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82002 was 2314.3 cases per 100 thousand population, prevalence - 22604.6 cases per 100 thousand population, and in 2007 - 2591.6 and 29899.0, respectively. The incidence of hypertension from 2002 to 2007 increased 1.1 times, and the prevalence - 1.3 times. In the Chernivtsi region, the figures are similar.
According to experts of the Ukrainian Research Institute of Cardiology. M.D. Strazheska, in Ukraine almost 13 million people have high blood pressure, but only 62% know about it, of which only 23.2% are treated. The structure of morbidity is traditionally formed by hypertension (47.1%), coronary heart disease (32.5%), cerebrovascular diseases (19.1%), which are characterized by negative dynamics.
The incidence of diseases of the circulatory system and mortality from them has clear regional features. The highest prevalence of diseases of the circulatory system is observed in the North-Eastern (281.6 %o), Central (281.2 %o) and South-Eastern (260.0 %o) regions. To some extent, this may be due to the aging of the population, as evidenced by the mean age, which is highest in the Northeast (39.3 years) and Central (38.1 years) regions. However, in the South-Eastern region the highest level of severe complications of hypertension - myocardial infarction and stroke: 1.63 %o and 2.8 %o, respectively, against 1.37 %o and 2.2 %o in Ukraine as a whole. Data from other authors also confirm the high level of these diseases in employees of heavy industry, which is very common in the SouthEastern region.
Among the rural population of Ukraine, diseases of the circulatory system are also the most common pathology. Almost 750,000 cases of newly diagnosed diseases of the circulatory system are registered annually, and the total number is 5.7 million. The leading nosological forms are, as already mentioned, hypertension, coronary heart disease, and cerebrovascular diseases. There are 44,000 cases of circulatory system diseases per 100,000 adult rural population, i.e. they occur in almost half of the rural population. Of particular concern are the high levels of
disability and mortality from cardiovascular disease. Almost two-thirds of all deaths in rural areas are caused by diseases of the circulatory system.
Thus, the main features of diseases of the circulatory system, especially hypertension, in Ukraine are: increasing mortality from them with a decrease in this indicator in the European region, north-eastern vector of pathology, higher level and growth rate of mortality among rural population, «rejuvenation» of contingents patients, a leading role in the disability of the population, a significant level of morbidity, in particular with temporary disability, especially in men of working age. These features lead to an increase in medical and social importance of hypertension and other diseases of the circulatory system in Ukraine, as they cause significant economic damage to the state: financial costs for diagnosis, treatment, rehabilitation of patients and more.
References
1. Navchuk I.V. Vyvchennia obiznanosti silskykh zhyteliv shchodo profilaktychnykh tekhnolohii arterialnoi hipertenzii / I.V. Navchuk // Prostir i chas suchasnoi nauky: materialy IV Vseukrainskoi nauk.-prakt. internet-konferentsii, 24-26 kvitnia 2008 r. - K., 2008. - Ch. 2. -S. 67.
2. Navchuk I.V. Vyvchennia rivnia znan iz problemy «medychna profilaktyka» likariv silskoi lanky okhorony zdorovia Chernivetskoi oblasti z metoiu profilaktyky khvorob systemy krovoobihu / I.V. Navchuk // Bukovynskyi medychnyi visnyk. - Chernivtsi. - 2008. -T.12, № 2. - S. 107-114.
3. Navchuk I.V. Profilaktychni tekhnolohii u vyrishenni problem arterialnoi hipertenzii u silskoho naselennia / I.V. Navchuk, V.E. Kardash // Okhorona zdorovia Ukrainy. - 2003. - № 4 (11). - S. 53-54.
4. Navchuk I.V. Formuvannia zdorovoho sposobu zhyttia yak zasobu pervynnoi profilaktyky khvorob systemy krovoobihu / I.V. Navchuk, V.E. Kardash // Bukovynskyi medychnyi visnyk. - Chernivtsi. - 2003. -T.7, № 4. - S. 19-22.
RISK FACTORS FOR HYPERTENSION AND OTHER DISEASES OF THE CIRCULATORY
SYSTEM
Navchuk I.
