Treadmill test

Treadmill (treadmill) is a device that allows you to reproduce walking or running at a certain speed at a certain slope (see Fig. ). The speed of the tape, and therefore the subject, is measured in m/s or km/h. In addition, the treadmill is equipped with a speedometer, a slope meter and a number of control devices.

The regularity of monitoring the main clinical and physiological indicators is the same as with the submaximal step test and test on a bicycle ergometer.

1) horizontal belt level with increasing speed from 6 km/h to 8 km/h, etc.;

2) constant speed with a stepwise increase in slope of 2.5 degrees, and in this case two options are possible: walking at a speed of 5 km/h and running at a speed of 10 km/h.

The treadmill reproduces the usual human activities. It is preferable when examining children and the elderly.

The WHO group of occupational physiologists noted the agreement between the results of various tests under identical loads. Thus, in the examined young healthy men, MPK was 3.68 ± 0.73 during the step test, 3.56 ± 0.71 during the bicycle ergometer test, and 3.81 ± 0.76 l/min during the treadmill test; Heart rate, respectively, 188 ± 6.1; 187 ± 9; 190 ± 5 in 1 min. The content of lactic acid in the blood is 11.6 ± 2.9; 12.4 ± 1.7; 13.5 ± 2.3 mmol/l.

Determination and assessment of the functional state of the body as a whole is called functional diagnostics.

In connection with the intensification of the educational and training process and the growth of sports results, frequent competitions, especially international ones, the need for a correct assessment of the functional state of athletes becomes obvious, and on the other hand, the importance of determining the adequacy of training for a given individual.

The study of the functional state of persons involved in physical education and sports is carried out through the use of various functional tests. During a functional test (test), the reaction of organs and systems to the influence of any factor, more often physical activity, is studied.

The main (mandatory) condition for this should be its strict dosage. Only under this condition is it possible to determine changes in the reaction of the same person to stress under different functional states.

For any functional test, the initial data of the studied indicators are first determined, characterizing a particular system or organ at rest, then the data of these indicators immediately (or during the test) after exposure to one or another dosed factor and, finally, after the cessation of loads until the test subject returns to the original state. The latter allows you to determine the duration and nature of the recovery period.

Most often in functional diagnostics, tests are used with physical activity such as running, squats, jumping, climbing and descending steps (step test) and others. All these loads are measured in both pace and duration (duration).

In addition to tests with physical activity, other tests are also used: orthostatic, clinostatic, Romberg test.

It should be noted that it is impossible to correctly assess the functional state of an athlete’s body using one indicator.

Only a comprehensive study of the functional state, including testing with physical activity, ECG recording, biochemical tests, etc., makes it possible to correctly assess the functional state of the athlete.

Functional tests are divided into specific and nonspecific. Specific are called such functional tests, the impact factor in which is the movements characteristic of a particular sport. For example, for a runner such a test would be running (or running on a treadmill), for a swimmer - on a hydraulic channel, etc. Nonspecific (inadequate) tests include tests that use movements that are not characteristic of a particular sport. For example, for a wrestler - bicycle ergometer load, etc.

Classification of functional tests

Classification of functional (stress) tests (tests). Functional tests can be one-stage, when one load is used (for example, running in place for 15 seconds, or 20 squats, or throwing a stuffed animal in wrestling, etc.); two-moment - when two loads are given (for example, running, squats), three-moment - when three tests (loads) are given sequentially one after another, for example, squatting, 15 s. running, and 3-minute jogging in place. In recent years, one-time tests (tests) are more often used and estimates are carried out (preliminary competitions) with the measurement of various indicators (heart rate, blood pressure, ECG, lactate, urea and other indicators).

When performing tests with physical activity, it is very important to perform them correctly and dosage in terms of pace and duration.

When studying the body's response to a particular physical activity, attention is paid to the degree of change in the determined indicators and the time of their return to the original level. Correct assessment of the degree of reaction and the duration of recovery allow a fairly accurate assessment of the condition of the subject.

Based on the nature of changes in heart rate and blood pressure (BP) after testing, five types of reactions of the cardiovascular system are distinguished: normotonic, hypotonic (asthenic), hypertonic, dystonic and stepwise (Fig. ).

Types of reactions of the cardiovascular system to physical activity and their assessment: 1 - normotonic; 2 - hypotonic; 3 - hypertensive; 4 - dystonic; 5 - step

Normotonic type of reaction cardiovascular system is characterized by increased heart rate, increased systolic and decreased diastolic pressure. Pulse pressure increases. This reaction is considered physiological, because with a normal increase in heart rate, adaptation to the load occurs due to an increase in pulse pressure, which indirectly characterizes an increase in the stroke volume of the heart. An increase in systolic blood pressure reflects the force of left ventricular systole, and a decrease in diastolic blood pressure reflects a decrease in arteriolar tone, providing better blood access to the periphery. The recovery period for such a reaction of the cardiovascular system is 3-5 minutes. This type of reaction is typical of trained athletes.

Hypotonic (asthenic) type of reaction The cardiovascular system is characterized by a significant increase in heart rate (tachycardia) and, to a lesser extent, an increase in stroke volume of the heart, a slight increase in systolic pressure and a constant (or slight increase) in diastolic pressure. Pulse pressure decreases. This means that increased blood circulation during exercise is achieved more by increasing heart rate rather than increasing stroke volume, which is irrational for the heart. The recovery period is delayed.

Hypertensive type of reaction physical activity is characterized by a sharp increase in systolic blood pressure - up to 180-190 mm Hg. Art. with a simultaneous rise in diastolic pressure to 90 mm Hg. Art. and higher and a significant increase in heart rate. The recovery period is delayed. The hypertensive type of reaction is assessed as unsatisfactory.

Dystonic type of reaction cardiovascular system on physical activity is characterized by a significant increase in systolic pressure - above 180 mm Hg. Art and diastolic, which after stopping the load can sharply decrease, sometimes to “0” - the phenomenon of endless tone. Heart rate increases significantly. Such a reaction to physical activity is regarded as unfavorable. The recovery period is delayed.

Step type reaction characterized by a stepwise rise in systolic pressure in the 2nd and 3rd minutes of the recovery period, when systolic pressure is higher than in the 1st minute. This reaction of the cardiovascular system reflects the functional inferiority of the regulatory circulatory system, therefore it is assessed as unfavorable. The recovery period for heart rate and blood pressure is prolonged.

The recovery period is important in assessing the response of the cardiovascular system to physical activity. It depends on the nature (intensity) of the load, on the functional state of the subject and other factors. The response to physical activity is considered good when, with normal initial pulse and blood pressure data, a recovery of these indicators is noted in the 2-3rd minute. The reaction is considered satisfactory if recovery occurs in the 4-5th minute. The response is considered unsatisfactory if, after exercise, hypotonic, hypertonic, dystonic and stepwise reactions appear and the recovery period lasts up to 5 minutes or more. No recovery of heart rate and blood pressure within 4-5 minutes. Immediately after exercise, even with a normotonic reaction, it should be assessed as unsatisfactory.

The Nowacki test is recommended by WHO for widespread use. To carry it out, a bicycle ergometer is used. The essence of the test is to determine the time during which the subject is able to perform a load (W/kg) of a specific power, depending on his own weight. In other words, the load is strictly individualized.

In Fig. the testing scheme is shown: the load starts with 1 W/kg of mass, every 2 minutes it increases by 1 W/kg until the subject refuses to perform the work (load). At this moment, oxygen consumption is close to or equal to MPK, and heart rate also reaches its maximum values.

Novakki test: W - load power; t - time

In the table Novacchi test parameters assessments of the testing results of healthy individuals are given. The Novakki test is suitable for studying both trained and untrained individuals, and can also be used in the selection of rehabilitation agents after injuries and diseases. In the latter case, the test should begin with a load of 1/4 W/kg. In addition, the test is also used for selection in youth sports.

Novacchi test parameters

*See picture .

