Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29
Filtrar
1.
J Hypertens ; 15(2): 143-6, 1997 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9469789

RESUMO

OBJECTIVE: To evaluate the effects of a westward transmeridian flight over six time zones (from Milan to New York) on ambulatory blood pressure monitoring (ABPM) in normotensive individuals. METHODS: Eighteen normotensive subjects (blood pressure < 140/90 mmHg), 11 men and seven women, of mean age 38.3 years, were studied. On the day of travel they underwent 26 h noninvasive ABPM (started at 1100 h); the take-off time was 1200 h and the landing time was 8 h later, at 1400 h New York time (2000 h Italian time). Subjects were requested not to sleep until 2300 h and to get up at 0700 h the following morning. The results were compared with those of a 26 h ABPM performed in Italy the week before during which they slept from 2300 h to 0700 h. RESULTS: During the flight blood pressure and heart rate did not change compared with values during the corresponding time interval of the control day. After the landing, during the New York afternoon and evening (corresponding to the Italian sleeping time), blood pressure and heart rate remained unchanged, whereas during the night they decreased significantly, although their drop was less pronounced than that during the control day. CONCLUSION: The results of this study indicate that the decrease in blood pressure during sleep is the result of sleep itself rather than of the actual time of day.


Assuntos
Medicina Aeroespacial , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Sono/fisiologia , Adulto , Ritmo Circadiano , Feminino , Humanos , Masculino
2.
Am J Hypertens ; 11(10): 1244-7, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9799042

RESUMO

To evaluate the effect of antihypertensive treatment on sexual activity, 90 hypertensive men, aged 40 to 49 years, all married and without history of sexual dysfunction were treated with 100 mg of atenolol or 20 mg of lisinopril for 16 weeks, according to a double-blind, randomized, cross-over design. During the first month of therapy, sexual activity, assessed as number of sexual intercourse episodes per month, significantly declined with both atenolol (from 7.8 +/- 4.3 to 4.5 +/- 2.8, P < .01 v placebo) and lisinopril (from 7.1 +/- 4.0 to 5.0 +/- 2.5, P < .05 v placebo). Ongoing with the treatment, sexual activity tended toward recovery in the lisinopril (7.7 +/- 4.0 sexual intercourse episodes per month, P = NS v placebo), but not in the atenolol group (4.2 +/- 2.8, P < .01 v placebo), with a statistically significant difference between the two drugs (P < .01). The percentage of patients who complained of sexual dysfunction symptoms was significantly higher in the atenolol- than in the lisinopril-treated group (17% v 3%, P < .05). These findings suggest that atenolol induces a chronic worsening of sexual activity, whereas lisinopril causes only a temporary decline.


Assuntos
Anti-Hipertensivos/efeitos adversos , Atenolol/efeitos adversos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Lisinopril/efeitos adversos , Caracteres Sexuais , Comportamento Sexual/efeitos dos fármacos , Adulto , Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , Estudos Cross-Over , Método Duplo-Cego , Humanos , Libido/efeitos dos fármacos , Lisinopril/uso terapêutico , Masculino , Pessoa de Meia-Idade
3.
Am J Hypertens ; 12(1 Pt 1): 63-8, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10075386

RESUMO

The influence of acute sleep deprivation during the first part of the night on 24-h blood pressure monitoring (ABPM) was studied in 36 never-treated mild to moderate hypertensive patients. According to a crossover design, they were randomized to have either sleep deprivation or a full night's sleep 1 week apart, during which they were monitored with ABPM. Urine samples for analysis of nocturnal urinary excretion of norepinephrine were collected. During the sleep-deprivation day, both mean 24-h blood pressure and mean 24-h heart rate were higher in comparison with those recorded during the routine workday, the difference being more pronounced during the nighttime (P < .01). Urinary excretion of norepinephrine showed a significant increase at night during sleep deprivation (P < .05). Blood pressure and heart rate significantly increased in the morning after a sleep-insufficient night (P < .05). These data suggest that lack of sleep in hypertensive patients may increase sympathetic nervous activity during the night and the following morning, leading to increased blood pressure and heart rate. This situation might represent an increased risk for both target organ damage and acute cardiovascular diseases.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Privação do Sono/fisiologia , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial , Ritmo Circadiano , Creatinina/urina , Estudos Cross-Over , Feminino , Seguimentos , Frequência Cardíaca , Humanos , Hipertensão/etiologia , Hipertensão/urina , Masculino , Pessoa de Meia-Idade , Norepinefrina/urina , Prognóstico , Fatores de Risco , Sistema Nervoso Simpático/metabolismo , Sistema Nervoso Simpático/fisiopatologia
4.
Am J Hypertens ; 9(5): 503-5, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8735182

