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6Table 2
Assessment of the functional state of patients with osteoarthritis by phenotypes
The attribute MJD CP MB MD P
N=20 N=20 N=20 N=20
Algofuntional Leken index 6,52±0,25 11,56±0,87 3,47±1,24 9,98±2,41 <0,05
Pain intensity according to VAS, mm 36,15±1,25 89,25±3,58 56,27±2,54 68,74±5,26 <0,05
The patient's condition according to VAS, evaluated by a doctor, mm 24,13±2,41 78,04±2,78 47,14±1,45 68,71±1,74 <0,05
The patient's condition according to VAS, assessed by the patient, mm 14,13±1,31 88,04±1,82 64,14±2,47 81,31±2,41 <0,05
Passage time per flight of stairs, sec 15,36±3,58 65,47±25,47 44,25±14,2 35,2±19,25 <0,05
Fibrinogen, mmol/l 422,17±17,63 457,17±25,14 328,19±24,35 652,21±17,21 <0,05
CRP, mg/dl 8,8±4,67 24,17±14,14 8,80±6,56 64,14±11,27 <0,05
According to the results of the study, there was a significant increase in the indicators of fibrinogen and C-reactive protein in all groups, with the exception of patients with a biomechanical phenotype. These changes reflect a close positive relationship (r=0.252, p0.05) between the systems of inflammation and coagulation processes.
According to the results of the study, a comparative analysis of the algofunctional Leken index shows the highest value in patients with the CP phenotype, which is explained by the consequence of the altered phenotype of chondrocytes mediated by various auto-crine and paracrine signals, which leads to the synthesis of many inflammatory mediators and degradation. For this reason, morphological features of both acute and chronic inflammation are observed and are characterized by recurring episodes of inflammation. At a late stage, fibrosis may dominate, which is confirmed by an increase in the amount of fibrinogen.
Conclusions: morphological features of both acute and chronic inflammation are observed and are characterized by recurrent episodes of inflammation. At a late stage, fibrosis may dominate, which is con-
firmed by an increase in the amount of fibrinogen. Taking into account the data obtained, a personalized approach to assessing the functional state is possible, followed by targeted therapy.
References:
1. Лила А.М., Алексеева Л.И., Телышев К.А. Современные подходы к фенотипированию остео-артрита. Современная ревматология. 2019;13(2):4-8. https://doi.org/10.14412/1996-7012-2019-2-4-8
2. Leonid Kandel, Gabriel Agar, Ori Elkayam, ey al. A novel approach for knee osteoarthritis using high molecular weight hyaluronic acid conjugated to plasma fibrinogen - interim findings of a double-blind clinical study, Heliyon, Volume 6, Issue 7, 2020,e04475,ISSN 2405-8440, https://doi.org/10.1016/j.heliyon.2020.e04475. (https://www.sciencedirect.com/science/article/pii/S24 05844020313190)
3. Dell'Isola A, Allan R, Smith SL, et al. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord. 2016 Oct 12; 17(1):425. doi: 10.1186/s12891-016-1286-2
THE NEUROLOGICAL AND PATHOPHYSIOLOGICAL COMPONENTS OF ARTERIAL HYPERTENSION. CAPABILITIES OF PREVENTION AND REHABILITATION
Cherkasov A.
candidate of biological sciences, senior researcher, Research Institute of General Pathology and Patho-
physiology Moscow, Russia
Petrova E.
candidate of physical and mathematical sciences, senior researcher, Institute for Information Transmission
Problems (Kharkevich Institute), Russian Academy of Sciences,
Moscow, Russia https://doi.org/10.5281/zenodo.7197885
Abstract
The article provides a theoretical analysis of the causes of arterial hypertension, describes a 3-month observation of the initial stage of the development of arterial hypertension and experiments for one year on non-drug normalization of blood pressure in a group of 33 volunteers. We show that arterial hypertension is associated with spastic conditions of the intervertebral muscles in the lower thoracic spine, which leads to compression of sympathetic nerves that control the transport of water through the kidneys, which in turn upsets the balance of fluid circulation through the circulatory system. Theoretical analysis and experimental data made it possible to formulate a hypothesis about the dominant role of disorders in the activity of the sympathetic part of the nervous system in the development of primary and persistent arterial hypertension. The possibility of prevention of arterial hypertension and non-drug rehabilitation of patients with this disease has been shown.
