Hyperesthesia - increased sensitivity of teeth to the effects of various irritating factors: sour and sweet, cold, hot or spicy. The pain occurs when the irritant hits the surface of the teeth and quickly passes. This distinguishes hyperesthesia from acute inflammatory disease pulp (nerve), in which the pain does not go away for a long time (several minutes). A characteristic sign of hypersensitivity may be pain while brushing your teeth or when going outside and inhaling cold air. This problem occurs in both adults and children, especially in puberty when the hormonal background of the child changes. Hyperesthesia can manifest itself as an independent syndrome, not associated with the development of another disease, or stand out as a sign of the underlying disease (periodontitis, periodontal disease, infectious diseases, endocrine disorders, etc.).

Causes of sensitive tooth reaction

Exposure to tooth enamel of fruit acids leads to an increase in its sensitivity.

Non-systemic factors:

• exposure to acids citrus juices, fruits, soda) on tooth enamel;
• the use of whitening toothpaste and a hard brush (you can compare the time of pain with the start of using new items and hygiene products, sometimes manifestations occur after a few days);
• pathological abrasion of dental tissues (initial manifestations of pain - along the cutting edges of the crowns of the teeth);
• enamel erosion;
• wedge-shaped defects (localized in the cervical areas of the teeth);
• initial (softening of the surface layer of enamel);
• periodontal disease (periodontitis);
• after turning the teeth under the crown;
• after removal of tartar (the enamel covered by it has a less dense structure and after removing deposits for several days remains susceptible to irritants);
• after a chemical procedure (the outer layer of enamel is damaged);
• microtraumas, enamel cracks, chipped corners of crowns (bad habits are important - chewing seeds, biting off wire or thread with teeth, etc.).

System factors:

• lack of minerals (calcium, phosphorus, etc.);
• toxicosis of pregnant women;
• infections and viruses;
• endocrine disorders;
• mental illness, stress;
• action of ionizing radiation;
• taking hormonal contraceptives;
• chemical production, occupational hazards.

Classification of hyperesthesia

1. Limited form (pain in the area of ​​one or more teeth)
2. Systemic form (pain in the area of ​​all teeth of one jaw or side)

According to clinical manifestations:

• Grade 1 - pain reaction to cold, heat.
• Grade 2 - pain from temperature stimuli plus from sweet, sour, salty, spicy.
• Grade 3 - tooth tissues react to all types of stimuli.

Why do teeth become sensitive?

The main tissues are enamel, which protects the teeth from the outside, and dentin, located closer to the nerve (pulp). The structure of dentin is similar to bone tissue, it contains microscopic dentinal tubules with liquid. They stretch from the nerve cells lying in the pulp to the tooth enamel. In the tubules are the processes of nerve cells, they transmit a pain impulse under the action of stimuli. This happens when the enamel is thinning as a result of various reasons.

Treatment of tooth sensitivity

Treatment should begin with the observance of certain dietary rules. With an increase in the reaction of tooth enamel to sour, sweet, cold, such products should be avoided. Citrus fruits, freshly squeezed juices and sodas contain acids that are aggressive to the teeth. Avoid sudden changes in temperature, such as hot coffee with ice cream. Crackers, nuts, seeds can cause the appearance of microcracks and chips on the surface of the teeth. Foods rich in calcium, phosphorus, potassium, magnesium, iron (sea fish, seafood, milk, cheese, cottage cheese, liver) are very useful for strengthening teeth.

To reduce the sensitivity of enamel and dentin is used various means. It can be special toothpastes, elixirs, gels and foams, varnishes, solutions and preparations for oral administration. Treatment of hypersensitivity should be complex, including not only local effects on dental tissues. It is necessary to find out the cause of the appearance of soreness, and if hyperesthesia is a symptom of another disease, it must first be treated.

Desensitizing toothpastes

A patient who complains of increased tooth sensitivity will probably be advised to clean the forelocks. special paste.

Using pastes at home is convenient for the patient. Every day, while brushing your teeth, not only oral hygiene is carried out, but also a therapeutic effect on dental tissues. Examples of such pastes:

• Oral-B Sensitive Original (contains 17% hydroxyapatite, similar in structure to the structural elements of enamel);
• MEXIDOL dent Sensitive;
• Sensodyne-F ​​(contains a potassium compound whose ions block nerve impulse transmission);
• "Rembrandt Sensitive" (forms a protective film on the teeth, you need to apply after each meal, it has an additional whitening effect).

Therapeutic pastes to reduce hyperesthesia contain alkalis (sodium bicarbonate, potassium and sodium carbonates), which, by binding to water in the dentinal tubules, cause their dehydration and, as a result, a decrease in susceptibility to irritation. It is necessary to apply such pastes in courses several times a year, the frequency of which depends on the degree of sensitivity of the teeth.

Therapeutic gels, varnishes, foams

Various companies have developed additional funds to combat hyperesthesia. Gels, foams and mousses can be used with mouthguards by putting them on your teeth before going to bed. It is especially effective in systemic hyperesthesia. Solutions are used in the form of rinses several times a day or they are moistened with cotton turundas, balls, with which the agent is applied to the teeth. Varnishes form a protective film on the teeth after application, after which it is not recommended to eat for 30–40 minutes. All funds should be used regularly, only after a few days or even weeks their therapeutic effect becomes noticeable.

• Bifluoride 12 (lacquer based on sodium and calcium fluoride);
• Fluocal - gel or solution (the latter can be used in conjunction with electrophoresis);
• Fluoride varnish (forms a yellow film on the teeth);
• Remodent is a powder that is used as a 3% solution (for rinsing or leaving it for 15–20 minutes on cotton balls, a course of at least 10 applications). It contains elements such as zinc, iron, sodium, calcium, magnesium, phosphorus, manganese;
• Strontium chloride paste 75% (for application to teeth) or 25% water solution(rinsing);
• 10% calcium gluconate solution (apply for 15-20 minutes on the teeth);
• Professional dental gel Tooth Mousse. Due to its special composition, it reacts with the saliva of the oral cavity to form a protective film. Apply the product to the teeth with cotton swabs or a finger, leave for 3 minutes. Can be used in children from 1 year;
• MI Paste Plus (dental cream with fluoride, applied to teeth for 3 minutes, contraindicated in children under 12 years old).

Means for the treatment of hyperesthesia can be used in the prevention of caries in children with weak enamel.

Electrophoresis (iontophoresis)

This is a method of electrotherapy, in which the patient's body is affected by a constant galvanic or impulse current along with the drug. The following agents are used to treat hyperesthesia:

• 5% solution (for children) or 10% solution of calcium gluconate (for adults) with a course of at least 10 procedures for 10-15 minutes;
• 1% sodium fluoride;
• Vitamin B1 with trimekain;
• Fluocal (solution).

Folk remedies for the treatment of increased sensitivity of the teeth

• Tea tree oil (3 drops per cup) warm water rinse your mouth several times a day).
• A decoction of oak bark (1 tablespoon of dry matter per glass boiled water, keep on fire or leave for 5-10 minutes).
• A decoction or infusion of chamomile and burdock (pour 1 teaspoon of dry herb with a glass of boiling water, leave for an hour and rinse your mouth).
• Hold warm cow's milk in your mouth (for short-term relief of pain).

Treatment of hyperesthesia of the teeth should be carried out systematically and regularly. When the first symptoms appear, you should immediately start using pastes or other means, follow a diet. The presence of chronic diseases, against which the soreness of the enamel manifested itself, or medication makes it difficult to treat hyperesthesia. In such cases, it is possible to influence the tissues of the tooth local preparations or to remove nerves in those teeth where the pain is very severe and local treatment does not help. One of the options is to cover the teeth with crowns.

The property of the human body to respond to an unfavorable change in weather conditions with a physiological, prepathological or pathological reaction is called weather sensitivity, which brings the defense forces and adaptive systems into a state of increased tension.

The weather sensitivity is most pronounced in those who suffer from any chronic diseases. However, it can also occur in healthy people, including children. younger age. It is believed that among the practically healthy population, women and small children under 5 years of age are the most weather-sensitive, as well as impressionable people with increased emotionality.

In addition, any change in the hormonal background, which is observed, for example, during pregnancy, a change in climate or time zone, also reduces a person's resistance to weather events. Scientists have found that weather sensitivity can even be inherited.

In the vast majority of weather-sensitive people (90%), the reaction of the body coincides in time with changes in the weather, in others it is 1-2 days late, and in some, on the contrary, it manifests itself 1-2 days before the onset of these same changes.