RESUMO

The influence of sleep deprivation during the first part of the night on 24-h ambulatory blood pressure monitoring (ABPM) was studied in 18 normotensive subjects. They underwent two ABPM, one week apart: during the first, they slept from 11 PM to 7 AM, and during the second, from 2 AM to 7 AM. The main differences were observed at dawn, before awakening, when SBP and DBP significantly decreased (P < .01) in the restricted sleep regimen, and during the morning after the recovery sleep, when SBP and HR significantly increased (P < .05). The explanation for these findings is not obvious. We suppose that the decrease in SBP and DBP at dawn might be due to a reorganization of the sleep phases in the restricted sleep regimen, whereas the increase in SBP and HR after awakening might be due to a greater sympathetic activation, as though sleep deprivation was a stressful condition.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea/fisiologia , Privação do Sono/fisiologia , Adulto , Diástole/fisiologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Sístole/fisiologia
5.
J Hum Hypertens ; 8(10): 761-4, 1994 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7837213

RESUMO

We investigated in a post hoc analysis the relationship between plasma endothelin (ET-1) levels (immunoreactive ET-1-like material: ir-ET-1) with both casual and noninvasive 24h ambulatory blood pressure monitoring (24h ABPM) values in EH. Fifteen uncomplicated EH patients (casual supine DBP > or = 100 mmHg), 10 males, age 54 +/- 6 years, 13 previously treated, enrolled in an antihypertensive drug trial (casual DBP > or = 100 mmHg), were evaluated. After a four week single-blind placebo wash-out period, measurements of supine casual SBP and DBP (three consecutive readings) and a 24h ABPM (Spacelabs 90207; automatic reading every 15 minutes) were carried out. Plasma ir-ET-1 was measured by radioimmunoassay kit (Amersham, UK). Pearson correlation coefficient tests were used for statistical evaluations. Mean (SD) casual SBP/DBP values were 166(5)/104(2) mmHg. The 24h ABPM mean values were 148(7)/87(3) mmHg. Daytime (07.00-23.00h) and nighttime (23.00-07.00h) SBP/DBP were 153(7)/91(3) and 137(10)/78(5) mmHg, respectively. Plasma ir-ET-1 levels were 0.9(0.5) pmol/l (range 0.3-2.1 pmol/l). Plasma ir-ET-1 was not correlated with casual SBP and DBP, age, serum creatinine and duration of EH. Positive and significant correlations were observed with 24h SBP (r = 0.59), daytime SBP (r = 0.58), nighttime SBP (r = 0.53) and DBP (r = 0.60). Unlike casual BP, ABPM mean values correlate positively with plasma ir-ET-1 in mild to moderate EH.


Assuntos
Pressão Sanguínea/fisiologia , Endotelinas/sangue , Endotelinas/fisiologia , Hipertensão/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
J Hum Hypertens ; 9(2): 131-5, 1995 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-7752175

RESUMO

The purpose of this study was to compare the effects of ramipril and nitrendipine on urinary albumin excretion (UAE) in hypertensive patients with non-insulin-dependent diabetes mellitus (NIDDM) and impaired renal function. Forty patients with mild hypertension with NIDDM and persistent albuminuria (> 300 mg/24h) were studied. After a 3-week run-in period on placebo, patients were randomly treated with ramipril 5 mg once daily or nitrendipine 20 mg once daily for 6 months, according to a double-blind design. Blood pressure (BP), UAE, creatinine clearance and glycosilated haemoglobin were evaluated at the end of the placebo period and after 1,3 and 6 months of active treatment. Both ramipril and nitrendipine significantly lowered BP values without affecting glucose homeostasis and renal function. Despite equivalent BP control, only ramipril afforded a significant reduction in UAE, thus suggesting that the antiproteinuric effect of ramipril is at least partially independent of its anti-hypertensive effect.


