Lviv clinical bulletin 2013, 4(4): 12-16

https://doi.org/10.25040/lkv2013.04.012

Peculiarities of the Hypertension Clinical Course Depending on Tonus of the Vegetative Nervous System

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O. Radchenko, L. Pylypiv

Danylo Halytsky Lviv National Medical University

Introduction. Arterial hypertension (AH) is one of the most urgent medical and social problems of the present time due to the considerable prevalence, high risk of complications, and lack of treatment efficacy. Assessing the status of the autonomic nervous system (ANS) is one of the perspectives for the further study and understanding of the disease, which is due to the active participation of the ANS in the processes of adaptation and pathogenesis of a large number of lesions. Vegetative dysfunctions are considered to be a key in the emergence of neurocirculatory dystonia, heart rate abnormalities and cardiac rhythm disorders, myocardial ischemia, hypertensive crises, and increased activity of the sympathetic part of the ANS for a long time is investigated in the course of the onset and progression of AH, including drug-resistant coronary heart disease, congestive heart failure, and metabolic syndrome.

Aim. To determine the tone of the ANS and describe the features of the AH course depending on the vegetative status.

Materials and methods. 70 patients with AH aged 33 to 81 years (mean age 61.1 ± 1.4 years) were examined, including 47 women (67.1%) and 23 men (32.9%). The average duration of AH was 9.6 ± 0.7 years. In addition to the standard laboratory and instrumental examination, the status of the ANS was assessed by the S. M. Pukhlik questionnaire (1998). The control group included 18 healthy volunteers with an average age of 33.4 ± 3.3 years.

Results. It has been found out that 81.4 % of patients with hypertension have sympathicotonia accompanied with higher indices of the systolic and diastolic blood pressure, cardiac rate, more often abdominal obesity (especially obesity classes II and III) as well as hyperlipidemia which conversely are additional risk factors for cardiovascular complications and potential indicators for further prognosis.

So, the use of non-medicated (body weight normalization, physical activity, stress reduction) methods and medications (β-blockers, α1-adrenergic blockers, imidazolin receptor blockers, β-stabilizers, sedative preparations) to provide a positive balanceof the ANS should be the subject of further research to normalize blood pressure and reducing the risk of cardiovascular complications.

Conclusions. Increasing the sympathetic tone in patients with AH leads to an increase in cardiovascular risk, which should be taken into account when assessing the total cardiovascular risk, identifying a program of treatment and prevention.

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