RESUMO
The antihypertensive efficacy and safety of mibefradil and nifedipine SR were compared in 143 patients with chronic renal failure and mild-to-moderate hypertension in a multicenter, double-blind, randomized, parallel-design study. At treatment week 12, a significantly greater decrease in sitting diastolic blood pressure (SDBP) was seen with mibefradil than with nifedipine SR (12.8 mmHg vs 8.1 mmHg, respectively; p = 0.014). A significantly greater number of mibefradil-treated patients achieved normalization of SDBP by week 12 (62% vs 37%; p < 0.01). The changes in renal function parameters and the incidence of adverse events were similar in both groups. In this population, 12 weeks of treatment with mibefradil were more effective than nifedipine SR for lowering blood pressure and had similar effects on renal function parameters.
Assuntos
Benzimidazóis/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Hipertensão/tratamento farmacológico , Falência Renal Crônica/complicações , Nifedipino/uso terapêutico , Tetra-Hidronaftalenos/uso terapêutico , Adulto , Idoso , Benzimidazóis/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Rim/efeitos dos fármacos , Rim/fisiopatologia , Falência Renal Crônica/fisiopatologia , Masculino , Mibefradil , Pessoa de Meia-Idade , Nifedipino/efeitos adversos , Tetra-Hidronaftalenos/efeitos adversosRESUMO
BACKGROUND: Although white coat hypertension (WCH) seems to occur in 20% or more of the adult hypertensive population, this clinical condition has rarely been described in adolescents. DESIGN: Routine use of ambulatory blood pressure monitoring (ABPM) procedure as part of the investigation of arterial hypertension in adolescents. METHODS: Office blood pressure was checked after 5 minutes of rest in the seated position by the auscultation method and ABPM was performed with oscillometrical equipment (SpaceLabs 90207, Redmond, Washington, USA). RESULTS: In the present study 6 adolescents (5 females, 3 white), suspected to suffer from arterial hypertension as judged by office blood pressure measurements, mean age 15.1 years (12.2 - 17.7), mean height 164.5 cm, mean weight 77.2 kg, mean body mass index 28.8 kg/m2 (25 - 35.2), were diagnosed with WCH using ambulatory blood pressure monitoring (ABPM). CONCLUSION: White coat hypertension should also be considered in the evaluation of arterial hypertension in adolescents.
Assuntos
Hipertensão/diagnóstico , Hipertensão/psicologia , Adolescente , Monitorização Ambulatorial da Pressão Arterial , Criança , Feminino , Humanos , Masculino , Visita a Consultório Médico , Estresse PsicológicoRESUMO
BACKGROUND: Background Ambulatory blood pressure monitoring (ABPM) has been shown to be more representative of blood pressure levels in adult patients than are casual measurements of blood pressure. OBJECTIVE: To evaluate, by means of ABPM, the behavior of blood pressure in children with chronic renal failure submitted to continuous ambulatory peritoneal dialysis and compare the results with casual blood pressure monitoring measurements. DESIGN: Evaluation of blood pressures in chronically dialyzed pediatric patients by ABPM. METHODS: Ten pediatric patients, treated by continuous ambulatory peritoneal dialysis were evaluated by ABPM using the oscillometric SpaceLabs 90207 monitor, every 10 min during the day and every 15 min during the night, for 24h. RESULTS: Six of 10 patients were found normotensive by office measurement of blood pressure; four of 10 patients were found hypertensive by casual measurements of blood pressure. With ABPM we obtained a mean success rate of 92.5%, confirmed hypertension in all the patients classified hypertensive in terms of office readings and reclassified six of six patients from normotensive to hypertensive. The mean systolic and diastolic physiologic falls in blood pressure at night were respectively by 10 and 15%. At the time of the ABPM study end-organ damage was present in two patients judged to be normotensive in terms of office blood pressures. CONCLUSION: Casual recordings of blood pressure are not representative of average blood pressure in dialyzed pediatric patients. ABPM seems to be a useful diagnostic aid for assessing treatment of hypertension in children with end-stage renal disease.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Adolescente , Adulto , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Criança , Diástole , Feminino , Humanos , Masculino , SístoleRESUMO