Assuntos
Albuminúria , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipertensão/tratamento farmacológico , Nitrendipino/uso terapêutico , Ramipril/uso terapêutico , Idoso , Albuminúria/etiologia , Análise de Variância , Intervalos de Confiança , Creatinina/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/urina , Método Duplo-Cego , Hemoglobinas Glicadas/metabolismo , Humanos , Hipertensão/complicações , Hipertensão/urina , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Nitrendipino/administração & dosagem , Nitrendipino/efeitos adversos , Ramipril/administração & dosagem , Ramipril/efeitos adversos , Insuficiência Renal/etiologia , Insuficiência Renal/fisiopatologia , Insuficiência Renal/urina
7.
J Hum Hypertens ; 13(1): 47-53, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9928752

RESUMO

The aim of this study was to compare the effects of ramipril and nitrendipine chronic treatment on urinary albumin excretion (UAE) in hypertensive patients with type II non-insulin-dependent diabetes mellitus (NIDDM) and impaired renal function. A 2-year, prospective, randomised study was conducted on 51 men with a diastolic blood pressure (DBP) > or =95 and < or =105 mm Hg, stable NIDDM, serum creatinine between 1.6 and 3.0 mg/dl and persistent UAE >300 and <2000 mg/24 h. After a 3-month preliminary observation period, during which patients began a low-protein, low-sodium diet, and a subsequent 4-week run-in period on placebo, patients were randomly treated with ramipril 5 mg or nitrendipine 20 mg for 2 years. Both drugs similarly reduced BP without affecting glucose homeostasis. In the ramipril group UAE significantly decreased after only 3 months of treatment, whereas in the nitrendipine group a significant although lesser reduction in UAE was observed only after 1 year. During the second year the UAE% change was not statistically different between the two treatments. Serum creatinine and creatinine clearance showed no significant change with both drugs. The progression of renal insufficiency as assessed by the rate of reduction of creatinine clearance over the 2 years of the study was similar in the ramipril and the nitrendipine groups. In conclusion both ramipril and nitrendipine were associated with a decrease in UAE although such a reduction was earlier and more marked with ramipril. The decline of renal function did not differ significantly between the two treatments.


Assuntos
Albuminúria/tratamento farmacológico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Hipertensão/complicações , Rim/fisiopatologia , Nitrendipino/uso terapêutico , Ramipril/uso terapêutico , Idoso , Albuminúria/etiologia , Creatinina/sangue , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Hipertensão/urina , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
8.
J Hum Hypertens ; 11(11): 753-7, 1997 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9416986

RESUMO

The aim of this double-blind, parallel group study was to compare the effects of nebivolol and atenolol on blood pressure (BP) and insulin sensitivity in hypertensive patients with type II, non-insulin dependent diabetes mellitus (NIDDM). After a 4-week run-in period on placebo, 30 patients (14 males and 16 females) aged 43 to 69 years, with stable NIDDM and mild to moderate hypertension (DBP > or =95 and <116 mm Hg) were randomised to receive either nebivolol 5 mg or atenolol 50 mg, both administered once daily for 6 months. At the end of the placebo and the active treatment periods, supine and standing BP was measured, 24-h urinary C-peptide, HbA1c, plasma glucose and lipid levels were evaluated and an euglycaemic hyperinsulinaemic clamp was performed to evaluate insulin sensitivity: glucose infusion rate during the last 60 min of clamp and total glucose requirements were evaluated. Nebivolol 5 mg once daily was of an equivalent efficacy as atenolol 50 mg once daily at reducing supine and standing systolic and diastolic BP values. Neither beta-blocker adversely affected carbohydrate metabolism in terms of insulin sensitivity, whole body glucose utilization, HbA1c and 24-h urinary C-peptide excretion. No significant changes in cholesterol (total, high density and low density lipoprotein) and triglycerides plasma levels were observed with both beta-blockers. These findings indicate that, in hypertensive patients with NIDDM, ie, in subjects who have established insulin resistance, treatment with nebivolol and atenolol neither further deteriorated insulin sensitivity nor adversely affected the lipid profile.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , Benzopiranos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Angiopatias Diabéticas/tratamento farmacológico , Etanolaminas/uso terapêutico , Hipertensão/tratamento farmacológico , Resistência à Insulina , Antagonistas Adrenérgicos beta/efeitos adversos , Adulto , Idoso , Anti-Hipertensivos/efeitos adversos , Atenolol/efeitos adversos , Benzopiranos/efeitos adversos , Diabetes Mellitus Tipo 2 , Angiopatias Diabéticas/fisiopatologia , Método Duplo-Cego , Etanolaminas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nebivolol , Método Simples-Cego
9.
Int J Clin Pharmacol Ther ; 32(11): 606-11, 1994 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-7874375

