METHOD AND MEANS OF ANXIETY-DEPRESSION DISORDERS CORRECTION IN PATIENTS WITH ARTERIAL HYPERTENSION ASSOCIATED WITH 2ND TYPE DIABETES

Aim. To elaborate the method and means for correction of anxiety-depression disorders in patients with arterial hypertension (AH) associated with 2nd type diabetes mellitus.
Material and methods. Totally 120 patients included with essential arterial hypertension (AH), associated with 2nd type DM, non-sufficient control of В P. Patients with AH had the second grade of BP increase at the background of 2nd type DM of mild or moderate severity compensated according to the levels of glycosilated hemoglobin 6,25%. Patients had quite high amount of comorbidities and risk factors complicating AH. All patients were taking basic ant hypertension therapy, mostly a variety of combinations of drugs (beta-blockers, ACE inhibitors, calcium antagonists,angiotensine receptor blockers II). Also the patients took the drugs for comorbidities treatment (hypolipidemic drugs, nitrates, glucose lowering drugs). The necessary criteria was patients' consent.
In outpatient conditions, at the 1st visit and in 1 year we performed a complex of events: anamnesis collection, clarification of complaints; palpation and auscultation of the heart and main vessels; BP measurement by Korotkov on upper extremities; ECG recording, echocardiography. Biochemical analysis of the whole plasma was done, fasting: we measured glucose level, glycosilated hemoglobin, lipid spectrum (cholesterol, triglycerides, LDL, HDL), clotting system parameters (PI, APTT, fibrinogen), electrolites (K, Mg). Also patients by themselves completed medical 

questionnaires of a special purpose. We used HADS questionnaire and self-assessment for depressions CED-S. If the increased levels of anxiety and depression were found we prescriben Qudesan® — mitochondrial coenzyme — coenzyme Q10 in dose 60 mg daily for 2 months. The dosage was calculated according to the drug sheet.
Results. The data we collected witnesses that clinical efficacy was reached in patients at the background of Qudesan® intake: significantly positively changed psychological status of patients — depression decreased by the scales of specialized questionnaires. Scoring of the influence of that drug was done by comparison of clinical characteristics after treatment. Before treatment the parameters studied were identical that is also confirmed by the absence of significance of their difference (p>0,01).
Conclusion. The study led to obtainment of a new data on that inclusion of Q10 containing drug into the standard treatment of AH with 2nd type DM has positive clinical effect that, particularly, leads to a significant decrease of systolic and diastoiic blood pressure, significant decrease of BP variability, significant decrease of blood glucose levels and glycosilated hemoglobin, significant increase of Mg level in blood. Also the positive influence of complex therapy noted on the decrease of anxiety and depression level in patients with AH and DM 2 type.

1. Boytsov SA. The Study of the pathogenesis of hypertension continues Ter. arch. 2006; 4: 5-12. Russian (Бойцов С. А. Изучение патогенеза гипертонической болезни продолжается Тер. арх. 2006; 4: 5-12).

2. Oganov RG, Maslennikova Ua. Prevention of cardiovascular disease — the real way of improving the demographic situation in Russia. Cardiology 2007; 1:4-7. Russian (Оганов Р. Г., Масленникова Г.Я. Профилактика сердечно-сосудистых заболеваний — реальный путь улучшения демографической ситуации в России Кардиология 2007; 1:4-7).

3. Kobalava JD, Kotovskaya YV, Villevalde SV, et al. The Possibilities for improving the control of hypertension by rational use of diuretics on the results of the Russian scientific-practical program ARGUS-2. Cardiovascular therapy and prevention 2007; 6(3): 61-7. Russian (КобалаваЖ. Д., Котовская Ю. В., Виллевальде С. В.и др. Возможности улучшения контроля артериальной гипертонии путем рационального использования диуретиков по результатам Российской научно-практической программы АРГУС-2. Кардиоваскулярная терапия и профилактика 2007; 6(3): 61-7).

4. Messerli F. Relation of beta-blocker-induced heart rate lowering and cardioprotection in hypertension. J Am Coll Cardiol 2008. Vol. 52. p. 1482-9.

5. Goldstein L.B., Adams R. Primary prevention of ischemic stroke. Circulation 2006. Vol. 63. p.873-923.

6. Koshanskaya AG. The Relationship of psychological and clinical characteristics of patients with diabetes mellitus type 2 in different variants of its course: author, dis. Kida. the course of studies. Sciences: 19.00.04/A., Koshanskaya. SPb., 2007. 22 S. Russian (Кошанская А. Г. Взаимосвязи психологических и клиническиххарактеристику больных сахарным диабетом 2 типа при различных вариантах его течения: автореф. дис. канд. психол.наук: 19.00.04/А. Г. Кошанская. СПб., 2007. 22 с).

7. Almawi W, Tamim H. Association of comorbid depression, anxiety, and stress disorders with Type 2 diabetes in Bahrain, a country with a very high prevalence of Type 2 diabetes. J. Endocrinol. Invest. 2008; 31: 1020-4.

8. Drobizhev MJ, Zakharchuk ТА. Depression in patients with diabetes mellitus. Part 1. Psychiatry and psychopharmacology. 2006; 8(4): 68-71. Russian (Дробижев М.Ю., Захарчук Т. А. Депрессии у больных сахарным диабетом (обзор литературы). Часть 1. Психиатрия и психофармакотерапия 2006; 8(4): 68-71).

9. Fischer L, Skaff MM. A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with type 2 diabetes. Diabet Med. 2008; 25:1096-101.

10. Das-Munshi J, Stewart R, Ismail K, et al. Diabetes, common mental disorders, and disability: findings from the UK National Psychiatric Morbidity Survey. Psychosom Med. 2007; 69 (6): 543-50.

11. Diagnosis and treatment of hypertension. Russian recommendations (fourth revision). Systemic hypertension 2010; 3: p. 34. Russian (Диагностика и лечение артериальной гипертензии. Российские рекомендации (четвертый пересмотр). Системные гипер-тензии2010;3;с34).

12. Tyukalov LI, Lukyanov MA. Method and means correction depressive disorders in patients with arterial hypertension associated with diabetes mellitus type 2. Priority help from 29 June 2014 No. 2014131439. The owner of the SSMU together with the authors: Russian (Способ и средства коррекции тревожно-депрессивных нарушений у пациентов с артериальной гипертонией, ассоциированной с сахарным диабетом 2 типа. Приоритетная справка от 29 июня 2014 г. № 2014131439. Обладатель СибГМУ совместно с авторами: Тюкалова Л. И., Лукьянова М. А.).

13. Andryushchenko AC, Drobizhev MD, Dobrovolsky AC. Comparative evaluation scale CES-D, BDI and HADS in the diagnosis of depression in General medical practice. Journal of neurology and psychiatry. S.S. Korsakov. 2003. 103, 5: 11-8. Russian (Андрющенко А. В., Дробижев М.Ю., Добровольский А. В. Сравнительная оценка шкал CESD, BDI и HADS в диагностике депрессий в общемедицинской практике. Журнал неврологии и психиатрии им. С. С. Корсакова. 2003; 103, 5: 11-8).