Speaking about the impact of weather on human well-being, it is necessary to take into account many factors, which include temperature, humidity and air composition, pressure, wind speed, solar radiation fluxes, long-wave solar radiation, type and intensity of precipitation, atmospheric electricity, atmospheric radioactivity, subsonic noise .

Abrupt change atmospheric pressure causes drops in blood pressure, fluctuations in the electrical resistance of the skin, as well as an increase or decrease in the number of leukocytes in the blood. So, at low atmospheric pressure, the electrical resistance of the skin significantly exceeds the norm, the number of leukocytes increases, the pressure in the stomach and intestines increases, which leads to a high standing of the diaphragm. As a result, activity is disrupted gastrointestinal tract, the work of the heart and lungs is difficult.

As a rule, atmospheric pressure drops that do not go beyond the norm do not affect the well-being of healthy people. The situation is different with sick or overly emotional natures. With a decrease in atmospheric pressure, for example, in people suffering from rheumatism, pain in the joints worsens, in hypertensive patients, health worsens, doctors note sudden jump angina attacks. People with increased nervous excitability with sharp jumps in atmospheric pressure complain of a feeling of fear, insomnia and a deterioration in mood.

A person's well-being is influenced not so much by indicators temperature how much its daily fluctuations. So, a slight change in temperature is a deviation from the average daily norm by 1-2 ° C, a moderate one - by 3-4 ° C and a sharp one - by more than 4 ° C. It is generally accepted that the optimal conditions for a person are those under which he feels an air temperature of 16-18 ° C at a relative humidity of 50%.

The most dangerous for people are sudden changes in temperature, as they are usually fraught with outbreaks of acute respiratory infectious diseases. Science knows such a fact, when during one night the temperature rose from -44 ° C to +6 ° C, which occurred in St. Petersburg in January 1780, 40 thousand inhabitants fell ill in the city.

Human vessels respond most quickly to fluctuations in air temperature, which, narrowing or expanding, carry out thermoregulation and maintain a constant body temperature. At long-term exposure At low temperatures, excessive vasospasm often occurs, which, in turn, in people suffering from hypertension or hypotension, as well as coronary heart disease, can cause severe headaches, pain in the heart area, and blood pressure jumps.

High temperatures also have a negative effect on work. human body. Her pernicious influence manifested in a decrease in blood pressure, dehydration of the body, deterioration of the blood supply to many organs. The same air temperature with different indicators of its humidity is perceived by a person in different ways. So, with high humidity, which prevents the evaporation of moisture from the surface of the body, heat is difficult to tolerate and the effect of cold intensifies. In addition, moist air increases the risk of airborne infections by several times.

Insufficient humidity leads to intense sweating, as a result of which, according to acceptable standards, a person can lose up to 2-3% of his mass. Together with sweat, a large amount is excreted from the body. mineral salts. Therefore, their stock in hot and dry weather must be constantly replenished with salted sparkling water. Profuse sweating dries up mucous membranes. As a result, they are covered with the smallest cracks, into which pathogenic microorganisms penetrate. Optimal indicator relative humidity for a healthy person - 45-65%.

People suffering hypertension and atherosclerosis, especially hard to endure days characterized by high humidity (80-95%). In rainy and inclement weather, the approach of an attack in such patients can be determined by the pallor that appears on their face. High humidity, which heralds the approach of a cyclone, is usually accompanied by sharp decline oxygen in the air. Lack of oxygen worsens the well-being of patients with chronic diseases of the cardiovascular and respiratory systems, as well as the musculoskeletal system.

Especially dangerous is high humidity in combination with high air temperature. Such a meteorological combination hinders heat transfer and can cause heat stroke and other disorders of the body.

In hot weather wind increases the release of heat, having a beneficial effect on well-being, and at low temperatures enhances the effect of cold, leading to a cooling of the body. In summer, we feel good at wind speeds of 1-4 m/s, but already 6-7 m/s bring us into a state of mild irritability and anxiety. Windy days exacerbate chronic diseases, especially if they affect the cardiovascular and respiratory systems. For people with a nervous or mental pathology, such weather can cause a feeling of anxiety, unreasonable longing and anxiety.

In the atmosphere oxygen content equal to 21%, although depending on geographical conditions this figure may change. Thus, in rural areas, the oxygen content, as a rule, exceeds 21.6%, in the city it is approximately 20.5%, and in large metropolitan areas it is even lower - 17-18%. However, under adverse weather conditions, the amount of oxygen in the air can drop to 12%. A healthy person practically does not feel the decrease in the oxygen content in the air to 16-18%.

Signs of oxygen deficiency (hypoxia) appear in most cases when the oxygen content drops to a level of 14%, and the figure of 9% threatens with serious disturbances in the functioning of vital organs. Lack of oxygen leads to a slowdown in metabolic processes, even practically healthy people complain of weakness, fatigue, distracted attention, headache, depression.

Many people are well aware of the state of depression, bordering on depressive, that they experience in a rainy autumn or the same rainy winter, when the sun hides behind clouds for several days. The reason for this mood should be sought primarily in lack of light. Interestingly, it is impossible to deceive the body with the help of artificial lighting on such days. Even if you stay in a room with a lot of lights on all day, the body will still recognize the substitution, since the spectral composition sunlight and artificial lighting varies considerably.

On the magnetic storms respond from 50 to 75% of the world's population. Moreover, the beginning of such a reaction depends on each individual and on the nature of the storm itself. Thus, most people begin to experience various kinds of ailments 1-2 days before a magnetic storm, which corresponds to the moment of solar flares that caused it.

The dependence of the human body on the weather is so great that along with the term " weather sensitivity”, which characterizes mild symptoms of malaise arising under the influence of environmental factors, doctors introduced another one -“ weather dependence' to denote more serious condition caused by extreme weather fluctuations.

weather dependence, or meteopathy, whose main features are sharp deterioration well-being and unmotivated mood swings, suffer from 8 to 35% of the inhabitants of our planet. In its most general form, we can say that meteorological dependence manifests itself as severe headaches, insomnia, or, conversely, increased drowsiness, weakness, which leads to fatigue, mood changes. With a sharp change in the weather, many chronic diseases and previous injuries are exacerbated.

To indicate the reaction of the human body to meteorological changes environment doctors use another term - " meteoneurosis”, by which they define a type of neurotic disorder associated with weather changes. Meteoneurotics experience a sharp deterioration in well-being on unfavorable days: irritability, depression, shortness of breath, palpitations, dizziness, etc. are observed. However, if you measure their temperature, pressure and other indicators, they will be in absolute norm. As a rule, meteoneurosis is observed in people with increased emotionality, or is outward manifestation internal mental breakdowns.

At sudden drop in air temperature even healthy people feel some discomfort. Their skin becomes covered with small pimples, increased tension and trembling are observed in the muscles, skin vessels narrow, and cold diuresis (frequent urination) often begins. All these are manifestations of the “regular” reaction of the body, which, having tuned in to heat, again finds itself in the cold.

If the weather does not change in the near future and the unseasonable cold sets in for a long time, a decrease in immunity may occur. As a result, there is a sharp increase in the number of acute respiratory diseases and exacerbation of chronic ones - bronchitis, pneumonia, tuberculosis, tonsillitis, sinusitis.

At stable high temperature sweating increases, heartbeat and respiration become more frequent, the amount of urine excreted decreases. In addition, along with sweat and exhaled air, a large amount of water-soluble vitamins and mineral salts (sodium, potassium, calcium, magnesium) is excreted from the body. The consequence of this, even in healthy people, is weakness, headache, apathy, drowsiness, and intense thirst.

If healthy people react to weather changes in almost the same way or do not react at all, then people with chronic diseases have their own set of symptoms corresponding to sudden changes in temperature, pressure, oxygen content in the air, etc. Moreover, such a “barometer”, depending on specific disease as the main one will be guided by different parameters.

The well-being of people suffering cardiovascular diseases, as a rule, a few hours before a sharp change in temperature and atmospheric pressure begins to deteriorate rapidly. Moreover, an attack of angina pectoris can be caused even by a change in the direction of the wind. During a magnetic storm, blood pressure rises in the cores and coronary circulation is disturbed, which often leads to hypertensive crisis, stroke and myocardial infarction.

However, the most unfavorable factor for this category of patients is high humidity. And on the eve of a thunderstorm, doctors register an increase in cases sudden death. Low oxygen content in the air, the so-called weather hypoxia, is especially dangerous for those suffering from coronary heart disease. Cores feel almost as bad during a sharp cold snap.