RESUMO

A double-blind, crossover, placebo-controlled study was undertaken in order to assess the antihypertensive efficacy of a fixed combination of benazepril and hydrochlorothiazide in two different dosages by ambulatory blood pressure monitoring (ABPM). After a three-week placebo wash-out period, 18 patients with mild to moderate essential hypertension, all males, aged 41-60 years, were randomized to receive benazepril 5 mg + hydrochlorothiazide 6.25 mg, benazepril 10 mg + hydrochlorothiazide 12.5 mg or placebo, all given once daily for 4 weeks, according to a 3 crossover period, arranged in a 3 x 3 latin square design. Patients were checked after the wash-out period and every 4 weeks thereafter. At each visit, 24-hour ABPM was performed by a non-invasive device (Spacelabs 90202); causal BP (by mercury sphygmomanometer) and HR were also measured. Both dosages of the fixed combination were equally effective in reducing systolic and diastolic BP values throughout the 24-hour period as compared to the placebo. The antihypertensive effect of the drug could be observed to a similar extent both during the day and night and was still significant 24-hour post-dosing. In addition, the fixed combination did not affect the normal BP circadian variability.


Assuntos
Anti-Hipertensivos/administração & dosagem , Benzazepinas/administração & dosagem , Monitorização Ambulatorial da Pressão Arterial , Hidroclorotiazida/administração & dosagem , Hipertensão/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/efeitos adversos , Benzazepinas/efeitos adversos , Ritmo Circadiano/efeitos dos fármacos , Estudos Cross-Over , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hidroclorotiazida/efeitos adversos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade
10.
Int J Clin Pharmacol Ther ; 33(8): 453-6, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8556225

RESUMO

The aim of this study was to assess the effects of ketanserin on insulin resistance in nondiabetic hypertensive patients. Eleven nonobese, nondiabetic mild to moderate hypertensives (6 males, 5 females, aged 39-59 years), after a 4 week run-in period on placebo, were treated with ketanserin 40 mg twice daily for 12 weeks. Blood pressure (BP) (by standard mercury sphygmomanometer) and insulin sensitivity (by the euglycemic hyperinsulinemic clamp technique) were evaluated at the end of the placebo period and at the end of the treatment period. Ketanserin produced a significant decrease in BP (from 160 +/- 13/100 +/- 4 mmHg to 146 +/- 10/89 +/- 5 mmHg p < 0.01). The amounts of exogenous glucose required to hold glucose levels constant during clamp were not changed by ketanserin as compared to placebo 34.5 +/- 3.5 g vs 33.8 +/- 3.1 g). The rate of glucose infusion required during the last 60 minutes of the clamp, used as an indicator of insulin sensitivity, was not different before and after treatment (5.52 +/- 0.41 mg/min/ kg vs 5.21 +/- 0.39mg/min/kg). These results suggest that in nonobese, nondiabetic hypertensive patients ketanserin monotherapy is effective in reducing BP values without affecting insulin sensitivity.


