RESUMEN
It has not yet been established whether angiotensin II receptor blockers (ARB), statins, and multiple drugs affect the severity of COVID-19. Therefore, we herein performed an observational study on the effects of 1st- and 2nd-generation ARB, statins, and multiple drugs, on COVID-19 in patients admitted to 15 Japanese medical facilities. The results obtained showed that ARB, statins, and multiple drugs were not associated with the primary outcome (odds ratio: 1.040, 95% confidence interval: 0.688-0.571; 0.696, 0.439-1.103; 1.056, 0.941-1.185, respectively), each component of the primary outcome (in-hospital death, ventilator support, extracorporeal membrane oxygenation support, and admission to the intensive care unit), or the secondary outcomes (oxygen administration, disturbed consciousness, and hypotension, defined as systolic blood pressure ≤90 mmHg). ARB were divided into 1st- and 2nd-generations based on their approval for use (before 2000 and after 2001), with the former consisting of losartan, candesartan, and valsartan, and the latter of telmisartan, olmesartan, irbesartan, and azilsartan. The difference of ARB generation was not associated with the primary outcome (odds ratio with 2nd-generation ARB relative to 1st-generation ARB: 1.257, 95% confidence interval: 0.613-2.574). The odd ratio for a hypotension as one of the secondary outcomes with 2nd-generation ARB was 1.754 (95% confidence interval: 1.745-1.763) relative to 1st-generation ARB. These results suggest that patients taking 2nd-generation ARB may be at a higher risk of hypotension than those taking 1st-generation ARB and also that careful observations are needed. Further studies are continuously needed to support decisions to adjust medications for co-morbidities.
Asunto(s)
Antagonistas de Receptores de Angiotensina , COVID-19 , Hipotensión , Humanos , Masculino , Femenino , Hipotensión/inducido químicamente , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Antagonistas de Receptores de Angiotensina/uso terapéutico , Persona de Mediana Edad , COVID-19/complicaciones , Japón/epidemiología , Tratamiento Farmacológico de COVID-19 , Hospitalización/estadística & datos numéricos , Anciano de 80 o más Años , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , SARS-CoV-2RESUMEN
OBJECTIVES: To assess whether acoustic stimulations relieve venipuncture pain and determine which stimulation is the most effective type. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov and the International Clinical Trials Registry Platform databases were systematically searched in September 2023. STUDY SELECTION: Randomised controlled trials evaluating the efficacy of acoustic stimulations on patients undergoing venipuncture were eligible. Acoustic stimulations were classified into seven categories: five types of acoustic stimulations (music medicine (researcher selected), music medicine (patient selected), music therapy, sounds with linguistic meaning and sounds without linguistic meaning) and two controls (only wearing headphones and no treatment). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes included self-reported pain intensity assessed during venipuncture and treatment cost, and secondary outcomes were self-reported mental distress and adverse events. RESULTS: Of 6406 citations, this network meta-analysis included 27 studies including 3416 participants; the mean age was 31.5 years, and 57% were men. Among the five types of acoustic stimulations, only musical interventions, such as music medicine (patient selected) (standardised mean difference (SMD) -0.44 (95% CI: -0.84 to -0.03); low confidence), music medicine (researcher selected) (SMD -0.76 (95% CI: -1.10 to -0.42); low confidence) and music therapy (SMD -0.79 (95% CI: -1.44 to -0.14); low confidence), were associated with improved pain relief during venipuncture compared with no treatment. No significant differences existed between the types of acoustic stimulations. Free-of-charge acoustic stimulations were provided to patients, and no specific adverse events were reported. In many studies, the risk of bias was rated high because of the difficulty of blinding the intervention to the participants and the self-reported pain outcome. CONCLUSIONS: Music interventions were associated with reduced venipuncture pain. Comparisons between types of acoustic stimulations revealed no significant differences. Therefore, music intervention could be a safe and inexpensive pain relief method for venipuncture. PROSPERO REGISTRATION NUMBER: CRD42022303852.
Asunto(s)
Musicoterapia , Flebotomía , Masculino , Humanos , Adulto , Femenino , Flebotomía/efectos adversos , Estimulación Acústica , Metaanálisis en Red , Dolor/etiología , Dolor/prevención & control , Musicoterapia/métodosRESUMEN
BACKGROUND AND OBJECTIVES: Pain during cannulation for vascular access is a considerable problem for patients with kidney disease who are undergoing hemodialysis. We examined whether listening to music can reduce cannulation pain in these patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a multicenter, single-blind, crossover, randomized trial of 121 patients who reported pain during cannulation for hemodialysis. We compared participants listening to "Sonata for Two Pianos in D Major, K.448" or white noise as control while undergoing the cannulation procedure. The cannulation operator was blinded to the intervention, and the hypothesized superiority of music over white noise was concealed during explanations to the participants. The primary end point was the visual analog scale score for cannulation pain independently evaluated by participants. RESULTS: The primary analysis was on the basis of the modified intention-to-treat principle. The median baseline visual analog scale pain score was 24.7 mm (interquartile range, 16.5-42.3). Median change of the visual analog scale pain score from the "no sound" to the music period was -2.7 mm (interquartile range, -9.2 to 3.6), whereas it was -0.3 mm (interquartile range, -5.8 to 4.5) from "no sound" to white noise. The visual analog scale pain score decreased when listening to music compared with white noise. (Adjusted difference of visual analog scale pain score: -12%; 95% confidence interval, -21 to -2; P=0.02.) There were no significant differences in the secondary outcomes of anxiety, BP, or stress assessed by salivary amylase (adjusted difference of visual analog scale anxiety score -8%, 95% confidence interval, -18 to 4; P=0.17). No intervention-related adverse events were reported. CONCLUSIONS: Listening to music reduced cannulation pain in patients on hemodialysis, although there was no significant effect on anxiety, BP, or stress markers.