Hypertension most acutely react to weather changes in spring. In summer, it is difficult for them to endure windless heat, but in winter and autumn, their body is more tolerant of changes in meteorological indicators. Typical manifestations of meteotropic reactions in people with hypertension: jumps in blood pressure, headache, tinnitus. Both hypertensive patients and hypotensive patients equally painfully perceive sudden changes in atmospheric pressure.

Sick, suffering respiratory diseases(especially chronic bronchitis and bronchial asthma), worst of all tolerate a sharp drop in air temperature, strong winds and relative humidity of more than 70%. In addition, this category of patients reacts heavily to changes in atmospheric pressure, and it does not matter whether it rises or falls, and low maintenance oxygen in the air. The response to such meteorological "aggression" is usually general weakness, shortness of breath, cough, and in especially severe cases - suffocation.

Magnetic storms have the same adverse effect, changing biological rhythms. Moreover, some patients feel their approach, and their health worsens on the eve of a magnetic storm, while the body of others reacts to it after. Doctors regret to state the fact that the possibility of adaptation of patients with chronic diseases of the respiratory system to the conditions magnetic storms practically equal to zero.

Although there are many examples of joint pain and aches, especially in cold and wet weather, the mechanism that causes these symptoms is still not understood. The most typical sign of the influence of weather on the health of people suffering from diseases of the joints and musculoskeletal system, is atmospheric pressure, which, of course, is influenced by the surrounding air. A decrease in atmospheric pressure on the eve of a thunderstorm can provoke swelling of the periarticular tissue, which, in turn, causes pain in the joints.

It is traditionally believed that sunny warm weather is a blessing. However, there are meteoneurotics who can hardly endure such grace and look forward to the onset of rainy cloudy weather that lifts their spirits. And the point here is not in physiology, but in personality traits. That is why it is not doctors who help get rid of meteoneurosis, but psychologists, who, of course, need the help of the patient himself, who has firmly decided to get rid of the dependence of his mood on the vagaries of the weather.

Measures to prevent meteotropic reactions are strictly individual and are determined by the state of health of each person individually, the nature of the reaction itself (meteosensitivity, meteorological dependence, meteotropic exacerbation, etc.), the reactivity of the organism, as well as the weather forecast and microclimatic features of the place of residence. However, the basis of the treatment of meteopathy in all these cases is healthy lifestyle life: observance of the regime of the day, work and rest, rational nutrition, regular physical activity, hardening, etc.

• Get a good night's sleep on the eve of a bad weather event. “Good sleep” is a purely individual concept. Scientists have found that women need a longer (1-2 hours) sleep to restore strength than men. If you have insomnia, then drink a cup of herbal tea or a glass of warm water or milk with honey at night, take a relaxing warm bath by adding a few drops of aromatic oil to the water.
• In the morning, several physical exercises should be done for 15 minutes without overloading the respiratory and cardiovascular systems.
• After morning exercises, you need to take a contrast shower.
• During the day, you need to allocate about an hour for a walk in the fresh air. It is best to choose a place for walking away from busy streets: in the forest, park, on the embankment.
• If spastic reactions occur (increased blood pressure), it is recommended to massage the neck shoulder girdle, mustard foot baths, put a mustard plaster on the back of your head, take a contrast shower, go to a bathhouse (Russian or sauna). In such cases, sedatives (valerian or motherwort tincture) or blood pressure lowering drugs help well.
• It is required to observe the regime of work and rest, avoiding overwork.
• You need to engage in an acceptable sport for yourself, yoga or do gymnastics regularly in the morning.
• You need to take care of your health. In the presence of a chronic disease, you should systematically visit a doctor and follow all his recommendations.

With a sharp drop in air temperature you need to dress warmly, take stimulants and adaptogens (tincture of eleutherococcus, magnolia vine, radiola rosea or echinacea), as well as vitamin complexes with micronutrients. Moreover, stimulants should be taken in the morning, as in the evening they can lead to sleep disturbance.

Food in cold weather should be more high-calorie, this is especially important for children. Before leaving the house, they should definitely offer a sandwich with butter, a piece of chocolate, pomegranate juice, bananas. Moreover, the obligatory components of the diet on such days are strong sweet tea with lemon or sea buckthorn syrup, herbal tea, rosehip broth, vegetables and fruits. An active lifestyle helps to cope with the cold: movement enhances energy metabolism and normalizes blood circulation.

As a warm front approaches give a good effect physical exercise, contributing to the saturation of the body with oxygen: walking, running, skiing, breathing exercises, cold rubdowns. The diet should be dominated by foods rich in ascorbic acid, potassium, calcium, iron - milk, fish, fruits. In addition, hypotensive patients are advised to take multivitamins, adaptogens, and drink strongly brewed tea.

TO high temperatures and high humidity a person adapts rather quickly, and the body's resistance to their effects is developed not at rest, but during muscular activity. That's right organized labor, as well as classes physical culture already in 1-1.5 weeks, they can double the efficiency at a temperature of 30 ° C.

In the heat, in order to avoid dehydration and to maintain a certain balance in the body, you need to drink a lot. It is best to do this in the morning and evening, and not in the middle of the day, when even watering the plants is not recommended. You can protect yourself from the hot wind with the help of pumpkin seed oil, which must be instilled into the nose. You can use rose oil instead.

If there is in the air oxygen deficiency, then it is necessary, if possible, to reduce physical activity, commensurating your activity with natural rhythms. Unhurried walks in the fresh air or a visit to an indoor ice rink help to survive hypoxia with the least losses.

TO magnetic storm young and healthy body adapts easily. As for adults, especially the elderly, it is advisable for them to adhere to the following recommendations:

• Do not drink alcoholic beverages.
• Do not eat fatty and sweet, so as not to increase the already high cholesterol levels on such days.
• There are more fruits and berries (blackcurrant, cranberry, blueberry, cherry, lemon, apricot, peach) fresh or canned.
• Avoid physical activity.
• Take a decoction of valerian root or motherwort leaves to get rid of nervousness and excessive tension.
• Take aspirin to thin your blood, unless contraindicated.
• In the presence of chronic diseases, carry with you the medicines prescribed by the doctor. Resume (do not start!) taking anti-inflammatory drugs if you have taken them before.
• Do morning exercises, which it is desirable to complete with water procedures (contrast shower, dousing, etc.).
• Do not make responsible decisions, do not do important things, do not sort things out. Try to keep calm and be extremely polite in any situation.
• Postpone the holidays both at home and at work.
• Do not watch horror films, as well as all those that stimulate the nervous system.
• If possible, do not drive a car.
• Do not undertake long journeys, especially from east to west or to places with a contrasting climate.
• Do not wear fur or synthetic fabrics that accumulate static electricity.

morning exercises significantly increases the adaptive forces of the body, reducing the impact of adverse factors. In the process of performing exercises, metabolic and regenerative processes are activated, blood circulation improves, and the nervous system is strengthened. For regular morning hygienic exercises recommended for weather sensitivity, any complex is suitable, as long as it matches the age and state of health.

By doing walk about 2/3 of all muscles are involved, which is a stimulus for the work of the organs that ensure their contraction. As a result, the activity of the nervous system is activated, which is responsible for muscle contraction and coordination of interaction. muscular system with other organs, the frequency and strength of heart contractions increase, the frequency of respiratory movements and the volume of inhaled air increase, the endocrine glands begin to produce hormones (adrenaline, noradrenaline) that facilitate muscle work.

General developmental exercises(tilts, lunges, squats, turns, circular rotations in the joints, etc.). Here it is important to observe the principle of a gradual increase in load: start with movements in small muscle groups (ankle, wrist joints), then move on to the middle ones (muscles of the arms, legs), and at the end - to the large ones (muscles of the body).

Exercises for the muscles of the shoulder girdle and head rotation should be especially carefully performed, as this stimulates cerebral circulation. When turning, tilting, circular movements of the head, one should not make sudden movements and break the set calm pace. With a tendency to dizziness, these exercises are best performed while sitting or leaning on the back of a chair. Individuals with vascular disease or cervical spine, neck muscle tension exercises should be performed in static mode: without moving your head, press it on your hand, trying to overcome resistance.

General developmental exercises eliminate congestion, improve tissue nutrition, maintain muscle elasticity and joint mobility, increase body temperature, stimulate the heart, lungs, and endocrine glands. In order to avoid monotony, exercises during morning exercises are recommended to be changed periodically.

