Batdieva V.A., Nagapetjan V.K., Rusenko N.I.
Scientific Center for Restorative and Resort Medicine RAMS, Moscow.
Hypertension makes significant contribution to the growing rate of cardiovascular diseases. According to the data of World Health Organization, one third of all the deaths registered in the world iscaused by cardiovascular diseases. (1)
Epidemiologic situation in Russian Federation proves a well conserved trend of high indices of cardiovascular diseases and death-rate caused by this type of diseases. The incidence of circulatory system diseases is currently growing to 1 million cases. The experts forecast that the rate of deaths caused by circulatory system diseases will grow even further. Current situation is connected with the rise of diseases with concomitant hypertension on the one hand, and with the strong tendency of these diseases to grow into an epidemic, on the other hand. The popularity of hypertension among population over 15 years old averages to 40 %. High rate of hypertension among children and teenagers claims attention. Annually, the number of registered children with hypertension increases by more than 5 %.
A lot of authors keep to the opinion that hypertension is one of the leading risk factors for development of coronary heart disease and at the same time represents a separate disease that requires diagnostics and adequate treatment.
In spite of the wide range of available medicines used for hypertension treatment, the number of patients is increasing. Thus, the search for new methods of treatment is still acute. In view of the above said, to decrease the risk of cardiovascular complication and extend life of patients is of primary importance in hypertension treatment (3,4). Physiotherapy, balneotherapy, acupuncture and influence of physical factors on acupuncture points have found wide application in multimodality treatment of hypertension.
It’s known that in case of the influence on acupuncture points the response is passed through nervous system with participation of neurohumoral factor. During the stimulation of acupuncture points, the most evident reaction is observed in the form of metametricor or segmental response of the internals, the point being stimulated is more bound up with. But, the irritation response is not restricted by the segmental reaction only. Systemic reaction including adaptive response and homeostatic mechanism develops as well. Systemic reaction appears as a result of signals coming from the periphery to the region of the subcortical brain, and reticular formation.
Afferent input moving through the spinal canal and autonomic channel changes the functional state of nonspecific activating system (i.e. reticular formation, hypothalamus, hippocampus, etc.). Systemic reaction is traced in normalization and rearrangement of hormonal profile and biological substances that participate in regulation of physiological processes. (5)
Dynamic electric neurostimulation (DENS) is the type of percutaneous electric neurostimulation that influences on reflexogenic zones and acupuncture points with pulses of current, the shape of the impulse depending on the total galvanic skin resistance in below-the-electrode area. Therapeutic action of dynamic electric neurostimulation is based on reflex mechanism, which is started up by irritation of receptors in reflexogenic zones and acupuncture points.
When The Nei-Kuan-Point is influenced by pulse current, pathogenetic action of hypertension development is being corrected. Hence, treatment with dynamic electric neurostimulation can be advised in case of hypertensive disease. Available foreign and domestic literature has no lights of application of the DENS –method to stimulation of acupuncture points in patients with hypertensive disease.
Purpose of Research
The purpose of the current research was to estimate the influence of “DiaDeNS – Cardio” apparatus on the blood pressure dynamics in patients with the initial and secondary stages of hypertensive disease.
Patients and Methods of the Research
60 patients with the initial and secondary stages of hypertensive disease (in accordance with classification given by World Health Organization and The Society of Cardiology of the Russian Federation) were divided into two randomized groups. All the patients were receiving baseline drug therapy.
The first group submitted to clinical observation included 30 patients with the initial and secondary stages of hypertensive disease. These patients received treatment with application of dynamic electric neurostimulation. The age of the patients varied between 43 to 70 years old, the duration of a disease made up 7,4±1,6 years. The sessions of dynamic electric stimulation were delivered everyday, the influence being targeted at The Nei-Kuan-Point. The duration of the session was determined by the program and averaged 5-6 minutes.
The second group under clinical observation consisted of 30 patients with the initial and secondary stages of hypertensive disease. These patients were getting placebo treatment, the applied apparatus didn’t differ from the working one, and it uttered the sounds but didn’t generate pulse current. The age of the patients varied between 41 to 70 years old, the disease lasted near 7,2±1,7 years.
Routine examinations, i.e. clinical trials and function studies, were provided for all the patients.