Casual blood pressure measurements were compared with mean ambulatory blood pressure values during wakefulness and sleep in 45 normotensive and 30 hypertensive adolescents of both sexes aged 10-18 years. Two sets of auscultatory casual blood pressure were obtained, one in a pediatric office setting (office blood pressure), performed by the physician, and one in the ambulatory blood pressure monitoring (ABPM) unit, performed by a trained nurse, prior to the initiation of ABPM (pre-ABPM blood pressure). In normotensive and hypertensive subjects of both sexes, the mean office systolic blood pressure (SBP) was lower than the mean pre-ABPM SBP, and the mean office diastolic blood pressure (DBP) was lower than the mean pre-ABPM DBP. In normotensive participants, the mean pre-ABPM SBP/DBP was lower than the mean ABPM SBP/DBP while awake, the mean ABPM SBP/DBP during sleep being lower than the mean ABPM SBP/DBP values while awake and the mean pre-ABPM SBP/DBP. No statistical difference was demonstrated between the mean office SBP and the mean ABPM SBP during sleep, the mean ABPM DBP during sleep being lower than the mean office DBP. The hypertensive adolescents presented a blood pressure profile similar to that of the normotensive group, albeit shifted upwards, with no significant difference between the mean pre-ABPM SBP and the mean ABPM SBP while awake but a higher mean pre-ABPM DBP than mean ABPM DBP while awake. This study suggests that, by evaluating the casual blood pressure in different environment/observer situations, the power of casual blood pressure to predict inadequate blood pressure control, manifested as abnormal ABPM parameters, can be enhanced. Our data indicate ABPM to be the method of choice for the early diagnosis and adequate follow-up of adolescent hypertension.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Adolescente , Criança , Feminino , Humanos , MasculinoRESUMO
CONTEXT: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE: To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. DESIGN: Prospective, cohort study. SETTING: Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS: Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES: Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS: The diastolic blood pressure was lower in summer than in fall and winter (95 +/- 8 vs 107 +/- 10 and 101 +/- 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 +/- 8 vs 130 +/- 11 and 124 +/- 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 +/- 1.6 vs 19.5 +/- 3.0 and 15.8 +/- 1.9 degrees C, respectively; p < 0.01). CONCLUSIONS: We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.
Assuntos
Pressão Sanguínea/fisiologia , Diálise Renal , Estações do Ano , Adulto , Idoso , Peso Corporal , Brasil , Estudos de Coortes , Feminino , Humanos , Falência Renal Crônica , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , TemperaturaRESUMO
PURPOSE: To evaluate the effectiveness and tolerance of the association of captopril 50 mg and hydrochlorithiazide 25 mg in hypertensive patients with diastolic pressure between 95 and 115 mmHg. METHODS: An open, multicenter and non-comparative study was performed. After 2 weeks of placebo, the patients received 1/2 tablet of drug association. Patients were evaluated after 4, 8 and 12 weeks, and those who had diastolic pressure > 90 mmHg after 8 weeks of therapy received 1 tablet/day. RESULTS: The results of 433 patients were analyzed: 47 +/- 10 years old, 30% female, 76% white. Initial systolic and diastolic pressures were 156 +/- 16 and 103 +/- 11 mmHg and after 14 days of placebo were 156 +/- 15 and 103 +/- 9 mmHg (p > 0.05). Systolic/diastolic pressure after 4, 8 and 12 weeks of treatment reduced progressively (p < 0.05) to 143 +/- 14/95 +/- 11, 140 +/- 13/91 +/- 9 and 134 +/- 11/86 +/- 8 mmHg. Blood pressure control was observed in 45, 67 and 88% (p < 0.05) of patients after 4, 8 and 12 weeks. Cough was the most important symptom, registered in 7% of patients under placebo and 12% in patients under treatment. The tolerance was considered good for 98% of patients. CONCLUSION: The association of captopril with hydrochlorothiazide is effective with good tolerance, being indicated as a once a day monotherapy for mild and moderate hypertension.
