раздел: Исследования... ДЭНС - метод стимуляции... Рефлексотерапия...

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Efficiency of dynamic electroneurostimulation in patients with arterial hypertension

A. Vlasov, A. Safronov, V. Vladimirsky, A. Vladimirskaya, M. Umnikova
Ural state Medical Academy, Yekaterinburg, Russia

Aim
Arterial hypertension (AH) is one of the most wide-spread vascular heart diseases, which is very dangerous for its complications. AH is the ground for development of atherosclerosis and further acute myocardial infarction resulting from diseases of coronary vessels; cerebral hemorrhage and cardiac failures also being dangerous complications. In spite of a wide range of drugs for correction of AH, efficiency of the therapy is still insufficient, there is a constant search for new nondrug methods of treatment. The complex treatment of this category of patients applies the method of transcutaneous electroneurostimulation (TENS).1,2 Information about hypotensive effect of TENS is quite contradictory. Some researches showed hypotensive effect of low-frequency TENS on the wrist and bend of the arm zones.3 In other researches electrostimulation did not result in changes of the arterial blood pressure of volunteers having no vascular heart diseases.4 Dynamic electroneurostimulation is a transcutaneous electroneurostimulation consisting in stimulus on reflexogeous zones and acupuncture zones with impulses of electric current which form changes depending on values of full electric impedance of the skin surface in the subelectrode zone. Form, amplitude and frequency of impulses of the alternating current are similar to action potentials of different single nerve fibres. In its turn, dynamic change of the impulse form which provides influence during the procedure minimizes habituation effect of stimulated tissues and therefore allows application of the DENS method within a longer period. A preliminary assessment of DENS efficiency was carried out on 24 patients with an initial stage of hypertension and on 11 patients with the second stage. These investigation showed that DENS results in a considerable reduction of daily average systolic blood pressure (SBP) from 132.5+13.2 mmHg to 124.3±19.1 mmHg (P=0.034) of patients with not high blood pressure (BP) against the control group where changes of the BP were not significant (130.1±15.4 and 131.0±14.7 mmHg correspondingly before and after the treatment course, P=0.965). But no significant difference between the main (n=6) and control (n=5) groups was found in 11 patients. May be this resulted from small sample of patients. The purpose of the present research is to evaluate the hypotensive effect of DENS in patients with different variants of arterial hypertension.

Methods
Randomized blind placebo-controlled research was carried out in which 60 patients with hypertension of stages l-ll participated. All patients had hypotensive drug therapy. The main group of patients (30 persons) also had DENS-treatment with the DiaDENS-Cardio apparatus (Certificate No.:CQ070361-V dd. 05 February 2007 issued by EUROCAT Institute for Certification and Testing GmbH, Darmstadt, Germany) on the neiguan zone on the inner surface of the lower third part of the forearm. The DiaDENS-Cardio apparatus is intended for therapeutic non-invasive course treatment of the neiguan zone by DENS method in order to correct arterial blood pressure. The DiaDENS-Cardio apparatus combines stimulation at 9.2 Hz and a special mode 77 10 under which the apparatus automatically alternates stimulation at 77 and 10 Hz. The duration of each impulse is from 50 to 60 fas, current rate up to 4.5 mA. The duration of the procedure was 5-6 minutes and determined by the apparatus depending on the change of the skin surface impedance in the subelectrode zone. The procedures were taken daily during 10 days. The second group consisted of 30 persons who had influence on the same zone with the placebo-apparatus which had the same appearance as the operating one. When it was switched on, all LEDs were on, sound signals were produced but the apparatus did not give any electric impulses. The patients were randomized by the envelopes method. Neither the patient nor the operator who applied the apparatus knew with which apparatus, the operating one or the placebo one, the procedure was carried out. All the patients had daily monitoring of ABP and ECG before and after the treatment course. In addition, the intensity of headache was assessed by 10 cm VAS. Assessment of the results during the research was carried out with Student t-criterion for matched and independent samples when comparing values in one group in different periods and in different groups correspondingly. Reliability criterion p was also calculated. The level of validity of means was taken equal P<0.05.

Results
Before start of the treatment course the compared groups did not differ by age, duration of the disease, daily average systolic blood pressure (SBP), intensity of headache by VAS (Table I). After 10-day treatment course reduction of SBP was registered in both groups (Table II), but in the main group who had DENS this reduction was more considerable. Dynamics of clinical presentation of arterial hypertension by changes of intensity of headache is given in table III. In the main group average indexes of VAS reduced significantly.

Conclusion
The data presented confirm the information that arterial hypertension is a psychosomatic disease. Even application of placebo apparatus with basic drug therapy results in reduction of BR But influence of the DiaDENS-Cardio apparatus adds up to the hypotensive effect and is more efficient than placebo.

More over, clinical presentation of the disease, namely headache, did not change at all in the group of patients who had placebo in spite of reduction of the arterial blood pressure. But patients who had DENS had a considerable reduction of headache which confirms an analgesic effect of electroneurostimulation of the neiguan reflexogenous zone. Connection between intensity of the pain syndrome and arterial blood pressure when treating with TENS was registered in other researches. The research executed by Ebersold (1977) showed that in the group of patients with chronic pains of different etiology, the most analgesic effect of TENS manifests in the group of patients with increased BP [5]. Under influence of the DENS-therapy a positive dynamics of the clinical presentation of AH and normalization of daily indexes of the BP were registered. But additional research is necessary to study the hypotensive effect of DENS.

References

1. Kaada В., Flatheim ?, Woie I. Low-frequency transcutaneous nerve stimulation in mild/moderate hypertension. Clin Physiol 1991;11:161-8.
2. Scudds R.J., Helewa A., Scudds R.A. The effects of transcutaneous electrical nerve stimulation on skin temperature in asymptomatic subjects. PhysTher 1995;75:621-8.
3. Campbell T.S., Ditto B. Exaggeration of blood pressure-related hypoalgesia and reduction of blood pressure with low frequency transcutaneous electrical nerve stimulation. Psychophysiology 2002;39:473-81.
4. Sherry J.E., Oehrlein KM., Hegge K.S., Morgan B.J. Effect of burstmode transcutaneous electrical nerve stimulation on peripheral vascular resistance. PhysTher 2001;81:1183-91.
5. Ebersold M.J., Law E.R. Jr, Albers J.W.. Measurements of autonomic function before, during, and after transcutaneous stimulation in patients with chronic pain and in contro subjects. Mayo Clin Proc 1977;52:228-32.
6. Vlasov A. Efficiency of dynamic elektroneurostimulation in patients with arterial hypertension / A. Vlasov, A. Safronov, V. Vladimirsky, A. Vladimirskaya, M. Umnikova // 16 European Congress of Physical and Rehabilitation Medicine. - Brugge, Belgium . - 2008. - p. 92-94.