Flexibility exercises(tilts to straight legs from a standing and sitting position, deep lunges, etc.). They require a lot of effort and often lead to injuries. Therefore, without preliminary warming up the muscles, they cannot be done. Tilts to the straight legs connected together from a sitting position improve the blood supply to the spine, increase the elasticity of the articular elements and back muscles. The use of flexibility exercises in the complex of morning exercises is also important because it is in the morning that a person has the best joint mobility.

After general developmental exercises, you can move on to more intense loads. Help facilitate this transition run and jumping, which are the best stimulus for all vital processes occurring in the human body. In order for the effect of jumping to be noticeable, they must be performed for at least 3 minutes: 2-3 series of 1-2 minutes each with an interval of 1 minute.

Slow running helps develop endurance, which is directly related to the body's ability to withstand various adverse factors. However, it should be remembered that running in the morning is a rather difficult task. Therefore, women, physically weak persons, as well as the so-called owls, must strictly dose this type of exercise. Instead of running and jumping, you can dance at a fast pace and for at least 5 minutes.

Exercises for the abdominal muscles serve not only to maintain a slim figure, but also internal organs in the correct position. Each such exercise should be performed 15-20 times, gradually increasing the load.

Breathing exercises best practice outdoors. If this is not possible, then a balcony or loggia will do. In any case, the study room should be well ventilated. To achieve a positive effect, the exercises must be done daily, devoting at least 20 minutes to this.

The exercises proposed below are divided into 3 groups, each of which is more difficult than the previous one, therefore, they must be mastered gradually: from simple to complex. Moreover, the development of each group of exercises should take about two weeks.

Complex 1:

1. Static exercises that can be performed lying on your back, on your side, sitting and standing:

• Close your mouth and breathe through your nose, keeping the usual rhythm, for 1 minute.
• Close your mouth and breathe alternately with one nostril, closing the other (3 times for 1 minute).
• Put one hand on the stomach, the other on the chest, close the mouth. Inhale, inflating the stomach, especially its lower part, then exhale, drawing in the stomach (abdominal breathing). And so 6-10 times. The chest should remain motionless. The correctness of the exercise is controlled by hands.
• Put your hands on your chest (on the sides), close your mouth. Take a breath, maximizing the volume of the chest, then exhale completely (thoracic breathing). And so 6-10 times.
• Put one hand on the stomach, the other on the chest, close the mouth. Inhale while pushing out the stomach and maximizing the volume of the chest, then exhale, drawing in the stomach and squeezing the chest (full breath). And so 6-10 times.
• Breathe through the nose in the usual rhythm, gradually making the breath deeper and slower (1-2 minutes).

2. Dynamic exercises: While walking in place, breathe through the nose, measuring the inhalation and exhalation with a certain number of steps, and the exhalation should be slightly longer than the inhalation (1-2 minutes).

Complex 2:

1. Static exercises; they can be performed lying down, sitting or standing:

• The usual breath through the nose alternates with 2-3 short exhalations through the mouth (6 times).
• Normal inhalation through the nose alternates with a long exhalation through the mouth. While exhaling, vowels or consonants are pronounced (6 times).
• Breathe through the nose in the usual rhythm: on inspiration, the chest expands, and the stomach retracts, on exhalation, the chest contracts, and the stomach protrudes (6-10 times).
• Inhale slowly through the nose, exhale quickly through the mouth, then hold the breath for 5 seconds (6 times).
• Inhale quickly and deeply through the mouth, exhale slowly through the nose (6 times).
• Lower your arms, connect your legs. Raise your arms through the sides up - inhale, lower - exhale (6 times).
• Extend your arms to the sides. Rotate hands to shoulder joints forward and backward 4 times in each direction (6 times). Breathing is arbitrary.
• Put your feet shoulder-width apart, bend your arms, clench your fingers into a fist. Imitate the blows of a boxer, trying to breathe evenly (8 times with each hand).
• Put your hands on your waist, connect your legs. Take the straight leg to the side, then return to initial position- inhale, pause - exhale (6 times with each leg).
• The arms are extended along the body, the legs are connected. Bend the leg at the knee - exhale, return to the starting position - inhale (6 times with each leg).
• Arms extended along the body, legs shoulder-width apart. Tilt the body forward - exhale, return to the starting position - inhale (6 times).
• Spread your arms to the sides, connect your legs. Tilt the torso to the side - exhale, return to the starting position - inhale (6 times in each direction).

Complex 3:

1. Static exercises:

• They are performed from the starting position, standing, feet shoulder-width apart, knees slightly bent, tailbone, heels and crown in one line, shoulders relaxed and lowered, hands on the stomach:
• Breathe through the nose in the usual rhythm: while inhaling, lower the diaphragm, sticking out the stomach, while exhaling (it is slightly longer), raise the diaphragm and draw in the stomach ( diaphragmatic breathing).
• Close your eyes and practice diaphragmatic breathing until it becomes habitual and natural.
• Sit down, bending your knees - exhale, straighten up - inhale.
• Stretch your arms out in front of you, palms down, elbows slightly bent. Sit down, lowering your arms slightly - exhale, return to the starting position - inhale.

2. Dynamic exercises:

• Lie on your back, stretch your arms along the body, connect your legs. Sit down - exhale, return to the starting position - inhale (6 times).
• Stand up straight, put your hands on your waist, connect your legs. Sit down - exhale, stand up - inhale (8 times).
• Stand up straight, put your hands on your waist, connect your legs. Perform jumps in place, trying to maintain even breathing (40 times).
• Running in place or on the move at a slower or faster pace. Breathing is uniform (1 minute).
• Climbing the stairs, breathe deeply through your nose.

Massage. good remedy to remove the meteopathic reaction is massage, including acupressure, and acupuncture. However, the services of a professional are not always available for a variety of reasons, which is why you can try to relieve the discomfort caused by bad weather with the help of self-massage techniques.

The simplest, but very effective type of self-massage can be done under a warm shower (36-38 ° C), rubbing the body with a stiff, long-handled brush. You can massage the whole body (general self-massage) and its individual parts (local self-massage). Depending on this, the duration of the procedure will be different: general massage, as a rule, lasts no more than 20 minutes, and local - 5.

General self-massage is performed in a strictly defined sequence: thigh, knee, shin, foot, neck, chest, side of the neck, shoulder girdle, forearm, hands, fingers, back of the neck and head, upper section spine, collar zone, lower thoracic spine, back, lumbosacral region, pelvis, abdomen.

In this case, it is important to observe the following rules:

• During the massage, there should be no painful or unpleasant sensations, but only sensations of warmth and relaxation.
• Do not massage areas of the lymph nodes. However, all movements should be directed towards them along the lymph flow. Massage of the upper limbs is carried out towards the elbow and axillary lymph nodes; lower - to the inguinal and popliteal lymph nodes; the chest should be massaged in front and to the sides towards the armpits; neck - towards the supraclavicular lymph nodes; lumbar and cross regions - towards the groin.
• In order for your hands to glide better, you can use a cream or talcum powder or do self-massage without removing thin cotton underwear.
• The room where self-massage is performed should be fresh and not hot (20-22 °C). The position of the body during self-massage should be as comfortable as possible so that relaxation is complete. Both general and local self-massage should begin and end with water procedures.

Phytotherapy. Phytotherapy with meteosensitivity has mainly a mild adaptogenic effect. Anti-stress and restorative effect possess green tea, mate (Paraguayan tea), lemon balm, turmeric, licorice. good herbal antidepressants are valerian, motherwort, hawthorn, peony. To relieve swelling and remove excess water from the body will help cudweed marsh and horsetail. In bad weather, it is recommended to take an infusion of chamomile: half a glass 30 minutes before meals.

To thin the blood at home, you can prepare a garlic cocktail. To prepare it, you need to take 3 cloves of garlic, knead them well, add 1 tablespoon of red wine, apple cider vinegar and olive oil, mix everything and let it brew for 4 hours. Then divide the mixture into 3 parts, pour one of them into a glass hot water and drink. After 6 hours, do the same with the second part, and after another 6 hours - with the third.

During magnetic storms, in addition to traditional sedatives, you can also relieve stress with the help of herbal collection. It is necessary to take 4 parts of rose hips, 3 parts of hawthorn and motherwort herbs, 1 part of St. John's wort leaves and mix. Pour a tablespoon of the vegetable mixture with a glass of boiling water, insist in a thermos for 4 hours and strain. Take half a glass 2 times a day before meals.

