Tensioregulome Concept. Quantitative-qualitative Blood Pressure Clusters of Patients at Truskavets' Spa and Their Accompaniments
Description
Horbachevskyi National Medical University, Ternopil, Ukraine
National Medical University, Ivano-Frankivsk, Ukraine
Kozyavkin International Rehabilitation Clinic, Truskavets, Ukraine
Nicolaus Copernicus University, Torun, Poland
Bohomolets Institute of Physiology National Academy of Sciences, Kyїv, Ukraine
Nataliya V. Kozyavkina
Yuliya V. Vovchyna
Nataliya M. Voronych-Semchenko
Walery Zukow
Igor L. Popovych
TENSIOREGULOME CONCEPT.
Quantitative-qualitative blood pressure clusters of patients at the Truskavets’ spa and their accompaniments
TERNOPIL
TNMU
UKRMEDKNYHA
2024
Authors
Nataliya V. Kozyavkina, MD, PhD; Horbachevskyi National Medical University, Ternopil; Kozyavkin International Rehabilitation Clinic nataliakozyavkina72@gmail.com; clinic@kozyavkin.com
Yuliya V. Vovchyna, MD; Ivano-Frankivsk National Medical University
Nataliya M. Voronych-Semchenko, MD, DS, Prof.; Ivano-Frankivsk National Medical University
Walery Zukow, MD, DS; Nicolaus Copernicus University, Torun, Poland w.zukow@wp.pl
Igor L. Popovych, MD, PhD, senior res. fel.; Bohomolets Institute of Physiology; Kozyavkin International Rehabilitation Clinic; i.popovych@biph.kiev.ua; i.l.popovych@gmail.com
We dedicate this monograph to the memory of Volodymyr Illich Kozyavkin (1947-2022)
with gratitude for his support of
the Truskavetsian Scientific School of Balneology
Recommended for publication by the Academic Council
of Horbachevs’kyi National Medical University
(protocol No. 9 dated 25/06/2024)
Reviewers:
Vastyanov Ruslan S., MD, DS, Prof, Head of the Department of General and Clinical Pathophysiology named after VV Podvysotskyi at the National Medical University, Odesa, Ukraine
Regeda Mykhaylo S., MD, DS, Prof, Head of the Department of Pathophysiology at the Danylo Halytskyi National Medical University, Lviv, Ukraine
Kozyavkina NV, Vovchyna YV, Voronych-Semchenko NM, Zukow W, & Popovych IL. Tensioregulome Concept. Quantitative-qualitative Blood Pressure Clusters of Patients at Truskavets’ Spa and Their Accompaniments. Ternopil: Ukrmedknyha; 2024: 194.
ISBN 978-1-4452-7212-2 DOI http://dx.doi.org/10.5281/zenodo.12664757
The monograph highlights the results of priority clinical-physiological studies of the state of blood pressure in patients at Truskavets’ spa and its hemodynamics, neuro-endocrine, immune, metabolic, and biophysics accompaniments. The authors put forward the concept of Tensioregulome as a constellation of neural, endocrine, immune and metabolic factors that determines the level of blood pressure and its changes under the influence of balneotherapy. Is it intended for physiologists, cardiologists, endocrinologists, immunologists, biophysicists, medical rehabilitation specialists.