Bukovina State Medical University, Ukraine
Navchuk G.
Bukovina State Medical University, Ukraine
SobkoD.
Bukovina State Medical University, Ukraine
Abstract
The fight against most non-communicable diseases, including hypertension, is the most effective, and in some cases the only possible, only in the preventive plane. Thus, the implementation of a number of programs to combat cardiovascular disease as the most significant nosological group of diseases has proven that control of risk factors helps reduce morbidity, disability and mortality. World experience shows that preventive measures aimed only at lifestyle changes reduce the incidence of new cases of hypertension by 50% and prolong life expectancy.
Keywords: risk factors, arterial hypertension, diseases of the circulatory system.
The onset and course of hypertension are closely linked to uncontrolled and controlled risk factors. Uncontrolled risk factors are age, gender, race and ethnicity, heredity, and so on.
Age. There is a direct relationship between blood pressure and age. Thus, the level of diastolic blood pressure rises to 55 years, then changes little, and systolic blood pressure increases with age constantly. If we talk about age groups, we have the most patients and the greatest costs at the age of 40-49 years.
Sex. Mean blood pressure levels and the prevalence of hypertension in young and middle-aged women are slightly lower than in men. With age, this dependence changes until reversal. We would like to note that women are more actively treated and prevent hypertension.
Heredity. This is one of the most influential factors for the future development of hypertension. A close correlation was found between the blood pressure of close relatives (parents, siblings). According to the literature, 51.7% of patients with hypertension have the presence of
high blood pressure in the family history, 18.1% do not have it, as evidenced by the results of our study, presented below. Hereditary dyslipidemic hypertension syndrome is associated with heredity.
Genetic aspects. The generally accepted concept of the genetic basis of high blood pressure. Although some monogenic hypertensive disorders in humans have been described, most of their hypertension is a polygenic disease. We are currently studying a number of genes that may be responsible for the development of hypertension. It is likely that in the future with the help of molecular biology it will be possible to identify the predisposition to the development of hypertension.
Managed risk factors for hypertension are the features of the neonatal period, central obesity and metabolic syndrome, body weight.
Features of the neonatal period. Adverse environment in critical periods of fetal development and premature birth are risk factors for cardiovascular disease, including high blood pressure. The feedback between the level of blood pressure and body weight at birth has also been proven in prospective studies among children and adults.
Central obesity and metabolic syndrome. Obesity is positively correlated with blood pressure. The association between obesity, insulin resistance, hyperinsulinemia, decreased glucose tolerance, lipid metabolism disorders and hypertension has been the subject of close attention by researchers. Thus, the effect of elevated insulin levels on the growth of blood pressure has been established.
Body weight. The correlation between body weight and blood pressure is direct, significant and stable. Excess weight is associated with a 2 to 6-fold increase in the risk of hypertension.
The influence of various nutritional factors on the level of blood pressure is extremely significant, for example:
NaCl - table salt, its use above the physiological norm is positively correlated with hypertension.
Other trace elements. There is an inverse relationship between the use of K +, Ca2 +, Mg2 + and blood pressure.
Macronutrients: proteins, fats, carbohydrates, dietary fiber. The predominance of vegetables and fruits, fish, chicken, restriction of saturated fats, cholesterol and sweets in the diet helps to reduce blood pressure.
Coffee. Restoration of the pressor effect of caffeine occurs a few hours after drinking coffee. Hypertension occurs three times more often among those who drink 1 to 5 cups of coffee a day compared to those who do not drink coffee at all. Caffeine, contained in strong coffee, raises diastolic blood pressure in men with high blood pressure by 8 mm Hg. Art., and in persons with normal blood pressure - 3 mm Hg. Art.
Alcohol. Alcohol consumption directly correlates with blood pressure levels. The incidence of hypertension is lowest in people who drink alcohol infrequently and gradually increases depending on the daily amount of alcohol consumed. Excessive alcohol consumption often causes resistance to antihypertensive therapy.
