Hypertension 1996 : One Medicine, Two Cultures

Electrotherapy of arterial hypertension

V.M. Bogoliubov*, U. Solimene**
*Russian Centre for Physiotherapy and Rehabilitation, Ministry of Health, Moscow, Russian Federation
**Chair of Medical Hydrology, University of Milan

Therapeutic factors produced by special apparatuses are widely used for the treatment of cardiovascular diseases. Their usage in cardiology was started only about 20 - 25 years ago. Currently they play an important role in cardiology, particularly for the treatment of arterial hypertension. These physical factors include halvanic currents, iontophoresis of medications, electrosleep (transcerebral impulse electrotherapy), sinusoid modulated currents (SMC), electromagnetic field 460mhz, 2500 MHz, magnetic field, laser, electric field 27 MHz. Among the topographic areas of application of physical factors the most important role belongs to reflex zones, i.e. zones that cause most hormonal and immune response from the body when stimulated. These are: zones of Hed (the projection of heart area), collar zone, sinocarotid zone, the area of cervical simpatico ganglions, Th2-Th4 sympatic ganglia - the ganglia, innervating the heart, etc.
Only medications that are able to dissociate into ions can be used for intophoresis. Hypotensive medications among which are some ganglion blockers, beta-blockers, analgesics can be used with intophoresis. This method is used for arterial hypertension, non-ischemic heart pain, hypertension complicated by aterosclerotic encephalopathy, chest pain secondary to thoracic osteoarthritis.

Electrosleep is a method of therapy when rectangular and sinusoid impulse currents are applied transcerebrally. The electrodes are located on the eyelids or on the skin of the forehead (katode) and on the skin of mastoid process (anode). Such position of electrodes directs the impulse currents through the skull; currents produce their influence on the subcortical areas of the brain: hypothalamus, thalamus, and reticular formation. These areas of the brain are the most important centres of the regulation of hormonal and immune response. This action of electrosleep on CNS has a positive effect on metabolism, reduces increased arterial pressure, decreases the heart rate, and increases tolerance of exercise in the patients with arterial hypertension and coronary artery disease. Electrosleep has an anxiolitic, analgesic effect, improves very day performance not only in the sick but also in the healthy people, including professional athletes. Electrosleep improves central and peripheral hemodynamics. It is able to reduce cardiac output in patients with hyperkinetic arterial hypertension through the reduction of secretion of catecholamines and their precursors. Electrosleep improves cerebral circulation. It is able to reduce hyperlipidemia, it reduces glucose levels in diabetics. Electrosleep is widely used not only for hypertension but also for coronary artery disease, acquired hyperlipidemia, circulatory changes of the menopause (flushes).
Sinusoid modulated currents (SMC) with frequency of 10 to 200 Hz penetrate through the skin better than AC or DC. Functional improvement of central and peripheral nervous system has been proved. These currents improve circulation in organs and tissues through local action. For example, their application on cervicothoracic spine area improves cerebral circulation, central hemodynamics and intracardiac circulation; the application of the currents on lumbar area improves kidney circulation; SMC application on sinocarotid area produces a profound hypotensive effect, improves micro-circulation in the peripheral tissues.
Electromagnetic field 400 MHz is able to penetrate into the tissues as deep as 9-13 cm without overheating the skin and subcutaneous tissue. Highly vascularised tissues (brain, lever, muscles etc.) get more intensive exposure of electromagnetic field 400 MHz. The body responds with an increase in capillary circulation, with more intense metabolism, increased neuronal activities, so “silent” neurones “switch on”, the protein synthesis is increased. Small intensities (20-40 Wt) of electromagnetic field reduce the aggregation of the platelets. Application of electromagnetic field on the head improves cerebral circulation when it had been compromised, for examples after stroke. The application of electromagnetic field on the heart facilitates tissue restoration after myocardial infarction.
The depth of penetration of alternating magnetic field (50Hz) is 3-6 cm. It is less active compared to electromagnetic field but it can reduce the aggregation of platelets, has a moderate anxiolytic and analgesic effect, it has some effect on the autonomic nervous system. It can reduce blood pressure when applied to the area of the projection of the heart and on the collar area.
Laser is rarely applied for the treatment of hypertension. When it is used it is directed to the reflex zones (sinocarotid, collar).
Electric field of high frequency (27 MHz) is used for the treatment of hypertension when it is combined by hyperlipidemia. In these cases electric field should be directed transcerebrally (picture). It achieves some decrease of blood pressure and reduction of cholesterol.
The effect of electric field of high frequency (27 MHz) is similar to the effect of electrosleep. It is understandable because in both cases the action is directed towards diencephalon. Although electrosleep, unlike the high-frequency electric field can be used at home. Electric field is able to penetrate into the tissues as deep as 20-25cm.
Now we would like to discuss and compare the hypotensive effect of different methods of electrotherapy. One application of sinusoid modulated currents on the kidney projection area in healthy people can sufficiently reduce blood pressure measured 30 mm after the end of application (table). It can improve kidney circulation and increase glomerular filtration rate (table). The effect was better when sinusoid modulated currents were applied on both kidney and collar area. Application on both areas produced a better effect than when currents were applied at kidney area only. The reduction of minute volume and cardiac index together with the increase of total peripheral resistance was observed in patients with hyperkinetic varient of arterial hypertension (table); in patients with hypokinetic variant of hypertension there was an increase in minute volume, growth of cardiac index and reduction of total peripheral resistance (table).
Treatment with electrosleep also resulted in a significant reduction of arterial pressure (table). The table shows that both systolic and diastolic pressures significantly decrease after 12 applications of electrosleep. In patients treated with electrosleep there was observed an axiolytic effect, improvement of concentration and intellectual work performance besides the hypotensive effect. Just as with the other forms of electrotherapy of arterial hypertension there was a decrease of minute volume, cardiac index and increase of total peripheral index in hyperkinetic variant, and increase of minute volume and cardiac index with the reduction of total peripheral resistance in hypokinetic variant of hypertension.
Speaking of the electrotherapy of arterial hypertension we need to point out that the combination of two or more factors acting on different mechanisms of pathogenesis of the disease produce better results than a single factor. This is why at the health resorts mineral waters are combined with electrotherapy, preferably with two different modes of it, that act through different mechanisms of pathogenesis. For example carbon dioxide baths (12 applications) are combined with:

• electrosleep

• sinusoid modulated currents applied on sinocarotid area

• massage of the collar area (picture). An example of a combined program of electrotherapy in an ambulatory setting follows (picture):

  • electrosleep - 12 procedures

  • sinusoid modulated currents on collar area - 10 procedures

  • electromagnetic field on kidney projection - 10 procedures.

The program of electrotherapy of hypertension complicating chronic glomerulonephritis or pyelonephritis should always include administration of electromagnetic field 460 MHz (10-14 procedures) on the kidney projection area or high frequency electromagnetic field 27.13 MHz or inductothermia. The reduction of arterial pressure will be accompanied by the reduction of inflammation due to the improvement of local immunity.

Changes of haemodynamic parameters in the patients with hypertension (stage II) of hyperkinetic variant after treatment with sinusoid modulated currents applied on the collar and kidney areas (n=28)

Decrease of arterial blood pressure in patients with hypertension (II stage) after a course of treatment with sinusoid modulated currents (SMC) applied on kidney projection area and colar area (n=52).

Indicators of kidney function in patients with arterial hypertension (stage II) before and after therapy with sinusoid modulated currents applied on kidney projection area (n=29).

Changes of. haemodynamic parameters in the patients with hypertension (stage II) of hypokinetic variant after treatment with sinusoid modulated currents applied on the collar and kidney areas (n=24)

Indicators of kidney function in healthy people before and after application of sinusoid modulated currents applied on kidney projection area (n=28).

A Sample Program of Therapy of Stage II Arterial Hypertension at a Health Resort

1. Carbon dioxide (or radon) baths - 12 baths
2. Electrosleep - 10-12 procedures
3. Sinusoid modulated currents applied on sinocarotid area - 9-10 procedures
4. Massage of collar area

A Sample Program of Therapy of Stage II Arterial Hypertension in an Ambulatory Setting

1. Electrosleep - 12 procedures
2. Sinusoid modulated currents applied on collar area - 9-10 procedures
3. Electromagnetic field applied at kidney projection area - 10 procedures

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Edited by Aldo Campana,