Aromatherapy:

• If the meteopathic reaction is accompanied by excitement and aggressiveness, essential oils of lavender, rosemary or geranium can be sprayed into the room.
• The smell of lemon and eucalyptus will help get rid of depression.
• Calamus oil has an anti-stress effect, which must be taken orally (2 drops 3 times a day), mixed with a teaspoon of honey.
• Basil oil is a good remedy for insomnia. It can be used both internally and externally. For internal use, mix 2-3 drops of oil with a teaspoon of honey. Add the resulting mixture to a cup of tea from lime blossom and drink at night. For external use, a few drops of oil can be rubbed between the palms, applied to temporal region, on the wrist or spray in the room.
• You can relieve fatigue, cheer up with the help of spruce oil, rubbing it in your palms or dropping a few drops on a handkerchief.
• With meteoneurosis, it is recommended to use coriander oil. It can be used both internally and externally. When used internally, mix 20 drops of oil with a tablespoon of powdered sugar, pour the resulting mixture with 4 glasses of red wine. Take the finished tincture 3 times a day, 5 tablespoons (shake before use!).
• Also, with meteoneurosis, you can use cypress oil, 2 drops of which must be applied to an electric light bulb to flavor the room.
• For sleep disorders, mix 2 drops of basil oil, 2 drops of rose oil and 4 drops of lavender oil. This mixture should be applied to a tissue napkin and before going to bed for 10 minutes inhale the resulting aroma. This mixture can be used to scent a room. To do this, add a quarter cup of water to it, pour it into a spray bottle an hour before bedtime and spray it in the room. The healing aroma will last until the morning.
• With persistent depression, a mixture of lavender and fir oils helps. 5 drops of lavender oil should be mixed with the same amount of fir oil and add 2 tablespoons to them sea ​​salt. The resulting aromatic salt should be dissolved in a bath of warm water and taken for no more than 15 minutes.

hardening Biorhythms can be trained by hardening. It should begin with taking air and sunbathing. At the same time, the air temperature should be above 24 ° C for children under one year old, from 18 ° C for older children, and from 12 ° C for adults. Moreover, for children, the first air baths are recommended to be arranged indoors, and adults can immediately begin hardening in the fresh air. The only condition is that the weather must be calm. You need to undress and move actively throughout the session.

The first air bath should be taken within 1 minute. Gradually, the duration of the sessions should be increased in order to eventually bring their duration to 40 minutes. It is also necessary to gradually increase the stay in the air with a decrease in temperature.

After air baths, you can proceed to water procedures, the first of which is rubbing. The temperature of the water for wiping should be equal to the temperature of the skin in the region of the heart. For children under 1 year old, it is 35 ° C, for older children - 33 ° C, for adults - 31 ° C.

The next stage of hardening is dousing and foot baths. To begin with, the water for dousing should be 1-2° higher than the temperature of the skin in the region of the heart, and the temperature of the foot bath, on the contrary, 1-2° higher. Gradually, the water temperature should be reduced: for children under 3 years old - up to 24 ° C, for older children - up to 16 ° C, for adults - up to 12 ° C. However, you can limit yourself to just foot baths and walking barefoot, since the legs are very sensitive to hardening.

Bathing in open water, especially winter swimming, has a powerful hardening effect. This is explained by the fact that in the process of bathing a person is exposed to three hardening factors at once: water, air and sun. In addition, swimming is an additional physical activity. This type hardening is indicated only for adults who do not have health problems. It is recommended to start bathing at a water temperature of at least 20 ° C, the duration of the first session should be no more than 5 minutes.

The duration of the hardening sessions indicated in the reference medical literature is rather arbitrary, since the main criterion is the well-being of the hardened. It is especially important to remember this when hardening children who still cannot control their condition.

Hardening, as a rule, is carried out in the first half of the day, since it excites the nervous system very much. After air baths and water procedures the body must be well rubbed. For adults, it is best to use a terry towel for this, and it is recommended to rub the delicate skin of the baby with your hands. Hardening also includes being outdoors in light clothing and sleeping with an open window at any time of the year.

When starting hardening, it must be borne in mind that children, people who have had an illness, and also poorly developed people are more sensitive to the effects of low temperatures.

Spa treatment. Strengthening health, and hence the body's resistance to adverse weather factors, is largely facilitated by the rational use of holidays, which do not have to be spent on the Black Sea coast or at resorts located exclusively in warm countries. For most people, it is much more useful to stay in the northern and continental regions of Russia: in Karelia, in the Urals, Baikal, in the Altai Territory. The climatic conditions of these areas have a pronounced training and hardening effect on the human body.

Climate therapy is whole complex special climatotherapeutic procedures, which are carried out not only for therapeutic and rehabilitation purposes, but also for preventive purposes:

• Aerotherapy is a long, and in some cases round-the-clock stay in the open air, which includes walks, air baths and even sleep.
• Heliotherapy - dosed exposure to the sun.
• Thalassotherapy - swimming in open water.
• Treatment (internal and external) with mineral waters, or balneological procedures. Internal application mineral water (drinking, gastric lavage, intra-intestinal procedures, inhalation with finely sprayed water particles, etc.) stimulates metabolic processes and normalizes the regulatory systems of the body.
• External use includes baths, including sitz and local baths (for hands and feet); shower-massage, including underwater; rising shower; head irrigation; swimming in the pool. As a result of the external use of mineral water, the body quickly acclimatizes and adapts to new meteorological conditions, activates its defenses and accelerates the rehabilitation process after an illness.
• Hydrotherapy - external use of fresh and mineral water, which includes Charcot's shower, underwater and fan shower, baths (contrast, chamber, whirlpool), dousing, wiping, etc. Hydrotherapy is based on thermal, mechanical and chemical irritation of skin receptors and mucous membranes.
• Mud therapy - the use of therapeutic mud in the form of wraps or applications. As a result of this procedure, nutrition and muscle tone improve, the work of the gastrointestinal tract normalizes, and inflammatory processes slow down.
• Radon therapy - the impact on the body with the help of radon in the form of water and air baths, showers, bathing in therapeutic pools, irrigation, microclysters, inhalations. Indications for the use of this procedure are diseases of cardio-vascular system, musculoskeletal system, digestive organs, central and peripheral nervous system, skin and gynecological diseases, metabolic disorders.

Diet for weather sensitivity. Under adverse weather conditions, an excess of free radicals is formed in the human body, which damage the cell membranes. As a result, the nutrition of the cell is disturbed, which, in turn, leads to disruption of metabolic processes. Reliable protection against free radicals are antioxidants - substances that prevent harmful oxidation. A large number of them are found in vegetables, fruits, berries, sprouted grains, vegetable oils.

The most useful vegetable in case of excessive solar activity is cabbage, rich in biologically active substances, including those that remove “bad” cholesterol from the body. It is very good to take half a glass of fresh cabbage juice an hour before bedtime.

During a magnetic storm, the secretion of gastric juice and its acidity decrease. That is why on such days it is recommended to abandon meat, fatty, spicy and sweet foods and replace them with fish dishes, seaweed, peas, beans, soybeans, lentils, rhubarb and turnips.

For breakfast, you can cook delicious and healthy vitamin sandwiches: mix chopped parsley and dill with cottage cheese, spread the resulting mixture on a piece rye bread. For lunch, serve jacket potatoes, baked beets, or baked apple. A wonderful dish for dinner will be a salad of carrots, apples and nuts, seasoned with honey and sour cream.

Before each meal, it is advisable to drink a glass of fresh vegetable or fruit juice, salted mineral water or water with lemon juice. In summer, you should try to eat more berries - gooseberries, cherries, sweet cherries, which include succinic acid.

Hypertensive patients on days of sudden changes in atmospheric pressure or temperature should limit the amount of salt and liquid consumed. Weather-sensitive people need a lot of vitamins, especially vitamins C and group B (B1, B6, B12). To replenish their supply will help dishes from carrots, beets, onions, tomatoes, cucumbers, as well as berry and fruit juices.

On unfavorable days, it is advisable not to drink alcohol, and, if possible, strong coffee and tea. It is better to replace them with herbal and fruit tea or weak coffee with milk.

To prevent meteosensitivity, it is recommended to include prunes, raisins, blueberries, beets in the daily diet, and on the eve of an unfavorable day, eat half an onion or drink 2 tablespoons of fresh onion juice. All kinds of cereals are very useful: rice, buckwheat, pea, lentil or bean porridge. In the UK, where there are more cloudy days per year than sunny days, it is precisely oatmeal helps to avoid weather dependence and cope with the lack of sunlight.