DOI http://dx.doi.org/10.5281/zenodo.12664757
© Horbachevskyi National Medical University, Ternopil, 2024
© Ivano-Frankivsk National Medical University, 2024
© Kozyavkin International Rehabilitation Clinic, Truskavets’, 2024
© Nicolaus Copernicus University, Torun, 2024
© Bohomolets Institute of Physiology, Kyїv, 2024
© Authors
ISBN 978-1-4452-7212-2
DOI http://dx.doi.org/10.5281/zenodo.12664757
CONTENT
AUTONOMIC AND ENDOCRINE ACCOMPANIMENTS OF QUANTITATIVE-QUALITATIVE BLOOD PRESSURE CLUSTERS 47
ELECTROENCEPHALOGRAPHIC ACCOMPANIMENT OF QUANTITATIVE-QUALITATIVE BLOOD PRESSURE CLUSTERS 60
IMMUNE ACCOMPANIMENT OF QUANTITATIVE-QUALITATIVE BLOOD PRESSURE CLUSTERS 73
METABOLIC ACCOMPANIMENT OF QUANTITATIVE-QUALITATIVE BLOOD PRESSURE CLUSTERS 82
TENSIOREGULOME AS AN ACCOMPANIMENT OF QUANTITATIVE-QUALITATIVE BLOOD PRESSURE CLUSTERS 92
EVALUATION OF QUANTITATIVE-QUALITATIVE LEVELS OF BLOOD PRESSURE BY TENSIOREGULOME 107
DISCUSSION 156
CONCLUSION 170
REFERENCES 174
INTRODUCTION
BACKGROUND
Despite the fact that Truskavets' Spa, officially opened in 1827, has long had a cardiological profile, the effect of balneotherapy on hemodynamics began to be fundamentally studied only in 1998, and blood pressure is still not in the focus of researchers, giving way to the urinary and digestive systems as the object of study, and then to the neuroendocrine-immune complex.
In the seminal monograph “Physiological effect of Naftusya mineral water” [Yessypenko BY, 1981] collected scant information on the effect of treatment at the Truskavets’ Spa on blood pressure.
It was reported that out of 100 patients who arrived at the Spa with blood pressure of 150-200 mmHg, in 21 patients it decreased by 10-20 mmHg, in 51 - by 40-50 mmHg, in 26 patients blood pressure did not change, and in 2 patients it increased [Bajkalov LK, 1966].
According to Fedyushko MM [1967], nephrogenic hypertension decreased in the vast majority of patients 14-18 days after treatment, and at the end of treatment, blood pressure normalized in many patients. In patients with urolithiasis with concomitant hypertension, blood pressure normalized at the end of treatment in 54% of cases, decreased in 35,5%, and remained unchanged in 10,5%. In patients with cholelithiasis, the corresponding figures were 48,5%, 39,3%, and 12,1%.
Of particular interest to us are the data of Khokhlov BA & Yessypenko BY [1975] on the normalizing effect of treatment on blood pressure in patients with chronic pyelonephritis: initial systolic blood pressure in the range of 125÷220 mmHg decreased, but in the range of 125÷100 mmHg increased, as documented by the regression equation:
Change in BPs = -0,56•BPs initial +72,6.
In the fundamental monograph “BALNEOCARDIOANGIOLOGY. Effect of balneotherapy in the Truskavets’ spa on the cardiovascular system and physical performance” [Popovych IL et al., 2005], the main subject of the study was inotropism, more precisely, cardioinotropic effects of balneotherapy, while blood pressure and its response to balneotherapy were considered as a concomitant parameter, along with other parameters of central and peripheral hemodynamics, autonomic nervous system, electrolyte, uric acid and lipid metabolism, and bicycle ergometry.
Using the example of a sample of 66 women aged 40-54 and 18 men aged 54-61 who underwent balneotherapy for chronic digestive diseases relevant to the resort, the authors analyzed the state of the cardiovascular system of this patient population.
At the first stage, the authors used the histogram analysis method [Majdannyk VH, 1994]. Parameters that deviate from the mean norm within ±7% were considered average; deviations within ±8÷20% were assessed as higher or lower than average, and more than 20% were considered high or low values, respectively. These percentage intervals correspond to sigmoidal intervals of ±σ, ±1σ÷2σ, and more than 2σ, respectively, as well as centile intervals 25÷75; 75÷90 and 25÷10; 90÷97 and 10÷3, respectively.
It should be noted that in the cited study, following the recommendations [Vinogradova TS, 1986], the normal values of blood pressure were calculated by the age (A) of the patients:
Ps = 109 + 0,4•A; Pd = 67 + 0,3•A; Pm = 81 + 0,333•A,
which is now considered an outdated approach.
