Hypertension 1996 : One Medicine, Two Cultures

SPA therapy of arterial hypertension

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

In the health resorts of Russia there has been accumulated a vast experience of using natural and artificial physical factors for the treatment of arterial hypertension. We are talking primarily about the prevention and then about the therapy of this disease. Especially impressive are both short-term and long-term results achieved at the early stages or the disease. After the formation of the stabile arterial hypertension the effect of spa therapy reduces, especially its long-term effect. This is why referral of the patients to the health resorts during early stages of the disease is a key to successful prevention.
The achievements of hydrological science have shown that the influence of baths with different composition on the body has a lot of common features, for instance, their thermal and mechanical (hydrostatic) action. However there are significant differences between therapeutic action of different kinds of waters associated with their chemical composition. These differences warrant a different approach to the administration of mineral baths considering the disease and its stage. Bath is currently considered as an irritator acting primarily on the receptors of the skin through temperature, hydrostatic and mechanical action. Hormonal and immune response that ultimately results in therapeutic effect is achieved under the influence of neural signal coming from the skin.

Radon, carbon dioxide, sulphur, iodine-bromide, sodium chloride baths are used for the therapy of arterial hypertension. The effect of radon, carbon dioxide and sodium chloride baths on the arterial pressure and other cardiovascular indicators in patients with arterial hypertension was studied in Russian Research Centre of Rehabilitation and Physical Therapy.
Treatment with radon baths was administered to 162 patients (82 - male, 79 - female) with stage II arterial hypertension characterized by stabile increase in blood pressure. Patients were 30-55 years old with arterial hypertension pre-existent for 5-20 years. Baths of concentration 40 nCu/L (52 patients), 120 nCu/L (66 patients), 200 nCu/L (20 patients) were administered. Pure water baths were uscd as a control (23 patients). The results of the baths action on systolic pressure are presented in table 1. This table shows that the largest reduction of arterial pressure was achieved in the group of patients receiving 40 nCu/L and 120 nCu/L, with the least reduction in 200-nCu/L group. This is true for diastolic pressure as well. Pure water baths also produced an hypotensive action, although it was less than in the group of radon baths of any concentration. Correction of the haemodynamic parameters was achieved. Heart rate decreased. In hyperkinetic variant the cardiac output decreased, in hypokinetic variant the cardiac output increased.
In hyperkinetic variant of arterial hypertension clinical improvement of signs of excessive simpatico activity correlated with the reduction of secretion of catecholamines and their precursors in 24-hour urine. With hypokinetic circulation the increase of cardiac output with the decrease in peripheral resistance under the influence of radon baths was achieved in 76,4% of the patients. The reduction of blood pressure was more prominent in the group with radon concentration 4O nCu/L than in 120-nCu/L group. Reduction of total peripheral resistance, increase of cardiac output and increase of excretion of dopamine accompanied decrease in arterial blood pressure.
Use of carbon dioxide baths (concentration 1.2 g/L and 2 g/L) also lead to the decrease of arterial blood pressure. The course of treatment consisted of 12 baths. The data on the arterial blood pressure changes are presented in Table .The data shows that carbon dioxide baths produce a significant result when used for the treatment of stable arterial hypertension. This effect is insignificantly different from the effect of radon bath on arterial hypertension.
A decrease in cardiac output and an increase in total peripheral resistance accompanied the therapeutic action in the patients with hyperkinetic variant of arterial hypertension, as it is demonstrated in Table. As you can see in the table, minute volume and cardiac output, and also peripheral resistance do significantly change. In hypokinetic variant of arterial hypertension the changes are reverse to the changes observed in hyperkinetic variant, i.e. minute volume and cardiac output increase while total peripheral resistance decreases. There was no significant difference between patient groups with carbon dioxide concentration of 1.2 g/L and 2.0 g/L.
It is especially attractive for the physicians that carbon dioxide gas baths can be used not only at the health resorts but also in hospitals and outpatient clinics. The data on the effectiveness of the therapy is presented in Table. The table demonstrates that the patients with stable arterial hypertension reach a significant decrease in blood pressure after 12 carbon dioxide gas baths. The effectiveness of treatment is somewhat less that with water carbon dioxide baths. Just as we observed in the water carbon dioxide baths, carbon dioxide gas baths reduce cardiac output minute volume and increase total peripheral resistance in patients with hyperkinetic variant of arterial hypertension. The results of the treatment of arterial hypertension patients with carbon dioxide gas baths show a little difference from the results of therapy with water carbon dioxide baths.
However, the research has demonstrated that gas carbon dioxide baths are more effective for the treatment of the patients with combined hypertension and coronary heart disease (functional classes II and III) and in the patients with combined hypertension and congested heart failure. Water, carbon dioxide baths are in fact contraindicated for the above-mentioned combinations of pathology. Unlike water baths, carbon dioxide gas baths have no hydrostatic action, they do not produce much impact on central haemodynamics, though they have the beneficial effect on pressor humoral mechanisms of arterial blood pressure regulation and the microcirculation.
Sulphur baths are also used for the treatment of arterial hypertension, although they are usually recommended to the patients without the signs of increased simpatico activity, i.e. without tachycardia, extrasystoles, cardalgias. Sulphur baths are of special benefit for the patients with arterial hypertension accompanied by vascular insufficiency in the extremities, for arterial hypertension accompanied by diabetes mellitus with angiopathies of kidneys or the extremities. The concentration of H2S should not exceed 100 mg/L.
Speaking of spa therapy for arterial hypertension, particularly about the mineral baths, we would like to point out that even though their effectiveness is evident is significantly less effective than the programs of combined application of mineral waters and apparatus physiotherapy. Unfortunately at the health resorts of the western countries (Italy, Germany, France, Austria etc.) unlike in Russia, natural factors (climate, mineral waters, curative mud) are almost never used in combination with apparatus physiotherapy. The results are better when the program of health resort therapy includes electrotherapy, for example electrosleep, halvanization, iontophoresis of hypotensive medications on the reflex zones (cervical simpatico ganglions, collar zones), application of electromagnetic field 460 MHz upon the kidney area, sinusoid modulated currents etc. There may be a good reason why the insurance companies deny reimbursing for the health resort treatment. It may be unreasonable to finance an incomplete treatment. There may be a better reason to finance an intensive and more effective treatment that would include a complex of physical methods of treatment, which are comparable with the pharmacological therapy and have good long-term results. As an example we would like to quote one of the programs of health resort treatment of stabile arterial hypertension (stage II).