Cooper test

Cooper test (K. Cooper). Cooper's 12-minute test involves covering the maximum possible distance by running in 12 minutes (on flat terrain without ups and downs, usually in a stadium). The test is stopped if the subject has signs of overload (severe shortness of breath, tachyarrhythmia, dizziness, pain in the heart, etc.).

The test results are highly consistent with the MPK value determined during treadmill testing (Table Gradations of physical condition based on the results of a 12-minute test).

Gradations of physical condition based on the results of a 12-minute test*

* The distance (in km) covered in 12 minutes by women is indicated in parentheses (according to K. Cooper, 1970).

To assess the functional state of the body based on MPK, various gradations have been proposed. G.L. Strongin and A.S. Turetskaya (1972), for example, based on the use of maximum stress tests in men, four groups of physical performance are distinguished: low - with MPK less than 26 ml/min/kg, reduced - with 26-28 ml/min/kg, satisfactory - with 29- 38 ml/min/kg and high - at more than 38 ml/min/kg.

Depending on the size of MPK, taking into account age, K. Cooper (1970) distinguishes five categories of physical condition (very poor, poor, satisfactory, good, excellent). The gradation meets practical requirements and allows one to take into account the dynamics of the physical state when examining healthy people and people with minor functional impairments. K. Cooper's criteria for various categories of physical condition of men based on MPK are given in Table. Assessment of physical condition based on MPK value.

Assessment of physical condition based on MPK (ml/min/kg)

The Cooper test can be used to select schoolchildren in sections for cyclic sports, as well as to monitor fitness (Table. Correlation between the results of the 12-minute test and MPK). The test makes it possible to determine the functional state of the athlete and those involved in physical education.

Correlation between the results of the 12-minute test and MPK (according to K. Cooper)

Tests and assessments of athletes' condition

Flack's test(determination of physical performance indicator). The patient inhales into the mouthpiece of the air pressure gauge, holding his breath at the pressure gauge reading of 40 mmHg. Art. The duration of the breath hold is noted, where the heart rate is calculated every 5 s in relation to the resting level. Test assessment: in well-trained people, the maximum increase in heart rate does not exceed 7 beats in 5 s; with an average level of fitness - 9 beats; in mediocre condition - 10 beats. and more. An increase in heart rate, followed by a drop, indicates that the subject is unsuitable for intense muscle loads. A significant increase in heart rate, and then its slowdown, occurs in individuals with increased nervous tone. They can have high performance.

The Flack test reflects the functional state of the right chambers of the heart.

Sample V.I. Dubrovsky tests resistance to hypoxia. The subject is placed on the chest and abdominal wall with cuffs connected to the scribe. After a deep breath, the breath is held and the first ascillations are recorded on the kymograph, indicating contraction of the diaphragm. The length of breath holding indicates the degree of resistance to hypoxia. The higher it is, the better the athlete’s functional state.

Frampton test. The subject moves from a lying position to a standing position, and immediately his heart rate and blood pressure are measured for 2 minutes. The results of this test are expressed using the formula:

Krempton index = 3.15 + PA = Sc / 20

where RA is systolic blood pressure, Sc is heart rate. The obtained data is evaluated according to the table:

Orthostatic test is carried out as follows. The athlete lies on the couch for 5 minutes, counting his pulse. Then he stands up and the pulse is counted again. Normally, when moving from a lying position to a standing position, the heart rate increases by 10-12 beats/min. Up to 20 beats/min is a satisfactory response, more than 20 beats/min is unsatisfactory, which indicates insufficient nervous regulation of the cardiovascular system.

Clinostatic test- transition from a standing position to a lying position. Normally, the pulse slows down, not exceeding 6-10 beats/min. A sharper slowdown in heart rate indicates increased tone of the parasympathetic nervous system.

Circulation efficiency coefficient (CEC)- This is essentially the minute volume of blood.

KEK = (BP max. - BP min.) x HR

Normally KEK = 2600, increases with fatigue.

Temporal blood pressure (TBP) is measured according to Ravinsky-Markelov with a special cuff 4 cm wide. Normally, it is equal to 1/2 of the maximum blood pressure. When tired, temporal pressure readings increase by 10-20 mmHg. Art.

Endurance coefficient (KB) is determined by the Kwas formula. The test characterizes the functional state of the cardiovascular system. This test is an integral value that combines heart rate and systolic and diastolic pressure. Calculated using the following formula:

CV = (HR x 10) / pulse pressure

Normally, KV = 16. An increase in it indicates a weakening of the activity of the cardiovascular system, a decrease indicates strengthening.

Valsalva maneuver is as follows. After a complete exhalation and a deep inhalation, the athlete exhales into the mouthpiece of the pressure gauge and holds his breath at 40-50 mmHg. Art. During exercise, blood pressure and heart rate are measured. With stress, diastolic pressure increases, systolic pressure decreases and heart rate increases. With good functional condition, the duration of tension increases, with fatigue it decreases.

Kerdo index (IK) represents the ratio of blood pressure, d and p, that is:

IK = 1 - [(D/P) x 100]

where D is diastolic pressure, P is pulse. In a healthy person, it is close to zero; when sympathetic tone predominates, an increase is observed, while parasympathetic tone decreases and becomes negative. When the state of the autonomic nervous system is in equilibrium, IK = 0.

When the balance shifts under the influence of the sympathetic nervous system, diastolic blood pressure falls, heart rate increases, IK = 0. With increased functioning of the parasympathetic nervous system, IK< 0. Исследование необходимо проводить в одно и то же время суток (например, утром после сна). ИK информативен в игровых видах спорта, где высоко нервно-психическое напряжение. Kроме того, этот показатель надо рассматривать в комплексе с другими показателями, в частности, с биохимическими (лактат, мочевина, гистамин, гемоглобин и др.), с учетом активности физиологических функций. Необходимо учитывать уровень подготовки спортсмена, функциональное состояние, возраст и пол.

Mean arterial pressure

Mean arterial pressure- one of the most important parameters of hemodynamics.

SBP = BP diast. + blood pressure pulse / 2

Observations show that with physical fatigue, average blood pressure increases by 10-30 mmHg. Art.

Systolic volume (S) and minute volume (M) calculated using the Lilienstrand and Zander formula:

S = (Pd x 100) / D ,

where Pd is pulse pressure; D - average pressure (half the sum of the maximum and minimum pressures); M = S x P, where S is systolic volume; R - heart rate.

Reaction Quality Index (RQI) Kushelevsky and Zislin are calculated using the formula:

RCC = (RA 2 - RA 1) / (R 2 - R 1)

where P 1 and RA 1 are the pulse values ​​and pulse amplitude in a state of relative rest before exercise; P 2 and RA 2 - pulse values ​​and pulse amplitude after exercise.

Ruffier index. The pulse is measured in a sitting position (P 1), then the athlete performs 30 deep squats for 30 seconds. After this, count the pulse while standing (P 2), and then after a minute of rest (P 3). The index is assessed using the formula:

I = [(P 1 + P 2 + P 3) - 200] / 10

The index is assessed:< 0 - отлично, 1-5 - хорошо, 6-10 - удовлетворительно, 11-15 слабо, >15 - unsatisfactory.

Functional test according to Kwerg includes 30 squats in 30 s, maximum running in place - 30 s, 3-minute jogging in place with a frequency of 150 steps per minute and jumping rope - 1 min. The complex load lasts 5 minutes. Immediately after the exercise in a sitting position, heart rate is measured for 30 s (P 1), again after 2 (P 2) and 4 minutes. (P 3).

The index is estimated using the formula:

[working duration (in sec) x 100] /

> 105 = very good, 99-104 - good, 93-98 - satisfactory,< 92 - слабо.

Skibinskaya index. The vital capacity of the lungs (VC) (in ml) and breath holding (in s) are measured. Using a combined test, the cardiorespiratory system is assessed using the formula:

[(VC / 100) x breath holding] / pulse rate (in min.)

