Selection of the optimal scheme of antihypertensive therapy in patients with arterial hypertension remains among the main priorities of reference for such patients. Modern methods of evaluation for prognosticaly significant criteria of therapeutic influence of major groups of antihypertensive drugs on various vital signs makes this choice absolutely reasonable. The study aims to: explore prognostically significant criteria of the effect of treatment of ACE inhibitor lisinopril, beta- blocker bisoprolol and their combination on heart rate variability, the magnitude of blood pressure and heart rate in patients with hypertension in different classes of ECG QRS complex duration and treatment groups. Current recommendations for the management and treatment of patients with hypertension, taking into account risk factors such as age, duration of disease, systolic and diastolic blood pressure, heart rate, heart rhythm variability (total capacity range, VLF, LF, HF, the ratio LF/HF), do not account for the duration of the QRS ECG and therapy group.

Inclusion criterion was essential hypertension. The study excluded individuals with stable angina, acute coronary syndrome, heart failure IIB-IV FC, hypertension stage I, grade 3, the duration of the QRS complex ECG>120 ms, acute myocarditis, valvular heart implanted pacemaker thyroid disorders, acute stroke and uncompensated comorbidities of pregnant women.

On the basis of the city hospital № 6 in Moskovsky district 138 patients (60 men and 78 women) with a 1-2 degree and stage II hypertension in age (57±17) years have been examined. The average duration of hypertension – (7±5) years. According to the Ukrainian Heart Association classification for the prevention and treatment of hypertension (2012, 2013) AG 1 degree occurred in 94 (68%), 2 – 44 (32%) patients. 71 (51%) patients had chronic ischemic heart disease (Hibs). 112 (81%) patients had symptoms of heart failure. According to the classification of Strazhesko ND – VH Vasilenko CH stage I was diagnosed in 39 (35 %), II A – in 73 (65%). According to the classification of the New York Heart Association (NYHA) 11 (10%) patients had CH I. FC, 28 (25%) – CH FC II and 73 (65%) – CH FC III.

We found no studies on the duration of the QRS complex space ECG monitoring in predicting hypertension. Our data SHDA made it possible to reliably identify the relevant parameters for the construction of dividing functions, using which it is possible to predict effectiveness of BP control in new patients with hypertension depending on the class duration of the QRS complex ECG. Statistically significant indicators in the treatment groups lizinorpilom, bisoprolol and their combination, respectively, in the class duration of the QRS complex ECG ≤ 100 ms – SBP, DBP, the ratio LF / HF, in the class of > 100 ms – SBP, DBP, QRS ECG, TR.

Differences of clinical parameters, statistically significant in each of the classes of ECG QRS duration, possibly due to the influence of duration of the QRS complex of ECG on the clinical course of hypertension justify the need for monitoring the ECG QRS duration in the treatment of hypertensive patients.

In the treatment of hypertensive patients in the class of QRS duration ≤ 100 ms ECG it is important to pay more attention to changes in SBP, DBP, LF / HF in the class > 100 ms it is important to pay more attention to changes in SBP, DBP, QRS ECG, TR. Prognostically significant criteria of the effectiveness of therapy in patients of AG classes ECG QRS complex duration ≤ 100 ms and > 100 ms lisinopril, bisoprolol and their combination to optimize it have been established.

Ключові слова: duration of the QRS complex of ECG, blood pressure, heart rate, heart rate variability, stepwise discriminant analysis

Повний текст: PDF (Ukr)