Keywords: arterial hypertension, rehabilitation, ki
Introduction
From the standpoint of official medicine and the WHO Expert Committee in 95% of cases, the causes of the essential hypertension are unknown [9]. Studying the causes of arterial hypertension showed the multifac-torial nature of this disease, which requires a systematic approach to studying this problem, taking into account the neural (neural regulation of blood vessel tone), hormonal (renin-angiotensin regulation of vasculatory tone), hydrostatic (changes in the capacitive properties of the circulatory system due to the vessels elasticity) and hydrodynamic (dynamics of water transport through the circulatory system) components, as well as neurodystrophic processes in the autonomic nervous system and kidneys. The first who declare that hypertension is not a disease, but a reversible functional impairment of the vasculatory tone regulation, was the Russian doctor [7]. Back in 1922, the Head of the Leningrad therapeutic science school G.F. Lang, in one of his works, wrote that they should clearly distinguish hypertension as an independent ailment and that hypertension, which appears as a symptom of some other diseases - for example, kidney damage. G.F. Lang regarded hypertonic disease as "vascular neurosis." He saw the cause of the disease in the obvious effect of extreme external stimuli - conflict situations, emotional overloads. As a treatment for hypertension, he proposed sedatives, starting with valerian. If you remove the "vascular neurosis" at the initial stage of the disease, then hypertension will not occur. Currently, official medicine believes that the cause of essential hypertension is unknown, and hypertension itself, as a disease, is incurable, and the patient must take medication for the rest of his life to prevent dangerous consequences.
Emotional stress and hypertension. A number of researchers convincingly proved that emotional stress is one of the leading causes of hypertension and cardiovascular diseases [7, 10]. However, as pointed out by academician P.K. Anokhin, "no crazy rhythm of modernity, no acuteness of nervous experiences can cause hypertension, if this is the rhythm, if the periods of greatest tension alternate with moments of rest" [3]. From this statement it follows that the arterial hypertension develops only in certain conditions. Domestic researchers were the first to provide convincing evidence that in many cases, primary disorders of the central nervous system are the cause of arterial hypertension [7, 1, 8]. The vascular baroreceptors have been found to play an initiative role in blood pressure self-regulation, reacting with an impulse activity increase into the blood pressure raising and informing the overlying vasomotor centers of the medulla oblongata [4, 2, 11]. At the same time, the impulse frequency of baroreceptors depends more on the rate of pressure rise than on the basic level of blood pressure. With prolonged pressure increases in chronic hypertension, barorecep-tors adapt to increased pressure. Currently, it is believed that the regulation of pressure is carried out by changing of blood vessels tone. At the same time, the mechanisms of neural regulation of blood circulation are divided into the group of short-term action (reaction
eys, gymnastics.
time at intervals of a few seconds), intermediate action (tens of seconds and minutes) and mechanisms of long-acting (tens of minutes and hours). The short-acting mechanisms are due to signals coming into the hypothalamus from baroreceptors located in the aorta [5 ,6]. Intermediate mechanisms of blood pressure regulation include: 1) changes in transcapillary metabolism; 2) relaxation of the vessel wall tension; 3) renin-angiotensin system.
The first two mechanisms are aimed at reducing pressure. The only pressure increasing mechanism is implemented in the renin-angiotensin system. The renin-angiotensin system plays an important role in the normalization of blood circulation in the event of a pathological decrease in blood pressure and (or) blood volume (blood loss caused by injuries). This mechanism is also not related to the essential hypertension. The long-term mechanisms of blood pressure regulation include mechanisms that mainly affect the ratio between the intravascular blood volume and the capacity of the vessels. It was shown that a slight (by 2-3%) continuous increase in the volume of fluid in the circulatory system when the sympathetic nervous regulation is turned off, leads to an increase in blood pressure by almost 50%. Normally, an increase in pressure with an increase in the volume of fluid in the circulatory system is compensated by the inclusion of nerve vascular reflex mechanisms of short-term regulation, and excess fluid is excreted by the kidneys before the adaptation of nerve mechanisms to new conditions occurs[13, 14]. Thus, the main mechanism responsible for the long-term increase of blood pressure is the kidneys control of fluid in the vasculatory system.
