ABSTRACT

INTRODUCTION. A decrease in heart rate variability indicates a violation of the autonomic control of cardiac activity, which is one of the reasons for the poor prognosis in this category of patients. Until now, the problem of the effectiveness and safety of correction of high blood pressure during the acute period of ischemic stroke remains a subject of debate.

AIM. To determine clinical, autonomic and hemodynamic changes at rest and during an active orthostatic test to assess the functional state and adaptive capabilities of the cardiovascular system and identify risk factors for the unfavorable course of arterial hypertension in patients with hypertension in the acute period of ischemic stroke.

MATERIAL AND METHODS. 78 patients with hypertension who were treated in a therapeutic hospital were examined. The first group consisted of 40 people with hypertension complicated by ischemic stroke, the second group included 38 people with uncomplicated hypertension. The patient's condition was assessed using the NIHSS scale and the Rankin scale. data from electrocardiography, duplex scanning of blood vessels, computed tomography of the brain, transthoracic ECHO-CG, portable monitor VNS-Micro and Poly-Spectrum SM from Neurosoft. The study of heart rate variability was carried out in patients with stroke upon admission, on days 5-10 and before discharge from the hospital (days 15-21). With the Revermead mobility index, more than 7 patients underwent an active orthostatic test with parallel ECG recording, measurement of blood pressure and heart rate at rest and when moving to a vertical position.

RESULTS AND DISCUSSION. Patients with insufficient recovery of neurological functions on days 5-7 of stroke demonstrate the development of hypotension during an orthostatic test. An active orthostatic test on days 15-21 of stroke is successfully performed by patients with increased tone of the sympathetic nervous system. Patients with good recovery of neurological functions at discharge have normal autonomic reactivity and an adequate response of the sympathetic division of the autonomic nervous system to standing.

CONCLUSION. Young men with hypertension should be closely monitored by physicians and receive primary stroke prevention. To increase tolerance to physical activity in patients who did not complete an active orthotest on days 5-7 of a stroke, daily passive verticalization is necessary.

KEYWORDS:  ischemic stroke, active orthotest, heart rate variability, hypertension, verticalization

For citation: Zabrodina A.A., Mishina I.E., Blinova K.A., Pshenichnikova T.V. Features of Hemodynamics  and Autonomic Regulation of Cardiac Activity in Patients with  Hypertension in the Acute Period of Ischemic Stroke. Comorbidity Neurology. 2024; 1 (3): 5-13. https://doi.org/10.62505/3034-185x-2024-1-3-5-13

*For correspondence: Ksenia A. Blinova, Cand. Sci. (Med.), assistant Department of Oncology and Radiation Therapy, Ivanovo State Medical University, Ivanovo, Russia, e-mail: xenny7@yandex.ru.

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ADDITIONAL INFORMATION

Anastasia A. Zabrodina, graduate student Department of Hospital Therapy, Cardiology and General Medical Practice, Ivanovo State Medical University, Ivanovo, Russia. E-mail: zabrodina_aa@mail.ru. ORCID: https://orcid.org/0000-0001-7801-1904

Irina E. Mishina, Dr. Sci. (Med.), Professor, First Deputy Director of the Medical Institute, Saint Petersburg State University, Saint Petersburg, Russia. E-mail: mishina-irina@mail.ru. ORCID: https://orcid.org/0000-0002-7659-8008

Ksenia A. Blinova, Cand. Sci. (Med.), assistant Department of Oncology and Radiation Therapy, Ivanovo State Medical University, Ivanovo, Russia. E-mail: xenny7@yandex.ru. ORCID: https://orcid.org/0000-0002-2896-8764

Tatyana V. Pshenichnikova, Cand. Sci. (Med.), Associate Professor Department of Hospital Therapy, Cardiology and General Medical Practice, Ivanovo State Medical University, Ivanovo, Russia. E-mail: psheni4nikovatv@mail.ru. ORCID: https://orcid.org/0000-0003-0191-5520

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Mishina I.E., Pshenichnikova T.V. – developing the concept of the article, editing the final text; Zabrodina A.A. – collecting material, writing text, methodology; statistical processing; Blinova K.A. – preparation of the article for publication.

Funding. This study was not supported by any external sources of funding.

Disclosure. The authors declare that they have no competing interests.

Ethics Approval. The study was approved by the ethical committee of the Ivanovo State Medical University (Ivanovo, Russia) (protocol No. 10 of December 10, 2012).

Informed consent for publication. All patients, and if it is impossible to review and sign, persons responsible for the patients (relatives, social workers, etc.) on behalf of the patients undergoing examination and participating in this study, signed informed consent.

The content is available under the Creative Commons Attribution 4.0 License.

©2024. Anastasia A. Zabrodina, Irina E. Mishina, Ksenia A. Blinova, Tatyana V. Pshenichnikova