Index Score:< 5 - очень плохо, 5-10 - неудовлетворительно, 10-30 - удовлетворительно, 30-60 - хорошо, >60 is very good.

For highly qualified athletes, the index is more than 80.

English
functional tests– functional tests
test on treadmill (treadmill)
classification of functional tests
Novakki test – test Novakki
Kupera test – test Kupera
tests and assessment of athletes – test and assessment of athletes
mean arterial pressure

The hypertensive type of reaction is associated with the phenomena of overfatigue or overtraining. It can also be a sign of a prehypertensive state, but it can also be observed in completely healthy, well-trained athletes who show changes mainly in the values ​​of maximum blood pressure. Cause. This is due to an increase in hemodynamic shock, proportional to the kinetic energy with which blood is ejected from the heart into the vessels. During physical activity, the kinetic energy of cardiac output always increases, and therefore the hemodynamic shock increases significantly (in some athletes it can reach 25-40 mm 64T. St.

The hypotonic type of reaction is characterized by a slight increase in maximum blood pressure, in response to the load, accompanied by a sharp increase in heart rate at the 2nd and 3rd loads (up to 170-190 beats/min). Recovery of heart rate and blood pressure is slow. These changes are apparently due to the fact that the increase in minute volume is provided mainly by increased heart rate, while the increase in systolic volume is small. This type of reaction is considered unfavorable.

The dystonic type is characterized mainly by a decrease in minimum blood pressure, which after the 2nd and 3rd loads becomes equal to zero (“infinite tone phenomenon”). Maximum blood pressure in these cases increases to 180-200 mm 64T. Art. The initial idea that this type of reaction is observed in individuals with impaired vascular tone (hence the name dystonic reaction) has not been confirmed. Most likely, the “infinite tone phenomenon” has a methodological origin. The fact is that Korotkoff sounds, heard when measuring blood pressure, arise due to the fact that “vortices” (turbulent fluid flow) are formed in the blood flowing through the artery narrowed by the cuff. As soon as the lumen of the vessel becomes normal, the blood flow in it is normalized and the blood movement becomes laminar; The “sounding” of the artery stops. During physical activity, when the volumetric velocity of blood flow sharply increases, turbulent flow can occur in a vessel of normal diameter. Therefore, if you use a phonendoscope to listen to the “sounding” of the arteries in the area of ​​the elbow bend directly during exercise, then the sound phenomenon will naturally be detected during any sufficiently intense work. Thus, the “infinite tone phenomenon” is a normal phenomenon for loading conditions and the very beginning of the recovery period. It is considered as a negative sign only in cases where the “sounding” of the arteries

And finally, during the test there may be a reaction with a stepwise increase in maximum blood pressure. This type of reaction is characterized by the fact that maximum blood pressure, which usually decreases during the recovery period, in some athletes increases in the 2nd-3rd minutes compared to the value in the 1st minute of recovery. This type of reaction is most often observed after a 15-second run. Experience shows that it is associated with a deterioration in the functional state of the athlete’s body. At the same time, it can be an indicator of the inertia of systems that regulate blood circulation. The fact is that the burn-in period, according to a number of indicators of the cardiovascular system, lasts 1-3 minutes. It follows from this that with 15 seconds of work, the activity of the cardiovascular system does not reach a steady state and in some individuals, despite the cessation of the load, the development of the circulatory function may continue for some time. The considered criteria used to assess the results of testing an athlete's fitness have different values ​​at different stages of the training macrocycle. They are most informative during the competitive period, when the appearance of certain atypical reactions may be the result of a violation of the training regime or improper construction of it. At the beginning of the preparatory period, with an insufficient level of functional readiness, atypical reactions are detected more often.

Table 1 Protocol for conducting a three-stage combined functional test by S.P. Letunova (normotonic type of reaction)

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Physical activity requires a significant increase in the function of the cardiovascular system, on which to a large extent (usually in close connection with other physiological systems of the body) depends on providing working muscles with a sufficient amount of oxygen and removing carbon dioxide and other products of tissue metabolism from tissues. That is why, with the onset of muscular work, a complex set of neurohumoral processes occurs in the body, which, due to the activation of the sympathoadrenal system, leads, on the one hand, to an increase in the main indicators of the circulatory system (heart rate, stroke and minute blood volumes, systemic blood pressure, circulating blood volume, etc. .), and on the other hand, it predetermines changes in vascular tone in organs and tissues. Changes in vascular tone are manifested in a decrease in tone and, accordingly, dilation of the vessels of the peripheral vascular bed (mainly hemocapillaries), which ensures the delivery of blood to the working muscles.

At the same time, in individual internal organs there is an increase in tone and narrowing of small vessels. The above changes reflect the redistribution of blood flow between functionally active and inactive organs during loading. In functionally active organs, blood circulation increases significantly, for example, in skeletal muscles by 15-20 times (at the same time, the number of functioning hemocapillaries can increase by 50 times), in the myocardium - by 5 times, in the skin (to ensure adequate heat transfer) - by 3- 4 times, in the lungs - almost 2-3 times. In organs that are functionally inactive under load (liver, kidneys, brain, etc.), blood circulation is significantly reduced. If in a state of physiological rest the blood circulation in the internal organs is about 50% of the cardiac output (MV), then with maximum physical activity it can decrease
up to 3-4% MOS.

Determination of the type of response of the cardiovascular system to physical activity. To determine the type of reaction of the cardiovascular system, the following parameters are taken into account:
1. Pulse excitability - an increase in pulse rate relative to the initial value, determined as a percentage;
2. The nature of changes in blood pressure (BP) - systolic, diastolic and pulse;
3. Time for the pulse and blood pressure to return to the initial level.

There are 5 main types of reaction of the cardiovascular system: normotonic, hypotonic, hypertonic, dystonic and stepwise.

The normotonic type of reaction is characterized by an acceleration of the pulse rate by 60-80% (on average by 6-7 beats per 10 s); moderate increase in systolic blood pressure up to 15-30% (15-30 mmHg); a moderate decrease in diastolic blood pressure by 10-30% (5-15 mm Hg), which is predetermined by a decrease in total peripheral resistance as a result of dilation of the vessels of the peripheral vascular bed to provide the working muscles with the necessary amount of blood; a significant increase in pulse blood pressure - by 80-100% (which indirectly reflects an increase in cardiac output, i.e. stroke volume and indicates its increase); the normal period of the recovery process: with the Martin test in men is up to 2.5 minutes, in women - up to 3 minutes.

The normotonic type of reaction is considered favorable, as it indicates an adequate mechanism of adaptation of the body to physical activity. The increase in minute volume of blood circulation (MCV) during such a reaction occurs due to an optimal and uniform increase in heart rate and stroke volume of the heart (SV).

The hypotonic (asthenic) type of reaction is characterized by a significant increase in heart rate - more than 120-150%; systolic blood pressure increases slightly, or does not change, or even decreases; diastolic blood pressure often does not change or even increases; pulse blood pressure often decreases, and if it increases, it is only slightly - by only 12-25%; The recovery period slows down significantly - more than 5-10 minutes.

This type of reaction is considered unfavorable, since the supply of working muscles and organs with blood in this embodiment is achieved only by increasing heart rate with a slight change in stroke rate, that is, the heart works little efficiently and with high energy costs.

This type of reaction is most often observed in untrained and poorly trained individuals, with vegetative-vascular dystonia of the hypotonic type, after illnesses, in athletes against the background of fatigue and overexertion. However, in children and adolescents, this type of reaction, with a decrease in diastolic blood pressure with a normal duration of the recovery period, is considered a normal variant.

The hypertensive type of reaction is characterized by: significant acceleration of the pulse - more than 100%; a significant increase in systolic blood pressure to 180-200 mm Hg. and higher; a slight increase in diastolic blood pressure - up to 90 or higher mmHg, or a tendency to increase; increased pulse blood pressure (which in this case is predetermined by increased resistance to blood flow as a result of spasm of peripheral vessels, which indicates significant stress in myocardial activity); the recovery period slows down significantly (more than 5 minutes).