Nervous vascular mechanisms of blood pressure regulation last less than an hour. Hypertension lasts for years. A natural question arises: in which cases the powerful mechanisms of blood pressure stabilization are violated and, at first transient, and then stable arterial hypertension occurs? The pioneering work of Russian scientists showed that the nervous mechanisms of blood pressure regulation are implemented in the hypothalamus and, using signals from the aorta barorecep-tors, carry out a damping (smoothing) effect on short-term fluctuations in blood pressure. Consequently, the solution to the problem of arterial hypertension should be sought in disorders of the neural mechanisms of regulation of fluid transport through the circulatory system.
Purpose of the study
Search for non-drug methods for normalizing blood pressure by normalizing the transport of fluid through the circulatory system.
The contingent of people who participated in the research
The research involved 33 people - participants in the health improvement course with an average age of 43 ± 7 years. The group included 3 doctors who took part in the examinations.
Methods
In rehabilitation activities massage of the muscles of the spine, gymnastics for the spine and health jogging were used.
Results
We invite readers to familiarize themselves with the following observation. This is the very rare case in which under clinical conditions for 3 months we were able to observe the development of arterial hypertension from the very beginning and to use experimental non-drug effects to normalize the arterial pressure level. Our 60-year-old patient (weight 74 kg, height 174 cm, no chronic kidney disease and any other chronic diseases for more than 20 years), who had been running for 20 years, had a stable pressure of 125/80 mmHg until recently. This patient, after prolonged stress, underwent a sympatho-adrenal crisis - the pressure was 193/90 mmHg with a pulse of 57-60. When administering drugs that reduce blood pressure, the effect was not observed. After then the sympatho-adrenal crisis was over, the state of persistent arterial hypertension came - the upper pressure was 160-18 mmHg 0 , the lower pressure was 110-120 mmHg with a pulse of 100-110 mmHg at rest. This level of pressure was maintained for more than two weeks before the sensation of pain in the lower back appeared in the area of the 8th - 12th thoracic vertebrae and the 1st - 2nd lumbar vertebrae. The patient was given a massage of a spinal muscular system. An hour after the massage, the pressure dropped from the level of 150/103 to the level of 137/86, and after another 2 hours it was steadily established at the level of 130/83. This level was already normal for the patient. The state of chronic stress in our patient persisted, and 2 weeks after the massage session, the pressure was again set at 160/100. And again, after stressful situations, 2 massages with blood pressure control were performed. In the first case, after the massage, the pressure decreased from 176/97 to 136/83. In the second case, after the massage, the pressure decreased from 160/97 to 137/88. In the third case, after the massage, the pressure decreased from 159/100 to 144/95. The massage took place in the morning. By the end of a day, the pressure increased slightly again, but did not reach a high initial level.
Three series of experiments were performed with the patient: 1) Tibetan gymnastics for 8 days on the shore of the warm sea; 2) 7 experimental runs: each run in 3 stages of 1650 meters each at a speed of 10 km / h, and performing gymnastic exercises for the spine after each stage; 3) 10 experimental runs of 5 km per day at a speed of 10 km / h with the implementation of exercises of Tibetan gymnastics for the spine after running.
Performing each series of experiments resulted in normalization of blood pressure. 1. Relaxation with the conducting of the daily Tibetan gymnastics "Five Tibetan Pearls" gradually led to the normalization of pressure. We give figures of daily monitoring: 160/100 -100; 154/104 - 96; 158/90 - 94; 150/90 - 93; 152/91 -93; 144/90 - 73; 134/82 - 75; 133/81 - 65. Indicators were measured at the same time and under the same conditions. 2. Experiments with a combination of running and Tibetan gymnastics turned out to be especially revealing. The average blood pressure at the beginning
of the day for the first three days of the experiment was 141/89 mmHg, and at the end of the day 123/86 mmHg. Over the past three days, the average blood pressure at the beginning of the day was 126/83 mmHg, and at the end of the day - 129/81 mmHg.
