UA55668A - Method for treating and preventing stress-induced cardiovascular disorders in elderly patients - Google Patents

Abstract

The method for treating and preventing the stress-induced cardiovascular disorders in the elderly patients provides for drug therapy employing melatonin. The drug is to be taken per os before exposure to the factors of the stress or immediately after development of the stress. In cases of the prolonged duration of the stress factor the drug is taken prior to the night sleep.

Description

The invention belongs to medicine, namely to cardiology, geriatrics and physiology, and it can find practical application for the prevention and treatment of cardiac disorders during intense stress.

A feature of the reaction of elderly people to stressful loads is an excessive increase in blood pressure (Shatylo V.B. Cardiovascular reactivity under psycho-emotional tension in healthy people and patients with chronic ischemic heart disease of the elderly // Ukrainian cardiology journal. - 1998. - Ме11. - b .21 - 27), which creates a high risk of developing disorders of the heart (myocardial infarction, heart failure, rhythm disorders) and brain (stroke). This determines the urgency of finding means capable of reducing stress reactions of the cardiovascular system, in particular blood pressure.

There is a known method of treatment of heart rhythm disorders of stress origin by using the tranquilizer gidazepam in a dose of 25 mg to 150 mg per day (Method of treatment of heart rhythm disorders of stress origin, RF patent Mo2004237). The disadvantage of this method is that its action does not apply to those cases of stress-related cardiovascular system disorders, which are manifested by an excessive increase in blood pressure. In addition, this method does not provide for the correction of disorders of the cardiovascular system in elderly people.

There is a "Method of limiting the stress reaction of the cardiovascular system in the elderly" by simultaneously prescribing the beta-adrenergic blocker anaprilin in a dose of 10 mg and the calcium channel blocker corinfar in a dose of 1 Ω 1-2 hours before the expected stress load or immediately during its occurrence (Dekl . Ukrainian patent Me36218А), which allows you to effectively control the increase in blood pressure and heart rate during psycho-emotional stress. The main disadvantage of this method is that pharmacological drugs (anaprilin, corinfar) are substances foreign to the body, their long-term use, especially in the elderly, can cause such undesirable side effects as fatigue, a significant decrease in blood pressure at rest, accompanied by dizziness , the main pain, deterioration of physical capacity. In addition, beta-blockers inhibit the synthetic activity of the pineal gland (Shatylo V.B. Melatonin: physiological functions, pharmacological effects and potential application areas in medicine // Journal of a practical physician. - 1999. - Mob. - P.35 - 41). As a result, the formation of melatonin decreases, and this causes a violation of the body's daily biorhythms, which worsens adaptation to environmental conditions.

On the other hand, it is known that the pineal gland and its neurohormone melatonin play an important role in the formation of the daily rhythms of many physiological processes (V.N. Anisimov, Physiological functions of the pineal gland // Russian physiological journal named after I.M. Sechenov. - 1997. - Vol. 83, Mo8. - P.1 - 13; Remei R.

Meiayupip apa Bioiodisa! pputtv // TPnegaria. - 1998. - M.53, Me5. - R.411 - 420).

Melatonin in experimental studies has demonstrated the ability to increase the vitality of the body in extreme conditions, in particular, it prevents the formation of stomach ulcers in experimental animals under stress (Arushanyan E.B. Participation of the pineal gland in antistress protection of the brain //

Physiological successes. of science - 1996. - 7.27, Me3. - 0.31 - 50; Pertsov S.S., Sosnovsky A.S., Pirogov G.V.

Melatonin and ulcer formation in the stomach during acute emotional stress // Byul. let's try biol. and medicine. - 1998. - T.125, Me1. - b. 12 - 15; Kayu K., Mygai I., Azai 5. ей а). Sepiga! Mesemi oi teiayupip adaipvi vigez5-ipdysey davigis tsisegv ip gaiv // Meigoheroig!i. - 1997. - M.8, Me9 - 10. - R.2305 - 2309).

"Method of blood pressure correction in young people by using melatonin" was adopted as the prototype (5sairegi E. ei a. Meiayupip apa gedshayop oi oleye sagaiomazsshiag zuziet // Tegaria. - 1998. - M.53, Me5. - R.459 - 465; Sadpassi A. yi ai. taking melatonin in a dose of 5 - 10 mg, as a result of which there is a decrease in systolic and diastolic blood pressure by - 15 mm Hg at rest.

The disadvantage of this method is: its effectiveness in disorders of cardiac activity of stress origin in the elderly is not determined, the dose of melatonin is not determined for the elderly, in whom the sensitivity of the body to the action of pharmacological drugs changes due to aging, other possible properties of melatonin are not taken into account, in particular its normalizing influence on the body's daily biorhythms and the quality of sleep, which are significantly disturbed by aging and stress.

The invention is based on the task of creating a method that allows to reduce the stress reactions of the cardiovascular system during physical and psycho-emotional stress and at the same time to normalize the disturbed daily rhythms of the cardiovascular system in elderly people.

The essence of the method is that 30-60 minutes before the expected stressful event (emotional tension) or when it occurs, the patient, being in a darkened room, takes

Zmg melatonin. In case of prolonged or repeated stress, melatonin is used for 10-12 days every evening in a dose of Zmg 30 minutes before bedtime, at the same time.

This method was used in 35 elderly people who had an excessive reaction of blood pressure during psycho-emotional stress (increase in systolic blood pressure by more than 20 mm Hg, diastolic blood pressure by more than 10 mm Hg). Her violation of the daily rhythm of blood pressure ( insufficient decrease at night and a significant increase in the morning hours).