Assuntos
Anti-Hipertensivos/uso terapêutico , Captopril/uso terapêutico , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Adolescente , Adulto , Idoso , Pressão Sanguínea , Diuréticos , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: The efficacy and safety of diltiazen 240mg was evaluated in essential hypertensive patients with diastolic pressure in the range of 95 to 115 mmHg. METHODS: In an open, non-comparative multicenter trial 2.165 hypertensives had the supine and orthostatic arterial blood pressure measured before, after 14 days with non pharmacologic therapy and after 40 days taking diltiazen 240mg/day. Also, the serum levels of lipids, glucose and electrolytes were measured before and after the use of the active drug. RESULTS: The systolic arterial pressure in the first day was 166 +/- 18mmHg, in the 14th day was 155 +/- 20mmHg; and, in the 54th day was 141 +/- 14mmHg (p < 0.05). Also, supine and orthostatic diastolic blood pressure was lower in the 14th and in the 54th days when compared to baseline (p < 0.05). Cholesterol, triglycerides, urea and uric acid levels decreased significantly (p < 0.05) during treatment. CONCLUSION: This study demonstrates that diltiazem 240mg/day for the treatment of hypertension is well tolerated, efficient and shows no metabolic undesirable effects.
Assuntos
Diltiazem/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Adulto , Idoso , Análise de Variância , Pressão Sanguínea/efeitos dos fármacos , Tolerância a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the criteria used for the technique of blood pressure measurement in scientific articles published in Brazilian journals. METHODS: Two hundred twenty three scientific articles from 18 medical journals, published between 1989 and 1994 were evaluated, in order to identify the type of sphygmomanometer used; the state of calibration; the cuff size; the position of the patient during the measurement; whether the blood pressure measurement was obtained after a resting period; the phase used to identify the systolic and diastolic pressures; and the number of readings taken. RESULTS: There was no reference in the articles about the following data: the type of sphygmomanometer in 51%, the accuracy of calibration in 82%, the cuff size in 64%, the position of the patient in 25%, the rest period before measurement in 60%, the systolic and diastolic phases in 49%, and the number of measurements in 52%. CONCLUSION: Most of the papers analyzed did not follow or omitted important aspects cited in national and international recommendations for the correct blood pressure measurement.
Assuntos
Determinação da Pressão Arterial , Editoração , Determinação da Pressão Arterial/normas , Brasil , Calibragem , Publicações Periódicas como Assunto , Postura , Descanso , EsfigmomanômetrosRESUMO
OBJECTIVE: To evaluate the sphygmomanometers calibration accuracy and the physical conditions of the cuff-bladder, bulb, pump, and valve. METHODS: Sixty hundred and forty five aneroid sphygmomanometers were evaluated, 521 used in private practice and 124 used in hospitals. Aneroid manometers were tested against a properly calibrated mercury manometer and were considered calibrated when the error was < or = 3 mm Hg. The physical conditions of the cuffs-bladder, bulb, pump, and valve were also evaluated. RESULTS: Of the aneroid sphygmomanometers tested, 51% of those used in private practice and 56% of those used in hospitals were found to be not accurately calibrated. Of these, the magnitude of inaccuracy ranged from 4 to 8 mm Hg in 70% and 51% of the devices, respectively. The problems found in the cuffs-bladders, bulbs, pumps, and valves of the private practice and hospital devices were bladder damage (34% vs. 21%, respectively), holes/leaks in the bulbs (22% vs. 4%, respectively), and rubber aging (15% vs. 12%, respectively). Of the devices tested, 72% revealed at least one problem interfering with blood pressure measurement accuracy. CONCLUSION: Most of the manometers evaluated, whether used in private practice or in hospitals, were found to be inaccurate and unreliable, and their use may jeopardize the diagnosis and treatment of arterial hypertension.