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Música , Humanos , Método Simple Ciego , Dolor/etiología , Dolor/prevención & control , Diálisis Renal/efectos adversos , Ansiedad/etiología , Ansiedad/prevención & control , Cateterismo/efectos adversosRESUMEN
Background We investigated the early postoperative effect of percutaneous transluminal renal angioplasty on ambulatory blood pressure (BP) and the circadian characteristics of natriuresis and autonomic nerve activity. Methods and Results A total of 64 patients with hypertension with hemodynamically significant renal artery stenosis (mean age, 60.0±21.0 years; 31.3% fibromuscular dysplasia) who underwent angioplasty were included, and circadian characteristics of natriuresis as well as heart rate variability indices, including 24-hour BP, low-frequency and high-frequency (HF) components, and the percentage of differences between adjacent normal R-R intervals >50 ms were evaluated using an oscillometric device, TM-2425, both at baseline and 3 days after angioplasty. In both the fibromuscular dysplasia and atherosclerotic stenosis groups, 24-hour systolic BP (fibromuscular dysplasia, -19±14; atherosclerotic renal artery stenosis, -11±9 mm Hg), percentage of differences between adjacent normal R-R intervals >50 ms, HF, brain natriuretic peptide, and nighttime urinary sodium excretion decreased (all P<0.01), and heart rate increased (both P<0.05) after angioplasty. In both groups, revascularization increased the night/day ratios of percentage of differences between adjacent normal R-R intervals >50 ms (both P<0.01) and HF, and decreased those of low frequency/HF (all P<0.05) and nighttime urinary sodium excretion (fibromuscular dysplasia, 1.17±0.15 to 0.78±0.09; atherosclerotic renal artery stenosis, 1.37±0.10 to 0.99±0.06, both P<0.01). Multiple logistic regression analysis indicated that a 1-SD increase in baseline low frequency/HF was associated with at least a 15% decrease in 24-hour systolic BP after angioplasty (odds ratio, 2.30 [95% CI, 1.03-5.67]; P<0.05). Conclusions Successful revascularization results in a significant BP decrease in the early postoperative period. Intrarenal perfusion might be a key modulator of the circadian patterns of autonomic nerve activity and natriuresis, and pretreatment heart rate variability evaluation seems to be important for treatment success.
Asunto(s)
Angioplastia de Balón , Aterosclerosis , Displasia Fibromuscular , Hipertensión Renovascular , Hipertensión , Obstrucción de la Arteria Renal , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia , Aterosclerosis/complicaciones , Sistema Nervioso Autónomo , Presión Sanguínea/fisiología , Monitoreo Ambulatorio de la Presión Arterial , Displasia Fibromuscular/complicaciones , Humanos , Hipertensión/complicaciones , Hipertensión/terapia , Persona de Mediana Edad , Natriuresis , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/terapia , SodioRESUMEN
BACKGROUND: There are few reports on the significance for the combined evaluation of blood humoral factors and urinary biomarkers in terms of worsening renal function (WRF) after coronary angiography (CAG)/percutaneous coronary arterial intervention (PCI). METHOD AND RESULTS: Urinary liver type-fatty acid-binding protein (L-FABP), neutrophil gelatinase associated lipocalin (NGAL), and adrenomedullin (AM) were measured less than 24 h before and 3 h, 6 h, 1 day, and 2 days after CAG/PCI. WRF was defined as a > 20% decrease in the estimated GFR. WRF occurred in seven of 100 patients and the increase in L-FABP/creatinine (Cr) at 1 day after CAG/PCI was significantly higher in the WRF group than in the non-WRF group. Plasma B-type natriuretic peptide (BNP) before CAG/PCI and L-FABP/Cr at 1 day after CAG/PCI were independent predictors for WRF. The areas under the receiver-operating characteristic curves were as follows: 0.760 for BNP before CAG/PCI, 0.731 for L-FABP/Cr at 1 day after CAG/PCI, and 0.892 for BNP and L-FABP/Cr. Urinary AM levels after PCI/CAG were negatively correlated only to serum potassium levels. Gene expressions of AM and AM-receptor were detectable in renal tubule epithelial cells. AM increased intracellular second messenger levels in a dose-dependent manner. CONCLUSIONS: Our results suggest that combined evaluation of plasma BNP and urinary L-FABP/Cr is useful as a predictor of renal dysfunction in CAG/PCI patients.