Results of the Research
The course of treatment with dynamic electric neurostimulation in the first group of patients resulted in positive dynamics in clinical presentation of the disease against a background of ambulatory blood pressure monitoring (ABPM) and allowed to decrease the drug dose, prescribed to the patients.
The intensity of headache significantly decreased. Change in pain, as measured on a 100-mm Visual Analogue Scale decreased from 4,35±0,36 to 1,95±0,36 (Р<0,001) in patients of the first group. In the second group the decrease of the headache intensity according to VAS was unauthentic, i.e. the rate shifted from 3,90±0,24 to 3,30±0,24 (Р>0,1).
Authentic depression of average daily systolic blood pressure (Р<0,05) was recorded after the course of dynamic electric neurostimulation. Moreover, the average value of systolic blood pressure varied from 151,5±2,6 mm Hg to 131,8±2,2 mm Hg (Р<0,01) during the day and from 132,2±3,6 mm Hg to 119,8±3,8 mm Hg (Р<0,05) at night.
The hypertension time index for systolic blood pressure decreased from 42,2±3,4% to 27,2±2,1% (Р<0,01), and in case of diastolic blood pressure the hypertension time index declined from 41,5±2,2% to 29,7±4,3% (Р<0,05).
Authentic decrease of the hypertension time index for systolic blood pressure (from 35,3±3,8% to 26,3±3,4% (Р<0,01)) and for diastolic blood pressure (from 34,6±4,1% to 23,4±4,1% (Р<0,05)) was observed during daylight hours. At night, sifnificant decline of the index was admitted for systolic blood pressure only (from 36,3±3,6% to 23,7±2,9% (Р<0,05)).
The analysis of the blood pressure variability allowed concluding that dynamic electric neurostimulation has an impact on variability of diastolic and systolic blood pressure during daylight hours and at night. Thus, variability of systolic blood pressure decreased from 19,9±2,0 mm Hg to 13,0±1,5 mm Hg (Р<0,05) during daylight hours, and from 23,6±2,2 mm Hg to 14,6±2,1 mm Hg at night. At the same time variability of diastolic blood pressure decreased from 16,6±1,6 mm Hg to 12,8±1,2 mm Hg during the day, (Р>0,05), and from 15,7±1,2 mm Hg to 11,2±1,7 mm Hg at night (Р<0,05).
As far as variability of average daily blood pressure is concerned, authentic data was received for systolic blood pressure only. The rate of variability shifted from 23,2±1,9 to 14,4±3,2 мм mm Hg (Р<0,05).
After the course of DENS – therapy the speed of morning rise in diastolic blood pressure slowed down from 12,2±1,3 to 6,4±1,4 mm Hg/h (Р<0,05), and the same tendency was traced in the speed of morning rise in systolic blood pressure.
Cardioversion was admitted to have positive impact on circadian rhythm of blood pressure. Thus, the number of “non-dippers” dropped from 57 % to 43 %.
In the second group under the placebo treatment only depression of average daily systolic blood pressure from 149,7±2,8 mm Hg to 138,3±3,8 mm Hg (Р>0,05) was registered.
Consequently, the achieved results allow considering dynamic electric neurostimulation to be an adequate method to increase the cure rate of the initial and secondary stages of hypertensive disease. The method delivers nosotropic treatment and allows decreasing drug dose and the number of medicine taken by the patients, reducing pharmacological body burden.
Literature
1.World Healf Organization, International Society on Hypertenzion Writing Group // J. Hypertens. 2003; 21:1983-1992.
2. Martynov A.I. Hypertension (standardized approaches to diagnostics and treatment) // Atmosphere, 2006, №3, p.32-39. (in Russian)
3. Semenkin A.A. Possible applications of angiolithic as a marker of negative metabolic effect of thiazide diuretic treatment in patients with hypertension// Ther. Archive, 2007, №4, p.31-38. (inRussian)
4. Tozhiev M.S., Khvan Y.E., Shestov D.B., and others. Prevalence of arterial hypertension and efficacy of long-term multifactor prophylaxis in some regions of Russia // Ther. Archive, 2007, №1, с.27-32. (in Russian)
5. Havaa Luvsan, Traditional and Modern Aspects of Oriental Reflexotherapy. М., Nauka, 1986, 575с. (in Russian)