Peculiarities of hemodynamic and psychovegetative disorders in young men with arterial hypertension

The dissertation is devoted to the study of the peculiarities of hemodynamic and psychovegetative disorders in young men with arterial hypertension employed in the internal affairs bodies. The work examines the prevalence of risk factors, the pattern of target organ damage, the state of systemic circulation and structural-geometric changes of the left ventricle, as well as psychovegetative disorders within the structure of the disease. Particular attention is paid to the interrelationship of hemodynamic parameters, autonomic regulation of cardiac rhythm, emotional disorders and the level of physical activity and working capacity depending on the stage of the disease, the place of residence and the nature of the work activity of the patients.

The study proposes a comprehensive approach to the assessment of target organ damage that integrates data from ambulatory blood pressure monitoring, echocardiography, exercise tests and psychometric scales. It is established that the combined effect of pathogenic factors leads to an increase in myocardial and psychovegetative disorders from stage I to stage III of the disease and forms a syndrome of psychophysical maladaptation, which is of importance for the development of individual programs of prevention, treatment and the resolution of expert issues.

Relevance of the topic

The epidemiological situation in the Russian Federation indicates a continuing steady trend of high morbidity and mortality rates from cardiovascular pathology among the population [25,223,146,74]. In recent decades, mortality from cardiovascular diseases in the Russian Federation has significantly exceeded the corresponding figure in Western countries and has led to a decrease in life expectancy of the population [47,198,132,58]. In 30-40% of the adult population of Russia, blood pressure exceeds 140/90 mm Hg [310,4,156,216]. The insidiousness of arterial hypertension lies in the fact that, often without clinical manifestations, it leads to the development of severe cardiovascular complications such as coronary heart disease and cerebral stroke, as well as to early disability and reduced life expectancy [208,25,110,97,116]. Moreover, the majority of patients are persons with mild AH, and the largest proportion of strokes and infarctions occurs precisely in this category of patients [157]. Of particular concern is the prevalence of AH among young people, as well as the increase in mortality in this population group [74,131,132,146,160,138]. It is known that before the age of 40 AH is more common in men, and after 50 years of age it is more common in women [160]; moreover, men, unlike women, are less aware of the presence of the disease and do not attach due importance to AH. Therefore, in order to develop individual therapeutic and preventive measures, a detailed study of risk factors and peculiarities of the course of AH in young men employed in the internal affairs bodies is required.

In recent years, interest in the study of cardiac rhythm regulation in patients with AH has increased [85,63,89]. At the same time, the peculiarities of autonomic regulation of cardiac rhythm and its interrelationships with the indices of the 24-hour blood pressure profile, physical activity and physical working capacity in young men with AH have not been sufficiently studied.

Neuropsychiatric disorders, being woven into the pathogenesis of AH, leave an imprint on the clinical picture and prognosis of the disease [82,152]. Numerous studies [52,57,58,133,303] have shown that depression and anxiety, being independent risk factors, influence both the development of AH and the survival of patients with this pathology [153,154]. In addition, there are difficulties in diagnosing depressive disorders in men [105] due to their mild severity. Therefore, it is necessary to study in detail the severity of anxiety-depressive disorders in young men with arterial hypertension depending on the nature of the work performed and their interrelationship with hemodynamic and autonomic disorders.

There are data [132,140] that more than one-third of the adult male population of the Russian Federation have low physical activity, both at work and in their leisure time. Low physical activity, as well as low physical working capacity, is associated with an increased risk of developing arterial hypertension [37]. Therefore, a detailed study of the relationship between physical activity and physical working capacity depending on the severity of hemodynamic and psychovegetative disorders in young men with AH employed in the internal affairs bodies is required.

At the same time, multilevel studies concerning the mutual influence of hemodynamic changes, neuropsychiatric disorders, autonomic reactivity and physical working capacity in young men with AH remain insufficiently studied. At the same time, it is precisely the clarification of the peculiarities of the formation and course of cardiac and cerebral lesions taking into account the nature of the work performed that could broaden the understanding of the degree of disorganization of target organs in AH in young men and develop special approaches to prevention and treatment, as well as to the resolution of expert issues.

Aim of the study

To expand the possibilities of diagnosing target organ damage in young men with arterial hypertension employed in the internal affairs bodies, on the basis of a comprehensive study of hemodynamic and psychovegetative disorders and physical working capacity.

Objectives of the study:

1) to study the prevalence of risk factors and the pattern of target organ damage in arterial hypertension in young men depending on the stage of the disease, the place of residence of the patients and the type of work activity;

2) to evaluate the 24-hour blood pressure profile and structural changes in the left ventricular myocardium in young men depending on the peculiarities of the course of arterial hypertension;

3) to clarify psychovegetative relationships in young men with AH according to changes in myocardial-hemodynamic homeostasis;

4) to describe physical activity and physical working capacity in young men with AH according to the severity of the disease, the severity of cerebral vascular insufficiency, the nature of the work performed and the degree of risk of cardiovascular complications.

Scientific novelty of the work For the first time: in young men with AH employed in the internal affairs bodies, heterogeneity of risk factor stratification among urban and rural residents has been revealed; it has been established that in young men with AH the severity of the degree of risk of cardiovascular complications depends not only on the stage of the disease, but also on the place of residence of the patients (higher in rural than in urban residents), as well as on the type of work activity (higher in subordinates than in managers); the peculiarities of structural-geometric changes of the left ventricle, heart rate variability and their interrelationships with the main indices of the 24-hour blood pressure profile have been clarified;

- it has been determined that in young men both PA and PWC decrease in parallel, especially in the crisis course of the disease, excess body weight, alcohol abuse, as well as among persons holding managerial positions and at high and very high CVR risk;

- the character of pre-stroke psychoemotional disorders in young men has been studied in accordance with changes in the 24-hour blood pressure profile and the severity of cerebral vascular insufficiency;

- it has been found that in young men with AH there is a close relationship between the severity of anxiety-depressive disorders and a decrease in physical activity and physical working capacity.

Practical significance of the work

In order to develop individual therapeutic and preventive programs for young men with AH employed in the internal affairs bodies, it is expedient to study the prevalence of behavioral risk factors depending on the place of residence of the patients and the nature of the work performed. For the purpose of timely diagnosis of AH and prevention of target organ damage, as well as for resolving expert issues, it is necessary to use a comprehensive approach that takes into account not only the indices of systemic hemodynamics, the functional state of the autonomic nervous system, exercise tests (bicycle ergometry, step test), but also the level of physical activity, which will allow the physician to correctly assess the compensatory capabilities of the body and to rationally design a program of rehabilitation measures.

Main propositions defended

1. In young men with AH employed in the internal affairs bodies, the severity of risk factors and the frequency of cardiovascular complications depend not only on the stage of the disease and target organ damage, but also on the place of residence and the type of work activity of the patients.

2. The combined effect of pathogenic factors under conditions of increased risk causes tension in the functioning of systemic hemodynamics, which is the basis for the development of myocardial and psychovegetative disorders, the severity of which increases from stage I to stage III of the disease, with the development of hypertensive crises and the intensification of cerebral vascular insufficiency.

3. In young men with AH, especially those living in the city, there is a relationship between the peculiarities of cardiac rhythm regulation and the severity of anxiety-depressive disorders, which together with circulatory disorders lead to a decrease in physical activity and working capacity, forming a syndrome of psychophysical maladaptation.