According to this approach, the histogram of systolic blood pressure has a two-humped appearance: the maximum proportion is found for the range of values both above average (42,9%) and below average (26,2%), while the narrowed norm is found in only 21,4% of patients. High and low levels of systolic blood pressure occurred in 4,8% of the subjects. Instead, diastolic blood pressure within the narrowed range was found in 61,9%; above-average values were detected in 16,7%, and below-average in 19,0%. The distribution of mean dynamic blood pressure largely coincides with that of diastolic blood pressure: the narrowed norm was found in 52,4%; above average values in 28,6%, and below average in 16,7%.
Using the method of cluster analysis, which allows for a natural classification of the sample by simultaneously taking into account all the features [Aldenderfer MS & Blashfield RK, 1985], Popovych IL et al. [2005] identified three groups whose members differ minimally from each other within each group, while differing as much as possible from the members of the other two groups of patients.
It was found that the maximum contribution to the division of the sample into clusters was made by the general peripheral vascular resistance (GPVR). In the members of the major cluster (78% of patients), it was 14,6±0,4 kPa•sec/m3, i.e. 94,9±3,8% of the average age norm (AAN). This was accompanied by systolic blood pressure of 123,0±2,5 mmHg, i.e. 96,2±1,8% of AAN, diastolic blood pressure of 80,2±1,3 mmHg, i.e. 98,4±1,4% of AAN and mean BP of 94,5±1,6 mmHg, i.e. 99,4±1,5% of AAN. The members of the second cluster (12% of patients) had a GPVR of 30,2±2,8 kPa•sec/m3, i.e. 180,0±23,5% of AAN, systolic BP of 120,0±6,5 mmHg (95,7±4,5% of AAN), diastolic BP of 76,0±4,0 mmHg (95,9±4,9% of AAN) and mean BP of 90,4±4,8 mmHg (97,6±4,7% of AAN). On the opposite pole, members of the third cluster (10% of patients) had a GPVR of 10,9±1,35 kPa•sec/m3 (77,8±5,7% AAN), systolic BP of 150,0±5,8 mmHg (113,0±5,3% AAN), diastolic BP of 91,3±1,2 mmHg (107,0±1,0% AAN) and mean BP of 111,0±1,1 mmHg (112,0±2,4% AAN).
After a two-week course of balneotherapy in members of the major cluster, GPVR increased by 18,1±6,5% in combination with a decrease in cardiac output (CO) by 9,1±4,5%. In the members of the second cluster, changes in these main hemodynamic parameters were more pronounced, amounting to +31,0±14,1% and -26,7±9,0%, respectively, while in the members of the third cluster they were oppositely directed: -34,3±5,9% and +63,6±16,5%, respectively. In contrast, no significant changes in either systolic or diastolic blood pressure were found in any cluster.
However, the authors' observation of another sample of 55 patients of both sexes yielded different results. After dividing patients into 5 clusters according to changes in cardiac hemodynamic parameters (the contractile activity index of the left ventricle, first proposed by Ruzhylo and Popovych, RPCAI; mean BP; heart rate, HR; stroke volume of the left ventricle, SV), the following patterns were found. In 16,4% of patients, BP did not change significantly; in 29,1%, there was a tendency to increase both diastolic BP (by 4,0±1,9%) and systolic BP (by 3,7±2,8%) in combination with an increase in GPVR and a decrease in SV, but not HR; in 20,0%, diastolic BP slightly increased (by 6,0±3,0%), but not systolic BP, in combination with an increase in SV and HR and a decrease in GPVR; 16,4% had a decrease in both diastolic BP (by 9,6±2,0%) and systolic BP (by 6,5±2,2%), combined with a decrease in GPVR and SV, but an increase in HR; the remaining 18,2% also had a decrease in both diastolic BP (by 13,1±3,1%) and systolic BP (by 9,9±3,0%), but in combination with a decrease in SV and HR and a tendency to increase in GPVR.
