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These studies investigated the role of spinal N-methyl-D-aspartic acid (NMDA) receptors in the mediation of cardiovascular responses evoked by L-glutamate (L-Glu) stimulation of the rostral ventrolateral medulla (RVM). Microinjections of L-Glu into the RVM of urethan-anesthetized rats increased mean arterial pressure (MAP) and heart rate. Intrathecal administration of the NMDA receptor antagonists D-(-)-2-amino-7-phosphonoheptanoic acid (D-AP-7) or 3-((+-)-2-carboxypiperazin-4-yl)-propyl-1-phosphonate (CPP) reduced MAP and heart rate. Blockade of NMDA receptors by D-AP-7 or CPP in the caudal thoracic spinal cord markedly reduced RVM pressor responses with little effect on evoked tachycardia. Administration of D-AP-7 to the rostral thoracic spinal cord had no effect on RVM pressor or tachycardic responses. Intrathecal D-AP-7 and CPP abolished the cardiovascular effects of intrathecal NMDA without reducing those produced by intrathecal kainic acid or the quisqualate agonist DL-alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA). These results indicate that 1) tonic activation of spinal NMDA receptors participates in the maintenance of sympathetic outflow to the heart and blood vessels, 2) pressor responses evoked from the RVM require synaptic activation of spinal NMDA receptors, and 3) an excitatory amino acid may be the neurotransmitter of pressor pathways descending from the RVM to the spinal cord.

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This study's objective was to compare the levels of patient medication adherence and knowledge achieved by medication consultations in two settings: a cardiology clinic and an outpatient pharmacy. Thirty-three patients were randomized to receive medication counseling either at the clinic or the outpatient pharmacy. Their medication knowledge and medication adherence (assessed by pill counts and by the Electronic Medication Events Monitoring System [MEMS]) were determined at baseline and at 1-month follow-up. Pill counts overestimated adherence compared with MEMS (90.8% vs. 80.7%, p < 0.001). The average medication adherence rate in patients who received therapeutic consultation at the clinic was 83.2% versus 78% for outpatient pharmacy patients (ns). Knowledge assessment scores of patients at follow-up were 69.7% and 59.7%, respectively (ns). No significant difference was observed in medication knowledge and adherence between the two groups. Other modalities, in addition to medication consultation, should be employed to improve patient medication knowledge and adherence.