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Enfermedad de la Arteria Coronaria/terapia , Proteínas de Unión a Ácidos Grasos/orina , Tasa de Filtración Glomerular , Enfermedades Renales/diagnóstico , Riñón/fisiopatología , Péptido Natriurético Encefálico/sangre , Intervención Coronaria Percutánea/efectos adversos , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Biomarcadores/orina , Células Cultivadas , Angiografía Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Creatinina/orina , Femenino , Humanos , Riñón/metabolismo , Enfermedades Renales/sangre , Enfermedades Renales/fisiopatología , Enfermedades Renales/orina , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Intradialytic hypotension (IDH) is associated with high mortality. Peripheral vascular resistance and circulating blood volume are important factors in IDH; however, the effects of hemodialysis (HD) on vascular resistance in IDH remain unclear. We herein performed a retrospective observational cohort study to investigate changes in and factors related to vascular resistance during HD. A total of 101 HD patients were divided into two groups (Decreased blood pressure (BP) during HD group: N = 19, Nondecreased BP group: N = 82), and cardiac output was measured with electrical velocimetry (AESCLON) for 3 h. The systemic vascular resistance index (SVRI) was significantly decreased in the Decreased BP group, while the cardiac index was similar in both groups. A multivariate regression analysis identified hypocholesterolemia as a predictor of reduced vascular resistance reactivity during HD. Furthermore, a correlation was found between changes in the SVRI and cholesterol levels in patients with a higher Geriatric Nutritional Risk Index (GNRI) but not in those with a lower GNRI. The present results suggest that hypocholesterolemia contributes to reducing systematic vascular resistance reactivity during HD, which is an important predictor of a reduction in BP during HD. The relationship between hypocholesterolemia and vascular resistance may involve mechanisms other than malnutrition.
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Hipotensión , Fallo Renal Crónico , Desnutrición , Anciano , Presión Sanguínea , Humanos , Fallo Renal Crónico/terapia , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Resistencia VascularRESUMEN
BACKGROUND: Repeated pain during haemodialysis access cannulations is a serious problem for haemodialysis patients even when prescribed oral or topical analgesics. Although some studies have observed the efficacy of music therapy for improving pain and anxiety, its effectiveness during haemodialysis access cannulations during dialysis is uncertain. The purpose of this study is to investigate the effects of music therapy for pain when cannulating haemodialysis access for haemodialysis patients. METHODS: A prospective, multi-facility, single-blind, crossover, randomised controlled trial will be implemented. The intervention includes listening to Mozart, along with a white noise control condition. One hundred twenty haemodialysis patients will be enrolled across five facilities. Patients will be randomly allocated to either an Early-sequence group or a Later-sequence group. The Early-sequence group will receive cannulation while listening to Mozart's Sonata for two pianos in D major (K.448) during the second week (Music period) and white noise during the fourth week (White noise period). The Later-sequence group will receive cannulation along with white noise first, followed by Mozart. All patients will also undergo cannulation during a no-sound period (wearing only headphones) during the first and third week (No-sound period). The music or no-music protocol will begin 8 min prior to the cannulating procedure, and participants will finish listening after starting haemodialysis during each period. The primary outcomes that will be assessed include the Visual Analogue Scale (VAS) score for pain during cannulation, and secondary outcomes are blood pressure, heart rate, VAS anxiety score, State-Trait Anxiety Inventory score, and salivary amylase activity. The operators who are in charge of haemodialysis access cannulation will be blind to the listening condition and VAS report. DISCUSSION: The proposed study has several methodological benefits. First, using white noise is a suitable control condition for addressing the role of sound in pain management. Additionally, using a crossover design with repeated measurements can help control individual differences between participants, which should better distinguish between- and within-participant variability. Overall, music therapy is a safe and inexpensive intervention that does not have the problematic side effects typically associated with pharmacological treatment. If effective, music therapy can be easily implemented for reducing pain and anxiety during cannulation. TRIAL REGISTRATION: This trial was prospectively registered to UMIN Clinical Trials Registry on 1 July 2018 (UMIN 000032850).