Assuntos
Esfigmomanômetros/normas , Determinação da Pressão Arterial , Calibragem , Falha de Equipamento , Equipamentos e Provisões HospitalaresRESUMO
PURPOSE: To compare both home blood pressure measurement (HBPM) and ambulatory blood pressure monitoring (ABPM) with office blood pressure measurement (OBP); and also to compare the correlation between HBPM and OBP with LVMI (left ventricular mass index). METHODS: Protocol 1--68 hypertensive patients (58 +/- 12 years, 37 females): a) self recorded blood pressure at home in the 7 days; b) recorded the ABPM during 24 hours; and c) the physician recorded blood pressure in the office. Protocol 2-41 hypertensive patients underwent the HBPM, OBP, and BI-dimensional echocardiogram. RESULTS: Protocol 1--OBP (153 +/- 24/96 +/- 13 mmHg) was higher (p < 0.05) than HBPM (133 +/- 18/84 +/- 12 mmHg) and ABPM (137 +/- 17/87 +/- 12 mmHg); Protocol 2--LVMI correlated better with HBPM (r = 0.39/0.49, p < 0.05, systolic and diastolic, respectively) than OBP (r = 0.02/ 0.22, p > 0.05, systolic and diastolic, respectively). CONCLUSION: This study showed that HBPM has a better correlation with LVMI than OBP.
Assuntos
Determinação da Pressão Arterial/métodos , Adulto , Monitorização Ambulatorial da Pressão Arterial , Feminino , Assistência Domiciliar , Humanos , Masculino , Pessoa de Meia-Idade , Consultórios MédicosRESUMO
PURPOSE: To evaluate clinical efficacy and tolerability of isradipine SRO (I.SRO), 5 mg O.D. in essential hypertensives. METHODS: Eighty-three of 87 selected outpatients with a mean age of 51.3 years (ranging from 25 to 65), 33 male, 48 white, 29 black and others of different races, who had clinical supine and orthostatic diastolic blood pressure (DBP) > or = 95 mmHg and < or = 115 mmHg underwent the study. After a three-week wash-out period, patients received I.SRO 5 mg O.D. at 8:00 am for a six-week period (phase I). After this phase, patients received I.SRO 5 mg O.D. at 8:00 pm for a six-week period (phase II). The patients had a follow-up with an interval of three weeks and the ambulatorial blood pressure monitoring (ABPM) for 24 hours was performed with a SpaceLabs 90207 or Del Mar Avionics devices after the wash-out period and at the end of phases I and II. Measurements were performed at 15-min intervals during the day (6 am to 10 pm) and at 30-min intervals during the night (10 pm to 6 am). RESULTS: a) Heart rate did not show significant changes during the treatment period (phases I and II) when compared with the wash-out period; b) causal blood pressure: at the end of both treatment periods (phases I and II) there were statistically significant decreases (p < 0.001) in supine SBP and DBP compared with wash-out values. The mean SBP decreased from 161.6 +/- 14 to 144.3 +/- 13 mmHg (phase I) and to 141.8 +/- 13 mmHg (phase II). The mean DBP decreased from 103.4 +/- 6 to 91.2 +/- 7 (phase I) and to 89.1 +/- 8 (phase II); c) ABPM: the mean systolic 24-h ambulatory blood pressure was significantly reduced (p < 0.001) from 148.8 +/- 17 to 137.2 +/- 15 mmHg (phase I) and to 133.4 +/- 13 mmHg (phase II). The mean diastolic 24-h ambulatory blood pressure was significantly decreased (p < 0.001) from 94.3 +/- 9 to 87.0 +/- 9 (phase I) and to 85.8 +/- 8 mmHg (phase II). The mean daytime and nighttime, systolic and diastolic 24-h ambulatory blood pressure were: wash-out--152.3 +/- 17, 140.2 +/- 21, 97.4 +/- 9, 86.8 +/- 13; phase I--139.9 +/- 15, 130.0 +/- 17, 89.3 +/- 9, 81.3 +/- 10; phase II--136.7 +/- 13, 125.3 +/- 15, 88.5 +/- 8, 79.1 +/- 10, respectively. Blood pressure load (percentage of systolic blood pressure values > 140 mmHg or of diastolic blood pressure values > 90 mmHg) was significantly reduced from 62.2/62% (SBP/DBP), on the was-out, to 37.9/39.9% (SBP/DBP) on phase I and to 32.3/34.3% (SBP/DBP) on phase II; d) side effects: most frequently related were palpitations (2.3%), headache (1.1%), flush (1%) and ankle oedema (1%). They were in general, mild-to-moderate and disappeared after the first 3 weeks of treatment. Only two patients were withdrawn because of headache (one of them with previous diagnosis of migraine). CONCLUSION: I.SRO, given by oral route, in the dosage of 5 mg O.D. as monotherapy, was effective and well tolerated, promoted significant reduction on 24-h ambulatory blood pressure attenuating the early morning rise and did not interfere with the circadian rhythm of blood pressure. No significant differences were detected in the BP lowering effect when I.SRO was given during the morning or evening. These results may indicate that the drug is as suitable as one of the first choice for treating mild and moderate hypertensive patients.