The type of reaction is considered unfavorable due to the fact that the mechanisms of adaptation to the load are unsatisfactory. With a significant increase in systolic volume against the background of an increase in total peripheral resistance in the vascular bed, the heart is forced to work with a fairly high voltage. This type occurs with a tendency to hypertensive states (including latent forms of hypertension), vegetative-vascular dystonia of the hypertensive type, initial and symptomatic hypertension; vascular atherosclerosis, fatigue and physical stress in athletes. A tendency to a hypertensive type of reaction when performing intense physical activity can cause the occurrence of vascular “catastrophes” (hypertensive crisis, heart attack, stroke, etc.).

It should also be noted that some authors, as one of the variants of the hypertensive reaction, identify a hyperreactive type of reaction, which, unlike the hypertensive one, is characterized by a moderate decrease in diastolic blood pressure. With a normal recovery period, it can be considered conditionally favorable. However, this type of reaction indicates an increase in the reactivity of the sympathetic part of the autonomic nervous system (sympathicotonia), which is one of the initial signs of a violation of the autonomic regulation of cardiac activity and increases the risk of pathological conditions during intense exercise, in particular, physical overexertion in athletes .

The dystonic type of reaction is characterized by a significant acceleration of the pulse - more than 100%; a significant increase in systolic blood pressure (sometimes above 200 mm Hg); a decrease in diastolic blood pressure to zero (“infinite tone phenomenon”), which lasts for more than 2 minutes (the duration of this phenomenon within 2 minutes is considered a variant of the physiological reaction); slowing down the recovery period.

This type of reaction is considered unfavorable and indicates excessive lability of the circulatory system, which is predetermined by a sharp disruption of the regulation of the vascular bed. It is observed in cases of disorders of the autonomic nervous system, neuroses, after infectious diseases, often in adolescents in puberty, with overwork and physical stress in athletes.

The stepwise type of reaction is characterized by a sharp increase in heart rate - more than 100%; stepwise increase in systolic blood pressure, that is, systolic blood pressure measured immediately after exercise - in the first minute - lower than 2 or 3 minutes of the recovery period; slow recovery period.

This type of response is also considered unfavorable because the mechanism of adaptation to stress is unsatisfactory. It indicates a weakened circulatory system, unable to adequately and quickly ensure the redistribution of blood flow necessary to perform muscle work. This reaction is observed in elderly people, with diseases of the cardiovascular system, after infectious diseases, with overwork, with low physical fitness, as well as insufficient general fitness in athletes.

Hypotonic, hypertonic, dystonic and stepwise type of reaction are considered pathological types of response of the cardiovascular system to physical activity. The normotonic type of reaction is also considered unsatisfactory if the recovery of pulse and blood pressure occurs for more than 3 minutes.

Currently, based on the assessment of the results of functional stress tests of the cardiovascular system, instead of five types of reaction, three types of pulse and blood pressure reactions are distinguished (Karpman V.L. et al., 1988, Zemtsovsky E.V., 1995): physiological adequate, physiological inadequate and pathological. In this case, to determine the type of reaction, in addition to changes in heart rate and blood pressure, ECG indicators are taken into account.

Physiological adequate type, characterized by an adequate increase in heart rate and systolic blood pressure in response to a stress test and a rapid recovery of values ​​after cessation of the load. There are no changes in the ECG and no pathological arrhythmias. This type of reaction is typical for healthy and well-trained athletes.

The physiological inadequate type, when performing a load, is characterized by a predominantly chronotropic response to the load, an inadequate rise in systolic blood pressure and a slow recovery of the pulse. The ECG may reveal minor (diagnostic) changes and rhythm disturbances (single extrasystoles). This type of reaction is characteristic of healthy, but poorly prepared or overtrained athletes.

The pathological or conditionally pathological type is characterized by a drop or inadequate rise in blood pressure during exercise or during the recovery period. There may be marked ECG changes and clinically significant changes in arrhythmia. With this type of reaction, three subtypes are distinguished depending on changes in blood pressure: hypotensive - in the case of insufficient rise or even fall in blood pressure during exercise; urgent hypertensive - when hypertension appears during exercise; delayed hypertensive - when blood pressure rises in the recovery period.

You can also evaluate the quality of the cardiovascular system’s response to stress by calculating the response quality index (RQR):

RCC (according to Kushelevsky) = RD 2 - RD 1 / R2 - R1/,

Where РД1 is pulse pressure before exercise; PP2 - pulse pressure after exercise; P1 - pulse before exercise; P2 - pulse after exercise.

RCC assessment: 0.1-0.2 - irrational reaction; 0.3-0.4 - satisfactory response; 0.5-1.0 - good reaction; >1.0 is an irrational reaction.

Ruffier's test. Currently, this test is widely used in sports medicine. It allows you to assess the functional reserves of the heart. During the test, only changes in heart rate are taken into account. In a subject who is in a supine position, after 5 minutes the pulse is recorded for 15 seconds (P1). Then, within 45 seconds, he is asked to perform 30 squats. After this, the patient lies down and his pulse is again recorded for the first 15 s (P2), and then for the last 15 s (P3) of the 1st minute of the recovery period.
Next, the Ruffier index is calculated.

Ruffier index = - 4 (P1 + P2 + P3) - 200 / 10

Ruffier-Dixon index = (4 P2 - 70) + (4 P3 - 4 P1).

Sakrut V.N., Kazakov V.N.

BMI = body weight (kg) / height2 (m)

Body mass index (BMI) is used to estimate weight in relation to height and provides a reasonable estimate of total body fat in studies involving specific populations. In addition, BMI correlates with both morbidity and mortality, thus providing a direct indicator of health status and risk of disease.

The method does not provide information about the distribution of fat in different parts of the body, it is difficult to explain to the client and it is difficult to plan for actual weight loss due to changes in BMI. In addition, BMI has been shown to overestimate body fat mass in muscular individuals (eg, many athletes) and underestimate in individuals with loss of muscle mass (eg, older adults).
Excess weight is defined when BMI is 25–29 kg/m2, and obesity is defined when BMI is greater than 30 kg/m2. For people with a BMI greater than 20 kg/m2, mortality for many health conditions increases with increasing body weight.
World Health Organization (WHO), for men and women, recommended BMI, 20 – 25 kg/m2

Vegetative index (Kerdo index)

VI = (1 – ABP/HR) X 100
VI is considered to be one of the simplest indicators of the functional state of the autonomic nervous system, reflecting the ratio of the excitability of its sympathetic and parasympathetic divisions (excitation and inhibition, respectively - SSF). The value of VI in the range from -15 to +15 indicates the balance of sympathetic and parasympathetic influences. A VI value greater than 15 indicates a predominance of the tone of the sympathetic division of the autonomic nervous system and indicates satisfactory adaptation to the workload; a VI value less than minus 15 indicates a predominance of the tone of the parasympathetic division of the autonomic nervous system, which is a sign of the presence of a dynamic mismatch (Rozhentsov, Polevshchikov, 2006; S. – 156).
For a trained person, VI before exercise usually has a minus sign, or ranges from - 15 to + 15.
An excessive increase in VI usually indicates a person’s hypertensive reaction to the load - a discrepancy between the proposed load and the level of training. Such loads should not be frequent even among well-trained athletes.
A decrease in VI also indicates poor exercise tolerance. VI values ​​below – 15 indicate the most unfavorable type of response of the autonomic nervous system to stress – hypotonic.