Assuntos
Anti-Hipertensivos/farmacologia , Hipertensão/tratamento farmacológico , Resistência à Insulina/fisiologia , Ketanserina/farmacologia , Adulto , Análise de Variância , Anti-Hipertensivos/administração & dosagem , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Humanos , Ketanserina/administração & dosagem , Masculino , Pessoa de Meia-Idade
11.
Int J Clin Pharmacol Ther ; 35(2): 61-4, 1997 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9147709

RESUMO

The aim of this study was to evaluate the lipid-lowering effect of acipimox as compared to pravastatin in patients with combined hyperlipidemia. One hundred and six subjects, all males, aged 18-60 years, with total cholesterol (TC) > or = 200 mg/dl, TC/HDL-C ratio > or = 5, triglycerides (TG) > or = 200 and > or = 350 mg/dl were randomized to receive acipimox 250 mg thrice daily or pravastatin 20 mg once daily for 3 months, according to a double-blind, double-dummy design. After a 1-month wash-out period patients were crossed to the alternative regimen for further 3 months. Prior to and at the end of each treatment period, TC, LDL-C, HDL-C, TG, blood glucose, and fibrinogen were evaluated. Both acipimox and pravastatin significantly decreased TC, LDL-C, TC/HDL-C ratio and TG and increased HDL-C, without affecting plasma glucose. However, at the dosages employed in the study acipimox was more effective in reducing TG and increasing HDL-C levels, whereas pravastatin was more efficient in decreasing TC and LDL-C. There was no difference between the 2 treatments in their effects on TC/HDL-C ratio. Unlike pravastatin acipimox caused a slight but significant reduction in fibrinogen plasma levels. No serious adverse event was observed with either drug, but a major incidence of side-effects was reported during treatment with acipimox. Our findings suggest that, although both drugs at the standard dose employed in the study were effective in improving the lipid profile; in the treatment of combined hyperlipidemia acipimox might be preferable in the presence of more pronounced hypertriglyceridemia with low levels of HDL-C, whereas pravastatin might be more useful when hypercholesterolemia is predominant.


Assuntos
Hiperlipidemias/tratamento farmacológico , Hipolipemiantes/uso terapêutico , Pravastatina/uso terapêutico , Pirazinas/uso terapêutico , Adolescente , Adulto , Estudos Cross-Over , Método Duplo-Cego , Humanos , Hiperlipidemias/sangue , Hipolipemiantes/efeitos adversos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Pravastatina/efeitos adversos , Pirazinas/efeitos adversos
12.
J Neurosci Nurs ; 27(6): 331-7, 1995 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8770776

RESUMO

Neurological illness often impairs a patient's mental status, sensory /perceptual and motor functions, creating significant disability. These deficits have been identified as factors that increase the fall risk in these patients. A review of the literature reveals three common manifestations of neurologic disease are related to inpatient falls. These antecedents are altered mental status, sensory/perceptual alteration and impaired physical mobility. These antecedents are found to influence a patient's risk to fall to some extent; however, further research is recommended to further quantify the risk.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Doenças do Sistema Nervoso/complicações , Transtornos Neurocognitivos/complicações , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Transtornos Neurocognitivos/epidemiologia , Exame Neurológico , Avaliação em Enfermagem , Transtornos Psicomotores/complicações , Transtornos Psicomotores/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologia
13.
Br J Clin Pharmacol ; 49(5): 423-7, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10792199

