METHODS OF TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION WITH MANIFESTATIONS OF HYPERVENTILATION SYNDROME
Introduction. Some patients with stage 1 arterial hypertension often have symptoms originating from various anatomic and functional locations in the absence of organic changes associated with manifestations of psychosomatic autonomic dysfunction. Among the manifestations, patients have "respiratory", cardiovascular, abdominal symptoms, as well as the signs of anxiety-depressive syndrome. These signs indicate the presence of comorbid psychosomatic disorders in the patient, which can affect the course of hypertension and the nature of the treatment.
Materials and methods. The screening was carried out in 125 patients with stage 1 AH. Hyperventilating syndrome was detected in 46.40% of them (n = 58) according to the Nijmegen questionnaire; these patients were included in the experimental group. At the same time, standard indicators of hemodynamics, state of anxiety as an additional marker of psychovegetative dysfunctions according to the Spielberger scale were evaluated. The control group consisted of 24 patients with stage 1 AH without signs of hyperventilating syndrome.
By randomization, all patients of the experimental group were divided into 4 groups depending on the treatment: patients from 1st and 2nd group received perindopril and amlessa; 3rd and 4th group – medication in combination with systematic diaphragmatic breathing. The latter provides an anti-stressor effect, normalizes the breathing pattern, eliminates the consequences of hypocapnia and possibly reduces the effect of bradykinin on bronchial tone after taking ACE inhibitors.
Results and discussion. A correlation was found (r = 0.72; p ˂ 0.05) between the severity of hyperventilating syndrome (41.63 ± 0.82) points and indicators of total peripheral vascular resistance (1476.13 ± 42.39) dyn•s•cm-5. The latter was significantly higher than the results obtained in the control group of patients – (1374.62 ± 36.11) dyn•s•cm-5 (р ˂ 0.05). At the same time, the signs of state anxiety comprised (42.96 ± 2.05) points vs. the result in the control group (22.36 ± 1.33) points (р ˂ 0.05). The evaluation of the results of the treatment after 2–3 months revealed a significant advantage of the combined effect of medications and systematic diaphragmatic breathing, which reduced hyperventilation in the 3rd and 4th groups by 12.92% and 15.37% (р ˂ 0.05); state anxiety by 16.73% and 20.31% (р ˂ 0.05), respectively, which was not significant in groups 1–2. In addition, diaphragmatic breathing increased the effect of amlessa. When treating patients with stage 1 hypertensive disease it is recommended to search for the signs of hyperventilating syndrome and prescribe combined therapy which includes diaphragmatic breathing and hypotensive medications.
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