Blood pressure (BP)

It is measured at rest, so there should be no activity for 15 minutes before its determination. If systolic pressure exceeds 126 mmHg. Art., and diastolic – 86 mm Hg. Art., measure it again after hyperventilation (five maximum deep and fast inhalations and exhalations). if the pressure remains elevated, check the cuff width and take readings again after 15 minutes. If it continues to be elevated, conduct a more in-depth examination.
Gender differences do not affect blood pressure levels, but after puberty (16–18 years), blood pressure in men is slightly higher than in women. Daily fluctuations in blood pressure are at least 10–20 mmHg. Art. and decrease during night sleep.
Horizontal body position, physical and mental rest are among the factors that reduce blood pressure. Eating, smoking, physical and mental stress leads to increased blood pressure. With heavy physical activity, blood pressure can increase significantly. The ADD reaction is especially important. In trained athletes, intense exercise is accompanied by a decrease in blood pressure.
BP in obese people is higher than in people with normal or low weight (muscle mass). In athletes living in cold climates, blood pressure is 10 mm Hg. Art. higher, in warm weather there is a tendency towards a decrease in blood pressure.
Normally, there is a pressure asymmetry: blood pressure on the right shoulder is slightly higher than on the left. In rare cases, the difference reaches 20 and even 40 mmHg. Art.

Systolic pressure (SBP)

Systolic pressure is considered normal at values ​​from 90 to 120 mm Hg.

• A value below 90 is hypotension, most often observed in women due to low absolute muscle and body mass in general, as well as short stature. It may also indicate insufficient nutrition (starvation, unphysiological diet).
• Values ​​from 120 to 130 mm Hg – moderately elevated blood pressure. Moderately elevated blood pressure can be observed at rest in individuals with large heights, body weight and/or muscle mass (especially with a sharp increase in body weight). It may be caused by a person's agitation before exercise, white coat syndrome, or caused by a recent meal.
• 140 and above are a sign of hypertension, but multiple measurements throughout the day are required to confirm the diagnosis. If the diagnosis is confirmed, the doctor is obliged to recommend taking medications that normalize blood pressure.

Diastolic pressure (DBP)

It is considered normal at values ​​from 60 to 80 mmHg.

• Values ​​from 80 to 90 mm Hg indicate a moderately increased blood pressure.
• Blood pressure of 90 mmHg and above is a sign of hypertension.

It should be noted that the final conclusion is made not based on the best, but on the worst of the indicators. Thus, both 141 over 80 and 130 over 91 indicate hypertension.

Pulse pressure (PP)

Defined as the difference between systolic and diastolic pressure. All other things being equal (same peripheral resistance, blood viscosity, etc.), pulse pressure changes parallel to the value of systolic blood volume (an indirect indicator of myocardial load). Normally it is 40 – 70 mmHg. Art. Pulse pressure may increase as a result of an increase in blood pressure or a decrease in blood pressure

Mean arterial pressure (MAP)

SBP = ADD + 1/3(ADS - ADD)
All changes in mean arterial pressure are determined by changes in cardiac output (MV) or total peripheral resistance (TPR)
SAD = MO x OPS
A normal SBP can be maintained against the background of a decrease in OPS due to a compensatory increase in the MO.

Five types of cardiovascular system (CVS) response to physical activity
(Kukolevsky, 1975; Epifanov. 1990; Makarova, 2002)

1. Normotonic type of CV response on physical activity is characterized by:

• adequate intensity and duration of work performed by increasing heart rate, within 50 - 75% (Epifanov, 1987);
• an adequate increase in pulse blood pressure (the difference between systolic and diastolic blood pressure) due to an increase in systolic blood pressure (no more than 15 - 30% (Epifanov, 1987)) and a small increase (within 10 - 35% (Makarova, 2002), 10 - 25 % (Epifanov, 1987)) by a decrease in diastolic blood pressure, an increase in pulse pressure by no more than 50 - 70% (Epifanov, 1987).
• rapid (i.e., within specified rest intervals) restoration of heart rate and blood pressure to initial values

The normotonic type of reaction is the most favorable and reflects the body’s good adaptability to physical activity.

2. Dystonic type of reaction , as a rule, occurs after loads aimed at developing endurance, and is characterized by the fact that diastolic blood pressure is heard to 0 (the “infinite tone” phenomenon), systolic blood pressure rises to values ​​of 180 – 200 mm Hg. Art. (Karpman, 1980). This type of reaction may occur after repeated exercise after exercise.
When diastolic blood pressure returns to initial values ​​within 1–3 minutes of recovery, this type of reaction is regarded as a variant of the norm; if the “endless tone” phenomenon persists for a longer time, it is considered an unfavorable sign (Karpman, 1980; Makarova, 2002).

3. Hypertensive type of reaction characterized by:

• an increase in heart rate that is inadequate to the load;
• inadequate load increase in systolic blood pressure to 190 – 200 (up to 220) mm Hg. Art. more than 160 - 180% (Epifanov, Apanasenko, 1990) (at the same time, diastolic pressure also increases slightly by more than 10 mm Hg (Epifanov, Apanasenko, 1990) or does not change, which is due to a significant hemodynamic shock during physical activity in some athletes (Karpman, 1980));
• slow recovery of both indicators.

The hypertensive type of reaction indicates a violation of regulatory mechanisms that cause a decrease in the efficiency of the functioning of the heart. It is observed in chronic overstrain of the central nervous system (neurocirculatory dystonia of the hypertensive type), chronic overstrain of the cardiovascular system (hypertensive variant) in pre- and hypertensive patients.

4. Stepwise reaction maximum blood pressure is characterized by:

• a sharp increase in heart rate;
• an increase in systolic blood pressure that continues in the first 2–3 minutes of rest compared to the 1st minute of recovery;

This type of reaction is unfavorable. It reflects the inertia of regulatory systems and is recorded, as a rule, after high-speed loads (Makarova, 2002). Experience indicates that this type of reaction is associated with a deterioration in the functional state of the athlete’s body (Karpman, 1980, p. 113). The time for performing the load (30 s) may be insufficient to train the cardiovascular system, which, according to a number of indicators, lasts 1 – 3 minutes. In some individuals, despite the cessation of the load, the development of circulatory function may continue for some time (Karpman, 1980, ibid.). Thus, this type of reaction is most likely to occur after the first test of 20 squats, which is performed before class.

5. Hypotonic type of reaction characterized by:

• a sharp, inadequate increase in heart rate (up to 170–190 beats/min (Karpman, 1980); more than 100% (Epifanov, Apanasenko, 1990); up to 120–150% (Epifanov, 1987));
• absence of significant changes in blood pressure (systolic pressure slightly or does not increase at all, and sometimes even decreases, pulse pressure decreases (Epifanov, Apanasenko, 1990));
• slow recovery of heart rate and blood pressure.

The hypotonic type of reaction is the most unfavorable. It reflects a disturbance (decrease) in the contractile function of the heart (“hyposystole syndrome” in the clinic) and is observed in the presence of pathological changes in the myocardium (Makarova, 2002). Apparently, the increase in cardiac output is provided mainly by an increase in heart rate, while the increase in systolic volume is small (Karpman, 1980).
Pathological reactions to stress during regular physical training can turn into physiological ones (Epifanov, 1987, p. 50). With unfavorable types of reactions, which most often appear at the beginning of the preparatory period (Karpman, 1980., P. 114), additional (clarifying) pressure measurements are possible, described (Richard D. H. Backus, and David K. Reid 1998., P. 372 ).

Additional Information.

If high-intensity training sessions are planned (especially preparation for competitions), it is necessary that the client undergo a full medical examination (including a dentist).
To check the state of the cardiovascular system, it is necessary to perform an ECG under stress. Possible myocardial pathologies are revealed by an echocardiogram.
Be sure to evaluate your diet (analysis of everything you ate for a week or more) and daily routine - the possibility of organizing adequate recovery.
It is strictly forbidden to prescribe medications to a client (especially hormonal ones) - this is the responsibility of the doctor.