Experimental jogging in 3 stages of 1650 meters each at a speed of 10 km / h and performing gymnastic exercises for the spine after each stage resulted in an average decrease in the upper pressure level from 150 to 135 mm Hg and increase the lower level of pressure from 88 to 91 mmHg. When examining the patient before the experiments, it was found that stress caused spastic states of the spinal muscles in the lower thoracic region. The massage eliminated the spastic states in the muscles. After an experimental run and gymnastics, the spastic states of the muscles also disappeared. Thus, it was found that the state of the spinal muscular system influences the regulation of blood pressure. Hypertonus and spastic states of the intervertebral muscles in the region of the lower thoracic spine lead to a persistent increase in blood pressure. The likely mechanism of such an effect is the compression of the sympathetic nerves that control the water transport through the kidneys. The elimination of hypertonus and spastic states of intervertebral muscles with the help of gymnastics for the spine regularly led to the normalization of blood pressure. Thus, long-term arterial hypertension at the initial stage with a high degree of probability is caused by a violation of the state of the sympathetic nerves that control the water transport through the kidneys.
Inflammatory processes in the kidneys - the second cause of persistent arterial hypertension
There are two other factors that lead to arterial hypertension. These are inflammatory processes in the kidneys - pyelonephritis and inflammatory processes in the adrenal glands, leading to the production of adrenaline. These are the same 15% of cases known from the point of view of WHO experts as the causes of persistent arterial hypertension.
In the first case, with a high upper pressure, the lower pressure is also high, and the difference between them can be normal or reduced, i.e. 40 mmHg or less. In the second case, the lower pressure is normal or slightly reduced, and the difference between the upper and lower pressure is from 60 to 100 mmHg. Such a big difference is caused by a powerful cardiac output under the action of adrenaline, but the cause of the release of adrenaline is not stress, but the inflammatory process in the adrenal glands.
This condition resembles a sympatho-adrenal crisis. And until the inflammatory process in the adrenal glands disappears, the upper pressure will not decrease. There is a third option - simultaneous inflammation of the kidneys and adrenal glands. In this case, high low pressure and a large difference between the upper and lower pressures are possible. In both these cases, it is necessary to eliminate the causes of the inflammatory process.
In our practice, we have encountered conditions characterized by pressures of 193/100, 208/110 and even 234/115 with a pulse below 70 beats / min. These conditions were also reactions to stress, but they disap-
peared only after the elimination of inflammatory processes in the kidneys and adrenal glands. The cause of inflammatory processes was the accumulation of metabolites in the blood, caused by the poor condition of the large intestine, and hypothermia of the kidney area was the provocateur.
In our health-improving activity, we met with a combination of nervous and inflammatory processes. Another provocateur of a rise in pressure is a persistent pathological reflex caused by nervous overstrain and persistent neurosis. In the presence of an inflammatory process in the adrenal glands, a slight nervous tension is sufficient and the pressure catastrophically increases to 200/100 mmHg, and more up to 234/110 mmHg.
This rise in pressure is caused by an increased release of adrenaline, resulting in an increase in myocar-dial contraction and an increase in cardiac output. These conditions are similar to the blockade hypertension described by Lang. In the presence of an inflammatory process in the adrenal glands, a slight nervous tension is sufficient and the pressure rises catastrophi-cally to 200 mmHg or more.
In this situation, it is necessary not only to eliminate the inflammatory process, but also neurosis and nervous tension caused by mental work. It is necessary to engage in physical activity and disconnect for a long time from intense mental activity.
Rehabilitation of persons suffering from arterial hypertension
The influence of gymnastics for the spine, massage of the muscles of the spine and health jogging on the value of blood pressure
The European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of hypertension in 2013 suggest that patients with arterial hypertension (AH) perform moderate aerobic exercise (walking, jogging, cycling, swimming) for a duration of at least 30 minutes for 5-7 days a week. Epidemiological studies suggest that regular aerobic exercise may be beneficial both in preventing and treating hypertension and in reducing cardiovascular risk and mortality.
A meta-analysis of randomized controlled trials showed that aerobic endurance exercise reduced resting SBP and DBP by 3.0/2.4 mmHg in the general population and even by 6.9 / 4.9 mmHg in patients with hypertension (EOAG / ESC Guidelines for the Diagnosis and Treatment of Arterial Hypertension, 2013). This is an insufficient reduction in pressure and, moreover, not its normalization.