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Musicoterapia/métodos , Manejo del Dolor/métodos , Diálisis Renal , Cateterismo , Estudios Cruzados , Humanos , Evaluación de Resultado en la Atención de Salud , Estudios Prospectivos , Proyectos de Investigación , Método Simple CiegoRESUMEN
BACKGROUND: This study investigated the association between circadian hemodynamic characteristics and asymptomatic hypertensive organ damage. METHODS: Circadian hemodynamics, including 24-hour brachial and aortic systolic blood pressure (SBP), pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 284 essential hypertensive patients (67.8 ± 16.0 years, 54% female). Hypertensive target organ damage (TOD), namely carotid wall thickening, left ventricular hypertrophy, and albuminuria, was assessed in all patients. RESULTS: Office SBP and 24-hour brachial and aortic SBP all increased with increasing number of organs involved (all P < 0.01 for trend). After multivariate logistic regression analysis, 24-hour brachial SBP (odds ratio [OR] = 1.04 for 1 mm Hg increase, P < 0.001) as well as aortic SBP (OR = 1.03 for 1 mm Hg increase, P < 0.05) maintained significance. Percent decrease during nighttime in brachial SBP, PWV, and TVR, but not cardiac index, showed a significant graded relationship with the number of organs involved. In a multivariate stepwise regression model, the nighttime values of brachial SBP, PWV, and TVR emerged as independent predictors of the presence of TOD. CONCLUSION: In essential hypertension, 24-hour aortic SBP could be a marker of subclinical TOD, and further, the blunted nocturnal BP reduction in TOD patients might be mediated by disturbed circadian hemodynamic variations in aortic SBP, vascular resistance, and arterial stiffness.
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Ritmo Circadiano , Hipertensión Esencial/fisiopatología , Hemodinámica , Adulto , Anciano , Anciano de 80 o más Años , Albuminuria/epidemiología , Albuminuria/fisiopatología , Presión Arterial , Determinación de la Presión Sanguínea , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedades de las Arterias Carótidas/fisiopatología , Hipertensión Esencial/diagnóstico , Hipertensión Esencial/epidemiología , Femenino , Humanos , Hipertrofia Ventricular Izquierda/epidemiología , Hipertrofia Ventricular Izquierda/fisiopatología , Japón/epidemiología , Enfermedades Renales/epidemiología , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Análisis de la Onda del Pulso , Factores de Riesgo , Factores de Tiempo , Resistencia Vascular , Rigidez VascularRESUMEN
OBJECTIVE: The present study aimed to compare circadian hemodynamic characteristics in hypertensive patients with and without primary aldosteronism. METHODS: Circadian hemodynamics, including 24-h brachial and central blood pressure (BP), SBP variability indices, central pulse wave velocity (PWV), augmentation index (AIx@75), cardiac index, and total vascular resistance (TVR), were evaluated using an oscillometric device, Mobil-O-Graph, in 60 patients with primary aldosteronism (63.4±13.3 years, 47% women) and 120 age-matched and sex-matched patients with essential hypertension. RESULTS: Office SBP, PWV, AIx@75, and BP variability indices were similar between groups; however, 24-h brachial (124â±â14 vs 130â±â11âmmHg) as well as central (112â±â12 vs 120â±â10 mmHg) SBP was higher (both Pâ<â0.01), and the difference between 24-h brachial and central SBP (11â±â5 vs 9â±â3âmmHg, Pâ<â0.05), an index of pressure amplification, was smaller in primary aldosteronism than in essential hypertension. In both groups, cardiac index decreased from daytime to night-time (both Pâ<â0.01), but this decrease was smaller in primary aldosteronism (Pâ<â0.05). During daytime, TVR in primary aldosteronism was higher than that in essential hypertension (Pâ<â0.05), and the significant increase of TVR from daytime to night-time was lost in primary aldosteronism. In a multivariate stepwise regression model, primary aldosteronism emerged as an independent predictor of 24-h central SBP as well as the difference between 24-h brachial and central SBP. CONCLUSION: Our results demonstrated that circadian hemodynamics in primary aldosteronism patients are characterized by increased central SBP, smaller disparity between brachial and central SBP, and disturbed circadian hemodynamic variation.
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Ritmo Circadiano/fisiología , Hipertensión Esencial/fisiopatología , Hiperaldosteronismo/fisiopatología , Anciano , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Gasto Cardíaco , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oscilometría , Análisis de la Onda del Pulso , Sístole , Resistencia VascularRESUMEN
OBJECTIVE: We investigated the impact of renal function on outcomes after percutaneous transluminal angioplasty. METHODS: A total of 139 hypertensive patients with atherosclerotic renal artery stenosis (mean age, 70 years, 80.6% men) who underwent renal percutaneous transluminal angioplasty were included. Renal function was evaluated on the basis of estimated glomerular filtration rate (eGFR) and albuminuria/proteinuria, and classified into three categories according to eGFR (≥45, 30-44, and <30âml/min/1.73âm) and albuminuria/proteinuria [normal-to-mild: albumin/creatinine ratio (ACR) less than 3.0, protein/creatinine ratio (PCR) less than 15; moderate: ACR 3.0-30.0, PCR 15-50; severe: ACRâ>â30.0, PCRâ>â50âmg/mmol]. RESULTS: During a median follow-up of 5.4 years, 36.0% of patients developed the primary composite end point, including cardiovascular and renal outcomes. In multivariate Cox regression analysis, eGFR less than 30 (hazard ratio 3.47, Pâ<â0.01) as well as severe albuminuria/proteinuria (hazard ratio 2.63, Pâ<â0.05) was an independent predictor of worse outcome. In the subgroup without events within 1 year after angioplasty (nâ=â117), the outcome differed among the three renal functional categories at 1 year based on eGFR (log-rank χâ=â16.28, Pâ<â0.001) as well as on albuminuria/proteinuria (log-rank χâ=â8.30, Pâ<â0.05). At 1 year, 24 patients (20.1%) showed at least 20% decrease in eGFR, and their outcome was worse than that in those with at least 20% increase (nâ=â23) (hazard ratio 3.50, Pâ<â0.05). Multiple logistic regression analysis indicated that pretreatment moderate-to-severe albuminuria/proteinuria was an independent predictor of at least 20% eGFR decrease (odds ratio 2.82, Pâ<â0.05). CONCLUSION: Impaired renal function, and in particular, a poor response of eGFR to angioplasty, is associated with worse outcome. Therapeutic effectiveness of renal angioplasty seems to be limited in patients with albuminuria/proteinuria.