Referring the client for echocardiography and stress ECG to exclude cardiac pathology is recommended under the following circumstances:

• Positive answers to questions about symptoms of cardiovascular diseases
• Slow recovery of pulse and/or respiration during orientation
• High heart rate and blood pressure with light loads
• Unfavorable type of reaction to physical activity
• History of cardiovascular diseases (previous)

Before receiving the test results:

• Pulse when walking is not higher than 60% of the maximum (220 - age). If possible, introduce additional aerobic exercise on days free from strength training, gradually increasing its duration to 40 - 60 minutes.
• The strength part of the lesson is 30-40 minutes, monitor the technique of performing the exercises, use a tempo of 3:0.5:2:0, while controlling your breathing (do not hold your breath). Use alternating exercises for “top” and “bottom”. Don't rush to increase intensity
• Of the available control methods Necessarily use blood pressure measurements before and after training, heart rate before and after (if you have a heart rate monitor, then during training). Observe the speed of breathing recovery, do not start the next approach until it normalizes.

The article was prepared by Sergey Strukov

Catad_tema Arterial hypertension - articles

The influence of antihypertensive drugs of different pharmacological groups on the response of blood pressure under stress testing conditions Part I

E. A. PRASKURNICHY, O. P. SHEVCHENKO, ST. MAKAROVA, V.A. ZHUKOVA, S.A. SAVELIEVA
Russian State Medical University. 117437 Moscow, st. Ostrovityanova, 1

Effect of Antihypertensive Agents From Various Pharmacological Groups on Blood
Pressure Reaction During Stress -Testing. Part I. Comparative Characteristics of Medications, Exerting Effect of Sympathoadrenal Block

E.A. PRASKURNITCHY, O.P. SHEVTCHENKO, S.V. MAKAROVA, V.A. ZHUKOVA, S.A. SAVELIEVA

Russian State Medical University; ul. Ostrovityanova 1, 117437 Moscow, Russia

The resting blood pressure level and 24-hour blood pressure monitoring (ABPM) data still serve as verification criteria for arterial hypertension (AH), the main parameters characterizing the degree of its severity, as well as the most informative indicators reflecting the effectiveness of antihypertensive measures. At the same time, it has been repeatedly emphasized that the usual registration of blood pressure using the Korotkoff method or under conditions of 24-hour monitoring leaves a significant portion of cases of increased blood pressure and uncontrolled hypertension that are stress-induced in nature undiagnosed.

The pronounced dependence of the blood pressure level on the degree of physical activity and the psycho-emotional state of the patient is most clearly manifested at the onset of hypertension, but can also be expressed at all stages of disease progression. The significant variability of hemodynamic parameters in these cases causes low reproducibility of the results of clinical measurements and ABPM. At the same time, stress testing data, reflecting the hemodynamic response to modeling different types of stress, allows for a more accurate assessment of the feasibility and effectiveness of using different approaches to antihypertensive therapy. It is in this regard that a trend has emerged for the wider use of stress testing results in the clinical diagnostic process.

Since the 90s of the last century, the prognostic value of increased blood pressure under stress testing has been widely discussed. However, a number of studies have reported mixed results. In particular, in the Framingham study, during a four-year follow-up, a hypertensive response of systolic blood pressure to physical activity in men was associated with an increased risk of developing hypertension, while this trend could not be observed in women. At the same time, the results of most studies indicate that a pronounced increase in blood pressure during physical activity is more than 200/100 mm Hg. at a power level of 100 W during a bicycle ergometer (VEM) test - is associated with a significant increase in the risk of target organ damage, the development of cardiovascular complications and death.

Taking into account the prognostic value of blood pressure during exercise, as well as the possibility of its significant increase in these conditions with normal blood pressure at rest and with standard assessment by the Korotkoff method, the identification of a hypertensive response during stress testing should be considered as an urgent task of diagnosis and monitoring hypertension, and its elimination is an important tactical task of antihypertensive therapy.

In clinical practice, the response of blood pressure to physical activity is most widely studied using the VEM test. Some studies have demonstrated the high information content of the isometric load test. At the same time, a pronounced increase in blood pressure, recorded during various types of stress testing, is associated with a high level of activation of neurohumoral systems, in particular the sympathetic-adrenal system. Therefore, in situations of the development of hypertensive reactions under stress testing, the most rational step to optimize therapy is to consider the possibility of using β-blockers and other agents that provide sympathetic-adrenal blockade

The purpose of the study was to compare the effectiveness of the β-blockers metoprolol and carvedilol and the I 1 -imidazoline receptor agonist moxonidine in reducing stress-induced increases in blood pressure that occur under conditions of static and dynamic physical activity.

Material and methods

The study included 81 patients aged 44 to 65 years with mild and moderate hypertension. Exclusion criteria from the study included clinical manifestations of coronary artery disease, congestive heart failure, renal failure, diabetes mellitus, bronchial asthma, as well as a history of myocardial infarction, acute and transient cerebrovascular accident.

Patients were randomized to antihypertensive treatment groups. Representatives of the 1st group (n=32) received moxonidine at a dose of 0.2-0.4 mg/day, patients of the 2nd group (n=28) received metoprolol at a dose of 100-150 mg/day, patients of the 3rd group groups (n=21) - carvedilol (Acridilol®, AKRIKHIN) 50-75 mg/day. All drugs were prescribed as monotherapy; combination with other antihypertensive drugs was not allowed.

All patients were observed on an outpatient basis for 12 weeks, examinations were carried out during 4 visits: 1st visit (randomization), 2nd visit (2nd week), 3rd visit (6th week), 4th visit (12th week). The start of active treatment was preceded by a two-week control period, during which previously prescribed antihypertensive therapy was discontinued.

At baseline and at the end of the 12th week, patients underwent examination, which included collection of anamnestic data, objective examination, ABPM, VEM test, and assessment of heart rate variability (HRV). During other visits, clinical monitoring of blood pressure was carried out, subjective and objective symptoms were assessed, as well as patient adherence to treatment.

In order to calculate the reference values ​​of cardiovascular testing parameters, a control group of practically healthy individuals was examined, consisting of 28 people, aged 27-60 years (average 51.4±7.2 years) with clinical blood pressure (BPcl.) less than 140/90 mm. Hg Art., average daily blood pressure less than 125/80 mm. Hg Art., as well as with a normotensive type of blood pressure reaction under the conditions of a VEM test.

ADcl. measured by auscultation using the Korotkov method, with the subject sitting in a sitting position after a 5-minute rest. ABPM was carried out using the CardioTens-01 device (Mediteck, Hungary) on weekdays for 24±0.5 hours, with an interval of 15 minutes during the day, 30 minutes at night, and 10 minutes in the early morning hours. All patients kept an individual diary of their well-being, physical and mental activity, time and quality of sleep. We analyzed such parameters as average daily, average day, average night levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as pressure load indicators (time index and area index of hypertension), blood pressure variability and daily index. The average daily blood pressure level is 130 mm Hg. or more for SBP and 80 mm Hg. or more for DBP was considered elevated.

The isometric test was carried out as follows. The maximum strength in the patient's right arm was determined using a dynamometer. Then, for 3 minutes, the patient squeezed the dynamometer with a force of 30% of the maximum. Heart rate (HR) and blood pressure levels were recorded immediately before the test and at the end of the 3rd minute of squeezing the dynamometer. Evaluated parameters: maximum SBP, DBP, HR, measured at the end of the 3rd minute of the test, increase in SBP, DBP, HR - the difference between the maximum SBP, DBP, HR and initial values.

The VEM test was carried out on a bicycle ergometer ERGOLINE D-72475 (Bitz, Germany) with the subject lying on his back, in the morning after a light breakfast, using the step-increasing load method. The test began with a load of 25 W, the power of which was increased by 25 W at intervals of 3 minutes. Blood pressure and heart rate were recorded at baseline and then at 1-minute intervals during exercise and at every minute of the recovery period. ECG monitoring in 12 standard leads was carried out throughout the entire test, recording - at the 3rd minute of each load step. An increase in blood pressure of more than 200/100 mmHg was considered the criterion for a hypertensive reaction during an exercise test. with a VEM test against a load of 100 W and blood pressure exceeding 140/90 mm Hg. at the 5th minute of the recovery period.