In our experiments, we obtained a normalization of blood pressure, and not a simple decrease in it. In these experiments, systolic pressure decreased by 40 mm Hg or more and remained so for a long time.
In our opinion, the range of physical activity should be supplemented by methods for restoring spinal mobility by eliminating spastic conditions in the intervertebral muscles.
To normalize blood pressure for a long time, you should conduct a series of massages of the muscular corset of the spine and perform regular, preferably every day, gymnastics for the spine. Running is optional, but desirable.
In our comprehensive health system to eliminate arterial hypertension, we use Chinese qigong breathing techniques based on performing a set of slow gymnastic exercises synchronously with breathing. Muscle tension is performed on inhalation, muscle relaxation on exhalation. Several goals are achieved here at once: general relaxation and calming of the central nervous system, slowing down breathing during exercise, which leads to an increase in the concentration of carbon dioxide in the blood and a decrease in the tone of blood vessels.
Another important factor is the elimination of the consequences of stress - the disappearance of compression of the renal sympathetic nerves after their exit from the spine and the normalization of the activity of the autonomic nervous system. A set of exercises for the spine is given in the section "Integrated Health System". The use of our system requires much more effort from the patient, both physical and volitional, but the effect of healing and getting rid of drug dependence is worth it.
During the year, at the Research Institute of General Pathology and Pathophysiology, we conducted a study of the influence of health factors on blood pressure. We had 33 subjects - volunteers, among whom were persons suffering from arterial hypertension. We divided all subjects into three groups: persons with normal blood pressure, SBP 90 - 120 mmHg - 16 people, persons with prehypertension, SBP 120 - 140 mmHg -11 people and persons with arterial hypertension, SBP over 140 mmHg - 6 people.
For all of them, we used a massage of the muscles of the spine 2-3 times, eliminating muscle blocks in the muscular corset of the spine. One of the volunteers, suffering from arterial hypertension, performed daily exercises for the spine and jogged for 3 km.
In persons with normal pressure, immediately after the massage, the pressure decreased by an average of less than 2 mmHg. Before massage: 108±8.5/69.3±7.2. After massage:
106.5±12.2/69.5±8.2 (N=39).
In persons with high blood pressure, immediately after the massage, the pressure decreased by an average of 6.8 mmHg. Before massage: 124.8±9.1/77.5±7.6. After massage: 118±8.2/74.5±6.0 (N=39).
In persons with high blood pressure, immediately after the massage, the pressure decreased by an average of 9 mmHg. Before massage: 149±11.8/86±12.6 (N=22). After massage: 140±12.7/87±13.4 (N=22).
Gymnastics for the spine led to a steady decrease in pressure. Before exercise, the pressure was 147±14.4/91±6.7 mmHg. Immediately after exercise, the pressure rose by an average of 3 mmHg and reached 150±17.7/88±6.8 mmHg. After 15 minutes, it decreased by an average of 7 mmHg in relation to the original and amounted to 140±10/89±7.4 mmHg (N=13) and persisted for a long time (more than 2 hours).
Jogging led to a decrease in pressure by an average of 7 mm Hg 10 minutes after the end of the run. The pressure before the start of the run was 141±12.8/85±6.42 mmHg. After the end of the run, the pressure decreased to 134±13.2/87±7.3 mmHg. (N=9).
An hour later, the pressure dropped to 121±9.8/80±6.8 mmHg (N=7) and remained so for up to several hours (4-6).