Bioadditives. When unfavorable days approach, doctors recommend taking multivitamins and adaptogens to strengthen the adaptive abilities of the body. Remember that only pharmaceutical preparations help you achieve the desired result.

Take multivitamins should be constantly, regardless of the time of year and diet. Do not expect that as a result of such a reception, you will dramatically improve your well-being. Vitamins are powerful prophylactic, which increases the body's resistance to adverse effects of external factors.

When the seasons change, it is recommended to take adaptogens, which have a powerful tonic effect and increase the body's resistance to all, without exception, adverse environmental factors. Adaptogens are taken once a day (no more!) in the morning on an empty stomach. The dose of the drug is selected individually, based on the average 6-15 drops.

The most effective adaptogens are Chinese magnolia vine (increases excitation processes, increases the acidity of gastric juice), maral root (increases protein synthesis, improves blood composition, stimulates nerve centers), eleutherococcus senticosus (improves thermoregulation), ginseng (increases appetite), Rhodiola rosea (increases contractility of the heart muscle), Manchurian aralia (reduces blood sugar, increases appetite), etc.

Ostroumova O.D.

Oksana Mikhailovna Drapkina

– I am pleased to give the floor to Professor Olga Dmitrievna Ostroumova, who will introduce us to the problem of blood pressure variability and answer whether this is a new target for stroke prevention. Please, Olga Dmitrievna.

Olga Dmitrievna Ostroumova, professor, doctor of medical sciences:

Thank you, Oksana Mikhailovna. Good morning, in Moscow, dear colleagues, although the country is large, and, of course, somewhere you can already say “Good afternoon” and maybe even “Good evening”.

So, the problem of blood pressure variability, to which special attention has been drawn for about the last three years. First of all, what is variability? Under the variability of blood pressure, it is customary to understand fluctuations in blood pressure that exceed the physiological norm. These are relative indicators that are calculated. They are calculated based on the numbers obtained by any of the methods of measuring blood pressure: our routine methods of measuring blood pressure - on the upper arm, doctor or patient; daily monitoring blood pressure; and also a method of self-control, that is, the measurement of pressure by the patient.

"... pressure fluctuations that exceed the physiological norm." You see that this definition does not include a time period. This means that fluctuations that exceed the same physiological norm can be observed at a variety of time intervals. And in this regard, there is not generally recognized, but, nevertheless, a commonly used classification of the types of variability. In fact, the word "blood pressure variability" is familiar to us from the method of daily monitoring of blood pressure, which has been very widely, actively and firmly established in our lives since the mid-90s. It is thanks to this method that we first began to use this term. You know that this very variability is present in the daily monitoring protocol, it is usually indicated Latin letters SD is the standard deviation, and it is determined for daytime, for nighttime, in general for the day and separately for systolic and diastolic pressure, respectively.

And now, since the mid-1990s, the problem of blood pressure variability during the day has been very actively studied, its role in the development of lesions of target organs, its relationship with the risk of developing cardiovascular complications has been studied. We know much less about the predictive value of variability, which is called intravisit variability. We all know very well that if we measure a patient's blood pressure three times in a row (as, in principle, it should be according to the method of measuring blood pressure), then all these three values ​​will differ from each other. And the first dimension usually varies greatly - the numbers are higher than in the second and third. Therefore, in many protocols where blood pressure is measured, the value of the first measurement is discarded, and then the value of the second and third is summed up.

But it happens in every way. It happens that the second dimension is higher than the first and third, and so on. But most often the first. “Intra-visit” is such a term – during one visit to the doctor. So both of these types of variability, intravisit and daily, are usually called short-term variability. V last years anything up to a day is called short-term variability.

It is determined either by measuring pressure by the Korotkov method by a doctor, or on the basis of self-monitoring data. It is possible, accordingly, to determine the very short-term, intravisit variability of blood pressure during the daytime hours. Unfortunately, at night - only by the method of daily monitoring.

Another type of variability, which is currently receiving special attention, is called long-term variability. This is variability over long periods of time - months and even years. Accordingly, this term refers to pressure fluctuations over long periods of time. The variability from visit to visit, that is, between different visits of the patient to the clinic, and, I repeat, with an interval of at least a month, is nothing more than the stability of the achieved antihypertensive effect. That is, for a practicing physician, the term “stability of the achieved effect” is more understandable here.

Long-term variability also includes seasonal variation. The pressure at different times of the year is not the same. Most high numbers in winter, the lowest in summer. Accordingly, autumn and spring occupy an intermediate position.

Besides, in Lately allocate the variability of blood pressure on different days, this also includes meteosensitivity. Usually this is a pressure measurement for seven consecutive days. You can, of course, measure the doctor, but then it is only a hospital, therefore, of course, the main method for diagnosing such variability is the self-measurement method. And from week to week. That is, one day is selected in different weeks, let's say Monday, and blood pressure is recorded on Monday for several weeks in a row.

What caused the surge of interest in the problem of blood pressure variability is, of course, with the release of the results of the ASCOT study, or rather, with the release of the results of its sub-analysis on variability. You know that in the ASCOT study, two combinations competed for antihypertensive efficacy and, accordingly, for the impact on hard endpoints: the combination of Amlodipine with an ACE inhibitor versus the combination of the beta-blocker Atenolol with a thiazide diuretic. And it was found that the combination of Amlodipine with an ACE inhibitor turned out to be much better in terms of the effect on almost all hard end points: strokes, heart attacks, kidney failure, and so on and so forth, mortality. And this effect, this success of the combination of Amlodipine with an ACE inhibitor, cannot be explained only by the difference in pressure reduction. Because if there was only a difference in pressure reduction (and it was, it was reliable, in favor of the combination of Amlodipine with an ACE inhibitor), then it would explain about only half of the success. So there is clearly another mechanism. The search for this mechanism was engaged in and drew attention to the variability.

The ASCOT study tested the predictive value of three types of variability: 24-h monitoring variability, that is, within a day; intravisit variability; and finally, long-term variability. So, it was found that all these three types of variability are independent prognostic adverse factors affecting the risk of both stroke and heart attack. Stroke - to a greater extent, heart attack - to a lesser extent, but nevertheless, both are reliable.

The variability of both systolic and diastolic pressure had prognostic independent significance, both of which are significant, but systolic - to a greater extent.

Finally, the predictive value of these three tested types of variability was compared. It was found that the long-term variability of blood pressure, that is, the persistence of the achieved antihypertensive effect, has the highest contribution to the prognosis.

After receiving such brilliant data, a purely practical question naturally arose: how does our group of antihypertensive drugs (you know that there are actually eight of them, but five are the main ones), at least the main ones, affect blood pressure variability? So, it was found that when testing a regimen of strict monotherapy, then only two classes - these are calcium antagonists and diuretics - significantly reduce long-term variability in systolic blood pressure. For comparison, this column shows the effect of different classes of drugs on the level of systolic pressure. Naturally, the level of pressure was reduced by all five main classes, but the variability was reduced only by two: calcium antagonists and diuretics. Sartans, inhibitors and beta-blockers did not significantly affect the variability.

I want to emphasize again that this is, of course, an effect class. A lot has been said and said to be very careful with this class-effect term, that drugs within a group sometimes differ so much that one increases mortality and another decreases. I'm not talking about neutral influence. But nevertheless, at least for the time being, for convenience, two have a class-effect.

And how can one not recall the TOMHS study - as I like to say, old (because 1993), but absolutely not outdated - where five antihypertensive drugs were tested in monotherapy in patients with first-degree hypertension, and just the reference calcium antagonist Amlodipine showed the most powerful hypotensive effect. But it’s much more interesting for us that after four years (that’s how many patients were observed in this study), it was with the use of Amlodipine that there was the largest number of patients who still received monotherapy and they had target pressure, that is, everything was fine. That is, it was Amlodipine, a representative of the class of calcium antagonists, the leader of the class of calcium antagonists, that showed not only a powerful, but also a stable antihypertensive effect, which reflects, in fact, long-term variability.

As you know, now all priorities in the treatment of hypertension, due to the peculiarities of its pathogenesis, are given, of course, to combined antihypertensive therapy. And now we are already raising the question not so much which class of drugs is more priority in one or another point, in one or another group of patients, but which combination is more effective in reducing the risk, for example, of strokes, and so on and so forth.