Cluster analysis was also used by Popovych IL et al. [2005] to naturally classify the variety of immediate (after 30 minutes) hemodynamic responses to the use of Naftussya bioactive water, which is the main component of the resort's balneotherapy complex. The maximum contribution to the division of the sample (21 women aged 35-45 and 38 men aged 38-52 years) into clusters was again found from GPVR, with significant contributions also from SV and end-diastolic (EDV) volume, HR, and RPCAI, but neither ejection time nor blood pressure. It was found that in 24 patients (41,4% of the sample), hemodynamic parameters remained without significant changes. In the other 23 patients (39,6% of the sample), a decrease in GPVR by 14,9±0,7% was noted, combined with an increase in SV by 11,2±1,3%, HR by 7,3±1,7%, EDV by 5,8±0,9%, and RPCAI by 4,4±1,9% in the absence of changes in blood pressure. In 4 patients (6,9% of the sample), the hemodynamic response was much more pronounced: a decrease in GPVR by 40,5±1,3% combined with an increase in SV by 46,5±7,8%, HR by 18,9±3,4%, EDV by 32,4±14,6%, RPCAI by 16,7±7,9%, as well as in systolic BP by 5,1±1,9%, but not in diastolic BP (1,4±3,0%). In 7 patients (12,1% of the sample), the opposite changes were found: an increase in GPVR by 13,2±5,1% combined with a decrease in SV by 17,6±2,7%, EDV by 8,0±5,1%, and RPCAI by 8,9±4,2%, but an increase in HR by 7,4±2,4% again in the absence of changes in blood pressure.
Interestingly, other components of the resort's balneotherapeutic complex, such as ozokerite application and mineral bath, also caused opposite types of urgent hemodynamic reactions [Popovych IL et al., 2005].
In the same year, Shakhbazova LV et al. [2005] for the first time in the Truskavets’ spa recorded a daily blood pressure profile in 105 patients (63 men and 42 women aged 31-62 years). The level of office systolic blood pressure was in the range of 145÷178 mmHg (mean 154,6±4,2 mmHg), diastolic blood pressure 90÷107 mmHg (mean 96,3±3,2 mmHg).
As a result of a three-week complex treatment (Naftussya bioactive water, dry carbon dioxide baths, supravenous laser therapy, singlet oxygen therapy), daily systolic blood pressure (mmHg) decreased from 151,4±5,2 to 131,2±3,4; daytime - from 156,8±3,5 to 139,5±2,7; nighttime - from 142,6±4,1 to 126,7±4,5. Daily diastolic blood pressure decreased from 90,9±2,9 to 81,9±2,6; daytime - from 93,7±2,7 to 84,7±2,8; nighttime - from 87,8±2,5 to 74,9±2,1 mmHg. Regarding the variability of blood pressure, a significant decrease was noted only for daytime systolic blood pressure: from 19,2±2,0 to 14,1±1,4 mmHg. The pressure load, estimated by the hypertension time index (over 140/90 mmHg during the day and over 120/80 mmHg at night), decreased in relation to systolic blood pressure during the day from 68,7±5,8% to 41,6±5,2%; at night from 72,4±5,6% to 47,6±4,4%; in relation to diastolic blood pressure during the day from 46,8±4,7% to 28,0±3,6%; at night from 56,4±4,0% to 33,5±4,1%. The magnitude of the morning rise in systolic blood pressure decreased from 54,4±5,3 to 37,2±3,4 mmHg, and diastolic blood pressure from 38,7±4,8 to 29,0±3,4 mmHg. Target blood pressure (below 140/90 mmHg) was achieved in 70,3% of patients.