Smoking. Nicotine dramatically raises blood pressure, even in heavy smokers. The effect of each cigarette lasts about 30 minutes. Already in the first minute after smoking a cigarette systolic blood pressure rises by 15 mm Hg. Art., and on the fourth - by 25 mm Hg. Art. Stroke and coronary heart disease with the same blood pressure levels occur 2-3 times more often among smokers than in non-smokers. Smoking contributes to the progression of atherosclerosis. When smoking 10 cigarettes a day, the risk of hypertension increases 2 times, and 20 - 3 times.
Psychosocial factors are stress and socio-economic
status.
Stress contributes to high blood pressure. However, it is not yet known whether prolonged stress leads to a long-term increase in blood pressure. Psycho-emotional stress, which activates innate physiological mechanisms (certain structures of the central nervous system, sympathetic division of the autonomic nervous system), increases the release of catecholamines, narrows blood vessels, increases blood sugar, cholesterol, blood pressure. The activation of these mechanisms was previously accompanied by muscle "discharge", which helped to relieve nervous tension. The living conditions of modern man have changed, in stressful situations "discharge" does not occur. Conditions are created for the development of neurosis, arterial hypertension, atherosclerosis.
Socio-economic condition. In post-transition countries, the feedback between blood pressure and education, income and occupational status is determined. At the same time, in the countries of transition and pre-transition periods the considerable prevalence of arterial hypertension among well-off segments of the population is defined. The experience of most countries shows that as the economy grows, there is a steady increase in blood pressure levels and the prevalence of hypertension among low-income groups.
Physical activity. People who lead a sedentary lifestyle have a 20-50% higher risk of developing hypertension than physically active people. Exercise during work hours increases blood pressure, and physical activity during leisure time - the opposite. Regular aerobic exercise is a very effective means of non-drug treatment of hypertension, in particular brisk walking for 3 - 5 times a week.
Environmental factors. Noise, air pollution, hardness of drinking water, food, soil, radiation levels, electromagnetic fields are risk factors for hypertension, their share of exposure is 20 - 21%.
The share of controlled risk factors for hypertension in the regulation of blood pressure is 51 - 52%.
Biochemical and physiological characteristics associated with an increased risk of SSC include hypertension, dyslipidemia, impaired glucose tolerance, diabetes, and obesity. The class of new risk factors or prognostic factors includes left ventricular hypertrophy, hyperhomocyste-inemia, excess lipoprotein, hypertriglyceridemia, elevated levels of fibrinogen and other thrombogenic factors, oxi-dative stress, infections, inflammation and atherosis.
In the early 1970s, mortality from circulatory system diseases was the same in most countries in the European region and the United States, where it was approximately 500 cases per 100,000 population. However, in the following years, most countries in Western Europe and the United States saw a significant reduction in cardiovascular mortality, while in Eastern Europe, including Ukraine, mortality increased sharply.
Successes in reducing circulatory mortality can be illustrated by the example of the United States, where the downward trend began in 1950 and reached 60% by the end of the century, with a 73% reduction in all-cause mortality over this period. In other words, advances in combating the risk factors that have caused circulatory diseases have played a crucial role in reducing mortality.
The main factors reducing the mortality due to diseases of the circulatory system in the United States are: reduction of smoking among people over 18 years from 42% (1965) to 25% (1995); reduction of average blood pressure levels among the population; an increase in the number of patients with hypertension who receive adequate control and treatment; reduction of average blood cholesterol levels in the population; changes in the diet of Americans (gradual decline in food intake of saturated fats
and cholesterol since 1999); improving medical care (achievements in diagnosis and treatment, development of effective treatments for hypertension and hypercholester-olemia, increasing the number of specialists in cardiovascular diseases and improving their skills, etc.).
In 1999, the financial cost of morbidity and mortality from cardiovascular disease, including health care and disability, was $ 286.5 million in the United States.