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Angioplastia , Hipertensión/complicaciones , Obstrucción de la Arteria Renal/fisiopatología , Anciano , Anciano de 80 o más Años , Albuminuria/fisiopatología , Aterosclerosis/fisiopatología , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Hipertensión/fisiopatología , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Modelos de Riesgos Proporcionales , Proteinuria/fisiopatología , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/terapia , Insuficiencia Renal/complicaciones , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
It currently remains unclear whether stroke volume variation (SVV) before hemodialysis (HD) is an independent predictor of decreased blood pressure (BP) during HD. Fifty-two patients were divided into two groups (Decreased BP during HD group: N = 10, Non-decreased BP group: N = 42). Fractional shortening was lower, and mean arterial pressure (MAP) and SVV were higher in the Decreased BP during HD group. A multiple logistic regression analysis identified low fractional shortening, high MAP, and high SVV as independent predictors of decreased BP during HD. The areas under the ROC curves were as follows: 0.849 for MAP, 0.712 for SVV, and 0.893 for MAP and SVV. Optimal threshold values were 93.0 mm Hg for MAP and 17.3 % for SVV. A multivariate regression analysis identified anemia and a longer dialysis vintage as independently related factors for higher SVV. Our results suggest that high SVV is an independent predictor for decreased BP during HD.
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Hipotensión/diagnóstico , Diálisis Renal , Volumen Sistólico/fisiología , Anciano , Presión Sanguínea/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROCRESUMEN
This study included 126 hypertensive patients with renal artery stenosis (mean age, 63 years; 22.2% fibromuscular dysplasia [FMD]) and investigated the effects of percutaneous transluminal renal angioplasty on office and home blood pressure (BP), and BP variability estimates derived from home BP, both at baseline and up to 12 months after angioplasty. Home BP was measured for 7 consecutive days, and the threshold defining uncontrolled home BP was ≥135/85 mm Hg. In both the FMD and atherosclerotic stenosis (ARAS) groups, office and home BP decreased significantly after angioplasty (all P<0.01), but the decrease in morning home (-22±19 versus -10±20 mm Hg; P<0.01) but not in office (-32±24 versus -23±28 mm Hg; P=0.11) systolic BP at 12 months was significantly greater in FMD. In both groups, all morning BP variability indices except the coefficient of variation in ARAS decreased significantly after revascularization (all P<0.05 by repeated-measures ANOVA). The decrease in all morning systolic BP variability estimates was greater for FMD than for ARAS (all P<0.05 by 2-way repeated-measures ANOVA), with the exception of variability independent of the mean (P=0.11). The prevalence of uncontrolled home BP was 77.0% at baseline and 38.9% after revascularization. Duration of hypertension (odds ratio, 1.48), ARAS (odds ratio, 3.18), and the presence of proteinuria (odds ratio, 2.10) were independent predictors of uncontrolled home BP after revascularization (all P<0.05). In conclusion, renal angioplasty produced a greater decrease of morning home systolic BP in FMD; however, in both groups, it decreased BP variability irrespective of BP response. Measurement of home BP seems to be important for treatment success, especially in ARAS.