The described favorable changes in the parameters of the daily blood pressure profile were accompanied by favorable changes in the morning HRV parameters. In particular, the reduced levels of markers of vagal tone increased: SDNN from 58,4±4,2 to 74,2±5,5 msec; RMSSD from 34,7±1,9 to 45,2±2,1 msec; pNN50 from 5,8±0,8 to 11,1±0,8%; triangular index from 16,3±0,8 to 19,6±1,1 units; HF from 623±55 to 753±52 msec2. At the same time, increased levels of sympathetic tone markers decreased: LF/HF from 2,43±0,12 to 1,64±0,11 and LFnu (calculated by us according to the available data) from 71,0% to 62,1%.
The next study of this group [Shakhbazova LV et al., 2006] showed that after a month of treatment of 35 patients of both sexes with office blood pressure 167±9,9/101±5,4 mmHg with enalapril in combination with Naftussya bioactive water, 62,8% achieved the target blood pressure level, while in the control group (n=20; BP 158±7,2/99±3,7 mmHg) monotherapy with enalapril was less effective (55,0%). In the other group (n=35; BP 164±6,3/101±3,6 mmHg), corvazan in combination with Naftussya bioactive water helped to achieve the target blood pressure level in 74,3% of patients versus 70,0% in the control group (n=20; BP 163±6,6/101±3,6 mmHg). The authors concluded that Naftussya bioactive water has additive activity in antihypertensive treatment.
Lukovych YuR et al. [2012] in their study of 30 women aged 30-60 years, whose systolic BP was in the range of 90÷160 mmHg and diastolic BP in the range of 60÷100 mmHg, found that its response to complex two-week balneotherapy (drinking Naftussya water and water from source #1 or #2, ozokerite applications, mineral baths) follows the law of initial level. In particular, the regression equation for systolic blood pressure is as follows:
Change in BPs = -0,6663•BPs initial +79,9; r=-0,746,
which is very similar to the one derived by Khokhlov BA & Yessypenko BY [1975].
The authors went further and documented the response of diastolic blood pressure:
Change in BPd = -0,7925•BPd initial +62,6; r=-0,592.
The points of change in the direction of the BP response were 120 and 79 mmHg, respectively.
In addition, this study analyzed the correlations between BP and HRV parameters before and after balneotherapy. It was found that balneotherapy initiates or strengthens the already existing positive correlations of diastolic BP with markers of sympathetic tone (LF relative: r=0,32 vs 0,04; AMo: r=0,54 vs 0,31; Stress Index: r=0,50 vs 0,29) and negative correlations with markers of vagal tone (HF relative: r=-0,40 vs -0,11; RMSSD: r=-0,43 vs -0,26; MxDMn: r=-0,53 vs -0,36; Triangular Index: r=-0,58 vs -0,38).
In relation to systolic blood pressure, the relationships were somewhat weaker (LF relative: r=0,32 vs -0,11; AMo: r=0,39 vs 0,24; Stress Index: r=0,43 vs 0,21; HF relative: r=-0,39 vs -0,04; RMSSD: r=-0,35 vs -0,15; MxDMn: r=-0,36 vs -0,19; Triangular Index: r=-0,41 vs -0,25). At the same time, balneotherapy negated the association of systolic blood pressure with ULF relative: r=-0,06 vs 0,38.
In the same population, other members of the same research group [Kozyavkina OV et al., 2013] found a negative relationship between changes in diastolic BP and Triangular Index (r=-0,65) as well as in systolic BP and MxDMn (r=-0,44).
Thus, as of 2013, a certain set of facts about the effect of balneotherapy on blood pressure, as well as some mechanisms of such an effect, had been accumulated. However, these findings were fragmentary and unsystematic. Moreover, in some observations, hypotensive factors were used for treatment, which are known to be much stronger than the balneofactors of the resort.
Therefore, we initiated the project “Neuro-endocrine-immune and metabolic mechanisms of the effects of balneotherapy on blood pressure”.
The materials from the monograph have been presented in the following publications:
1. Vovchyna YuV, Zukow W. The influence of balneotherapy on spa Truskavets’ on arterial pressure and its regulation at children. Journal of Health Sciences. 2014;4(10):151-160.
