ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(4): 131–137
Clinical Medicine

Predictors of Adverse Course of Uncomplicated Hypertensive Crisis in the Prehospital Stage

Goldovsky B. M., Leliuk D. V.

Hypertension ranks first in the structure of the prevalence of diseases of the circulatory system, the prevalence of which among the adult population is about 30%, and it is one of the most important factors destabilizing coronary heart disease and the development of acute cerebrovascular disorders. Despite the large number of modern antihypertensives, today achieving and maintaining the target level of blood pressure remains an urgent problem. The strategic goal of pharmacotherapy of patients with hypertension is to reduce the risk of cardiovascular complications and mortality from them. The purpose of the study was to improve the treatment of uncomplicated hypertensive crises at the prehospital stage by studying the state of systemic hemodynamics, determining the balance of the autonomic nervous system, markers of systemic inflammatory response in patients with hypertension in uncomplicated hypertensive crises. Material and methods. An open, prospective, comparative study of 206 patients with documented stage II hypertension was conducted, 131 of them sought emergency medical care from the Municipal Non-Profit Enterprise "Territorial Medical Association" Regional Center for Emergency Care and Disaster Medicine "of Zaporizhia Regional Council, and 75 persons who had a stable course of the disease and were examined on an outpatient basis on the basis of KZ "Center for Primary Health Care № 10". Almost healthy 31 people were examined on the basis of KU "Regional Medical and Physical Dispensary" of Zaporizhia Regional Council. All subjects under the design were measured blood pressure with the calculation of hemodynamic parameters, ECG with the determination of HRV, Echo-CG, also determined the level of HF-CRP, IL-1β, IL-10, TNF-α in blood plasma. Statistical processing of the obtained data was performed using the SPSS application package (version 0.10.2, GNU Project, 1998-2016) and Apache Open Office (version 4.1, GNU GPL licenses). Results and discussion. The analysis of distribution on each studied criterion was carried out. The indicators of systemic hemodynamics in persons with hypertension with crisis, in persons with hypertension without crisis, as well as in almost healthy individuals were analyzed. There was no significant difference in this indicator between the group of patients with hypertension without crisis and almost healthy individuals (p >0.05), and in numerical indicators of heart rate variability in the subjects. In the group of hypertension with hypertensive crisis, we detected activation of the sympathetic division of the autonomic nervous system (by increasing the LF / HF ratio). Thus, the obtained results indicate that the decrease in compensatory capacity for HRV SDNN and TP is more pronounced in patients with hypertension with the development of hypertensive crisis. In the group of patients with hypertension with hypertensive crisis, there was a significant increase in HRV by 3.4 times the level of 12.98 [9.45-18.61] mg / l against the value of 3.84 [1.93-4.89] mg / l in the group of stable hypertension. Conclusion. The use of markers of systemic inflammatory response, indicators of heart rate variability in the diagnosis of patients with hypertension is appropriate because they reflect the potential for recurrent crises or complications, and can be used as prognostic markers.

Keywords: hypertension, hypertensive crisis, systemic inflammatory response, adverse course

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