Therefore, no less, and perhaps even more interesting are the results of another meta-analysis on the effect on variability, which tested just the addition, respectively, of calcium antagonists, diuretics, sartans, inhibitors, and so on, to some already class of antihypertensive drugs, that is, as it were, an increase in antihypertensive therapy.

Once again, I draw your attention to this column. Naturally, an increase in the antihypertensive effect always occurred. But blood pressure variability only decreased when added to any other class that was used as the first drug, the calcium antagonists. Even diuretics have lost their effect here: on the verge of reliability, but formally not reliable.

Naturally, this is also why now great attention is drawn to various combinations, primarily fixed (fixed, because again, according to modern recommendations, all priorities are already given to fixed combinations within combination therapy) combinations of antihypertensive drugs containing exactly antagonists as a component calcium, most commonly amlodipine. You know that there are such combinations of blockers, respectively, with a calcium antagonist, in particular, the drug "Ekvator", there are such combinations of a beta-blocker with a dihydropyridine calcium antagonist. That is, now special attention is paid to them.

But back to the diurnal variability of blood pressure. We are mainly interested in the variability separately during the daytime and at night, because the variability in the whole day has such a rather ascertaining value. Accordingly, we have two pressures - systolic and diastolic, two periods of time of the day - wakefulness and sleep - four parameters. If at least one of these parameters exceeds the norm, it is considered that the patient has an increased variability in blood pressure during the day. I will also immediately make a reservation that the daily standards for blood pressure variability for daily monitoring, unfortunately, are not generally recognized. I am giving you the data obtained at the Russian Cardiology Research and Production Complex under the leadership of Rogoza. Here, the problem of blood pressure variability has been dealt with for a very long time, including the development of standards.

Here are the most commonly used. In general, we have known for a long time, since the mid-90s, that increased variability in blood pressure during the day is associated with a higher incidence of target organ damage.

For example, left ventricular myocardial hypertrophy in patients with normal pressure variability during the day occurs in about a quarter of cases, that is, in every fourth. And in patients with increased variability - already in half, that is, twice as often. But, of course, the most impressive relationships are seen with vascular damage as target organs. Atherosclerosis of the carotid arteries, according to ultrasound, was detected only in every fifth patient with arterial hypertension and normal variability of pressure during the day. While in patients with increased variability, exactly the opposite, about a fifth of patients had normal carotid arteries, while the rest, that is, four-fifths, had signs of either thickening of the intima-media complex or atherosclerotic plaque. True, it must be said that this is the cause, and that the consequence is still a big question, because of the many reasons that lead to an increase in blood pressure variability, it is the decrease in the rigidity of the vascular wall that is now put in the first place, one of the reasons for which is, of course, , atherosclerosis.

After the ASCOT study, where, as I said, the independent prognostic contribution of increased variability to the development of complications of both heart attack and stroke was also confirmed, a new surge of interest. And already in 2007, another work was published, where it was shown, in particular, that all four types of variability (two times of day and two pressures - it turns out four) are independent prognostic significant risk factors for the development of coronary complications in our patients. But if we talk about cerebrovascular, first of all, of course, about a stroke, then three of them showed a significant value: the variability of both pressures - both systolic and diastolic - in the daytime; and mean systolic blood pressure.

And you see that where the variability of blood pressure was increased, at the same level of blood pressure at this time of day, the risk of complications and heart attacks and strokes was always higher.

In terms of coronary complications, as we have already said, all four types of variability were important, but systolic pressure variability at night showed the greatest predictive value. This has not been found for stroke. Once again, three types of variability mattered in the daytime - both systolic and diastolic pressure, at night - only systolic, and they all had approximately equal importance as an additional risk factor for stroke.

You saw that only adding a calcium antagonist class to some other therapy led to a significant reduction in variability. At the same time, ACE inhibitors as a class of drugs, taken as a whole, did not have such an effect. And we know that in ASCOTE, the addition of Perindopril specifically to Amlodipine caused a significant decrease in variability. This means that ACE inhibitors do not have a class effect, and, accordingly, each inhibitor will have to be dealt with separately.

It would be my pleasure to present our own data to you. The fixed combination Equator in patients with arterial hypertension of the first or second degree was used at a dose of 1-2 tablets per day (morning intake of either one or two tablets). Approximately equal numbers of men and women. Slightly less than half of our patients were smokers. You see that 70% of these patients were either overweight or first degree obese. We simply did not take higher degrees of obesity. The dose of Equator, of course, was titrated. And as a result, in all patients, one hundred percent, it was possible to achieve the target level of blood pressure according to routine measurement. At the same time, three-quarters received one tablet of Equator in the morning, and 25% - two. You see, 33 and 18.5 millimeters of mercury - a decrease in routine pressure. This is a very good result.

Also excellent results of the hypotensive effect this drug also demonstrates daily monitoring - by 28 and 26, respectively, for systolic day and night, 17 and 15 - for diastolic day and night.

Our goal was to look at the effect of this drug, primarily on variability. And you can see that against the background of the use of the Equator, all four types of blood pressure variability significantly decreased. If we look at the number of patients in whom normal variability values ​​were found, then you see that after 12 weeks of treatment, the number of such patients increased significantly for all types of variability, all four, but this was especially true (the numbers were close to one hundred percent after 12 weeks of treatment). weeks of treatment) daytime diastolic pressure, nighttime systolic blood pressure, the most dangerous, and nightly diastolic blood pressure.

This problem, its relevance, has just been posed, and, accordingly, there is still a lot to be studied, including in comparative studies. Nevertheless, we have real opportunities to further reduce the risk of developing both stroke and myocardial infarction with the right choice of antihypertensive therapy.

Thank you for your attention, colleagues.

Vladimir Trofimovich Ivashkin, Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

Thank you, Olga Dmitrievna. I have a question for you. I often listen to presentations of the results of various randomized, placebo-controlled clinical trials investigating the effectiveness of various antihypertensive drugs and combinations. I am a practical doctor, and I ask myself this question. On the one hand, yes, this is a well-selected population of patients included in this randomized trial, with high adherence to treatment, carefully monitored, with frequent visits to the doctor, and so on. On the other hand, let's say, the wild population, where recommendations are transferred, and in this population, doctors are trying to introduce the results of these randomized trials. And here the question arises, is there a correction factor for the effectiveness of the developed treatment regimens? In particular, this adjustment factor should take into account: adherence to treatment, because one thing is the observed population, and another thing is the non-observed population; secondly, the desire or unwillingness of patients to buy for a long time, that is, to spend money, is also a rather significant problem; thirdly, the fear of patients taking drugs for a long time, because in addition to the recommendations that doctors receive from patients, they receive recommendations from their relatives, acquaintances, neighbors who have both good and bad experience, and so on. That is, there are a lot of such factors that really, probably, can change the high efficiency, which we see in randomized trials and which, it seems to me, can never be achieved in this population of real patients. Are there such coefficients?

Ostroumova O.D.:

– Vladimir Trofimovich, naturally, you have raised a very big problem. Of course, a randomized trial is a kind of ideal, it is, as it were, the maximum, above which it is hardly possible to achieve anything.

Ivashkin V.T.:

– This is, in general, a magical world in a snuffbox in some way.

Ostroumova O.D.:

– Yes, but real life, real practice, real patients… naturally, there are real patients, and therefore, of course, the situation is such that blood pressure control is achieved much less frequently than it is claimed according to randomized trials. That is, it is an ideal. Of course, such a direct coefficient, the numbers - for example, 0.5 - are not yet given to us. But I think that in order to really look at how this or that treatment regimen, this or that drug will work, observational studies are needed. That is, a real population is taken, without restrictions ... Because in clinical trials there is still a huge list of contraindications for comorbidity. And how will the drug work in a real patient who sometimes has ten diagnoses? limited. And it will already be possible to orientate oneself on those real figures that will be obtained there.

Ivashkin V.T.:

– Probably, after all, we can say that in countries where the percentage of the population suffering from arterial hypertension is much higher in terms of taking antihypertensive drugs, in all likelihood, both the number of strokes and the number of heart attacks goes down.

Ostroumova O.D.:

- Unfortunately yes.

Ivashkin V.T.:

– Countries not covered by such universal treatment, in all likelihood, are on the same level there.

Ostroumova O.D.:

- We will not remake the sick, it is too difficult. Here is the art of a doctor, too much in our profession is psychology.

Ivashkin V.T.:

- And not only the art of the doctor. Still, social factors, you know?

Ostroumova O.D.:

“It will also be difficult for us to somehow influence this.