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Angioplastia/métodos , Monitoreo Ambulatorio de la Presión Arterial/métodos , Presión Sanguínea/fisiología , Hipertensión Renovascular/cirugía , Obstrucción de la Arteria Renal/cirugía , Arteria Renal/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Humanos , Hipertensión Renovascular/etiología , Hipertensión Renovascular/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Renal/diagnóstico por imagen , Arteria Renal/fisiopatología , Obstrucción de la Arteria Renal/complicaciones , Obstrucción de la Arteria Renal/diagnóstico , Estudios Retrospectivos , Resultado del Tratamiento , Ultrasonografía Doppler Dúplex , Adulto JovenRESUMEN
Uric acid (UA) has been associated with hypertension, renal disease and cardiovascular disease. The aim of the present study was to compare the UA-lowering effects of a standard dose of the UA synthesis inhibitor febuxostat to a standard dose of the uricosuric agent benzbromarone, and to investigate the effects of a low-dose combination of both agents in hypertensive patients with hyperuricemia. Twenty hypertensive patients with inadequate UA control were administered febuxostat 40 mg (Feb), benzbromarone 50 mg (Ben) and febuxostat 20 mg and benzbromarone 25 mg (feb/ben) for 3 months each in a randomized modified crossover manner. UA metabolism, blood pressure (BP) and the indices of organ damage were assessed at baseline and the end of each treatment period. No significant changes were observed in BP or estimated glomerular filtration rate (eGFR) after the treatment with each UA-lowering regimen. The change in UA was significantly greater with feb/ben than with Feb. The excretion of UA and clearance of UA were higher with Ben than with Feb and feb/ben. Urinary 8-hydroxydeoxyguanosine and liver-type fatty-acid-binding protein levels were slightly lower with Ben, whereas flow-mediated dilation was slightly higher with feb/ben and Ben. The UA-lowering effects of the low-dose combination of the UA synthesis inhibitor and uricosuric agent were greater than those of the standard dose of each agent alone. The uricosuric agent may be more effective at improving vascular function than the UA synthesis inhibitor. Thus, the appropriate management of hyperuricemia with uricosuric drugs appears to be useful for hypertensive patients with hyperuricemia.
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Benzbromarona/uso terapéutico , Febuxostat/uso terapéutico , Supresores de la Gota/uso terapéutico , Hipertensión/complicaciones , Hiperuricemia/tratamiento farmacológico , Ácido Úrico/sangre , Anciano , Estudios Cruzados , Quimioterapia Combinada , Femenino , Humanos , Hipertensión/sangre , Hiperuricemia/sangre , Hiperuricemia/complicaciones , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: Percutaneous transluminal renal angioplasty (PTA) is one of the standard treatments for renal artery stenosis (RAS). We investigated the frequency and risk factors for restenosis, and its impact on blood pressure (BP) control. METHODS: A total of 175 hypertensive patients with RAS [mean age 60 years; 34% women; 30.3% fibromuscular dysplasia (FMD)] with 207 treated renal arteries were included and followed for more than 1 year without reangioplasty. Diagnosis of restenosis was based on duplex ultrasonographic findings, and data including BP and antihypertensive medication were collected consecutively. RESULTS: During follow-up (mean, 5.1 years), 56 patients (32.0%) developed restenosis. In multivariate Cox regression analysis, FMD was an independent predictor of restenosis (hazard ratio 2.65, Pâ<â0.05). When divided into two groups based on FMD or atherosclerotic RAS (ARAS), the presence of previous cardiovascular disease (hazard ratio 2.84) as well as severe RAS (≥90%) (hazard ratio 3.95) in ARAS were independent predictors of restenosis (Pâ<â0.05, respectively). At 1 year after PTA, 35 patients (20.0%) had developed restenosis. When divided into four groups on the basis of FMD or ARAS, and the absence/presence of restenosis at 1 year, the number of antihypertensive drugs was significantly lower in both FMD and ARAS patients without restenosis (Pâ<â0.01, respectively); however, a significant difference in decrease in SBP (-31â±â19 vs. -12â±â25âmmHg, Pâ<â0.05) as well as cure of hypertension (36.4 vs. 5.0%, Pâ<â0.01) between the absence/presence of restenosis was found only in FMD patients. CONCLUSION: The frequency of restenosis after renal PTA is significant, and the presence of restenosis diminishes the benefit of its treatment, especially for FMD.
Asunto(s)
Arteriosclerosis/complicaciones , Presión Sanguínea , Displasia Fibromuscular/epidemiología , Hipertensión/fisiopatología , Obstrucción de la Arteria Renal/epidemiología , Obstrucción de la Arteria Renal/fisiopatología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia , Antihipertensivos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/tratamiento farmacológico , Incidencia , Masculino , Persona de Mediana Edad , Recurrencia , Obstrucción de la Arteria Renal/etiología , Obstrucción de la Arteria Renal/cirugía , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
The aim of the present study was to investigate trends in the awareness of salt restriction and actual salt intake in hypertensive patients at a hypertension clinic and general clinic following guidance regarding salt restriction. Subjects comprised 107 patients (mean age 71 ± 12 years) who were followed at a hypertension clinic and 164 patients (mean age 68 ± 11 years) who were followed at a general clinic. Estimated salt intake using spot urine samples and awareness of salt intake using a self-description questionnaire were assessed in 2013 and one year after guidance regarding salt restriction. No significant changes were observed in office blood pressure at the two clinics. Estimated salt intake in 2013 was slightly lower at the hypertension clinic than at the general clinic (8.9 ± 2.5 vs 9.3 ± 2.5 g/day). Estimated salt intake decreased and the awareness of salt intake improved significantly after one year at both clinics; however, the reduction in estimated salt intake was larger at the general clinic than that at the hypertension clinic (-1.6 ± 3.2 vs -0.6 ± 2.9 g/day, p < 0.01). Individual guidance including data on actual salt intake appeared to be effective and important for reducing salt intake in hypertensive patients.
