of higher nervous activity into equal groups with a predominance of excitatory (sympathicotonia) or inhibitory (parasympathicotonia and activation of the renin-angiotensin-aldosterone system in the central nervous system) processes with high and low anxiety. Reactive and personal anxiety, the coefficient of oxygen utilization by tissues, the coefficient of endurance and maximum hand strength, as well as the level of complications of hypertension were determined. Some groups of high- and low—anxiety patients took the empirical option, while others of the same groups of the corresponding activity of the central nervous system and departments of the autonomic nervous system took a personalized version of antihypertensive therapy. It included correction of sympathicotonia in people with a predominance of excitatory processes, and blockade of mineralocorticoid receptors in those with a predominance of inhibitory processes. Results and discussion. In contrast to the empirical one, against the background of personalized therapy, the value of the oxygen utilization coefficient by tissues, the coefficient of endurance of the hand and the maximum strength of the hand were higher, and the minute volume of blood fl ow was lower. The values of the indicators against the background of personalized antihypertensive therapy were the same as in healthy individuals with the corresponding activity of the central nervous system and departments of the autonomic nervous system. The level of hypertension complications due to acute cerebral blood f ow disorder in the groups of patients taking the personalized therapy option was significantly lower than in the groups taking the empirical option. Conclusion. The equality of values with healthy individuals in terms of the coeffi cient of oxygen utilization by tissues, the coefficient of endurance of the hand and the maximum strength of the hand, as well as the low level of complications of hypertension, compared with the empirical treatment option, indicate the effectiveness of a personalized approach to pharmacotherapy of hypertension.