2. Vovchyna JV, Voronych NM, Zukow W, Popovych IL. Relationships between normal or borderline blood pressure and some neural, endocrine, metabolic and biophysic parameters in women and men. Journal of Education, Health and Sport. 2016;6(2):163-182.
3. Kozyavkina NV, Kozyavkina OV, Vovchyna YB, Popovych IL. Neurogenic mechanism of the influence of balneotherapy on arterial pressure. Fiziol Zhurn. 2019;65(3,Sup):54-54.
4. Kozyavkina NV, Kozyavkina OV, Vovchyna YV. Balneotherapy influences on arterial pressure by neurogenic mechanism. In: Rehabilitation Medicine and Health-Resort Institutions Development. Proceedings of the 19th International Applied Research Conference (Kyїv, 11-12 December 2019). Edited by O. Gozhenko, W. Zukow. Toruń, Kyiv. 2019:41-42.
5. Kozyavkina NV, Voronych-Semchenko NM, Vovchyna YV, Zukow W, Popovych IL. Quantitative and qualitative blood pressure clusters in patients of Truskavets’ spa and their hemodynamic accompaniment. Journal of Education, Health and Sport. 2020;10(6):445-454.
6. Kozyavkina NV, Voronych-Semchenko NM, Vovchyna YV, Zukow W, Popovych IL. Autonomic and endocrine accompaniments of quantitative-qualitative blood pressure clusters in patients of Truskavets’ spa. Journal of Education, Health and Sport. 2020;10(7):465-477.
7. Kozyavkina NV, Popovych IL, Popovych DV, Zukow W, Bombushkar IS. Sexual dimorphism in some psycho-neuro-endocrine parameters at human. Journal of Education, Health and Sport. 2021;11(5):370-391.
8. Kozyavkina NV, Voronych-Semchenko NM, Vovchyna YuV, Zukow W, Gozhenko OA, Popovych IL. Variety of blood pressure reactions in patients of Truskavets’ spa and their hemodynamic, autonomic and hormonal accompaniments. Balneo and PRM Research Journal. 2021;12(3):A17.
9. Kozyavkina NV, Vovchyna YV, Voronych-Semchenko NM, Zukow W, Popovych IL. Electroencephalographic accompaniment of quantitative-qualitative blood pressure clusters in patients of Truskavets’ spa. Journal of Education, Health and Sport. 2021;11(10):435-444.
10. Kozyavkina NV, Vovchyna YV, Voronych-Semchenko NM, Zukow W, Popovych IL. Metabolic accompaniment of quantitative-qualitative blood pressure clusters in patients of Truskavets’ spa. Journal of Education, Health and Sport. 2022;12(2):377-386.
11. Kozyavkina NV, Vovchyna YV, Voronych-Semchenko NM, Zukow W, Popovych DV, Popovych IL. Immune accompaniment of quantitative-qualitative blood pressure clusters in patients of Truskavets’ spa. Journal of Education, Health and Sport. 2022;12(3):320-329.
12. Popovych IL, Kozyavkina NV, Barylyak LG, Vovchyna YV, Voronych-Semchenko NM, Zukow W, Tsymbryla VV. Variants of changes in blood pressure during its three consecutive registrations. Journal of Education, Health and Sport. 2022;12(4):365-375.
13. Popovych IL, Kozyavkina NV, Vovchyna YV, Voronych-Semchenko NM, Zukow W, Popovych DV. Tensioregulome as an accompaniment of quantitative-qualitative blood pressure clusters. Journal of Education, Health and Sport. 2022;12(6):418-436.
14. Kozyavkina NV, Popovych IL, Vovchyna YV, Voronych-Semchenko NM, Zukow W, Popovych DV. Evaluation of quantitative-qualitative levels of blood pressure by Tensioregulome. Journal of Education, Health and Sport. 2022;12(8):1216-1236.
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