RESUMO

AIMS: As melatonin has been found to play a role in the mechanisms of cardiovascular regulation, we designed the present study to evaluate whether the evening ingestion of the pineal hormone might interfere with the antihypertensive therapy in hypertensive patients well-controlled by nifedipine monotherapy. METHODS: Forty-seven mild to moderate essential hypertensive outpatients taking nifedipine GITS 30 or 60 mg monotherapy at 08.30 h for at least 3 months, were given placebo or melatonin 5 mg at 22.30 h for 4 weeks according to a double-blind cross-over study. At the end of each treatment period patients underwent a 24 h noninvasive ambulatory blood pressure monitoring (ABPM) during usual working days; sleeping period was scheduled to last from 23.00 to 07.00 h. RESULTS: The evening administration of melatonin induced an increase of blood pressure and heart rate throughout the 24 h period (DeltaSBP = + 6.5 mmHg, P < 0.001; DeltaDBP = + 4.9 mmHg, P < 0.01; DeltaHR = + 3.9 beats min-1, P < 0.01). The DBP as well as the HR increase were particularly evident during the morning and the afternoon hours. CONCLUSIONS: We hypothesize that competition between melatonin and nifedipine, is able to impair the antihypertensive efficacy of the calcium channel blocker. This suggests caution in uncontrolled use of melatonin in hypertensive patients. As the pineal hormone might interfere with calcium channel blocker therapy, it cannot be considered simply a dietary supplement.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Melatonina/farmacologia , Nifedipino/uso terapêutico , Adulto , Idoso , Estudos Cross-Over , Método Duplo-Cego , Interações Medicamentosas , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade
14.
J Adv Nurs ; 23(5): 896-903, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-8732515

RESUMO

Emphasis on meaning underpins a current thrust of knowledge development in nursing, especially in the client domain. Examination of meaning in the interactional context and through varying levels of consciousness has not been examined. Initially, an integrated model was developed deductively from philosophical, theoretical and research-oriented sources. This model was meant as a guide to begin examining how patients with varying levels of consciousness make sense of their intensive care unit experience. Over a 10-month period of fieldwork, this author observed patients twice daily through their intensive care unit stay to capture the nature and content of thinking processes. The resulting neuro-interactional model describes patients' thinking processes and scope of meaning as a function of levels of consciousness as well as factors which affect thinking and meaning. Theory, research and practice implications are presented.


Assuntos
Atitude Frente a Saúde , Estado de Consciência , Cuidados Críticos/psicologia , Modelos Psicológicos , Respiração Artificial/psicologia , Pensamento , Estado Terminal , Escala de Coma de Glasgow , Humanos , Modelos Neurológicos , Modelos de Enfermagem , Respiração Artificial/enfermagem , Simbolismo
15.
Pediatr Nephrol ; 6(4): 356-7, 1992 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-1498006

RESUMO

Two children with extensive ileal resection are reported. They developed gross haematuria of "non-glomerular origin", without stones or nephrocalcinosis. Previous reports indicate that acquired hyperoxaluria is common in children with a variety of intestinal disorders. Our patients had hyperoxaluria. We think that hyperoxaluria may be the cause of haematuria through a pathogenetic mechanism similar to the one ascribed to haematuria secondary to hypercalciuria and hyperuricosuria.


Assuntos
Hematúria/etiologia , Hiperoxalúria/etiologia , Adolescente , Pré-Escolar , Feminino , Humanos , Hiperoxalúria/complicações , Íleo/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia
16.
Blood Press Suppl ; 5: 24-8, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8973789

RESUMO

The aim of this multicenter study was to evaluate the efficacy and tolerability of manidipine hydrochloride, a new calcium-antagonist of the dihydropyridine group, in the long-term treatment of mild to moderate hypertension. After a 2-week run-in period on placebo, 183 patients, 98 males and 85 females, with mean age of 53.8 years, sitting DBP > or = 95 and < or = 115 mmHg and SBP < or = 210 mmHg, were given manidipine 10 mg once daily. Two weeks later, patients whose DBP was > or = 90 mmHg or with a reduction in DBP < 10 mmHg were administered with manidipine 20 mg once daily. Follow-up visits were performed at 6, 10, 14, 26, 38 and 52 weeks after starting manidipine treatment. All BP (by mercury sphygmomanometer, Korotkoff I and V) and heart rate (HR) measures were made 24 h after dosing. Adverse events and laboratory data were recorded. Particular attention was paid to the collection of possible major cardiovascular (angina pectoris, myocardial infarction) and cerebrovascular (IRA, stroke) events, observed during the treatment period. One-hundred-and-fifty-one patients completed the study (79 on a 10 mg dose and 72 on a 20 mg dose), whereas 32 dropped out (11 lost to follow-up, 11 insufficient therapeutic response, 7 ADRs, 3 other causes). Significant reductions of BP values were achieved during the manidipine 10 mg treatment period. Analysis of covariance between doses confirmed a more potent hypotensive effect of manidipine 20 mg as compared to 10 mg on sitting DBP and mean BP and on standing SBP, especially in patients with moderate hypertension. At the end of 1 year of treatment the success rates (defined as sitting DBP > or = 90 mmHg or a reduction of > or = 10 mmHg vs baseline) were similar in the two groups (manidipine 10 mg: 96.1%; manidipine 20 mg: 94.5%). No clinically relevant change in HR was observed. Overall, 28 patients (17 in the manidipine 20 mg and 11 in the manidipine 10 mg treated group) complained of adverse events, the most common being ankle oedema (4.9%), headache (3.8%), palpitation (2.7%) and flushing (2.2%). Neither cardiovascular nor cerebrovascular events or other serious adverse event were reported. In conclusion, a significant and constant reduction of BP values was observed with long-term treatment with manidipine. The reduction in BP was dose-related especially in patients suffering from moderate hypertension. Adverse events were mild and relatively more frequent with the higher manidipine dosage.


