Search

The paper deals with methodological problems of electrolyte intake in clinical and population-based studies. Marked inter- and intraindividual fluctuations were found to substantially affect the reliability of assessing the intake of electrolytes, which should be borne in mind in practice. Specifically, individual-based reliable characteristics of electrolyte intake (excretion) may be obtained after examining at least 8 daily urinary collections. The adequate validity of group electrolyte intake may be attained when a group consists of at least 8 persons. It is shown that it is feasible to employ the definite urine amounts to gain an insight into electrolyte intake.

For successful control over the arterial hypertension among mass populationit is necessary to create the information system of automated register. In practice, its realization is possible on the basis of different polyclinical departments: prephysician examination, fluorography, and physician cabinets. A micro-computer installed in the polyclinic would be purposeful (and real) for operative decision of the automatic register's problems.

The study included 43,197 men aged 40-54 years, of whom 23,378 were in the intervention group and 19,819 in the comparison group; the number of man-years of follow-up totalled for the whole group 177,703. The study proved the efficacy of active, predominantly secondary prevention of arterial hypertension (AH), carried out in men aged 40-54 years over a period of 3-5 years in 12 centres within the framework of the cooperative programme. In comparison with the control group, the following changes were registered in the intervention group: 1) overall mortality decreased by 17.3%; 2) stroke mortality decreased by 48.4%; 3) non-lethal stroke morbidity decreased by 51.4%; 4) morbidity of non-fatal myocardial infarction decreased in the course of four years by 23.8%. In contrast to this, mortality due to ischaemic heart disease was in the intervention group and in the control group practically the same.

Cerebral circulation in relation to central hemodynamics was examined by means of rheoencephalography and chest rheography in 667 individuals with normal and elevated arterial blood pressure. Cardio-cerebral mechanisms are shown to be pathogenetically engaged since early stages of arterial hypertension. They are manifested as decreased cerebral stroke volume, smaller pulse inflow to cerebral arteries and increased vascular tonicity. Cerebral circulatory disorders grew more severe as the disease progressed.

A study was made of the peculiarities of the cerebral circulation with regard to the central hemodynamics in 326 men and 410 women aged 20 to 54 with normal and raised arterial pressure (AP) by the methods of bipolar rheoencephalography and tetrapolar chest rheography. In the groups with raised AP men (women) demonstrated a decrease in the blood pulse inflow in the cerebral arteries up to 57% (36%), in the stroke volume cerebral fraction up to 69% (53%), an increase in the vascular tone up to 137% (161%), an increase in the total blood-filling up to 157% (176%), inhibition of the rate of the maximum blood-filling up to 54% (37%) as compared to that in normal. With the transition of an AP borderline level to arterial hypertension the frequency and intensity of rheoencephalographic pathology was on an increase.

Questionnaire survey of 934 residents of various regions of the European part of the USSR and the results of the experimental impact of health education media under polyclinical conditions showed that awareness of alcohol-related risk could be achieved only due to doctor's assistance.

The article reflects the results of five-year secondary and primary prevention of arterial hypertension among the workers of a large automobile plant. Secondary prevention of arterial hypertension is an important means of reducing arterial hypertension complications and mortality (the overall mortality went down by 20%, and brain stroke morbidity was 70% lower in the intervention population than in the comparison one). Besides, the search and implementation of the methods of primary prevention of arterial hypertension constitutes the main perspective of the scientific and practical solution of the problem on the population level, as non-drug intervention normalized arterial blood pressure in 70% of subjects with mild hypertension. Thus, arterial hypertension is a complex medico-social problem, the solution of which depends on the fulfillment of equally important medical and socio-cultural tasks.

