medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-14-36-43medsovet-6390Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯARTERIAL HYPERTENSIONГемодинамические эффекты комбинированной антигипертензивной терапии при физической нагрузке у мужчин с артериальной гипертензией и хроническими заболеваниями венHemodynamic effects of combined antihypertensive therapy during exercise in men with arterial hypertension and chronic venous diseaseshttps://orcid.org/0000-0002-1635-7149ЛетягинаС. В.LetyaginaS. V.

Летягина Светлана Витальевна, врач отделения ультразвуковой диагностики

614064, Пермь, ул. Героев Хасана, д. 47а

Svetlana V. Letyagina, Doctor of the Ultrasound Department

47а, Geroev Khasana St., Perm, 614064

sveeet.l@yandex.ruhttps://orcid.org/0000-0001-9283-8094БаевВ. М.BaevV. M.

Баев Валерий Михайлович, д.м.н., профессор кафедры анестезиологии, реаниматологии и скорой медицинской помощи

614000, Пермь, ул. Петропавловская, д. 26

Valeryi  Baev, Dr. Sci. (Med.), Professor of the Department of Anesthesiology, Intensive Care and Emergency Medicine

26, Petropavlovskaya St., Perm, 614990

vmbaev@hotmail.comhttps://orcid.org/0000-0001-9935-0040АгафоноваТ. Ю.AgafonovaT. Y.

Агафонова Татьяна Юрьевна, к.м.н., доцент кафедры пропедевтики внутренних болезней №1

614000, Пермь, ул. Петропавловская, д. 26

Tatyana Y. Agafonova, Cand. Sci. (Med.), Associate Professor of the Department of Propaedeutics of Internal Medicine No. 1

26, Petropavlovskaya St., Perm, 614990

agaf74@mail.ruМедико-санитарная часть Министерства внутренних дел Российской Федерации по Пермскому краюРоссияHospital of the Police of Russia on the Perm EdgeRussian FederationПермский государственный медицинский университет имени академика Е.А. ВагнераРоссияVagner Perm State Medical UniversityRussian Federation2021151020210143643Copyright © Летягина С.В., Баев В.М., Агафонова Т.Ю., 20212021Летягина С.В., Баев В.М., Агафонова Т.Ю.Letyagina S.V., Baev V.M., Agafonova T.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6390

Введение. В настоящее время недостаточно данных о влиянии современной антигипертензивной терапии на венозное кровообращение, особенно при физиологических нагрузках.Цель исследования. Изучить гемодинамические эффекты комбинации блокатора кальциевых каналов и  ингибитора ангиотензинпревращающего фермента при физической нагрузке у мужчин с артериальной гипертензией (АГ) и хроническими заболеваниями вен (ХЗВ).Материал и методы. У 46 мужчин 30—50 лет с АГ на фоне комбинированной антигипертензивной терапии (АГТ) выполнена сравнительная оценка динамики систолического (САД) и диастолического артериального давления (ДАД), периферического венозного давления (ПВД), ультразвуковых параметров венозного кровотока левой ноги в  ответ на  физическую нагрузку (проба Руффьера). Оценивали параметры у 23 пациентов с АГ без ХЗВ и 23 пациентов с АГ и ХЗВ. Изучали реакцию до и после 14-дневной комбинированной АГТ с  применением блокатора кальциевых каналов (БКК) (амлодипин) и  ингибитора ангиотензинпревращающего фермента (АПФ) (лизиноприл).Результаты. До лечения реакция на нагрузку у пациентов обеих групп была одинаковой и проявлялась двукратным увеличением площади просвета вен и падением скорости кровотока. Пациенты с ХЗВ до лечения при нагрузке характеризовались измененной реакцией системной гемодинамики, более частыми случаями дилатации вен и снижения скорости кровотока. После АГТ при нагрузке в обеих группах отмечается нормализация и идентичность САД, ДАД, ПВД, уменьшение выраженности дилатации вен и снижение скорости кровотока. Пациенты с ХЗВ после АГТ в ответ на нагрузку характеризуются более выраженной дилатацией вени и большей скоростью кровотока.Выводы. После 14-дневной АГТ у пациентов с АГ без ХЗВ и пациентов с АГ и ХЗВ при физической нагрузке отмечается нормализация САД, ДАД, ПВД, уменьшение дилатации вен и снижение скорости кровотока. Пациенты с ХЗВ после АГТ при нагрузке характеризуются расширением вен и ускоренным венозным кровотоком.

Introduction. Currently, there is insufficient data on the effect of modern antihypertensive therapy (AHT) on venous circulation, especially during physiological stress.Aim of the study – the investigation was to study the hemodynamic effects of a combination of a calcium channel blocker (CCB) and an angiotensin-converting enzyme (ACE) inhibitor during exercise in men with arterial hypertension (AH) and chronic venous diseases (CVD).Material and methods. In 46 men 30–50 years old with AH on the background of AHT, a comparative assessment of the dynamics of SBP, DBP, peripheral venous pressure (PVP), ultrasound parameters of venous blood flow of the left leg in response to physical activity (Ruffier’s test) was performed. The parameters were assessed in 23 patients with hypertension without CVD and 23 patients with hypertension and CVD. We studied the reaction before and after 14 days of combined AHT with the use of CCB (Amlodipine) and an ACE inhibitor (Lisinopril).Results. Before treatment, the response to exercise in patients of both groups was the same and was manifested by a twofold increase in the area of the lumen of the veins and a drop in blood flow velocity. Patients with CVD before treatment with exercise were characterized by an altered systemic hemodynamic response, more frequent cases of venous dilatation and decreased blood flow velocity. After AHT with exercise, both groups showed normalization and identity of SBP. DBP, PVP, a decrease in the severity of venous dilatation and a decrease in blood flow velocity. Patients with CVD after AHT in response to exercise are characterized by more pronounced venous dilatation and higher blood flow velocity.Conclusion. After 14  days of  antihypertensive therapy in  patients with hypertension without chronic venous disease and in patients with hypertension and chronic venous disease during exercise normalization of systolic blood pressure, diastolic blood pressure, PVP, a decrease in venous dilatation and a decrease in blood flow velocity are noted. Patients with CVD after AHT under load are characterized by varicose veins and accelerated venous blood flow.

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The authors declare that there are no conflicts of interest present.