Zemlyanskaya N.A., Kushnir K.G., Kolbasina L.P., Severinova S.K.

SI “Crimea State Medical University named after S. I. Georgievsky”

Methods of adaptation potential correction in patients with chronic hypertonic disease on the stage of health resort rehabilitation

Human vital activity is regulated by précised coordination of biorhythms which react adequate on changes both in the organism and in environment. The ability to answer on different exogenous and endogenous stimuli with the remake of biorhythms characterizes heath and stability of human organism.

The main endogenous rhythms messenger is melatonin, whose secretion depends on circadian (daily) rhythm. This pituitary gland hormone has rhythm-regulating, antioxidant, immunomodyfing and other activities that determine organism systems consistent activity.

Melatonin impact on cardiovascular system is manifested by decrease of systolic arterial pressure in rest and decrease of systolic pressure growth in case of psychoemotional test, which says about cardiovascular system limited stress reactivity.

If to say that hypertonic disease partially is the disease of disadaptation (essential hypertension) the studying of melatonin production in case of such pathology is justified. When patients with hypertonic disease have the rehabilitation in health resorts the fact of migration to new climatic zone and changes of common regimen may cause tension of adaptation processes and circadian deregulation. Regulatory systems tension and organism functional reserves mobilization is the “price” for adaptation in such conditions. Despite sleep impairments and depression level increase are also present in such cases, main vital indexes such as heart beat rate, cardiac output and arterial pressure stay for a long in normal limits. That’s why it is important to determine adaptation potential of cardiovascular system for its function measurements. The target of our investigation is the adaptation period optimizing on health resort stage of rehabilitation of patients with hypertonic disease. Next problems are solved:

1. The determination and intensity of adaptation is measured by 6-hydroxymelatoninsulphate (6-HMS) excretion in nocturnal urine of patients with hypertonic disease in health resort conditions.

2. Analyzing of adaptation potential is such patients before and after melatonin drug intake.

The investigation was performed on the base of “Ukraine” health resort (Yalta city) and laboratory investigation department of scientific-medical state complex of SI “CSMU named after S.I. Georgievskiy” hospital. The 4 groups of patients were formed: 1^st group was composed of 15 male patients with hypertonic disease of II stage, average age of patients - 52±6,15 years; second group – 15 female patients with hypertonic disease of II stage, average age - 51±6,15 years; 2 control groups – first control group of 15 healthy young people with average age about 24±3,11 years and second control group of 15 almost healthy men without arterial hypertension and CHD signs with average age of 51±5,48 years.

Measurement of melatonin concentration has daily rhythm and its half-life is only 45 minutes, that’s why blood samples for analyze should be taken in short time. Considering that sleep disturbance at night may cause melatonin level changing, the best way to measure its level is melatonin metabolites analyze, mostly hydroxymelatoninsulphate (6-HMS) in urine, because 80-90% is secreted in urine in melatoninsuphate form, which correlates with melatonin level in blood during blood sampling. All analyzes were performed in the dynamics before and after course of melatonin drugs (“Vita-Melatonin”, Ukraine) in 3 mg daily dosage once a day at 21:00 p.m.

After taking of 5-day “Vita-Melatonin” course positive changes in both groups of patients is marked. In first group adaptation potential after taking of the melatonin course increased on 11,8%, in second group – on 10,19%. After 14 days of melatonin drugs taking adaptation potential increased relatively on 16,35% and 16,07%, but differences with control group stayed reliable.

In such a way after the receiving of melatonin drug course adaptation potential in males with hypertonic disease was equal to adequate functional possibilities of cardiovascular system (average adaptation), in females potential level changed from insufficient to intense level of adaptation. Arterial pressure in first group decreased on 14, 96% (from 144,9±18,36 to 123,22±9,89) and on 16,81% in second group (from 143,69±13,26 to 119,54±7,25). Simultaneously with decrease of arterial pressure patients felt better, up to normalization of “sleep-wake” processes and its circadian regulation with arterial pressure. Melatonin excretion in women is lower, this may be connected with endogenous melatonin production inhibition because of hyperprolactineemia. In such a way we may say that melatonin drugs prescribing to women of menopausal and postmenopausal age is important in case that they have chronic hypertonic disease.

Conclusions:

1. Rehabilitation in health resorts and changes of common regimen may cause tension of adaptation processes and circadian deregulation in patients with chronic hypertonic disease.

2. After the receiving of melatonin drug course adaptation potential in males with hypertonic disease was equal to adequate functional possibilities of cardiovascular system (average adaptation), in females potential level changed from insufficient to intense level of adaptation.

3. Rehabilitation in health resorts is necessary for adequate treatment of patients with chronic hypertonic disease.

4. Melatonin drugs prescribing to women of menopausal and postmenopausal age are important in case that they have chronic hypertonic disease.