EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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Introduction. Arterial hypertension (AH) is one of the urgent medical problems because it accelerates the development of arteriosclerosis and is a risk factor of development of vascular disorders. Despite the fact that AH is metabolically greatly connected with obesity, dislipidemia and other risk factors, the functional correlation of stiffness of the vascular wall and psycho-emotional status is not sufficiently studied.

Objective. The aim of our study is to estimate the indices of analysis of pulse-wave shape and the function of endothelium in patients with AH depending on a state of anxious disturbances.

Material and Methods. We examined 202 patients (96- males, 106 – females) with AH II and III stages. They were divided into 2 groups according to the hospital scale of anxiety and depression HADS. The 1st group consisted of 98 patients (age 55,0 ± 0,2) without the signs of anxiety and the 2nd group - 104 patients (age 56,0 ± 0,2) with moderate and obvious alarm disorders. Besides the general clinical examination, the analysis of pulse-wave shape and the test of reactive hyperemia for estimation of endothelium function with photoplethysmographic device AngioScan -1 was assessed according to stiffness index of the large arteries (SI), reflection index of the resistant arteries (RI), augmentation index (Alp), type and amplitude of pulse-wave, shift of phases between channels (C2-C1) before and after occlusion.

Results. During the time of analysis of pulse-wave shape the average meaning of SI in the 1st group (the level of anxiety 4 ± 0,08 scores) was 6,68 ± 0,06 m/sec., RI – 32,79 ± 4,8%, Alp -27,26 ± 4,5%. Herewith the type of wave “A” was observed in 84% of patients which showed the highest degree of vascular stiffness, however in the type of wave “B” it was 16%, showing the smaller vascular elasticity. Dysfunction of endothelium was observed in 98% of patients and it was characterized by the increase in 1,82 ± 0,02 times of pulse-wave amplitude after occlusion and by the shift of phases between the channels (C2 -C1) before and after occlusion - 5,3 ± 0,3 m/sec. During the analysis of pulse-wave shape it was marked the increase SI till 7,9 ± 0,3 m/sec (p= 0,001), RI – 46,34 ± 4,8% (p= 0,05), Alp – 40,45 ± 4,8% ( p= 0,05) in the 2nd group (the level of anxiety 9 ± 0,08 scores (p=0,001) in compare with the 1st one. The type of wave “A” was revealed in 100% of cases. Dysfunction of endothelium was marked in all examined patients. It was more expressed and showed smaller increase of amplitude of pulse-waves (1,42 ± 0,2 times; p=0,05) and smaller shift between the channels (C2 –C1) before and after occlusion -4,3 ±0,2 m/sec (p=0,001).

Conclusions. Thus, it was noted the increase of stiffness of arterial wall and dysfunction of endothelium in patients suffering from arterial hypertension with moderate and expressed alarm disorders. It must be taken into account while developing the individual rehabilitative programs and undertaking the physical social expertise.