Zemlyanskaya N.A., Kolbasina L.P., Kushnir K.G., Lavrinovskaya O.M.
SI “Crimea State Medical University named after S. I. Georgievsky”
Human organism adaptation potential development in patients with chronic
hypertonic disease in the conditions of health resort rehabilitation
Melatonin is also known chemically as N-acetyl-5-methoxytryptamine, is a
naturally occurring compound found in animals, plants, and microbes. In
animals, circulating levels of the hormone melatonin vary in a daily cycle,
thereby allowing the entrainment of the circadian rhythms of several biological
functions.
Many biological effects of melatonin are produced through activation of
melatonin receptors, while others are due to its role as a pervasive and
powerful antioxidant, with a particular role in the protection of nuclear and
mitochondrial DNA.
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. Influence of melatonin on cardiovascular system manifested
by decrease of systolic blood pressure at rest within the physiological
rationality and reduce increase of systolic blood pressure during the psycho-emotional
test, that shows the restriction of stress reaction of cardiovascular system.
On the basis of notions, that
hypertonic disease (essential hypertension) in a certain sense is the disease
of maladjustment, justified the study of melatonin production in this
pathology.
Cardiac output and peripheral resistance are
the two determinants of arterial pressure.
and so blood pressure is normally dependent on the
balance between cardiac output and peripheral resistance. Cardiac output is
determined by stroke volume and heart rate;
stroke volume is related to myocardial
contractility and to the size of the vascular compartment.
Peripheral resistance is determined by functional and anatomic changes in
small arteries and arterioles.
The pathophysiology of essential hypertension is an area of research, and until
now remains not well understood, but many theories have been proposed to
explain this.
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.
Certain researches shown that
melatonin supplementation in the evening in premenopausal women
produces an improvement in thyroid function and gonadotropin levels, as
well as restoring fertility and menstruation and preventing the depression
associated with the menopause. And as we know, in women hypertonic disease
usually develops in this age.
The purpose of our investigation is
optimization the adaption period at the sanatorium rehabilitation of patients
having hypertension by effects of melatonin on desynchronosis processes. 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. Analyzing of
adaptation potential is such patients before and after melatonin drug
intake.
The investigation was carried out on
the basis of clinical sanatorium “Ukraine” (Yalta, Crimea) and department of
laboratory studies of state educational, scientific and medical complex of
clinic state institution “Crimea state medical university named after S. I.
Georgievsky”. We formed 4 group of examined patients:1st group – 15 male
patients with hypertension stage II, the mean age was 52±6,24 years, 2nd
group - 15 female patients with hypertension stage II, the mean age was 51±6,15
year; 2 control group: 1st – 15 healthy young people, the mean age was 24±3,11;
2nd – 14 almost healthy men without arterial hypertension and CHD symptoms, the
mean age – 51±5,48 years.
Melatonin was measured in urine,
collected in night time(from 21.00 to 6.00)
In this way, the results of conducted
investigation evidence that:
1. The decrease of adaptive
possibility in male patients having hypertension accompanied by low nocturnal
excretion of melatonin metabolite (6 - 6-hydroxymelatoninsulphate (6–HMS))(p<,005) in comparison with control group. The
female patients have more significant differences(p<0,001). After melatonin
containing preparation using the difference of 6-HMS indexes in control and
experimental group has leveled.
2 . In spite of difference of indexes
of 6-HMS excretion in men and
women the adaptive potential of cardiovascular system in both groups has
improved (on 16,35% in men and on 16,07% in women) and remained optimal after
discontinuation of medication in 84% of patients.
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. ).
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 patients with chronic
hypertonic disease are very important because potential level changed from
insufficient to intense level of adaptation.