HRV was studied by analyzing ECG records recorded for 5 minutes using VNS-Rhythm Neurosoft equipment (Russia), in the morning at rest 15 minutes after the patient was in a supine position. HRV analysis was carried out using statistical methods (SDNN was determined, ms - standard deviation from the average duration of all sinus R-R intervals; RMSSD, ms - root mean square difference between the duration of adjacent sinus R-R intervals; pNN50, % - the proportion of adjacent R-R intervals that differ by more than 50 ms obtained over the entire recording period) and spectral analysis (total spectrum power - T P, high-frequency spectrum component - HF, low-frequency spectrum component - L F, very low-frequency spectrum component - VLF, relative value HF%, LF%, VLF% of the total power spectrum, index of vago-sympathetic interaction - LF/HF).

When conducting an active orthostatic test, the patient, after a 15-minute rest in a horizontal position with a low headboard, upon command, without delay, assumed a vertical position and stood without excessive tension for 6 minutes. Blood pressure and heart rate levels were measured immediately before the orthostatic test at rest, immediately after the transition from a horizontal to a vertical position, and at the end of the 1st, 3rd and 6th minutes of taking a standing position. The ECG was recorded throughout the entire test for 6 minutes.

Statistical analysis was carried out using the Exel 7.0 and BIOSTAT software package using the recommended criteria. Differences were considered significant at p results

Initially, the results of treatment with the I 1 -imidazoline receptor agonist moxonidine, the β1-selective adrenergic blocker metoprolol, and the non-selective β-adrenergic blocker with the property of α1-adrenergic blockade carvedilol were analyzed. The use of these drugs in moderate doses was characterized by comparable antihypertensive effectiveness. A negative chronotropic effect was noted only in groups of individuals receiving β-blockers metoprolol and carvedilol. The dynamics of blood pressure and heart rate according to clinical measurements are presented in table. 1. The number of patients who managed to achieve a reduction in blood pressure less than 140/90 mm Hg in the moxonidine, metoprolol and carvedilol groups did not differ significantly and amounted to 59%, 64% and 69%, respectively.

Table 1. Dynamics of blood pressure and heart rate during therapy according to clinical measurements

According to the results of a dynamic assessment of ABPM indicators, the decrease in SBP was approximately equally expressed during the use of all compared drugs and was due to their predominant effect on the average daily level of SBP (Table 2). There was no significant increase in blood pressure at night before the initiation of therapy, and the hypotensive effect of the drugs at night was minimal. At the same time, therapy with carvedilol was accompanied by a decrease in DBP more pronounced than with the prescription of moxonidine and metoprolol, although it was in the 3rd group that this indicator was changed to a much greater extent initially. A negative chronotropic effect was recorded only with the use of β-blockers.

Table 2. Dynamics of 24-hour blood pressure monitoring indicators during therapy

Taking into account the task set for the study (assessment of the effect of the studied drugs on stress-induced increases in blood pressure), an analysis of the dynamics of hemodynamic parameters recorded during stress testing was carried out during therapy with moxonidine, metoprolol and carvedilol. The results of the isometric exercise test generally reflected the comparable effect of the compared drugs in suppressing the hypertensive response (Fig. 1).

Rice. 1. Dynamics during therapy of maximum blood pressure recorded during the isometric test.

SBP - systolic blood pressure; DBP - diastolic blood pressure. * -p

Meanwhile, of particular interest is the analysis of the dynamics of hemodynamic parameters recorded during the VEM test (Table 3). It is noteworthy that, with comparable antihypertensive efficacy in terms of the effect on blood pressure at rest, the studied drugs correct blood pressure to varying degrees during exercise. In particular, the I1-imidazoline receptor agonist moxonidine did not significantly affect the hypertensive reaction that occurs during the VEM test. β-adrenergic receptor blockers, on the contrary, significantly reduce the maximum SBP and DBP that are achieved when performing this version of stress testing. Moreover, in 85% of patients in the metoprolol group and in 89% of patients in the carvedilol group, the hypertensive type of reaction to exercise was eliminated.

Table 3. Dynamics of hemodynamic parameters recorded during the VEM test

The decrease in maximum blood pressure when performing a test with dynamic physical activity under the influence of therapy with β-blockers metoprolol and carvedilol (Fig. 2) is ensured due to a decrease not only in blood pressure recorded immediately before testing, but also in the degree of increase in both blood pressure and heart rate under conditions of increasing intensity physical activity of dynamic type. The I 1 -imidazoline receptor agonist moxonidine does not have a significant effect on these indicators.

Rice. 2. Dynamics of the increase in blood pressure during therapy, recorded during the VEM test when the load power reaches 100 W

VEM - bicycle ergometer; SBP - systolic blood pressure, DBP - diastolic blood pressure, * -p

When assessing hemodynamic parameters recorded when the load power reached 100 W, it was shown that carvedilol, to a much greater extent than metoprolol, causes a decrease in maximum blood pressure and an increase in blood pressure at the height of the load, and this applies to both SBP and DBP.

Analysis of the effect of moxonidine, metoprolol and carvedilol on HRV parameters revealed diametrically opposed trends characterizing these groups of antihypertensive drugs. Both β-blockers increased the overall power of the spectrum, pNN 50%; metoprolol significantly increased SDNN, which generally reflects an increase in HRV. Metoprolol, to a significantly greater extent than carvedilol, caused a shift in the sympathovagal ratio towards the predominance of the vagal influence, although changes in this indicator were unidirectional and significant in both groups. The use of moxonidine was accompanied by a decrease in the total power of the spectrum, the RMSSD indicator, reflecting a trend towards a decrease in HRV.

The effect of drugs on the autonomic support of vascular tone was also studied during an orthostatic test. The nature of fluctuations in hemodynamic parameters during therapy with moxonidine and metoprolol was close to physiological, while during the use of carvedilol, there was no increase in SBP recorded at the moment of transition to a vertical position. At the same time, under these conditions, no pronounced decrease in blood pressure was observed, and in the patients we observed, such hemodynamic changes were not accompanied by clinically significant manifestations. In addition, when beta-blockers were used during an orthostatic test, a significant decrease in heart rate was recorded, while moxonidine did not significantly affect this indicator.

Rice. 3. Dynamics of heart rate recorded during an orthostatic test

HR - heart rate, * -p

Rice. 4. Dynamics of maximum SBP recorded during an orthostatic test

SBP - systolic blood pressure. The difference between the values ​​of the indicator during therapy with all drugs and the initial data is significant (p

Discussion

Studying changes in hemodynamic parameters in response to physical activity and the effect of various antihypertensive drugs on them is of key importance for the choice of drug treatment for patients with hypertension. The results of the analysis of the characteristics of the response of the circulatory system in these conditions open up the possibility of optimizing antihypertensive therapy by including drugs with the most beneficial hemodynamic characteristics in a given clinical situation. At the same time, it should be emphasized that recommendations for changing the structure of antihypertensive treatment based on the results of stress testing should not conflict with its fundamental principles, namely the focus on achieving the target blood pressure level.

In light of the above, the results of this study are of great importance, indicating comparable antihypertensive effectiveness of the I 1 -imidazoline receptor agonist moxonidine and the β-blockers metoprolol and carvedilol according to clinical measurements of blood pressure. Monotherapy based on the use of these drugs allows one to achieve target blood pressure values ​​in a significant proportion of cases of non-severe hypertension.

The drugs studied in this study are characterized by different mechanisms of suppression of sympathetic-adrenal activity. I 1 -imidazoline receptor agonists are drugs of central action, highly selective for I 1 -imidazoline receptors found in the nuclei of the reticular formation, rostral-ventrolateral region of the medulla oblongata (subtype 1). A decrease in blood pressure and a decrease in heart rate are associated with a sympatholytic effect, which is caused by activation of I 1 -imidazoline receptors. The effect of β-adrenergic blockers on the sympathetic-adrenal system is their competitive antagonism with catecholamines at β-adrenergic receptors. Currently, third-generation β-blockers, which have additional vasodilating properties, are widely used in cardiology. In particular, carvedilol, being a combined β1- and β2-blocker and having an α1-blocking effect, provides a more pronounced vasodilating effect. Obviously, it was the additional vasodilating effect of the drug that provided it with an advantage over other drugs in our study, in which, according to ABPM results, carvedilol was superior to comparison drugs in terms of their effect on the average daily level of DBP.

