The method of treatment of anxiety disorders and disritmia blood pressure in hypertensive patients with alexithymia

 

(57) Abstract:

The invention relates to medicine, namely cardiology, and for the treatment of hypertension. In addition to traditional antihypertensive therapy appointed tranxen at a dose of 10 mg for 40 minutes before going to sleep the first three days daily, then every other day for three weeks followed by a repetition rate of one month. The method allows a shorter period to normalize the indicators of circadian rhythm of blood pressure, reduce hypertension load that is accompanied by a reduction in anxiety, improved sleep, improved health and quality of life of the patient. 6 table.

The invention relates to medicine, namely cardiology.

For the treatment of anxiety States, occurring in somatic diseases, the most commonly used benzodiazepine tranquilizers stimulants (Mashkovsky M. D. pharmaceuticals, part 1. - M - 1993. - S. 87; Basic and clinical pharmacology, vol. 1, edited by Bertram G., Katzung. M , Saint-Petersburg. - 1998. - S. 423-425).

A comparative study of the anxiolytic activity and safety of administration of certain benzodiazepines, taking into account individual pagbabasa, panic and anxiety disorders within the depression without somatic pathology (Bogdan A. N. Clinical pharmacology and therapy. - 1998, N 7. - S. 59-61).

When hiring tranxene, unlike diazepam and phenazepam, in patients with phobic neurosis and panic disorders, noted the small frequency of occurrence of such side effects as drowsiness, dizziness, reduction reactions, and weakness. Whereas in the group of patients with neurotic disorders side effects were equally pronounced when taking all of the studied drugs. Continuation of reception of tranxene led to the gradual disappearance of the above complaints during the first two days in patients with panic disorders and for the first seven days - with neurotic depression.

Already in the first three days of starting treatment with tranxene patients with phobic disorders noted a decrease in Intrusive thoughts, fears, anxiety, feelings of tension and normalization of sleep. At that time, as patients with neurotic depression only at the end of the first week of normal sleep, and by the end of the second disappeared anxiety.

All patients receiving diazepam or phenazepam, p is and by the end of the month observation under the influence of these drugs decreased, but to a lesser extent than under the influence of tranxene. When hiring and phenazepam diazepam often thought about the possible return of the disease, which required increasing doses.

Thus, anxiolytic activity and safety of tranxen superior to diazepam and phenazepam. The timing of the development of anxiolytic, sedative-hypnotic effects when treatment with tranxene depend on the form of depression.

However, in our opinion, a daily intake of tranxene in the above doses during the month impractical, because the drug has a low rate of excretion, resulting in a marked prolongation of effects on the Central nervous system.

The aim of the invention is to reduce side effects. This goal is achieved by the fact that in addition to traditional antihypertensive therapy has been used tranxen at a dose of 10 mg for 40 minutes before going to sleep the first three days daily, then every other day for three weeks, followed by repetition of the course in one month.

Example 1.

The history N 20542. Patient K., 46 years old, a teacher. Clinical diagnosis: hypertension, mild current, II stage. N. 0.

19.08.99 entered cardiologica pain behind the breastbone, lasting several hours, with irradiation to the left arm, headache, dizziness, nausea, cold sweat, weakness, poor sleep.

The history of the disease. Within ten years after emotional experiences, the patient noted increased numbers of blood pressure (BP) up to 160 mm and 90 mm RT. century, accompanied by headaches in the occipital region, tinnitus, dizziness. About the last two years bother pressing or stabbing pain in the left half of the chest with irradiation to the left hand, arise when raising HELL, nitroglycerine ineffective. A few months worried about insomnia. Care of the patient is not treated. 19.08.99 when climbing to the third floor appeared above complaints and the patient was taken by ambulance to the hospital with a preliminary diagnosis of CHD. Possible myocardial infarction. Hypertension, mild current, II stage. N. 0. On electrocardiogram (ECG) from 19.08.99: sinus rhythm, the electrical axis of the heart rejected left, left ventricular hypertrophy. The diagnosis of myocardial infarction is cleared through a day of observation in the intensive care unit.

When applying the General state of moderate severity. Sick braillenote. The shape of the thorax correct, symmetrical, respiratory rate 18 in minutes With percussion of the lungs clear pulmonary sound. Auscultation - vesicular breathing, wheezing no. The rhythmic pulse, symmetrical, satisfactory filling and voltage, frequency 78 in minutes AD 170 and 90 mm RT. senior Border of the heart: right - 1 cm laterally from the right edge of the sternum, the upper and the lower edge of the third rib, left - 2 cm outwards from the left of the mid-clavicle line. Muffled heart sounds. Language and wet clean. The belly of the correct form, palpation of soft, painless. The liver edge of the costal arch. Spleen not palpated. No edema.