Assuntos
Hipertensão/tratamento farmacológico , Isradipino/administração & dosagem , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização FisiológicaRESUMO
PURPOSE: To evaluate technical aspects of ambulatory blood pressure monitoring (ABPM) in normal adolescents. METHODS: Forty five normal adolescents (27 female), 10-18 years old. RESULTS: ABPM recordings showed a mean of 90% successful readings; 30% of the patients complained of sleep disruption related to the functioning of the ABPM monitor; the mean systolic, diastolic and heart rate fall during sleep was 13%, 23% and 24% respectively; the mean systolic and diastolic blood pressure load, while awake, was in male adolescents 25.4 +/- 27.7% and 11.8 +/- 14.6%, and in female adolescents, 17.5 +/- 18.7% and 11.8 +/- 11.4%, respectively; the mean systolic and diastolic blood pressure load, while asleep, was in male adolescents 15.4 +/- 22.9% and 2.8 +/- 4.9% and, in female adolescents, 10.5 +/- 18.2% and 1.8 +/- 2.7%, respectively; the mean diastolic values of the first two hours of recording were higher than the ones obtained during the rest of the hours of recording while awake; different mean systolic, diastolic and heart rate values were found during the afternoon and nocturnal sleep periods. CONCLUSION: ABPM was well accepted by the adolescent population, with good technical results.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Adolescente , Pressão Sanguínea/fisiologia , Criança , Feminino , Humanos , MasculinoRESUMO
PURPOSE: To evaluate during 12 weeks the effectiveness and safety of once-a-day fosinopril (10 or 20 mg/day comparative to placebo) in mild to moderate hypertensives according to an open design comparative to placebo. METHODS: One hundred and nineteen patients were studied; 52 +/- 11 years (mean +/- sd) range 18 a 76 years, 86 women and 33 men, 57% whites, 26% blacks and 17% mulattos, 71 mild hypertensives (95 < or = diastolic pressure < or = 104mmHg) e 48 moderate hypertensives (101 < diastolic pressure < or = 115mmHg). RESULTS: There was a significant reduction in systolic/diastolic pressure on the 6th week of treatment (from 161 +/- 16/103 +/- 7 before to 148 +/- 16/94 +/- 9mmHg on the 6th week). On the 12th week of treatment there was an additional significant reduction in systolic/diastolic pressure (from 148 +/- 16/94 +/- 9 on the 6th week to 145 +/- 17/89 +/- 8mmHg on the 12th week). There was a "favorable" response in 71% of the patients on the 12th week; 62% showed diastolic pressure < or = 90mmHg and 9% presented diastolic reduction > or = 10mmHg. There was no difference in the normalization rates between whites and non-whites, mild and moderate hypertensive, obese and non-obese patients, under or above 50 years of age and those patients from no drug-treatment to those on 3 drug before the study. There was no clinically relevant changes in laboratory evaluations before and at the end of the study. The number of adverse reactions was reduced in comparison with previous treatment. CONCLUSION: Fosinopril, according to our and others data, is effective and safe for the treatment of mild to moderate hypertensives, in whites or non-whites, obese or non-obese, younger or older than 50 years and receiving 0 or 3 drugs before the study.