The results shown in table 1 and table 2 show that in elderly people who had an excessive increase in blood pressure during stress, both single and long-term administration of a physiological dose of melatonin significantly reduced the increase in systolic and diastolic blood pressure and heart rate abbreviations

Table 1

To At height Growth at

Group indicators of stress stress stress stress | load | load isotonic blood pressure, mm Hg before taking melatonin 13014 152 of 4 220 x 3.87

Diastolic blood pressure, mm Hg. before taking melatonin 772 Vaj v

Sho 67 2 T213 4.8 51.67

Note. The probability of changes in the indicator from the initial level: "p" 0.05.

Table 2

I I - I After the course reception

I Normoreactors 8.0x1.2 154 52.37 ! : Standard reactors 61 1.5 5.9 821

AI Hyperreactors 8.3 51.6 41 51.57

Note. The probability of changes in indicators under the influence of melatonin: "- p.« 0.05.

Example 1. Patient S., 72 years old. According to the results of the exercise test, chronic coronary heart disease, stable angina pectoris of the 2nd functional class was diagnosed.

The reaction of the cardiovascular system to stress factors is excessive: with a dosed physical load of 55 W, the increase in systolic blood pressure was 3 mm Hg, diastolic blood pressure was 10 mm Hg, and with psycho-emotional stress, it was 25 mm Hg, respectively. and 15 mm Hg. Before the treatment, sleep disturbances were also observed (falling asleep 1 - 1.5 hours, 4 - 5 awakenings, total sleep duration 6 hours).

After taking 1mg of anaprilin and 2mg of corinfarin under stress, the increase in systolic blood pressure decreased by 20 mm Hg, diastolic blood pressure by 10 mm Hg, and heart rate by 1 baud/min. But at the same time, there was a significant decrease in blood pressure at rest - systolic blood pressure from 120 mm Hg. up to 100 mm Hg, diastolic blood pressure - from 80 mm Hg. to b0 mm Hg, which was accompanied by a side effect - weakness, dizziness, reduced work capacity. With long-term use of anaprilin and corinfar, there was no normalization of sleep.

After a one-time intake of Zmg melatonin, the increase in hemodynamic parameters during stress significantly decreased: systolic blood pressure - by 15 mm Hg, diastolic blood pressure - by 10 mm Hg, heart rate - by 7 beats/min. At rest, blood pressure did not change. No side effects of melatonin have been recorded. At the same time, with long-term use of melatonin, the patient's sleep improved (duration of falling asleep - 15 - 20 minutes, 1-2 awakenings, total sleep duration 7 hours).

Thus, in this case, the effectiveness of melatonin correction of an excessive increase in blood pressure during stress does not differ from the effectiveness of the combined use of anaprilin and corinfar. The advantage of melatonin is that it did not lower resting blood pressure, had no side effects, and improved sleep.

Example 2. Patient K., 68 years old. Clinical, laboratory and instrumental examination did not reveal any organic pathology of the cardiovascular system. The patient has an excessive stress reaction of the cardiovascular system during psycho-emotional stress (increase in systolic blood pressure by 40 mm Hg, diastolic blood pressure by 15 mm Hg). He is under the influence of intense emotional stress for a long time.

Disturbed sleep, increased irritability, restlessness. Violated daily rhythm of blood pressure (increase in the morning hours of systolic blood pressure by 35 mm Hg, diastolic blood pressure by 15 mm Hg) and oral body temperature (amplitude of the daily rhythm 0.4 degrees).

After a single intake of the beta-adrenergic blocker anaprilin (100 mg) and the calcium channel blocker corinfar (10 mg), the response of blood pressure and heart rate to emotional stress decreased. Course use of drugs for 2 weeks reduced the stress reaction of the cardiovascular system, but sleep disturbances, restlessness, and irritability remained. Normalization of the daily rhythm of oral body temperature and blood pressure was not observed.

In this regard, a few days later, melatonin was prescribed in a dose of Zmg every evening 30 minutes before bedtime for 12 days. Against the background of the use of melatonin during the 1st week, sleep normalized, the patient became emotionally balanced, the amplitude of blood pressure fluctuations during the day decreased. Re-examination after course intake of melatonin revealed a halving of the increase in systolic and diastolic blood pressure with a dosed psycho-emotional test. In addition, the daily rhythm of the oral temperature normalized (rhythm amplitude 0.8 degrees), the level of blood pressure at night and the increase in blood pressure in the morning hours decreased.

In this case, the stress-protective effect of physiological doses of melatonin turned out to be the same as the effect of the use of two pharmacological drugs - anaprilin and corinfar. The advantage of melatonin was a favorable normalizing effect on the body's daily biological rhythms.

Thus, the use of the method makes it possible to reduce the stress reaction of the cardiovascular system in the elderly during physical and emotional stress and at the same time reduce the emotional manifestations of the stress reaction (restlessness, anxiety, irritability), improve the quality of sleep, normalize the daily biological rhythms of oral temperature and blood pressure . The advantage of the method is its simplicity and safety for the elderly.

Claims (1)

The method of treatment and prevention of disorders of the cardiovascular system of stress origin in elderly people through the use of medicines, which is distinguished by the fact that in 30 - 60 min. before a short-term stressful event or immediately during its occurrence, 3 mg of melatonin is taken orally, and with a longer duration of action of the stressful factor, melatonin is used in a dose of 3 mg 30 minutes before bedtime for 10 - 12 days.