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THE METHODOLOGY OF ASSESSING THE EFFECTIVENESS OF THE THERAPY

Objectives: To substantiate the methodology for assessing the effectiveness of drug therapy, based on the effect of therapy not only on the target organ or function, but also on the regulatory and adaptive status (RAS) of the organism. Material and methods: The cardio-respiratory synchronism test (CRS), proposed as one of the rationale for the concept of the hierarchical system of cardiac rhythmogenesis in an integral organism, was used to evaluate the RAS, since it characterizes the complex reaction of the two most important vegetative functions – respiratory and cardiac. The technique of obtaining cardio-respiratory synchronism in humans, analyzing its parameters and calculating the regulatory-adaptive status index (iRAS) by the parameters of the CRS is described. Results: Pronounced changes in iRAS under cyclic changes in the body of pregnant women with psycho-emotional stress before delivery are shown expressed. These observations revealed high information value of the method in assessing the dynamics of regulatory and adaptive capabilities of the organism. Monotherapy of arterial hypertension was carried out by agents of different groups. The treatment outcomes were compared in those patients who reached the target blood pressure level in 6 months (140/90 mm Hg). It was found that under the same effectiveness of therapy according to the target function parameter – the level of blood pressure, preparations of different groups had unequal influence on the body's RAS. In the treatment with lisinopril, hydrochlorothiazide, nifedipine, and diltiazem, iRAS increased; when treated with atenolol and doxazosin, on the contrary, it decreased below the baseline values before the start of the therapy. Conclusion: The evaluation of the dynamics of RAS provides a new methodological approach to the characterization of the effectiveness of drug therapy, based on the assessment of the effect not only on the target organ or function, but also on the regulatory and adaptive capabilities of the organism.

Иллюстрации

Video 1. Measurement of the sample of cardio-respiratory synchronism in humans

Table 1. Parameters of cardio-respiratory synchronism

Table 2. Scale of qualitative evaluation of the level of regulatory-adaptive status

depending on the value of the index (IRAs)

Fig. 1. The index of the regulatory-adaptive status of women with the duration of the menstrual cycle is 28-32 days in different age groups depending on the phase of the cycle (m±m). * - the accuracy in comparing values in different phases for each age group is p<0.001.

Table 3. The index of the regulatory-adaptive status (IRAs) of women with different temperament types on the first appeal, confirmation or denial of the cancer diagnosis (M±M)

Fig. 2. The index of the regulatory-adaptive status in the initial state and under the action of stress factors in students (S), the beginners parachutists (BP), beginner rescuers (BR), experienced parachutists (EP), experienced rescuers (ER); * p<0.001.

Fig. 3. The direction of change of the index of the regulatory-adaptive status in the treatment of antihypertensive drugs. The zero line – the initial level before treatment. * - reliability in comparison with the initial level of p<0.05.

DOI: 10.18413/2313-8971-2017-3-2-91-100
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