Assuntos
Fosinopril/administração & dosagem , Hipertensão/tratamento farmacológico , Adolescente , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Brasil , Esquema de Medicação , Feminino , Fosinopril/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
PURPOSE: To evaluate the antihypertensive efficacy and safety of cilazapril compared to nifedipine retard in mild to moderate hypertension. METHODS: forty randomized out-patients with mild moderate hypertension, diastolic pressure (DP) between 95 and 115 mmHg, with placebo for 15 days were randomized and allocated for treatment, double-blind, once daily with cilazapril 2.5 mg (n = 20) or nifedipine retard 20 mg (20 = n) for four weeks. The non-responders (DP > 90mmHg) had the dosage increased twice, b.i.d., while responders were maintained up to 10 weeks. Clinical visits were performed before, at baseline and every two weeks and the laboratory test was performed after placebo run-in, 4th and 10th weeks of treatment. RESULTS: The blood pressure (BP) were similar between groups at the end of the placebo (cilazapril 151 +/- 14/103 +/- 5 - nifedipine 157 +/- 17/108 +/- 7mmHg, p > 0.05). DP decreased already at second weeks (cilazapril 95 +/- 9 - nifedipine 96 +/- 11mmHg, p < 0.05, compared to week 0) in both groups at the end of study with no difference inter groups. BP normalization was obtained in 58% of the patients with cilazapril and in 61% in the nifedipine group. Adverse biochemical effects were not observed in any group. Six (16%) patients of the cilazapril and 15 (39%) of nifedipine related collateral events, although no difference were observed between groups. CONCLUSION: Cilazapril 2.5 to 25mg normalized BP in 58% of mild and moderate hypertension patients, and this efficacy was similar to sustained-release nifedipine 20 to 40mg. Cilazapril had no adverse effects on the biochemical parameters with low incidence of collateral effects.
Assuntos
Cilazapril/administração & dosagem , Hipertensão/tratamento farmacológico , Nifedipino/administração & dosagem , Adulto , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Cilazapril/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nifedipino/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the antihypertensive effect of captopril in mild and moderate hypertensive patients uncontrolled with diuretics. METHODS: Low dose of captopril (25 to 50 mg) bid were associated during 9 weeks in 120 patients previously treated with 100 mg of hydrochlorothiazide. A subgroup of patients (74) were followed additionally for 3 weeks with the same dose of the drugs administered as a single dose. The patients were clinically evaluated after two weeks placebo, and each three weeks of active drugs. Blood pressure normalization were considered when diastolic arterial pressure was < or = 90 mmHg. Laboratory tests were measured before diuretic, before captopril and at the end of combined twelve weeks treatment. RESULTS: After 15 days washout, the baseline supine arterial pressure, 168 +/- 2/ 109 +/- 1 mmHg decrease significantly with diuretic to 151 +/- 1/ 101 +/- 1 mmHg and the drop was further increased with captopril b.i.d., with a mean dose of 44 +/- 1 mg, to 137 +/- 1/ 90 +/- 1 mmHg. Blood pressure normalization was obtained in 58% patients with captopril b.i.d. and in 63% as single dose. Blood pressure normalization was achieved in 63% of non-white patients and in 56% patients over 45 years old. Plasmatic potassium decreased significantly with diuretic and did not recovered when captopril was associated. CONCLUSION: Our results indicate that the addition of low dose of captopril twice or once a day may result in a marked additional blood pressure reduction in cases of insufficient control by the diuretic alone.
