ACTUAL PROBLEMS OF ARTERIAL HYPERTENSIONS PATHOGENESIS, CLINICS AND TREATMENT
V. M. Haroutyunian
Results of invrstigations, conducted by collaborators of
Internal Diseases Department N2, Department of Diagnostics of
Yerevan State Medical University, laboratory of clinical biochemistry
with chronobiologist from SII of Cardiology, RMC "Armenia"
Republican (dispansary) endocrinological dispansary, presented
in this book, concern different actual aspects of essential
and secondary arterial hypertension.
Here presented interesting data of epidemiological investigations,
concerning spread of AH in stress-groups of the RA population.
High frequency of AH presence among refugees from
Azerbaijan is revealed. These results point out necessity to
conduct special mass examination among these groups of RA population.
Chronobiological method is new and prospective direction in
diagnostics of essential hypertension (EH). BP level chenges in
patients with EH are under the influence of biorythmological
regularity. Biorythmological investigations in patients with EH
are very actual, thet's why methodical basis of
chronodiagnostics have to be outlined because of great
importance for the furder effective curative and preventive
measures in dynamics, and also for prognostication of possible
complecations in patients with EH.
Series of investigations are devoted to the comparative
study of ultrasound scanning, reontgenocontrast methods,
radioisotope renography, scintigraphy and CT properties in
diagnostics of different nefrogenic hipertension forms. Authors
defined that ultrasound renography allows to discover renal
changes in 86,1% of cases and make a sure diagnosis in 64%. High
informative valae and absence of contradications give us a
reason to recomend this method for wide use not only in special
medical institutions, but also in the system of practical Public
Health.
Some works in this book concern pathogenesis, structural
and functional heart reorganization and changes of GIT in
patients with AH. We have to take into account ways of heart
reorganization during adaptation for further prognosis and
correct estimation of adaptation mechanisms of the heart in
patients with AH, and also to control efficacy of
antihypertensive therapy for remodelling of left ventricle
hypertrophy and restoration of functional heart condition.
In works, devoted to pathogenesis of GIT disturbances in
patients with EH, presented new, not traditional ideas about
frequent affection of GIT due to hypertension. Pure blood supply
in tissues, especially during paroxysm, has important role in
pathogenesis of noted digestion disorders. These facts have to
be used for preventive measures and theraphy of GIT disturbances
in patients with EH.
Two works are devoted to the pathogenesis of AH in patients
with FMF and amyloidosis. First work concerns causes of AH
absence in patients with FMF during paroxysm, despite high level
of sympathomimetic amines in blood. Mechanisms of AH in patients
with amyloid dystrophy of kidneys and causes of AH absence with
the presence of endent ischemia of both kidneys, caused by
amyloid accumulation, are discussed in second work. Authors
suppose, that hypertension and especially hypotension in
patients with amyloidosis is caused by extrarenal factors, in
particular by amyloid distrophy of endocrine system and liver
condition.
Interesting data about hemorheological effects of Cardil
(diltiazem) are presented in works, devoted to problems of AH
therapy.
Some works, concerning chronoeffects of antihypertensive
remedies, in particular clonidine and chronobiological reactions
of kidneys in patients with chronic glomerulonephritis and AH,
are very interesting. Authors convince, that time factor,
physiological biorhythms of organism are to be taken into
account while using pharmacological remedies, that
allowsbiorhythms of organism are to increase efficacy of
therapeutic influence in doses without adverse reactions.
Two works are devoted to the pharmacotherapy of AH by propranolol
and renitec.
Thus, results of different investigations, conducted in
different scientific groups, concerning actual aspects of AH,
are presented in this book. Investigative work is to be
continued and new data, acquired during that process, having
theoretical and practical interest, are to be presented in the
next book, devoted to not solved problems of AH.
Head of Internal Diseases Department N2
of Yerevan State Medical University
Head of Armenian Internists Assocition,
MD, professor
V.M. Haroutyunian
Yerevan 1996, p. 107