Assuntos
Anti-Hipertensivos/administração & dosagem , Di-Hidropiridinas/administração & dosagem , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Di-Hidropiridinas/efeitos adversos , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nitrobenzenos , Piperazinas , Fatores de Tempo , Resultado do Tratamento
17.
Eur Heart J ; 16(8): 1120-5, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8665975

RESUMO

In order to compare the long-term effects on ambulatory blood pressure and left ventricular hypertrophy of hydralazine and lisinopril we studied 30 patients, all males, still hypertensive (diastolic blood pressure > or = 95 mm Hg) despite combined beta-blocker/diuretic therapy and with echocardiographic evidence of left ventricular hypertrophy (left ventricular mass index > or = 1.31 g.m(-1)). They wer randomized to receive hydralazine slow release 50 mg/ chlorthalidone 12.5 mg) for 6 months. Casual blood pressure, non-invasive ambulatory blood pressure monitoring (ABPM), M-mode echocardiogram, plasma renin activity and plasma catecholamines were evaluated before the randomization and after 6 months of treatment. Both drugs significantly reduced casual as well as daytime systolic and diastolic blood pressure, without statistical differences between the two treatments. Lisinopril was significantly more effective than hydralazine in reducing night-time systolic and diastolic blood pressure. Plasma norepinephrine was significantly reduced by lisinopril and increased by hydralazine. Left ventricular mass was significantly reduced by lisinopril but not by hydralazine. The results of linear regression and multiple regression analysis suggested that the lisinopril-induced decrease in both day- and night-time blood pressure might account for the regression of left ventricular hypertrophy, whereas the lack of left ventricular hypertrophy regression during hydralazine treatment could be due mainly to the reflex sympathetic activation induced by the drug.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Hidralazina/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertrofia Ventricular Esquerda/tratamento farmacológico , Lisinopril/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Catecolaminas/sangue , Diuréticos/uso terapêutico , Quimioterapia Combinada , Ecocardiografia , Frequência Cardíaca , Humanos , Hipertensão/sangue , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise de Regressão
18.
Blood Press Suppl ; 5: 16-23, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8973788