Signs of left ventricular hypertrophy according to Minnesota code (categories 3-1, 3-3) and ECG findings (RAVL greater than or equal to 7 mm, RV5,6 + SV2 greater than 35 mm, RV6 greater than RV4, with RV6 greater than RV5; S V2 greater than 24 mm and RI + SIII greater than 25 mm) were studied in 779 men, aged 40-54 and 296 women, aged 35-50 in whom essential hypertension was revealed during screening. The control group was formed of a random sample from 341 normotensive men and 103 women of the same age. Signs of left ventricular hypertrophy were observed in 18.2% of men and 5% of women in patients with essential hypertension and in 6.7% of men and 5.8% of women in the control group. Electrocardiographic findings of left ventricular hypertrophy are of high specificity (more than 0.9) and low sensitivity (about 0.1) in regard to essential hypertension.

Results of two years of observation over groups of intervention among men and women indicate that the efficacy of non-medicamentous treatment of mild arterial hypertension in women was 1.5 times higher than in men (90 and 65%, respectively). During the same observation period, the mean level of the DBP in women dropped to a larger degree than in men while in women, the treatment usually made the DBP return to normal whereas in men, only the borderline DBP level could be attained. Thus, the systematic control of the BP in patients with mild arterial hypertension, the patients' counselling as regards the healthy way of life, aiding the patients in the observance of health recommendations, early transfer of patients to drug therapy, if the disease takes an unfavourable course, make it possible to attain satisfactory therapeutic effects, the hypotensive effect included, without resorting to permanent use of drugs.

The ECG data are analyzed in the adolescents, aged 15-16, with arterial hypertension, revealed during the prospective examination. Th main group consisted of 238 adolescents with arterial hypertension, and the control group of 172 healthy adolescents. ECG recording was done in 12 conventional leads. ECG was assessed according to the Minnesota code. The data were compared with the criteria of the clinical electrocardiography. 1/3 of the adolescents had normal ECG. The duration of RQ interval, P wave, QRS complex and internal deviation time were within normal, as in the adults. The signs of the left ventricular hypertrophy were revealed in 11.3% of the adolescents of the main group. The sign RV5,6 + SV1 greater than 35 mm was the most typical one. The left ventricular electric prevalence by the position of the transitional zone was observed in 44.1% of the adolescents of the main group. Sinus tachycardia was detected in 14.7% of the cases.

A total of 569 subjects (91.2% response rate) were examined from a 5% random sample of 40 to 64 year-old men and women in the framework of a prophylactic program on hypertension control. There are 181 patients (31.8%) suffering from arterial hypertension (blood pressure 160/95 mm Hg and above). In 111 of them cardiac insufficiency was diagnosed by standard clinical methods and in 60 patients by bicycle spiroergometry. Two-stage bicycle spiroergometry has some advantages over one-stage test: work load volume, physical adaptation coefficient, time of heart rate recovery were increased by 202.7%, 124.4% and 220%, respectively, the exercise tolerance being improved. Cardiac insufficiency was found in 35.3% of cases, latent IA stage, diagnosed by bicycle spiroergometry, being revealed in 18.3%, IB stage in 10.0%, IIA stage in 3.4% and IIB in 3.6% of cases.

A representative sample of the population of one Moscow district (people aged 35-64) was studied. All the examined subjects were asked, how often they used alcohol. Only 31.1% of women and 14.3% of men used no alcohol at all. The highest was the percentage of persons using alcohol several times a year: 42.1% of men and 60% of women. Men using alcohol several times a week proved to have arterial hypertension more often than those not using alcohol. Among men aged 55-64 using alcohol several times a week nobody had normal blood pressure. The more alcohol people used, the less they cared for their health and the more rarely they visited a doctor.

A three-percent random sample (1267 persons) of the unorganized population of one of the administrative districts of Moscow was examined. Arterial hypertension (AH) was diagnosed in 38.5 percent of the examinees of both sexes aged 35 to 64 years. 65.9 percent of men and 80.9 percent of women were fully aware of being affected with AH. However, only 10.1 percent had received efficient treatment. According to the Rose questionnaire angina pectoris of effort was discovered in 9.6 percent of the examinees. In all 25.8 percent of cases and 30 percent of disability days fell to the lot of essential hypertension and coronary heart disease. The repeated issue of sick-leaves (from 2 to 6 times a year) due to essential hypertension was recorded in 33.8 percent of cases which indicates the lack of regular treatment and control on the part of the treating physician. The sick-leaves were found to be closed irregularly but with the definite intervals, primarily on the 7th, 14th, 21st and 30th days of disability. If hypotensive treatment was given routinely, the mean duration of disability per one patient was two times shorter as compared to that in patients who did not receive any regular treatment.