It was assumed that the known features of the hemodynamic profile of the compared antihypertensive drugs would be most demonstrably manifested during stress testing.

At the same time, during the isometric load test, no advantage of any drug was noted in terms of its effect on blood pressure and heart rate. As is known, isometric muscle tension during static load is accompanied by an inadequate increase in blood pressure and an increase in heart rate. Endothelial dysfunction is considered as a possible mechanism responsible for this type of hemodynamic disturbances. The corrective effect of antihypertensive drugs, including sympatholytics, on endothelial dysfunction in hypertension has been demonstrated in many studies and appears to play an important role in suppressing the hypertensive response induced by static exercise.

In contrast to the isometric test, stress testing using dynamic physical activity made it possible to identify significant differences in the hemodynamic effects of the compared drugs. The superiority of the β-blockers metoprolol and carvedilol in suppressing the hypertensive response to exercise over the I 1 -imidazoline receptor agonist moxonidine was obvious. At the same time, β-blockers effectively reduced the stress-induced increase in both SBP and DBP. Therefore, at least in terms of correcting hypertensive reactions induced by dynamic exercise, I 1 -imidazoline receptor agonists, despite the available information about their sympathetic-adrenal blockade effect, cannot be considered as an alternative to β-blockers.

The key role of activation of neurohumoral systems, in particular the sympathetic-adrenal system, in the pathogenesis of stress-induced increases in blood pressure is well known. In this regard, it would be logical to assume that the influence of I 1 -imidazoline receptor agonists and β-blockers on the functional status of the sympathetic and parasympathetic parts of the autonomic nervous system may be fundamentally different, and that these differences can play an important role in modifying stress-induced hypertensive reactions to during therapy with these drugs.

The results of assessing the effect of moxonidine, metoprolol and carvedilol on HRV parameters - one of the most informative and accessible from a practical point of view methods for assessing the state of autonomic support of cardiovascular processes - confirm the above assumption about the existence of fundamental differences in the effects of these drugs in relation to the sympathovagal balance.

By comparing the features of the influence of representatives of various classes of antihypertensive drugs on the vegetative status with the nature of the modification of stress-induced hypertensive reactions, we can come to the following conclusions. A decrease in the severity of the stress-induced hypertensive reaction under the influence of the β-blockers metoprolol and carvedilol is associated with their optimizing effect on the main parameters of HRV, including the sympathovagal ratio (LF/HF), which ultimately serves as a manifestation of sympathetic-adrenal blockade when using these drugs. Against the background of pronounced suppression of the activity of the sympathetic-adrenal system by the studied β-blockers, not only the hypertensive type of reaction in response to physical activity was eliminated, but also the increase in blood pressure during exercise was reduced. The absence of an effect on the stress-induced increase in blood pressure under conditions of dynamic load during therapy with moxonidine was stated along with signs of an increase in heart rhythm rigidity, reflecting an increase in the contribution of the sympathetic part of the autonomic nervous system to the control of cardiac activity.

When determining a β-blocker as the optimal drug for suppressing the stress-induced hypertensive response caused by dynamic exercise, one should take into account the large number of representatives of this pharmacological group at the present stage and the wide variety of their pharmacological properties. Discussion about the clinical significance of certain characteristics of a β-blocker is not the subject of this publication. At the same time, it should be noted that with the advent of new generation β-adrenergic receptor blockers, which provide an additional vasodilating effect, the possibilities of antihypertensive therapy based on the use of drugs of this class have significantly expanded.

The question of whether β-blockers with additional vasodilating properties have advantages over “classical” β1-selective blockers is considered in this work in the context of assessing their comparative effectiveness in limiting the stress-induced hypertensive response in individuals with hypertension. In general, the results of the VEM test indicated the advantages of the β- and α1-adrenergic blocker carvedilol in suppressing the hypertensive reaction that occurs under the conditions of this version of stress testing. Therefore, in conditions of clinically effective β-adrenergic blockade, the vasodilation effect, caused in this case by the anti-α1-adrenergic action, provides the drug with additional capabilities in suppressing the hypertensive response during exercise testing.

Along with achieving a pronounced antihypertensive effect, an important condition for the pharmacotherapy of hypertension is the exclusion of orthostatic hypotensive reactions fraught with adverse consequences against the background of adequate dosages of drugs. In order to clarify the degree of risk of such episodes, as well as to characterize the features of autonomic regulation that play an important role in their development, a dynamic analysis of the results of the orthostatic test was carried out.

During the transition from a horizontal to a vertical position, the flow of blood to the right parts of the heart decreases, and the central blood volume decreases by an average of 20%, and the cardiac output by 1-2.7 l/min. Then, during the first 15 contractions of the heart after moving to a vertical position, the heart rate increases due to a decrease in vagal tone, and after about 20-30 s, the parasympathetic tone is restored and reaches its greatest degree (at the same time relative bradycardia is recorded). Approximately 1-2 minutes after the transition from a horizontal to a vertical position, catecholamines are released and the tone of the sympathetic division of the autonomic nervous system increases, and therefore an increase in heart rate and peripheral vascular resistance is noted. After this, the renin-angiotensin mechanism of hemodynamic control is activated.

The preservation of the nature (close to physiological) of hemodynamic changes recorded during an orthostatic test during therapy with moxonidine and metoprolol indicates the relative safety of these drugs with respect to the development of orthostatic hypotensive reactions. This property of antihypertensive drugs is of great importance when choosing drugs suitable for inclusion in therapy for people with low adaptive potential of the blood circulation.

In this regard, the data obtained in the carvedilol treatment group are of particular interest. In general, the absence of a pronounced increase in systolic blood pressure should apparently be considered as a manifestation of the pronounced vasodilating effect of this drug, which is probably due to its α1-adrenergic blocking effect. In turn, the β-adrenergic blocking component in the pharmacological profile of carvedilol significantly eliminates the described side effects. Nevertheless, we consider it necessary to point out the undesirability of prescribing this drug to patients who have a tendency to develop orthostatic hypotensive reactions during functional tests.

Thus, the results of the study made it possible to demonstrate that, with comparable antihypertensive effectiveness according to casual measurements and ABPM, antihypertensive drugs of different pharmacological groups have different abilities to suppress the stress-induced hypertensive reaction that occurs during stress testing.

conclusions

1. Drugs that have the properties of sympathetic-adrenal blockade - the I 1 -imidazoline receptor agonist moxonidine, the β-blockers metoprolol and carvedilol - reduce the severity of the hypertensive reaction recorded during an isometric stress test.
2. In contrast to the I 1 -imidazoline receptor agonist moxonidine, in dosages that provide a comparable antihypertensive effect, the β-blockers carvedilol and metoprolol suppress the stress-induced hypertensive response that occurs during a dynamic exercise test.
3. A decrease in the increase in blood pressure recorded during a bicycle ergometer test during therapy with β-blockers is associated with an increase in heart rate variability, while the lack of effect on the stress-induced increase in blood pressure under these conditions when prescribing moxonidine, on the contrary, is combined with signs of a decrease in heart rate variability, noted while taking this drug.
4. With comparable antihypertensive effectiveness, according to 24-hour blood pressure monitoring and casual blood pressure measurements, the non-selective β-blocker with the property of α1-adrenergic blockade carvedilol (Acridilol®) has a corrective ability to reduce the hypertensive response under stress testing conditions that is higher than the selective β1-blocker. adrenergic blocker metoprolol.
5. The I 1 -imidazoline receptor agonist moxonidine, β-blockers metoprolol and carvedilol, when taken regularly, do not provoke the development of postural phenomena in persons who do not have hypotensive conditions before prescribing these drugs during an orthostatic test.