Резюме
Ігнатенко Г.А., Мухін І.В., Іванченко Ю.О., Кошелева О.М. Перебіг гіпертензивного синдрому у хворих з хронічним обструктивним захворюванням легенів.
Мета дослідження полягала в аналізі особливостей перебігу гіпертензивного синдрому у хворих з коморбідним ХОЗЛ. Клінічний перебіг гіпертензивного синдрому в хворих з ХОЗЛ проявляється головним болем (у 73,7%), запамороченням (у 42,1%) і нудотою (у 18,4%). Додатковими проявами гіпертензивного синдрому є тривога (у 55,3%), серцебиття (у 77,6%) і перебої в роботі серця (у 30,3%). Найчастіше зустрічалася надшлуночкова (42,1%) і шлуночкова екстрасистолічна аритмія (32,9%). Пароксизмальна форма фібриляції передсердь була встановлена за допомогою холтерівського моніторування ЕКГ у 19,7% пацієнтів. Понад 50% хворих мали вихідну синусову тахікардію (67,1%) і синусову аритмію (у 27,6). Перший та другий класи шлуночкової екстрасистолії спостерігали у 32,0 і 32,0% хворих. Друге місце займав 3-ій клас (16,0%). У 12,0 і 8,0% визначалися життя небезпечні шлуночкові порушення.  У 46,1% досліджених хворих встановлено ЕКГ-ознаки ізольованої гіпертрофії лівого передсердя, у 32,9% - ознаки гіпертрофії лівого шлуночка і у 31,6% - ознаки гіпертрофії лівих відділів серця. Встановлено ознаки гіпертрофії правого передсердя у 21,1%, правого шлуночка – у 18,4% та правого передсердя і правого шлуночка у 14,5%. У 27,6% встановлена гіпертрофія лівого та правого передсердя. Мала місце помірна систоло-діастолічна артеріальна гіпертензія з переважанням тиску крові в денні часи.
Ключові слова: гіпертензивний синдром, хронічне обструктивне захворювання легенів.
Резюме
Игнатенко Г.А., Мухин И.В., Иванченко Ю.А., Кошелева Е.Н. Течение гипертензивного синдрома у больных с хроническим обструктивным заболеванием легких.
Цель исследования заключалась в анализе особенностей течения гипертензивного синдрома у больных с коморбидным ХОЗЛ. Клиническое течение гипертензивного синдрома у больных с ХОЗЛ проявляется головной болью (у 73,7%), головокружением (у 42,1%) и тошнотой (у 18,4%). Дополнительными проявлениями гипертензивного синдрома является тревога (у 55,3%), сердцебиение (у 77,6%) и перебои в работе сердца (у 30,3%). Чаще встречалась наджелудочковая (42,1%) и желудочковая экстрасистолическая аритмия (32,9%). Пароксизмальная форма фибрилляции предсердий была установлена с помощью холтеровского мониторирования ЭКГ у 19,7% пациентов. 67,1% больных имели исходную синусовую тахикардию, а 27,6% - синусовоую аритмию. Первый и второй классы желудочковой экстрасистолии наблюдали у 32,0 и 32,0% больных. Второе место занимал третий класс (16,0%). У 12,0 и 8,0% определялись жизнеопасные желудочковые нарушения сердечного ритма. У 46,1% обследованных больных установлено ЭКГ - признаки изолированной гипертрофии левого предсердия, у 32,9% - признаки гипертрофии левого желудочка и у 31,6% - признаки гипертрофии левых отделов сердца. Установлены признаки гипертрофии правого предсердия у 21,1%, правого желудочка - у 18,4% и правого предсердия и правого желудочка у 14,5% пациентов. У 27,6% выявлена гипертрофия левого и правого предсердия. Имела место умеренная систоло-диастолическая артериальная гипертензия с преобладанием давления крови в дневные часы.
Ключевые слова: гипертензивный синдром, хроническое обструктивное заболевание легких.
Summаry
Ignatenko G.A., Mukhin I.V., Ivanchenko I.A., Kosheleva E.N. The course of hypertensive syndrome in patients with chronic obstructive pulmonary disease.
The purpose of the study was to analyze the peculiarities of hypertensive syndrome in patients with comorbid COPD. For the purpose of the study examined 250 patients with COPD , including further study selected 76 (30,4%) hypertensive patients with COPD aged 45 to 65 years (mean age 55,3±2,6 years). The clinical course of hypertensive syndrome in patients with COPD was manifested with headache (in 73,7%), dizziness (42.1%) and nausea (18,4%). The additional manifestations of hypertensive syndrome were anxiety (at 55,3%), palpitations (at 77.6%) and disruption of the heart rhythm (at 30,3%). The supraventricular (42.1%) and ventricular extrasystolic arrhythmia (32,9%) were appeared more frequently. Paroxysmal atrial fibrillation was founded while Holter ECG monitoring in 19,7% of patients. The 67,1% of patients had initial sinus tachycardia, and 27,6% of them had sinus arrhythmia. The first and second classes of ventricular arrhythmias were observed in 32,0% and 32,0% of patients. The second place was taken by the third class (16,0%). The life-threatening ventricular arrhythmias were determined in 12,0 and 8,0%. In 46,1% of the patients the ECG - signs of isolated hypertrophy of the left atrium was identified, at 32,9% the signs of left ventricular hypertrophy was founded and in 31,6% - the signs of hypertrophy of the left chambers of the heart. The right atrium hypertrophy was identified in 21,1%, the right ventricle - in 18,4%, and the right atrium and right ventricle- in 14,5% of patients. At 27,6% of patients, hypertrophy of the left and right atrium were revealed.
Key words: hypertension syndrome, chronic obstructive pulmonary disease.
Рецензент: д.мед.н., проф. Л.М. Іванова