Thus, the negative trends in mortality from cardiovascular disease in Ukraine and Eastern Europe are explained by the following reasons: lifestyle, socio-economic conditions, level of social protection, psychological factors, the state of health care. The economic crisis in these countries, and in Ukraine in particular, declining living standards, unemployment, and political instability have had a negative impact on the health of the population. Unhealthy lifestyles have become widespread, including tobacco and alcohol abuse, poor nutrition, and lack of physical activity. To this is added untimely treatment, lack of effective medical treatment, ignorance of many doctors of modern treatment regimens, ineffective rehabilitation measures. In addition, less than a third of patients agree to
modern treatment because it is expensive.
References
1. Haennel R.S., Lemire F. Physical activity to prevent cardiovascular disease // Can. Fam. Prysician. -2002. - Vol. 48, № 1. - P. 65-71.
2. Navchuk I.V. Epidemiolohichni osoblyvosti khvorob systemy krovoobihu, yikh dynamika v Ukraini y Chernivetskii oblasti / I.V. Navchuk // Klinichna ta eksperymentalna patolohiia. - Chernivtsi, 2009. - T. VIII, № 1. - S. 41-46.
3. Navchuk I.V. Vyvchennia obiznanosti silskykh zhyteliv shchodo profilaktychnykh tekhnolohii arterialnoi hipertenzii / I.V. Navchuk // Klinichna ta eksperymentalna patolohiia. - Chermvtsi, 2008. - T. VII, № 2. - S. 65-70.
4. Navchuk I.V. Vyvchennia obiznanosti silskykh zhyteliv shchodo profilaktychnykh tekhnolohii arterialnoi hipertenzii / I.V. Navchuk // Prostir i chas suchasnoi nauky: materialy IV Vseukrainskoi nauk.-prakt. internet-konferentsii, 24-26 kvitnia 2008 r. - K., 2008. - Ch. 2. -S. 67.
ИНТЕРЛЕЙКИНЫ И ИХ РОЛЬ В ПРОГРЕССИРОВАНИИ ХРОНИЧЕСКОЙ ПАТОЛОГИИ ПОЧЕК
(ОБЗОР ЛИТЕРАТУРЫ)
Абдурашитова Д.И.
Кандидат медицинских наук, доцент кафедры внутренних болезней №1
медицинского факультета ОшГУ, г. Ош, Кыргызстан Нурматов Ш.Ж.
Старший преподаватель, завуч кафедры неврологии, нейрохирургии и психиатрии медицинского факультета ОшГУ,
г. Ош, Кыргызстан Юсупов А.Ф.
Аспирант кафедры общественного здоровья и здравоохранения Кыргызской государственной медицинской академии им. И.К. Ахунбаева,
г. Бишкек, Кыргызстан Юлдашев А.А.
Аспирант кафедры неврологии, нейрохирургии и психиатрии медицинского факультета ОшГУ, г. Ош, Кыргызстан Айдаров З.А.
Доктор медицинских наук, профессор, зав. каф. общественного здоровья и здравоохранения Кыргызской государственной медицинской академии им. И.К. Ахунбаева, член правления общества специалистов
по хронической болезни почек, г. Бишкек, Кыргызстан
INTERLEUKINS AND THEIR ROLE IN THE PROGRESSION OF CHRONIC KIDNEY DISEASE
(LITERATURE REVIEW)
Abdurashitova D.
Ph.D., Associate Professor of the Department of Internal Medicine N1
Medical Faculty of Osh State University, Osh, Kyrgyzstan Nurmatov Sh.
Senior Lecturer, Head of the Department of Neurology, Neurosurgery and Psychiatry,
Faculty of Medicine, Osh State University, Osh, Kyrgyzstan
Yusupov A.
Postgraduate Student, Department of Public Health and Health Care Kyrgyz State Medical Academy named after I.K. Akhunbaeva,
Bishkek, Kyrgyzstan Yuldashev A.
Graduate student of the Department of Neurology, Neurosurgery and Psychiatry
Medical Faculty of Osh State University, Osh, Kyrgyzstan
Aidarov Z.
M.D., Doctor of Sciences, Professor, Head of the Department ofpublic health and health care Kyrgyz state medical academy named after I.K. Akhunbaeva, board member of the Society of Specialists
in Chronic Kidney Disease, Bishkek, Kyrgyzstan
