Zemlyanskaya N.A.,Shishko E. Y.,Kushnir K.G. Nepreluk O.A.

Crimea state medical university named after S. I. Georgievsky, Simferopol.

Tavrida National V.I. Vernadsky University ,Simferopol

The influence of preparations, containing the melatonin on adaptation processes in patients, having arterial hypertension at the sanatorium rehabilitation.

The vital activity of the body occurs with precise coordination of biological rhythms, that respond to changes in both: in the organism and environment.The ability to response to different endogenic and exogenic stimuli by biorhythms restructuring characterizes the stability and health of human body. The main messenger of endogenic rhythms is melatonin, the secretion which submit to circadian rhythm. Is known , that the cardiovascular system activity associated with this cycle.

Melatonin – neuropeptide, which synthesized by small brain gland – epiphysis, and has unique influence on the body. The main functions of epiphysis are: the regulation of circadian and seasonal rhythms; regulation of reproductive function, antioxidant and antitumor protection.

Melatonin has expressive antioxidant and immunomodulatory effects. Some authors belive, that epiphysis takes control of the endocrine, nevous and immune systems, integrates system response to unfavorable factors, acting on the body's resistance. The most important physiological function of melatonin is biorhythmological, the ability of correction the endogenic rhytms relative to exogenic rhytms of environment, that provides adequate reaction of the body to different stimuli.

The structure of biological rhytms is not absolutely stable, it can change under the influence of internal and external factors.Distortion of biological rhytms, it transformation in not periodical wavering evidence about internal exacerbation of adaptational process.

The moving to a new climate zone and change of regular regimen can caused the stress of adaptation processes and circadian disregulation.The fee of adaptation is voltage of regulator systems and mobilization of functional reserves such as sleep disturbance, increased depression, and other signs of desynchronosis, that happen with patients with arterial hypertension in sanatorium rehabilitation conditions. The adaptation of patients with arterial hypertension may last 7 and more days, that reduce the efficiency of redort therapy.

Therefore is actual the use of preparations, containing melatonin and agomelatine - the agonist of melatoninergic MT1 and MT2 receptors and antagonist of seratonineergic 5HT receptors.

The purpose of our investigation is optimization the adaptional period at the sanatorium rehabilitation of patients having hypertension in sanatorium rehabilitation conditions.

The investigation carried out on the basis of clinical sanatorium “Ukraine” (Yalta,Crimea). Were examined 60 patients ith arterial hypertension1-2 stage. Carried out daily monitoring of blood pressure, Holter ECG mount.

Determined the level of metabolites of melatonin: melatonin-sulfate( 6 - 6-hydroxy-melatonin-sulfate ) in urine, cause the 80-90 % of melatonin excreted with the urine as melatonin-sulfate, which correlates with overall level of melatonin in the blood during the collection of samples. Melatonin examined in urine from 21.00 till 06.00. Before conducting of analysis the portions of 4 ml frozen at – 20 °C and stored no more than 3 months.

The concentration of 6-HMS in samples of urine determined by enzyme-linked immunosorbent assay on ELISA analyzer CES(Russia) with use the standart samples of company IBL-Hamburg GmbH(Germany). The concentration determined by the construction of the calibration graph of dependence of received optical density standards of the concentration appropriate standarts.

During te study determined the initial level of melatonin , 6 -HMS, and his level after course of taking the malatonin, and in 15 patients determined the level of agomelatine.

Patients received (Vita-melatonin,Ukraine), daily dose 3 mg and selectively agomelatine 25 mg(melitor). The observations have shown, that the adaptation of the patients to the resort conditions characterized by decrease of adaptive ability, which accompanied with low night excretion of 6-HMS(p<0,05). Inclusion in the therapy complex the preparations, containing melatonin and agomelatine allowed to decrease and eliminate the desynchronosis manifestation, that expressed in normalization of sleep-wake processes, improvement of health and in generally circadian self-regulation with blood pressure normalization.

1.The decrease of adaptive possibility in male patients having hypertension accompanied by low nocturnal excretion of melatonin metabolite (6 - hydroxymethyllatoninsulfata (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. Is appropriate to include the melatonin and agomelatine in sanatorium rehabilitation conditions of the patients, suffering from arterial hypertension taking into account gender differences.