DETERMINATION OF THE EFFECTIVENESS OF PERSONALIZED PHARMACOTHERAPY FOR ARTERIAL HYPERTENSION IN DIFFERENT CENTRAL NERVOUS SYSTEM ACTIVITY
Aim . Acute and chronic emotional stress reactions play a significant role in the pathogenesis of cardiovascular diseases which is associated with the characteristics of the higher nervous activity (HNA), and the equilibrium state of the cortical processes. The aim of the study was to determine the effectiveness of antihypertensive therapy for arterial hypertension (AH) in patients with different equilibrium of cortical processes in the central nervous system (CNS), departments of autonomic nervous system (ANS) and state of renin-angiotensin-aldosteron system (RAAS). Materials and Methods . Outpatient, single-center, cohort, prospective, controlled, non-randomized, long-term clinical study was performed. From 2011 to 2018 the patients with AH of the 2d degree of risk ( n = 328) and healthy ( n = 164) men (54,2 ± 1,8 years) were divided into groups according to the type of HNA into equal groups with the prevalence in the CNS of the processes of excitation(sympathicotonia) or inhibition (parasympathicotonia and RAAS activation)with high and low anxiety. Personal anxiety, minute blood volume (MBV), oxygen utilization coefficient by tissues (OUCT, %) and number of persons, who have suffered complications of AH were determined. Some groups of high and low anxiety patients took empirical AT (EAT), while others in the groups of the corresponding type of HNA personalized AT (PAT) with correction of sympathicotonia, and in other patients with renin-angiotensin-aldosteron-system (PAAS) activity - correct it’s activity by mineral corticoid receptors blockade. Results . In the setting of EAT or PAT, the personal anxiety and the number of persons with complications of hypertension were higher, and MBV and OUCT in patients with a predominance of inhibitory processes were lower than in patients with a predominance of excitatory processes in the central nervous system. The same differences were obtained in groups of healthy individuals of the corresponding type of HNA. However, in contrast to EAT, in cases with PAT, the values of the MBV and OUCT indices did not differ from those in healthy individuals of the corresponding type of HNA. The proportion of people who had complications of hypertension under PAT is significantly lower than under EAT. Conclusion . The effectiveness of a personalized approach to the pharmacotherapy of hypertension was determined depending on the prevalence of excitatory (sympathicotonia correction with a beta-blocker) and inhibitory processes (blockade of mineralocorticoid receptors with spironolactone/eplerenone) in the central nervous system. The feasibility of randomized clinical trials of this approach has been revealed.