ESTIMATION OF HYPOTENSIVE EFFECT OF DENS IN PATIENTS WITH ARTERIAL HYPERTENSION

Parameter

Vlasov A. Estimation of hypotensive effect of dynamic electroneurostimulation in patients with arterial hypertension (placebo controlled trial) / A. Vlasov, M. Umnikova, Y. Kotovskaya // 17th ESPRM European Congress of Physical and Rehabilitation Medicine. Venice. 2010. p. 11-12.

ESTIMATION OF HYPOTENSIVE EFFECT OF DYNAMIC ELECTRONEUROSTIMULATION IN PATIENTS WITH ARTERIAL HYPERTENSION (PLACEBO CONTROLLED TRIAL)

A. Vlasov, M. Umnikova, 
Ural State Medical Academy, Yekaterinburg, Russia

Y. Kotovskaya
Russian People’s Friendship University, Moscow, Russia

Aim

Decrease and stabilization of blood pressure (BP) is the major factor of cardiovascular risks decreasing in patients with arterial hypertension (AH). Now alongside with drug treatment more and more attention is given to drug-free methods of BP correction.1 Assume that such approach can become the initial stage for patients with the labile form of AH and can lower the pharmacological load. Regulatory mechanisms of heart and blood vessels activity are constantly supervised by the central nervous system. BP level is caused by influence of sympathetic nervous system that in turn defines the norepinephrine level in monoamine nucleus of brain trunk. The effect orientation depends on concrete point choosing and on influence intensity. Weak influence reduces and intensive influence strengthens the catecholamines secretion by adrenal glands. It has been shown that acupuncture reduces minute heart volume (MHV) and raises the common peripheral vascular resistance (CPVR) in patients with hyperkinetic type of blood circulation but within the limits of normal values. In hypokinetic type CPVR decreases and MHV slightly raises under acupuncture influence. Thus acupuncture can produce the favorable effect reducing the sympathicotonic influence on heart and blood vessels. However acupuncture application is limited. Dynamic electroneurostimulation (DENS) is a transcutaneous electroneurostimulation consisting in stimulus of short electric impulses on reflexogeous zones and acupuncture points. The form of such impulses changes depending on values of full electric impedance of skin surface in subelectrode zone. Form, amplitude and frequency of impulses of the alternating current are similar to action potentials of different single nerve fibers. In its turn dynamic change of the impulse form which provides influence during the procedure minimizes habituation effect of stimulated tissues and allows to applicate the DENS method within a longer period. In the previous research the positive influence of dynamic electroneurostimulation (DENS) on parameters of average daily systolic BP and expressiveness of a headache in patients with AH has been shown.2 The purpose of the present research was the estimation of DENS influence on BP dynamics measured as patient’s self-control at home twice a day and during the daily monitoring of BP.

Methods

It was a single blind placebo controlled study. Sixty patients who have been randomly divided into two groups participated in the research. Standard medicines (enalapril 20 mg, hydrochlorthiazide 25 mg and metoprolol in maximal tolerant dose) have been appointed to all patients. In 30 patients of main group (mean age 55.6±4.9 years, AH duration 8.3±4.7 years) besides drug therapy DENS procedure by DiaDENS-Cardio device (Certificate No.: CQ070361-V dd. 05 February 2007 issued by EUROCAT Institute for Certification and Testing GmbH, Darmstadt, Germany) has been appointed on the neiguan zone once a day in the morning within 15 days. In 30 patients of the second group (mean age 51.8±6.2 years, AH duration 7.9±5.1 years) the imitation of DENS procedure has been executed by the placebo device. The patients did not know which devices (functioning or placebo) they have been treated by. After randomization all patients carried out the BP self-checking in the morning and in the evening. Measurement was spent in sitting position on the same hand three times. The first measurement was not analyzed. Clinical measurements of BP were spent by the same doctor during control visits. Besides daily BP monitoring has been executed before and after course of treatment. Statistical processing was accomplished with nonparametric tests (Wilkokson, Mann-Whitney, Fisher). Frequency of attribute distribution was compared by .2 method. At P<0.005 the differences were considered as statistically authentic. Results are present in M±SD.

Results

Both groups were comparable on clinical and demographic parameters (Table I). At comparison of BP measured by the patients independently and clinical BP measured by the doctor during the visits before and after treatment course the essential distinctions were received with lower parameters in active group (Table II). The analysis of daily BP monitoring has revealed the systolic BP decrease in the main group (from 153.3±4.7 mm to 125.8±4.9 mm, P<0.05) unlike placebo group. Variability of systolic BP has decreased from 19.9±2.0 mm up to 13.0±1.5 mm (P<0.05) in the day time and from 23.6±2.2 mm up to 14.6±2.1 mm (P<0.05) at night.

Table I

Clinical and demographic parameters of compared group

Table II

Dynamics of self-control and clinical measured BP in compared group

Variability of diastolic BP has decreased from 16.6±1.6 mm up to 12.8±1.2 mm (P<0.05) in the day time and from 15.7±1.2 mm up to 11.2±1.7 mm (P<0.05) at night. Last years interest to alternative methods of treatment has considerably increased. Approximately each fourth citizen of the USA though one time in a life resorted to alternative medicine. Since 1990 to 1997 the number of such patients has considerably increased from 33.8% to 42.1%.3 Financial investments are comparable to expenses for traditional medicine and reach 21.2 billion dollars vs. 29.3 billion dollars a year.4 Dynamic electroneurostimulation is a new method of reflexotherapy. DENS activates the most part of nervous fibers and through neuropeptides allows to influence on physiological mechanisms. In present research DENS was used in patients with AH. It was noted that BP decreased in group of active DiaDENS-Cardio device especially in the morning. In placebo group some decrease of BP also took place that confirms psychosomatic character of AH. It is important to note that decreasing of BP variability in group of active device can matter by way of threat of cardiovascular complications in AH patients.

Conclusion

The obtained data allow considering that DENS is an adequate method of increase of treatment efficiency in patients with AH. DENS allows to lower dozes and quantity of accepted medicines.

References

1. Whelton PR, Appel LJ et al. What Should 1. We Eat? South Med J 2006;99:744-8.
2. Vlasov A, Safronov A, Vladimirsky V, Vladimirskaya A, Umnikova M. Efficiency of dynamic electroneurostimulation in patients with arterial hypertension. Proceedings of the 16th European Congress of Physical and Rehabilitation Medicine 2008, June: 92-4.
3. Jacintha S, Cauffield. Psychosocial Aspects of Complementary and Alternative Medicine from Pharmacotherapy. Abstract http://www.medscape.com/viewpublication/132.
4. Mehmet C, Lemole EJ, Whitworth GC, Lemole GM. Treating CAD with Cardiac Surgery Combined with Complementary Therapy. Medscape General Medicine 1999;1:351-6.