Assuntos
Captopril/administração & dosagem , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Adulto , Idoso , Pressão Sanguínea/efeitos dos fármacos , Captopril/uso terapêutico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Potássio/sangueRESUMO
OBJECTIVE: To evaluate the anti-hypertensive effect of verapamil COER-24 180/240 mg in a single dose at bedtime as single therapy in mild to moderate hypertensives. METHODS: A multicentric, open, placebo controlled study of 81 hypertensive patients older than 20 years-old followed to 8 weeks. Blood pressure was measured in doctor's office and by 24 h ambulatory monitoring (ABPM). RESULTS: We observed a decreased in systolic and diastolic blood pressure in doctor's office at 4th and 8th weeks. ABPM showed that both systolic, diastolic and mean blood pressure, heart rate and the mean 24-hour blood pressure load decreased after the 8-week treatment. In addition, there was a reduction of the double-product, especially in the morning and 68% of the patients didn't have any adverse events. CONCLUSION: The therapy verapamil COER-24 180/240 mg in a single dose is useful for mild and moderate hypertensive patients, with significant pressure decrease in both office blood pressure measurements and in the ABPM/24 hours, as well as showing good tolerability.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Bloqueadores dos Canais de Cálcio/administração & dosagem , Hipertensão/tratamento farmacológico , Verapamil/administração & dosagem , Adulto , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
PURPOSE: Evaluation of the efficacy and tolerability of nifedipine oros in patients with mild to moderate essential hypertension without major target organ damage and the anti-hypertensive effect along the 24 hours. METHODS: Two hundred and three patients were studied. After two weeks placebo running period single dose of nifedipine oros (30 mg/day) was administered for 8 weeks. At the end of the 4th week, the non-responders (diastolic blood pressure > 90 mmHg or reduction in diastolic pressure < 10 mmHg), had the dosage increased to 60 mg/day. Laboratory tests and 24h blood pressure monitoring (60 patients) were performed at the beginning and at the end of the study. RESULTS: One hundred and ninety one patients completed the study. Fifty nine percent were considered responders at the end of the 4th week with nifedipine oros 30 mg/day and 41% needed dosage increment to 60 mg/day. At the end of the 8th week, all patients were considered responders to nifedipine oros. The blood pressure control extended throughout the 24h of the day. The most common adverse events were edema (14.6%) and headache (12.4%). Good and very good tolerability were informed by 85% of the patients. CONCLUSION: Nifedipine oros was able to control blood pressure efficaciously along the 24h period without important side effects. The possibility of once day dosage, increases the patient adherence to anti-hypertensive therapy.
Assuntos
Hipertensão/tratamento farmacológico , Nifedipino/uso terapêutico , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Microneurography is a valuable and safe method for direct intraneural recording of sympathetic nerve activity to muscle and skin in humans. The technique and its application for the study of autonomic function will be briefly discussed. The regulation of muscle sympathetic nerve activity will be focused in different clinical situations and or stimuli, such as: essential hypertension, mineralocorticoid induced hypertension, exercise mental arithmetic stress, cold pressor test, hyperinsulinemia, oral alcohol ingestion.
Assuntos
Fenômenos Fisiológicos Cardiovasculares , Sistema Nervoso Simpático/fisiologia , Consumo de Bebidas Alcoólicas , Temperatura Baixa , Estimulação Elétrica , Exercício Físico , Humanos , Insulina/fisiologia , Microeletrodos , Músculos/inervação , Neurofisiologia/métodos , Pele/inervação , Estresse Psicológico , Sistema Nervoso Simpático/efeitos dos fármacosRESUMO
The blood pressure measure is part of the physical exam and it should be accomplished in every medical consultation. To verify the blood pressure measured in the accomplished medical consultations record of first they were consulted it consults 500 patient's ambulatorial being 335 (67%) coming of medical and surgical clinics and 165 (33%) of the gynecological and obstetric clinics. The blood pressure was written down in 39% of the accomplished consultations (135 + 32 mm Hg 85 + 19 mm Hg), and 11% of this annotations the pressure diastólica was above 90 mm Hg. In relation to the previous diagnosis of hypertension it was verified that: a) in 62% of the records there was not this information; b) 20% referred to have hypertension, and in 79% of these the arterial pressure was scored; and c) 18% referred not to have hypertension and 46% of these had registration of the arterial pressure. Therefore, most of the patients didn't have its logged arterial pressure.