[Effect of the presence of a drug in the list of supplementary drug provision on compliance to its administration by outpatients with arterial hypertension].

Aim of the study was to investigate relationship between the presence of a drug in the list of supplementary drug provision (SDP) and compliance to its consumption by outpatients with arterial hypertension as well as determination of the place of SDP in a row of other factors affecting compliance to treatment. Methods. Patients (men and women) older than 18 years with initial level of office systolic arterial pressure (AP) 140-179 mm Hg and diastolic AP up to 100 mm Hg who visited regional internist. The study was conducted at the base of 82 Moscow polyclinics with participation of 185 physicians and 5474 patients. In all patients besides general clinical examination with office AP measurement calculation of body mass index and assessment of risk factors and concomitant therapy were carried out. All patients assessed themselves their self feeling with the use of visual-analog scale (VAS). Compliance of patients to antihypertensive therapy was evaluated with the help of the Moriski - Green test. Fact of continuous use of antihypertensive drugs received by patients within framework of the SDP system was necessarily obligatory. For final analysis 4816 ambulatory cards were selected. Results. Portion of patients with low compliance to therapy was greatly than that of patients with high compliance to therapy (61.1 vs. 38.9%, respectively, p=0.00001). Inclusion into analysis of additional factor (presence of CHD) reduced contribution of SDP to compliance to 25%, but it remained as before significant (p<0.0007). However addition to these factors of other parameters such as presence of diabetes mellitus or tonometer at home completely leveled effect of SDP on compliance to therapy (p<0.12). Conclusion. Presence of drugs in the SDP list significantly elevates compliance to therapy. However SDP does not appear the only independent predictor of high compliance. If SDP is considered together with other determining factors (presence of concomitant IHD and diabete, readiness to spend money for tonometer) its role as independent factor of high compliance is diminished and loses significance.

[Platelet activation and inflammation markers in patients with coronary heart disease and depression].

AIM: To study morphological features and functional activity of platelets, their relations with the level of inflammation markers in coronary heart disease (CHD) patients with depression. MATERIAL AND METHODS: The study group consisted of 33 CHD patients with stable effort angina (NY-HA FC I-III), 14 had depression, 19 were free of depression. Sixteen healthy volunteers comprised the control group. Platelet aggregation was registered by a mean size of aggregates and turbidometrically. Platelets shape, leukocytic-thrombocytic and erythrocytic-thrombocytic aggregates (LTA, ETA) in the whole blood were studied electron-microscopically. The levels of IL-2, IL-6, TNF-alpha, sVCAM, hsCRP were measured in the blood, serotonin--in platelets. RESULTS: Spontaneous aggregation enhanced in 52.6% CHD patients (p < 0.05). The blood contained reticular platelets, high number of prothrombocytes (p < 0.05), mean volume of thrombocytes was greater (p < 0.05). This reflected changes in megakaryocytopoiesis. Some of the patients had LTA and ETA. Out of inflammation markers, only IL-6 and sVCAM were elevated (p < 0.01), hsCRP concentration rose, but not above normal range. Serotonin in platelets was the same in the patients and controls. Depression aggravated the disorders and elevated other indices. Spontaneous aggregation was high in 71.4% of depressive CHD patients. The count of reticular platelets, prothrombocytes, mean volume platelets were also elevated. LTA and ETA were high in all the depressive patients. Elevated were also concentrations of IL-6, sVCAM, IL-2, hsCRP. Serotonin in platelets was low (p < 0.05). CONCLUSION: Depression stimulates functional activity of platelets, is a factor of risk of intravascular inflammation and contributes to development of thrombotic complications in CHD patients.