Psychological testing was conducted using the Toronto alexithymics scale methods Including Doctor of Spilberger, modification Y. L. Hanina. The total score of quality of life (QOL) was calculated using the questionnaire developed by A. G. Gladkov et al. (1982) modified by B. N. Zaitsev and T. A. Ayvazyan (1989). The results (table. 1) indicate the presence of the patient K. alexithymics characteristics and the high level jet (RT) and personal (LT) alarm when entering the hospital. This combined with the low quality of life.

Data dopo 10 /l, color index of 0.9, leukocytes 4.8 x 10 /l WBC: stab neutrophils - 1%, segmented - 66%, eosinophils 2%, monocytes 6%, lymphocytes 25%. The erythrocyte sedimentation rate (ESR) 2 mm/h

Biochemical analysis of blood from 19.08.99: glucose 3.9 mmol/l, urea of 6.3 mmol/l, creatinine 0,058 mmol/l, amylase 7,0 mg (CL), aspartate aminotransferase 38,9 nmol (CL), alanine aminotransferase 55,6 nmol (CL), bilirubin 12 Ámol/l, total protein, 74 g/l, prothrombin index 91%.

Triglycerides from 19.08.99: ACTV 57, ethanol test negative environment, thrombin time 16, fibrinogen "B" is negative, fibrinogen 3.7 g/l, hematocrit of 48%.

Analysis of urine from 19.08.99: urine color straw-yellow, transparent, acidic reaction, the proportion of 1,016, no protein, leukocytes per field of view. Sample zimnitsky: specific gravity from 1,012 to 1,019; daily diuresis 1140 ml, night - 525 ml.

Ultrasound examination of the kidneys. The size of the kidney: right 9,9 x 4.6 x 2.1 cm, left 10,6 x 5.0 x 2.3 see the Contours equal, homogeneous parenchyma. Calyx not enlarged.

Echocardiography. The cavity of the left ventricle is not extended: end-systolic dimension of 50 mm, end-diastolic size 35 mm Airway diseases satisfactory,DKI 11 mm, the thickness of the posterior wall of the left ventricle 12 mm Valve pathology was not detected.

Consultation of the oculist. The fundus of the eye: the disks of optic nerves with clear boundaries, the color is pale pink. Vessels without features.

Monitoring of ECG and BP was carried out using a system Cartotecnica-4000 AD (firm INKART, St. Petersburg). Before treatment, the dynamics of the heart rate (HR) without features. The decrease in the heart rate at night within normal limits (table. 2). On the background of sinus rhythm registered the following types of arrhythmias: single supraventricular extrasystole (29, 26 of them during the day, 3 at night); single ventricular premature beats (3 total). Ischemic changes of the ST segment-T is not detected.

The BP measurement was conducted on the colours Korotkova addition oscillometric during waking hours (from 7:00 to 23:00) every 15 min during sleep at night (from 23:00 to 7:00) every 30 minutes

The average systolic and diastolic blood pressure characteristic: during the whole observation time for moderate hypertension (table. 4). Observed lack of reduction in systolic and diastolic blood pressure: 4.6% and 1.1%, respectively (table. 5). Index load pressure sistoliceski is 6).

Recommended treatment: capozide 25 mg in the morning, tranxene 10 mg for 40 minutes before going to sleep: to normalize sleep daily, then every other day for three weeks.

When treating on the third day from the beginning of therapy the patient had normal sleep. After a week decreased and became less bothered by headaches, dizziness and pain in the heart area. By the end of three weeks, the patient noted increasing mental and physical performance, reduce anxiety, and excitability. Side effects of therapy were observed.

Repeated psychological testing, laboratory and instrumental examinations were carried out after 7, 14 and 21 days after initiation of therapy.

The results of the observations showed that during treatment alexithymics personality characteristics do not disappear, however, tends to decrease the total score of alexithymia from 94 to 86 points (PL. 1). By the end of the third week significantly decreased the level of anxiety and improved the quality of life of the patient K. (PL. 1).

Substantial and significant changes in routine laboratory tests and echocardiography during therapy were not found.

By the end of the observation, pre PVCs (PL. 3).

By the end of the second week of observation observed decrease, and by the end of the third normalization average daytime and nighttime values of systolic and diastolic blood pressure, index and square hypertensive load (PL. 4, 5) and the normalization of the circadian rhythm of systolic blood pressure (PL. 6). Despite the fact that the daily index diastolic blood pressure remains low, however, by the end of the observation there is a tendency to its gradual increase.

Thus, the use of tranxene in a comprehensive antihypertensive therapy resulted in shorter time to normalize the indicators of circadian rhythm of blood pressure, reduce hypertension load. This is accompanied by a reduction in anxiety, improved sleep, improved health and quality of life of the patient.

The method of treatment of anxiety disorders and desitin blood pressure in hypertensive patients with alexithymia, including traditional anti-hypertensive therapy, characterized in that it further assigned tranxen at a dose of 10 mg for 40 minutes before going to sleep the first three days daily, then every other day for three weeks followed by a repetition rate in a month.

 

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