Ivashkin V.T.:

- But nevertheless, we have a certain standard, and with the proper willful efforts of doctors, with the proper desires of our society, our society, we, in general, have a tool with which we can very significantly ... we, in general, do this – reduce mortality from all these cardiovascular pathologies.

Ostroumova O.D.:

– At least in mortality from strokes, there is already progress. True, only in mortality, not in morbidity.

(0)

In the heat, it seems to you that the whole body is on fire and it is impossible to cool off in any way. Or in the cold you shiver to the bone so that it is impossible to warm up. You are always cold or hot. Either cold or hot, depending on ambient temperature. If you agree with at least one of these statements, read on.

If one of the above options is familiar to you, you may have a symptom called temperature sensitivity.

On the this moment it is not known what causes this symptom, but there are some studies. Most of them associate it with disorders of the autonomic nervous system, which "understands" homeostasis and the body's reactions to environmental changes, including reactions such as "fight or flight."

Based on the results of these studies, scientists can now look deeper into the problem and find out what exactly is going wrong. And they have already found some interesting things.

Temperature sensitivity in fibromyalgia

In fibromyalgia, some studies show an unnatural body temperature, an inability to adapt to temperature changes in the environment, and a lower pain threshold for both high and low temperatures. This means that a person with fibromyalgia only needs very small fluctuations in temperature to feel pain. For example, sunlight shining through a car window on the hand can cause burning pain, while for other people it causes only mild discomfort.

One study (Albrecht) has suggested a single cause of temperature sensitivity based on a series of discoveries.

The first phase of the study included people who were the exact opposite of fibromyalgia sufferers - i.e. those who felt no pain at all. This is a rare condition that is given to a person from birth. Doctors believe that these people can feel the temperature, which is misleading.

Why did the same nerves, which are responsible for the sensation of temperature, and for the sensation of pain, react differently?

This question led scientists to the discovery that they are not the same nerves at all. It turns out that a separate nervous system is responsible for the sensation of temperature. She is in circulatory system, and scientists are used to thinking that they are dealing with blood flow.

So it turns out that these special nerves not only regulate blood flow, they detect temperature. These nerves soon became a logical target for fibromyalgia research, as both temperature sensitivity and blood flow abnormalities are known to co-exist.

The researchers found that participants with fibromyalgia had additional temperature-sensitive nerves called arteriovenous fistulas. They are found in the hands, feet and face. They regulate blood flow in response to temperature fluctuations. This can be seen with your own eyes at low temperatures: the cheeks turn pink, the fingers swell and turn red. This just happens because of the arteriovenous fistulas, which are trying to keep warm.

This is the first study trying to figure out how this whole nervous system is connected to fibromyalgia. Therefore, it is impossible to say for sure how accurate it is. But in any case, this is an interesting direction for further research and explanation of temperature reactions.

Temperature sensitivity in chronic fatigue syndrome (CFS)

So far, there has been too little research on this symptom in CFS, but we already know something.

One study (Ulrich) used identical twins. In each pair of twins, one had CFS and the other did not. It turned out that twins with CFS reacted differently to cold compared to their healthy siblings when it came to pain sensitivity (how much pain they could bear) and pain threshold (the point at which cold becomes pain).

Another study (Meeus) discovered something about a process called pain suppression. In a healthy person, the brain takes steps to reduce pain sensitivity to both expected pain (such as pricking a finger for blood sampling) and recurring pain (such as a pebble in a shoe that interferes with walking).

The study found that the waiting process responded more slowly to cold stimulation in people with CFS than in healthy people. The scientists who conducted the study believe it may play a role in the disease's chronic, widespread pain. But scientists also point out that more research is needed to confirm.

A study looking at adolescents with CFS (Wyler) could reveal important information about homeostasis. The researchers found that when the hand was exposed to cold, teens with CFS shivered more and changed skin color more quickly compared to healthy subjects. Blood flow to the arms also changed differently between the control group and the patient group. Body temperature decreased more in patients with CFS.

Thus, this symptom is introduced into the medical literature, there are already initial studies that require even more research and confirmation.

How to live with temperature sensitivity?

At the moment, there are no drugs and methods aimed at combating this symptom. However, if you are sensitive to heat or cold, you can make changes to your daily life to help relieve the symptom. There are ways to reduce sensitivity to cold and heat. In order to reach best results, you should tell your therapist about the symptom, which will help the doctor make judgments about your condition and how to help you feel better.

Not everyone can easily adapt to such a sharp change in temperature, especially for people with diseases of the nervous and cardiovascular systems.

Our body reacts to any environmental temperature, trying to keep its own temperature regime constant. He does this, mainly due to the blood vessels. If a person is cool, the blood vessels constrict, and when warmed, they expand. With sudden changes in temperature, the vessels have to change their tone several times during the day. Not everyone can bear it. First of all, naturally, people suffer whose vessels are not in order. And these are all hypertensive and hypotensive patients, too, persons suffering from increased intracranial pressure, migraine, atherosclerosis.
Often, after going several times from warm room in cold weather or vice versa, then a person cannot warm up for a long time, he is shivering, and his skin turns red, as if he has a fever. But there are perfectly healthy people who are simply by nature more sensitive to heat or cold than others. Such people are often hot when others feel comfortable; or they are constantly cold and wrap themselves in warm clothes even in a well-heated room. If this phenomenon has been observed for a long time, then there is nothing particularly dangerous in this. At the same time, if these phenomena occur in a person for the first time, this may be a sign of a particular disease.
Hypersensitivity to changes in temperature can be a symptom of a cold, an infection, menopause, or a migraine.
The feeling of coldness is also characteristic of depression and the so-called seasonal mood swings that occur in people who are sensitive to a decrease in the amount of sunlight in winter time. Individuals with these disorders often experience disruption temperature regime organism. Most people have their lowest body temperature around 3 am. In people with seasonal mood swings, the rhythm is disturbed. Their minimum body temperature shifts closer to 6 o'clock in the morning. Therefore, when they wake up, they feel cold. The physiological state of these people is close to that which happens at midnight.

How to help yourself
Fortunately, hypersensitivity to temperature changes does not usually lead to serious disorders health and manageable. To do this, you can use the following tips.
Check your temperature
Increased sensitivity to heat and cold can be observed with an increase in body temperature. So the first thing you should do is take your body temperature. It is necessary to measure the temperature before going to bed, since at this time temperature fluctuations occur to a lesser extent. If a rise in temperature is detected, rest for a while and drink more fluids.

Review your medications
Certain drugs, such as those used for high blood pressure, heart disease, thyroid gland, migraines, can increase the sensitivity of hands to cold. Ask your doctor about side effect medications you are taking and whether you can change them more suitable medicines.

Try to change your mode
People who are cold and depressed in the morning can try resetting their biological clock. To do this, it is recommended to take a 15 or 20-minute walk with sunrise as soon as you wake up, three times a week. Morning is the best time for light therapy. At that time The biological clock easier to correct. Once you get them working, you'll wake up refreshed and less responsive to temperature changes.

Keep an eye on your iron content
Iron deficiency is the most common cause of anemia, especially in women with heavy menstruation and poor nutrition. If you are anemic, you may feel cold all the time. To prevent it, you need to eat food rich in iron, such as lean meat, turkey, tuna, cauliflower and potatoes. When iron deficiency persists despite proper nutrition, your doctor may do an examination to check for intestinal disorders and prescribe iron tablets.

Consult a gynecologist
For menopausal women with hot flashes, it makes sense to ask your doctor to check the content of female sex hormones in the body. With their reduced content in the body, the doctor may advise hormone replacement therapy.

Eliminate certain foods from your diet
Some people complain of cold hands and feet during migraine attacks. Foods such as red wine, coffee, cheese, nuts, tea, chocolate, and spiced meats often trigger migraine attacks. Therefore, their use should be avoided.

Check your thyroid
Since thyroid hormones are responsible for thermoregulation, when they are lacking, body temperature often decreases. It is not surprising that a person is constantly cold, even in summer, feels lethargic and tired. See your doctor if your sensitivity to heat or cold is accompanied by insomnia, brittle nails, or trembling fingers.

When should you see a doctor
 If you usually feel cold or hot more than others.
 If you feel hot for five days or longer.
 If you often feel tired, weak and irritable.
 If, in addition to increased sensitivity to temperature changes, you also have insomnia, brittle nails or trembling fingers.
 With sharp fluctuations in weight without changes in nutrition.
 With excessively heavy or scanty menstruation.