Within the framework of the 5-year program for the control of arterial hypertension, "detriment" to the population program caused by the lack of preventive work among the so-called healthy portion of the population was estimated at a Moscow machine-building plant. The proportion of patients in whom arterial hypertension was successfully reduced or controlled was matched against the proportion of those whose arterial BP went up above the normal or marginal level during the same period. The study demonstrated the possibility of identifying high-risk individuals in need of primary preventive care within a population, and timely and purposive planning of preventive programs.

Questionnaires were used to examine the extent of hypertensive patients' knowledge of the measures needed to prevent crises and complications of essential hypertension (EH), attitudes to physicians' prescriptions and recommendations and certain elements of hygienic behavior. Male EH patients below 40-50 years of age were found to follow the "I-know-it-is-needed-but-don't-do-it" principle with respect to their health. Many of the older men and the majority of women with EH demonstrated a different health credo: "It is needed, so I am doing it", or "It is needed, so I am trying to do it". Young and middle-aged male hypertensive patients were shown to require medical education to be of convincing or, at some points, even threatening modality, with short and clear-cut health recommendations, while hypertensive females and older males would benefit more from explanatory aids with detailed recommendations on diets, exercise, daily routines, etc.

Relationships between the prevalence of electrocardiographic high-amplitude R and S waves, the stroke index, mean hemodynamic arterial BP and left-ventricular myocardial thickness (MT) were examined in a population of 411 individuals, aged 35-64 years. The prevalence of those waves is shown to have independent functional relationships with the stroke index and mean hemodynamic BP, irrespective of left-ventricular myocardial morphology. This functional approach is used to explain the causes of low sensitivity of electrocardiographic signs of left-ventricular myocardial hypertrophy when used for diagnostic purposes at population screenings.

The obtained experience of echocardiography use in wide population examinations demonstrate that it is of practical value for diagnosis of lesions of heart valves or other heart structures (about 10% of pathology in grown-up population). The efficacy of the method could be highly increased (from 37% to 81%) if the investigation was performed in patients with murmurs above the heart area, with cardiovascular diseases in anamnesis and with marked ECG alterations. Children and adolescents exhibited mainly various types of mitral valve prolapse.

Aim. To assess social status and selected psychological characteristics in organised urban populations from 5 Russian regions; to compare the results with the prevalence of traditional risk factors (RFs) and chronic disease. Material and methods. In 2009-2010, representative samples of organised populations from 5 Russian cities were examined (total n=2227, 1336 women and 891 men). The questionnaires assessed socioeconomic status (SES), as well as somatic and psychological health. The assessed psychological parameters included Lifestyle Index (LI), psychological resilience mechanisms (PRM), social adaptation, sanogenic reflection, Eysenck phychoticism scale, personal moral potential, emotional burnout syndrome, Hospital Anxiety and Depression Scale (HADS), and Perceived Stress Scale (PSS). The examination included the measurement of blood pressure, heart rate, waist circumference, and hips circumference. Results. The proportion of higher-educated people ranged from 82% in Nalchik to 29,3% in Omsk. Low self-rated wealth levels were highly prevalent (from 10,4-13% to 40,4%). Arterial hypertension was registered in 1,29% and 1,64% of men and women aged 25-34 years. In people aged 65-74 years, the respective figures were 60% and 75,8%. Obesity (body mass index ≥30 kg/m2) was registered in over 50% of the participants from all social groups. Negative (pathological) levels of LI significantly correlated with the majority of somatic diseases (рConclusion. The development and implementation of population-level preventive programmes should take into account not only morbidity levels and traditional RFs, but also psychosocial features of the respective population groups.