Asunto(s)
Concienciación , Presión Sanguínea/fisiología , Dieta Hiposódica/métodos , Hospitales Generales , Hospitales Especializados , Hipertensión/dietoterapia , Cloruro de Sodio Dietético/administración & dosificación , Anciano , Presión Sanguínea/efectos de los fármacos , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/fisiopatología , Hipertensión/psicología , Masculino , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
The aim of the present study was to compare the effects of the aldosterone blocker eplerenone and thiazide-like diuretic indapamide on blood pressure (BP) and target organs with reference to salt intake in hypertensive outpatients. Twenty hypertensive patients (nine women and 11 men, mean age 71 ± 13 years) with inadequate BP control despite taking calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) were administered eplerenone (50 mg/day) or indapamide (1 mg/day) for 3 months each in a randomized crossover manner. Salt intake, BP and indices of organ damage were assessed at baseline and at the end of each treatment period. Eplerenone and indapamide were similarly effective in lowering office and home BPs. Both the treatments significantly reduced the estimated glomerular filtration rate (eGFR) and increased serum uric acid levels. The treatment with eplerenone significantly increased serum potassium levels, whereas the treatment with indapamide significantly decreased them. The treatment with eplerenone significantly decreased pulse wave velocity and urinary 8-hydroxydeoxyguanosine levels. These changes were not significantly affected by the treatment with indapamide. In conclusion, eplerenone and indapamide were similarly effective in lowering office and home BPs in hypertensive patients treated with CCBs and ARBs. Eplerenone may exert more favorable effects on arterial stiffness and oxidative stress.
Asunto(s)
Presión Sanguínea/efectos de los fármacos , Hipertensión , Indapamida/administración & dosificación , Espironolactona/análogos & derivados , 8-Hidroxi-2'-Desoxicoguanosina , Anciano , Determinación de la Presión Sanguínea/métodos , Bloqueadores de los Canales de Calcio/uso terapéutico , Desoxiguanosina/análogos & derivados , Desoxiguanosina/orina , Diuréticos/administración & dosificación , Eplerenona , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/metabolismo , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Potasio/sangre , Análisis de la Onda del Pulso/métodos , Espironolactona/administración & dosificación , Resultado del Tratamiento , Ácido Úrico/sangreRESUMEN
PURPOSE: To identify candidates for PTRA in terms of the preservation of renal function, we herein evaluated factors that caused worsening renal function (WRF) after PTRA. METHODS: We evaluated 92 patients with atherosclerotic renal artery stenosis (mean age 70.7 ± 8.4 years). WRF was defined as a ≥0.3 mg/dL increase in creatinine levels after PTRA compared to before PTRA. RESULTS: A total of 92 patients exhibited non-WRF 83 (90.2%), WRF 9 (9.8%). Significant differences were observed in serum creatinine levels between two groups both before (non-WRF 1.34 ± 0.49 versus WRF 1.70 ± 0.68 mg/dL, p = 0.0462) and after PTRA (non-WRF 1.31 ± 0.43 versus WRF 2.42 ± 1.12 mg/dL, p < 0.0001). Patients with WRF had higher comorbidity rate of diabetes mellitus (DM) (non-WRF 31.3% versus WRF 66.7%, p = 0.0345) and proteinuria (non-WRF 27.7% versus WRF 66.7%, p = 0.0169), and had higher systolic blood pressure (non-WRF 143.6 ± 18.7 versus WRF 157.1 ± 19.9 mmHg, p = 0.0436), higher plasma B-type natriuretic peptide (BNP) levels, and larger left atrial and left ventricular end-diastolic dimensions before PTRA. Patients with WRF had a higher rate of taking diuretics (non-WRF 27.7% versus WRF 66.7%, p = 0.0169) after PTRA. Multiple logistic regression analysis revealed that comorbidity of DM was an independent related factor for WRF (comorbidity of DM, yes: OR 31.0, 95% CI 2.44-1024.62, p = 0.0055). CONCLUSIONS: Comorbidity of DM, coexisting of proteinuria, high creatinine level, high blood pressure, high BNP levels, and large left atrial and ventricular dimensions were related to WRF after PTRA in patients with atherosclerotic renal artery stenosis.