УДК 616.12-008.331.1+616.24-007.272-002.2]-085.835.3

Донецький національний медичний університет ім. М. Горького

Донецкий национальный медицинский университет им. М.Горького

M. Gorky Donetsk National Medical University 

i12041964m@yandex.ru

Arterial hypertension and chronic obstructive pulmonary disease (COPD) is the most frequent diseases of modern mankind. The course of each individually very carefully studied. Meanwhile, a disease occurring in conditions of comorbidity with certain features of clinical and instrumental manifestations. The study was carried out in accordance with the basic plan research Donetsk National Medical University by Gorky and is a fragment of the planned research themes of the department of internal medicine and propaedeutic "Use of interval normobaric hypoxytherapy in treatment and combined therapy monoorganic pathology» (№ state. registration 0108U009884). The purpose of the study was to analyze the peculiarities of hypertensive syndrome in patients with comorbid COPD. For the purpose of the study examined 250 patients with COPD , including further study selected 76(30.4%) hypertensive patients with COPD aged 45 to 65 years (mean age 55,3±2,6 years). Diagnosis and treatment of hypertension was performed according to current WHO recommendations (1996), European and Ukrainian Association of Cardiology. Having established hypertension with systolic blood pressure ≥ 140 mm Hg. century. or diastolic blood pressure ≥ 90 mm ​​Hg. century. Diagnosis of COPD was conducted in accordance with the order of the Ministry of Health of Ukraine № 128 from 12.03.2007 year and provisions contained in the document GOLD. Inclusion criteria were presence of "mild" hypertension (1-2 stage and 1-2 grade) and COPD 1-2 stage in its stable form. Exclusion criteria in the study were: secondary (symptomatic) hypertension, acute coronary syndrome, myocardial infarction, angina pectoris, permanent atrial fibrillation, valvular heart disease, chronic heart failure stage III by NYHA, stage 3 grade 3 of hypertension, dysfunction of thyroid gland, period of infectious exacerbation of COPD, the presence of bronchial obstruction. During the study used a set of research techniques: resting ECG (6/12 channel electrocardiograph «Bioset» 8000, Germany), Holter monitoring of ECG and blood pressure (heart rate monitor «Cardio Tens» company «Meditech», (Hungary) and "Kardyotehnyka" - 04-DR-3 (M), «Incart» (Russia)). Statistical analysis of the material was performed by using software for statistical analysis «Statistica 6". The clinical course of hypertensive syndrome in patients with COPD was manifested with headache (in 73.7%), dizziness (42.1%) and nausea (18.4%). The additional manifestations of hypertensive syndrome were anxiety (at 55.3%), palpitations (at 77.6%) and disruption of the heart rhythm (at 30.3%). The supraventricular (42.1%) and ventricular extrasystolic arrhythmia (32.9%) were appeared more frequently. Paroxysmal atrial fibrillation was founded while Holter ECG monitoring in 19.7% of patients. The 67.1% of patients had initial sinus tachycardia, and 27.6% of them had sinus arrhythmia. The first and second classes of ventricular arrhythmias were observed in 32.0% and 32.0% of patients. The second place was taken by the third class (16.0%). The life-threatening ventricular arrhythmias were determined in 12.0 and 8.0%. In 46.1% of the patients the ECG - signs of isolated hypertrophy of the left atrium was identified, at 32.9% the signs of left ventricular hypertrophy was founded and in 31.6% - the signs of hypertrophy of the left chambers of the heart. The right atrium hypertrophy was identified in 21.1%, the right ventricle - in 18.4%, and the right atrium and right ventricle- in 14.5% of patients. At 27.6% of patients, hypertrophy of the left and right atrium were revealed. There was founded a moderate systolic and diastolic hypertension with prevalence of blood pressure during daytime. In analyzing the types of daily blood pressure variability was found that in the majority of patients (46.1%) was detected predominantly full-hypertension and insufficient (sub-optimal) reduction in blood pressure at night (type Non-dipper). Only 22.4 % had daily fluctuations that to approach them to physiological categories Dipper. In 23.7% there was a type of Night-peaker, the presence of which indicates a predominantly nocturnal hypertension, which in systolic and diastolic values ​​than daily. Thus, the studied cohort of patients can be roughly divided into several categories, among which is a mainly day hypertension with low blood pressure reduction at night (46.1%), mainly daily hypertension approaching the physiological pressure fluctuations during the day (22.4%) and mainly nocturnal hypertension prevalence of pressure at night (23.7%). These data imply that 2/3 of the patients had hypertension usually daily, 1/3 - Dipper and Night-peaker types of hypertension. It is believed that the nature of the hypertension in patients with COPD is characterized by various changes daily fluctuations in blood pressure dominated daytime hypertension. Meanwhile, the presence Night-peaker type may indicate the presence of a dangerous nature arterial hypertension is at night on cardiac and cerebral hemodynamics. In addition, this version is observed in people with COPD and sleep apnea syndrome, and is viewed from a dangerous option.

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