Discussion
Analysis of the causes of hypertension. Water transport through the circulatory system. Every day, up to 10 liters of fluid is absorbed into the circulatory system, which is almost 2 times the volume of blood. The water up to 3 liters is consumed with food, up to 7 liters of digestive juices produced by the stomach (2.5 liters), pancreas (0.7 liters) and the proximal part of the small intestine (the first half of the small intestine, 2.5 liters), 1 liter of lymph. All these 10 liters are absorbed back into the circulatory system in the distal part of the small intestine and along the entire length of the large intestine. The fluid passes through the liver and is injected back into the circulatory system. At the same time, the level of blood pressure remains stable. In fact, in the circulatory system there is a "3rd circle of blood circulation". And whatever the blood pressure, and whatever the tone of the blood vessels, the "pumps" of the small and large intestines will still "pump" 10 liters of fluid into the bloodstream. The circulatory system itself will transport this fluid back to the gastrointestinal tract and expel it through the kidneys. In this case, the question arises: which system supports the balance in moving of 10 liters of fluid per day (200% of the volume) through the circulatory system? It is quite obvious that this is the hypothalamic nervous system of the kidneys. With an increase in pressure of 1 mm Hg water excretion by the kidneys increases by 100%. Water excretion by kidneys can increase 8 times even with a slight increase in blood pressure up to 10 mm. Hg [13]. It is through this mechanism that the stabilization of blood pressure under the control of the hypothalamus is achieved. Dener-vated kidneys reduce their "pressure - speed" water transport characteristic of by 6-8 times [13]. The sympathetic nerves of the kidneys emerge from the spine at the IX, X and XI thoracic vertebrae level. With the appearance of muscle blocks in this section of the spine, compression of sympathetic nerves is possible, which, unlike motor and sensory nerves, do not have a solid myelin sheath. Compression of the sympathetic nerves that control the kidneys is similar to denervation, it translates the kidneys to be controlled by the metasym-pathetic nervous system, which supports the stabilization of blood pressure at a higher level. In fact, we are dealing with a functional partial denervation of the kidneys. In this we see the main cause of hypertension. We realize that solitary observation of the development of arterial hypertension with daily monitoring for 5 months does not comply with the principles of evidence-based medicine and cannot be the basis of a theory. At the same time, we consider it sufficient to form a hypothesis that needs to be tested in a clinical setting.
Hypothesis
Persons with persistent arterial hypertension also have stabilized blood pressure, but at a higher level. The pressure level is controlled by the sympathetic nervous system along the chain: baroreceptors, hypothalamus, sympathetic nerve pathways passing inside and out of the spine in the IX-XI vertebrae region, sym-
pathetic fibers of the spinal nerves, neurons of the sympathetic ganglion and metasympathetic nerves kidney system. The fibers of the sympathetic nerves do not have a solid myelin sheath and may be subjected the compression when passing between stiff spasmed muscles. The control of fluid removal from the circulatory system is impaired by compression of the sympathetic nerve fibers of kidneys in the region of IX to XI thoracic vertebrae. The metasympathetic nervous system of the kidneys, which has a higher threshold for regulating the transport of fluid, provides stabilization of the volume of fluid in the circulatory system, but already at a higher blood pressure. This regulation at a higher level of blood pressure is manifested as persistent arterial hypertension. Rehabilitation activities of sympathetic innervation of the kidneys restoring are aimed at eliminating spastic conditions of intervertebral muscles (massage, gymnastics for the spine and proper rest). They are able to prevent the development of hypertension in its initial stage. At later stages of arterial hypertension development, dystrophic processes in the sympathetic innervation and the metasympathic nervous system of the kidneys are very likely, which will not allow to overcome the state of arterial hypertension quickly. However, this does not mean that rehabilitation activities will be useless. Massage of the spinal muscular system leads to a prolonged decrease in pressure from 7 to 15 mm Hg. Regular and prolonged exposure to the spine muscular corset leads to a disappearance of muscle blocks and eliminates compression of spinal sympathetic nerves [12].
Conclusions
1. The initial stage of hypertension with a high degree of probability is caused by a violation of the kidneys sympathetic innervation.
2. Rehabilitation measures to eliminate spastic conditions in the intervertebral muscles and to restore sympathetic innervation of the kidneys (massage, gymnastics for the spine and proper rest) can prevent the development of hypertension at its initial stage.
3. Primary arterial hypertension is not a disease, but a reversible functional disorder in the sympathetic part of the nervous system that regulates the removal of fluid from the circulatory system through the kidneys.
4. These observations show that arterial hypertension is associated with the state of the muscular corset of the spine. All volunteers who took part in the studies and had high blood pressure had problems with the spine. The elimination of spastic conditions in the intervertebral muscles led to the normalization of pressure in persons with high blood pressure and a significant decrease in pressure in persons with arterial hypertension.
5. The effect of spinal gymnastics and jogging on blood pressure also confirms the existence of a neural component of arterial hypertension. All these methods can be recommended as preventive and rehabilitative measures to combat arterial hypertension.
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