Asunto(s)
Angioplastia/efectos adversos , Riñón/fisiopatología , Obstrucción de la Arteria Renal , Arteria Renal , Insuficiencia Renal , Anciano , Angioplastia/métodos , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertrofia Ventricular Izquierda/diagnóstico , Pruebas de Función Renal/métodos , Pruebas de Función Renal/estadística & datos numéricos , Masculino , Péptido Natriurético Encefálico/análisis , Arteria Renal/patología , Arteria Renal/cirugía , Obstrucción de la Arteria Renal/diagnóstico , Obstrucción de la Arteria Renal/fisiopatología , Obstrucción de la Arteria Renal/cirugía , Insuficiencia Renal/diagnóstico , Insuficiencia Renal/etiología , Insuficiencia Renal/fisiopatología , Factores de RiesgoRESUMEN
The purpose of the present study was to investigate awareness of salt restriction and actual salt intake in hypertensive patients at a hypertension clinic and general clinic. Subjects included 330 patients, with a mean age of 69±12 years, who were followed at a hypertension clinic and 200 patients, with a mean age of 67±11 years, who were followed at a general clinic. We estimated 24-h salt excretion using spot urine samples and checked the awareness of salt intake using a self-description questionnaire. The number of antihypertensive drugs available at the hypertension clinic was significantly higher than that at the general clinic (2.2±1.1 versus 1.6±0.9, p<0.01); however, no significant difference was observed in office systolic blood pressure between the two groups. Urinary salt excretion was significantly lower at the hypertension clinic than at the general clinic (8.7±2.5 versus 9.3±2.5 g/d, p<0.01). The rate of achievement of salt intake<6 g/d was 15% at the hypertension clinic and 6% at the general clinic. In patients with excessive salt intake (≥10 g/d), 28% of patients at the hypertensive clinic and 23% at the general clinic thought that their salt intake was low. Urinary salt excretion in hypertensive patients was lower at a hypertensive clinic than at a general clinic. This may be due to the professional nutritional guidance at the hypertension clinic. However, most patients could not comply with the guidelines, and the awareness of salt restriction in patients with excessive salt intake was low.
Asunto(s)
Concienciación , Presión Sanguínea/efectos de los fármacos , Dieta Hiposódica , Hospitales Generales , Hipertensión/psicología , Cooperación del Paciente , Cloruro de Sodio Dietético/efectos adversos , Adulto , Anciano , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Cloruro de Sodio/orina , Encuestas y CuestionariosRESUMEN
A 76-year-old man with lung cancer and multiple metastases was admitted for purpura and rapidly progressive glomerulonephritis. Adenosquamous cell carcinoma of the lung had been diagnosed 6 months earlier. Two anti-cancer drug regimens had no effect. At admission, his survival with his malignancy was estimated to be several months. Renal biopsy revealed pauci-immune necrotizing crescentic glomerulonephritis (CrGN). Negative results were obtained for myeloperoxidase-anti-neutrophil cytoplasmic antibody (ANCA) and proteinase-3-ANCA by enzyme-linked immunosorbent assay, and for peripheral-ANCA and cytoplasmic-ANCA by indirect immunofluorescence. He was diagnosed with ANCA-negative pauci-immune CrGN. Although steroids were initiated, the patient died of renal failure and intestinal bleeding 2 weeks later. It was later found that cancer cells were positive for interleukin (IL)-6 and that serum IL-6 levels were significantly elevated, concomitantly with increased IL-8, granulocyte-colony stimulating factor and transforming growth factor-ß levels. Some kinds of lung cancer are known to produce IL-6 that activate neutrophils and are related to ANCA-associated CrGN. It appears that IL-6 can activate neutrophils in the pathogenesis of ANCA-negative pauci-immune CrGN with lung cancer. Therapy that blocks IL-6 may prove to be effective in vasculitis and cancer-related symptoms in such cases.
RESUMEN
The incidence of metastatic calcification is influenced by high serum calcium and phosphate concentrations and local physicochemical conditions, such as pH. A high pH accelerates tissue calcification. Patients with milk-alkali syndrome typically present with renal failure, hypercalcemia, and metabolic alkalosis, which are caused by the ingestion of calcium and absorbable alkali. Among patients with impairment of renal function, milk-alkali syndrome is a major cause of hypercalcemia. Long-term use of furosemide will lead to hypokalemia, metabolic alkalosis, and eventually renal failure (i.e., pseudo-Bartter syndrome). Even if the level of calcium ingestion is relatively low, the renal failure caused by long-term furosemide use can readily lead to milk-alkali syndrome. We describe a case of a 45-year-old woman who was admitted with cough and dyspnea and presented with pulmonary and gastric metastatic calcification. She had been taking alfacalcidol and oral alkaline medications such as sodium bicarbonate and calcium carbonate as well as oral furosemide for a long time. The patient was found to have hypercalcemia, chronic renal failure, and metabolic alkalosis, so milk-alkali syndrome was diagnosed. Saline was administered and oral medications were discontinued. Serum creatinine levels subsequently decreased, but pulmonary metastatic calcification was not diminished. In this case, the milk-alkali syndrome that caused the severe metastatic calcification was exacerbated by multiple factors, including oral alkaline medications such as sodium bicarbonate and calcium carbonate. In addition, metabolic alkalosis and renal failure were affected by long-term furosemide use (i.e., pseudo-Bartter syndrome).