[Psychological Characteristics of Patients With Stress-induced Arterial Hypertension: a Violation of the Regulation of Emotions as a Central Link of Pathogenesis].

GOAL: The study of emotional and personality characteristics of patients with hypertension in the workplace (HW) and comparative assessment of the effectiveness of antihypertensive therapy in these patients. MATERIAL AND METHODS: The study included 170 patients c hypertensive disease stage II, 1-2-th degree, aged 32-52 years, including 85 patients with and 85 patients without WAH, and 82 healthy subjects matched for age and sex. To carry out simulation of the situation of emotional intensity (level of claims assessment process - UE) and a modified version of the test Rosenzweig. Patients with WAH were randomized into 2 groups: patients of group 1 received bisoprolol, 2nd group -eprosartan. If target blood pressure (BP) in 2 weeks, all patients were added indapamide retard. At baseline and after 16 weeks of treatment was carried out daily monitoring of blood pressure and the working day. RESULTS: When modeling a situation of emotional intensity in patients with WAP become, compared with patients without a healthy and WAH, revealed (1) marked increase in systolic blood pressure - 16.1, 4.1 and 3.0 mmHg, respectively (p <0,001 ), (2) the dominance of motivation "avoid failure" (UP underestimated in 34.1% of cases, unformed UP - in 21.2% of cases, healthy - 14.6% and 3.7% of cases, cootvetstvenno, p<0,001 in patients without WAH - 20% and 11.8%, respectively, p<0,05). Patients with WAP become different from normal was significantly (p<0.05) the number of the selected blshim emotionally meaningful situations (9.7 and 7.8, respectively) and emotional descriptors (11 and 7, respectively). Patients with WAH differ significantly (p<0,05) more frequent than in healthy, the use of ineffective strategies of emotion regulation in an emotionally meaningful situations: the suppression of the expression of emotions (38.3 and 20.3%, respectively), rumination and disasterization (19 and 11.8%, respectively) and more rare - high performance: sequential actualization of new meanings (25.7 and 31.7%, respectively) and the strategy of interactive subject-subject transformations (12.6 and 25.2%, respectively). After 16 weeks of treatment showed a significant (p<0,001) reduction of blood pressure in the 1st and 2nd groups. The number of patients achieving target blood pressure, at 2, 4 and 6 weeks, respectively, was as follows: 14 in the bisoprolol group and 93 (100%), in the eprosartan group - 0, 52 (100%). Both groups showed significant (p <0,001) reduction in mean daytime and nighttime blood pressure in the weekdays and weekends. In the group of bisoprolol showed a significant (p <0,01) higher average daily decrease in systolic blood pressure in the working day, compared with eprosartan group (26.2 and 19.3 mm Hg, respectively). CONCLUSION: Patients with WAP become emotionally meaningful situations frequently resorted to repression of emotions, choose the inefficient strategies of emotion regulation, they noted the expressed reaction of BP in response to the emotional burden. Antihypertensive therapy based on bisoprolol, is highly effective and has advantages over circuit-based therapy with eprosartan.

[Attitude of district internists to the problem of secondary prevention of ischemic heart disease (results of a special questionnaire survey)].

Attitude of district internists to the realization of a concept of secondary prevention (SP) of ischemic heart disease was studied in one of large cities in Russia. Among preparations most necessary for SP the following were named: b-blockers (79.5%), angiotensin converting enzyme inhibitors (49.3%), antiaggregants (43.8%), hypolipidemic drugs (13.7%), nitrates (63%), biologically active supplements, phyto-preparations, metabolic drugs, and glycosides (3-5% each). However actually prescribed drugs were b-blockers (100%), nitrates (96%), angiotensin converting enzyme inhibitors (89%), calcium antagonists (87%), antiaggregants (83%), cardiac glycosides (66%), vitamins (39%). Average doses of drugs were low: 21.7, 47.4 and 35.5% of possible maximal doses for statins, angiotensin converting enzyme inhibitors, and beta-blockers, respectively. Nondrug measures were used "rarely" and "often" by 26 and 74% of physicians, respectively. Only 18% of physicians directed their patients to corresponding specialists. Recommendations were mostly formal, without explanation of goals, methods and specific features of recommended measures. Moreover their prescription by physician was determined largely by subjective factors: availability of sufficient time (50%), cultural level of a patient (79%), patient's own initiative (33%), physician's personal attitude to a patient (21%).