1. carbon dioxide baths (1.5 - 2.0 g/L) - 12 baths
2. electrosleep (transcerebral electroimpulse therapy – 12 procedures
3. iontophoresis of propranolol on the synocarotid area and cervical simpatico ganglions - 12 applications. In iontophoresis on the cervical simpatico ganglions two smaller electrodes are located on the lateral sides of the neck, while the third electrode covers posterior part of the neck and superior thoracic spine
4. massage of the collar area

Changes of arterial blood pressure before and after series of 12 carbon dioxide baths (concentration 1.2 g/L) in patients with arterial hypertension (n=39)

Decrease of arterial blood pressure in patients with hypertension (II stade) after a course of treatment radon baths 120 nCu/l

Changes of arterial blood pressure after 12 radon baths 200 nCu/l in patients with arterial hypertension (II stage)

Changes of arterial blood pressure after 12 radon baths 40 nCu/l in patients with arterial hypertension (II stage)

Changes of haemodynamic parameters in the patients with hypertension of hyperkinetic variant after treatment with gas carbon dioxide baths (n=32)

Changes of haemodynamic parameters in the patients with hypertension of hypokinetic variant after treatment with carbon dioxide (2.0 g/L) baths (n=33)

Changes of haemodynamic parameters in the patients with hypertension of hyperkinetic variant after treatment with carbon dioxide (2.0 g/L) baths (n=28)

Changes of haemodynamic parameters in the patients with hypertension of hyperkinetic variant after treatment with gas carbon dioxide baths (n=30)

Content of catecholamines and their precursors in 24-hour urine of patients with hypertension of hyperkinetic variant before and after treatment with radon baths 40 and 120 nCu/L (n=65)

Content of catechoiarnines and their precursors in 24-hour urine of patients with hypertension of hypokinetic variant before and after treatment with radon baths 40 nCu/L (n=26)

Changes of arterial blood pressure before and after series of carbon dioxide gas baths in patients with arterial hypertension (n=68)

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Edited by Aldo Campana,