RESUMO

In a double-blind, randomized, placebo-controlled, parallel-group study the ambulatory blood pressure monitoring (ABPM) and relative tolerability of different doses of manidipine hydrochloride (10, 20 and 40 mg) were compared to placebo in patients with mild to moderate essential hypertension. After an initial 2-week run-in period on placebo, 52 patients, 32 males and 20 females, aged 40 to 63 years, were randomized to receive manidipine 10 mg, 20 mg, 40 mg or placebo, all administered once daily for 4 weeks. Patients were checked after the initial placebo phase and every 2 weeks thereafter. At each visit, casual BP and HR were measured. At the end of the placebo period and after 4 weeks of active treatment, non-invasive 24-h ABPM was performed. 24-h, day-time and night-time ambulatory BP as well as the area under the curve (AUC) and casual BP were dose-dependently reduced by manidipine 10, 20 and 40 mg, without changes in the normal BP circadian profile. The trough:peak ratio for both SBP and DBP was higher than 50% for all three manidipine dosage regimens. The percentage of abnormal ambulatory SBP and DBP readings was significantly reduced in all manidipine-treated groups versus placebo. The risk/benefit ratio suggests that the intermediate manidipine dosage (20 mg) could be a suitable dose regimen for the majority of patients with mild to moderate hypertension.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Di-Hidropiridinas/administração & dosagem , Hipertensão/tratamento farmacológico , Adulto , Monitorização Ambulatorial da Pressão Arterial , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nitrobenzenos , Piperazinas
19.
Z Kardiol ; 85 Suppl 3: 121-3, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8896314

RESUMO

Ambulatory blood pressure monitoring (ABPM) is utilized to identify "dippers" and "non dippers" among hypertensives. Such a classification has either prognostic or therapeutical implications. Rigid definitions of nocturnal time period (e.g., from 10 p.m. to 7 a.m.) may not correspond to actual sleep patterns, and thus may lead to faulty interpretations. In our study, we analyzed 32 ABPM; diurnal and nocturnal blood pressure (BP) were assessed by three different ways: the patients' diary method; fixed intervals utilized by Spacelabs software; Multi-P Analysis (MPA) of the data. MPA method proved to be effective to evaluate nocturnal BP values. In comparison with Spacelabs program, it seems to define more precisely nocturnal BP, which differs less from the real sleep-time values. This modifies the percentage of dippers, which is greater than that obtained by Spacelabs program and equal to that calculated by the patients reported nocturnal sleep intervals. These results suggest that MPA method may be a contribution to a better definition of nocturnal BP.


Assuntos
Monitores de Pressão Arterial , Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Hipertensão/diagnóstico , Polissonografia/instrumentação , Adolescente , Adulto , Idoso , Feminino , Humanos , Hipertensão/classificação , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade , Processamento de Sinais Assistido por Computador/instrumentação , Software
20.
J Cardiovasc Risk ; 3(1): 55-9, 1996 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-8783031

RESUMO

BACKGROUND: Cigarette smoking has been reported to cause an acute increase in blood pressure (BP). Nevertheless, many epidemiological studies have found lower average BP values in smokers than in non-smokers. The aim of this study was to evaluate the possible existence of a systematic difference in BP values between smokers and non-smokers in a worker population. METHODS: We studied 7109 employees of a metallurgical factory, all men, aged 18-60 years, 3237 non-smokers and 3872 smokers; of the latter, 816 smoked less than 10 cigarettes per day (light smokers), the others smoked 10 or more cigarettes per day. Clinical examination included measures of resting BP (by mercury sphygmomanometer), heart rate (HR) (by pulse palpation), body weight and height. Data were adjusted for age and body mass index (BMI). Four age groups (18-30, >30, >40 and >50 years) and 3 BMI groups (< 25, 25-30, >30) were considered. RESULTS: In smokers, the adjusted values of systolic BP (SBP) and HR (127.72 mmHg and 75.16 beats/min, respectively) were slightly but significantly higher than in non-smokers (127.1 mmHg, P < 0.05 and 72.64 beats/min, P < 0.001), whereas diastolic BP (DBP) was significantly lower (83.37 versus 84.31 mmHg, P < 0.001). Considering the amount of cigarettes smoked, the mean BP values of light smokers were not significantly different from those of subjects smoking 10 or more cigarettes per day, whereas HR mean values were significantly higher in the latter. The prevalence of hypertension (WHO criteria) was similar in smokers and non-smokers in each age group. CONCLUSIONS: Our data showed slightly but statistically higher SBP and HR, and lower DBP mean values in smokers than in non-smokers; however, the differences in BP, although significant from the statistical point of view, were not of actual clinical significance.


Assuntos
Hipertensão/etiologia , Metalurgia , Fumar/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial , Estudos Transversais , Frequência Cardíaca , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Fatores de Risco , Local de Trabalho
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA