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1.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 407-412, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185139

RESUMO

Objetivo. Identificar el patrón de práctica clínica habitual respecto al tratamiento crónico con sacubitrilo-valsartán (SV) durante los episodios de insuficiencia cardiaca aguda (ICA), sus determinantes y su efecto sobre la evolución. Método. Estudio exploratorio de pacientes con ICA incluidos en el Registro EAHFE-6 en tratamiento crónico con SV. Se recogieron características basales, del episodio y del tratamiento con SV, y se identificaron factores relacionados con la interrupción de SV y su asociación con eventos adversos 180 días postevento índice (mortalidad por cualquier causa) y postalta (reconsulta a urgencias u hospitalización por ICA, muerte o evento combinado). Resultados. Se incluyeron 50 pacientes (mediana desde inicio de SV: 81 días; RIC: 43-284) y SV se interrumpió en 19 casos (38%; 5 en urgencias, 14 en hospitalización). Se identificó un motivo de retirada en 16 casos (4 por insuficiencia renal; y 3 por hipotensión arterial, hiperpotasemia, debilidad/mareo y empeoramiento de ICA, respectivamente). La retirada de SV se asoció con edad avanzada, no estar en tratamiento con betabloqueantes e hiperpotasemia. No hubo diferencias significativas entre grupos en eventos adversos a los 180 días postevento índice o postalta. Conclusión. En los pacientes en tratamiento crónico con SV que presentan ICA, este es suspendido en más de un tercio de casos, si bien ello no se asocia con cambios evolutivos


Objectives. To describe the pattern of care usually given to patients with acute heart failure (AHF) who are taking sacubitril/valsartan (SV) and to explore the effects of care characteristics on clinical outcomes. Methods. Exploratory study of AHF cases in patients taking SV who were included in the register for the Epidemiology of Acute Heart Failure in Emergency Departments during the sixth period of data collection (EAHFE-6). We extracted baseline and episode variables and information related to SV treatment. We also analyzed associations between the discontinuation of SV therapy and adverse events within 180 days (all-cause mortality) and after discharge (emergency revisits, admission for AHF, death from any cause, or a composite event). Results. Fifty patients on SV were included. The median time on SV therapy was 81 days (interquartile range, 43-284 days). SV was discontinued in 19 cases (38%; 5 in the emergency department and 14 on the ward). Sixteen records specified the reason for discontinuing SV: renal insufficiency, 4 cases; arterial hypotension, 3; weakness/dizziness, 3; and exacerbated AHF, 3. SV discontinuation was associated with older age, absence of treatment with a betablocker, and hyperkalemia. The EAHFE-6 cases did not reveal significant differences related to SV discontinuation with respect to the rates of adverse events within 180 days or on discharge after the index event. Conclusions. Long-term SV therapy is discontinued in over a third of patients who present with exacerbated AHF even though no association with clinical outcomes could be identified


Assuntos
Humanos , Masculino , Feminino , Idoso , Insuficiência Cardíaca/tratamento farmacológico , Serviços Médicos de Emergência , Hospitalização , Valsartana/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Antagonistas Adrenérgicos beta/uso terapêutico , Hiperpotassemia/tratamento farmacológico
3.
Arch. Soc. Esp. Oftalmol ; 94(7): 355-358, jul. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185192

RESUMO

Varón de 32 años que acude con un cuadro agudo bilateral caracterizado por visión borrosa, ojo rojo, fotofobia severa y dolor ocular tras un cuadro seudogripal. El paciente presentaba un cuadro con afectación bilateral caracterizado por pupilas en midriasis media, escasamente reactivas a la luz, transiluminación del iris, despigmentación difusa del estroma iridiano, dispersión de pigmento en la cámara anterior e hipertensión ocular. Tras el examen ocular se descartó un cuadro inflamatorio y un glaucoma pigmentario. El paciente presentaba características tanto de la despigmentación como de la transiluminación bilateral de iris. Ambas entidades podrían formar parte del espectro de la misma enfermedad


The case is presented of a 32 year-old male who arrived with acute bilateral symptoms with blurred vision, red eye, severe photophobia and severe ocular pain after suffering from a flu-like syndrome. The patient presented with a clinical picture of bilateral involvement characterised by pupils in mid-mydriasis, scarcely reactive to light, iris transillumination, diffuse depigmentation of the iridian stroma, pigment dispersion in the anterior chamber, and ocular hypertension. After the eye examination an inflammatory syndrome and pigmentary glaucoma were ruled out. The patient showed depigmentation characteristics as well as bilateral iris transillumination. Both conditions could form part of the spectrum of the same disease


Assuntos
Humanos , Masculino , Adulto , Doenças da Íris/diagnóstico , Doença Aguda , Anti-Hipertensivos/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Epitélio Posterior/patologia , Glaucoma de Ângulo Aberto/diagnóstico , Iridociclite/diagnóstico , Doenças da Íris/tratamento farmacológico , Doenças da Íris/etiologia , Midríase/etiologia , Hipertensão Ocular/complicações , Pan-Uveíte/complicações , Pigmentos Biológicos/análise , Prednisolona/uso terapêutico , Lâmpada de Fenda , Síndrome , Transiluminação
4.
Farm. comunitarios (Internet) ; 11(2): 5-13, jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186873

RESUMO

Introducción: el proyecto mundial May Measurement Month pretende sensibilizar a la población de todos los países participantes, entre ellos España, sobre la importancia de la medida periódica de las cifras de presión arterial (PA). Objetivo: el objetivo principal de este estudio es difundir entre la población española, a través de las farmacias comunitarias, la importancia de conocer sus cifras de PA para poder prevenir los problemas derivados de su mal control. Métodos: estudio descriptivo transversal realizado en farmacias comunitarias de las 17 comunidades autónomas españolas durante el mes de mayo 2017. Participaron voluntarios mayores de edad. Variables principales: presión arterial sistólica (PAS), presión arterial diastólica (PAD) en milímetros de mercurio (mmHg) y frecuencia cardíaca en latidos/minuto.Resultados: se realizaron 3.267 determinaciones por 190 farmacéuticos. El 25,6 % de los participantes tenía cifras elevadas de PA. El 40,6 % del total estaba con tratamiento para la hipertensión arterial. El 40,2 % de los que estaban en tratamiento no tenían la PA controlada. El 43,3 % de los participantes con cifras de PA elevada no recibía tratamiento. Conclusiones: la campaña MMM17 se difundió a través de las farmacias comunitarias en todas las comunidades autónomas y ha permitido realizar medidas de PA a sujetos que nunca y/o que hacía más de un año que se la habían medido. Un cuarto de la población mostraba valores elevados de PA. El grado de control en los participantes con tratamiento antihipertensivo era malo y casi la mitad de los que tenían valores elevados de PA no recibía tratamiento


Introduction: May Measurement Month is a global project that aims to raise awareness among the population in all participating countries, including Spain, of the importance of regular measurement of blood pressure (BP). Aim: The primary objective of this research is to raise awareness among the Spanish population through the community pharmacies of the importance of knowing their BP figures in order to prevent problems resulting from poor control. Methods: Cross-sectional descriptive study carried out in community pharmacies of the 17 Spanish Autonomous Communities during the month of May 2017. Volunteer adults participated. Primary endpoints: systolic blood pressure (SBP), diastolic blood pressure (DBP) in millimetres of mercury (mmHg) and heart rate in beats per minute. Results: 3.267 measurements were performed by 190 pharmacists. 25.6% of participants had high BP figures. 40.6% of the total were treated for hypertension. 40.2% of those on treatment had uncontrolled BP. 43.3% of participants with high BP figures were untreated. Conclusions: MMM17 campaign was spread through community pharmacies in all Autonomous Communities and has allowed to carry out BP measurements in patients who had never been measured and/or who had it measured more than a year ago. A quarter of the population showed high BP values. The degree of control in participants with antihypertensive treatment was poor and almost half of those with elevated BP values were untreated


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Promoção da Saúde/organização & administração , Pressão Arterial , Farmácias/organização & administração , Farmacêuticos/normas , Espanha , Epidemiologia Descritiva , Estudos Transversais , Tamanho da Amostra , Pressão Sanguínea , Tabagismo/complicações , Anti-Hipertensivos
6.
Hipertens. riesgo vasc ; 36(1): 44-52, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181584

RESUMO

Se estima que alrededor del 10 al 30% de los pacientes hipertensos pueden considerarse como resistentes al tratamiento (HR). Estos pacientes son definidos como aquellos no controlados con 3 fármacos, a las dosis máximas toleradas, incluyendo un diurético, como así también aquellos con una presión arterial controlada con 4 fármacos o más. Se utiliza este término con el fin de identificar a los pacientes que pueden beneficiarse de consideraciones diagnósticas y/o terapéuticas especiales. Recientemente, el término «hipertensión refractaria» se ha propuesto como un nuevo fenotipo de insuficiencia antihipertensiva. Estos pacientes son aquellos cuya presión arterial no puede controlarse con el tratamiento máximo. Los primeros estudios de este fenotipo indican que es poco común y afecta a menos del 5% de los pacientes con HR. La adhesión o cumplimiento del tratamiento médico es vital para asegurar la definición de hipertensión resistente. Desde la publicación de la primera declaración científica para el diagnóstico, evaluación y tratamiento de la HR de la American Heart Association en 2008, y en las guías europeas, se ha establecido una mayor atención en la investigación clínica y experimental. En esta revisión se expondrán los conceptos relacionados con prevalencia, pronóstico y cumplimiento abarcando las últimas novedades sobre el tema


An estimated 10% to 20% of hypertensive patients could be considered resistant to treatment (RH). These are patients who are not controlled using three drugs, at the maximum tolerated doses, including a diuretic, as well as those with high blood pressure controlled using four or more drugs. The term is used to identify patients that might benefit from special diagnostic and/or therapeutic consideration. The term 'refractory hypertension' has recently been proposed as a novel phenotype of antihypertensive failure. It refers to patients whose blood pressure cannot be controlled with maximum treatment. The first studies of this phenotype indicate that it is rare and affects less than 5% of patients with RH. Adherence to or compliance with medical treatment is key to defining resistant hypertension. Closer attention has been paid to clinical and experimental research since the first scientific statement for the diagnosis, assessment and treatment of RH from the American Heart Association, and in the European guidelines, was published in 2008. This review will set out the concepts relating to prevalence, prognosis and compliance and cover the latest developments on this subject


Assuntos
Humanos , Hipertensão/classificação , Hipertensão/epidemiologia , Adesão à Medicação , Prognóstico , Hipertensão/fisiopatologia , Anti-Hipertensivos/administração & dosagem , Estudos de Coortes , Fatores de Risco , Cooperação do Paciente
9.
Nefrología (Madrid) ; 39(1): 67-72, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181911

RESUMO

Introducción: El presente estudio tiene como objetivo destacar la importancia de la monitorización ambulatoria de la presión arterial (MAPA) y de los parámetros de lesión subclínica de órgano diana en el diagnóstico de hipertensión refractaria (HR). Métodos: Se estudiaron pacientes con diagnóstico de HR (n = 112). Se analizaron variables demográficas, antropométricas, riesgo cardiovascular y lesión subclínica de órgano diana y se relacionaron con la confirmación de HR a través de la MAPA. Resultados: Del total de 112 pacientes con el diagnóstico de HR derivados desde atención primaria se confirmaron mediante MAPA el 61,6% de los casos (n = 69). Se observaron diferencias estadísticamente significativas (p < 0,001) en la aparición de lesión subclínica de órgano diana en los hipertensos refractarios respecto a los pseudorrefractarios. Un 84% de los pacientes con HR presentaban microalbuminuria: 66,25 ± 30,7 mg/dl). El 44,9% tienen una enfermedad renal crónica estadio 3 con filtrado glomerular medio de 59 ml/min/1,73 m2. El 56,5% presentaba hallazgos ecocardiográficos de hipertrofia de ventrículo izquierdo. El examen de fondo de ojo reveló que un 64% de los pacientes presentaban retinopatía hipertensiva. Las 3 variables que se asociaron a mayor riesgo de HR fueron la presencia de microalbuminuria, retinopatía hipertensiva e hipertrofia de ventrículo izquierdo por ecocardiograma (OR 5,7, 6,2 y 11,2, respectivamente). Conclusiones: Nuestro estudio demuestra que la búsqueda sistemática de daño de órgano diana, especialmente en lo referente a albuminuria, es una herramienta sencilla y barata, con un valor predictivo de HR alto (85%). Podría ser de utilidad en circunstancias en las que es necesario priorizar la realización de MAPA


Introduction: We aimed to assess the effectiveness of ambulatory blood pressure monitoring (ABPM) and subclinical target organ damage parameters for diagnosis of resistant hypertension (RH). Methods: We assessed demographic and anthropometric variables, the incidence of cardiovascular events and subclinical target organ damage (n = 112). We also studied the relationship between these variables and the ABPM results. Results: Of the 112 patients referred from primary care with a diagnosis of RH, 69 (61.6%) were confirmed by ABPM. We found statistically significant differences (P < .001) between patients with RH and pseudo-resistant hypertension in the appearance of subclinical target organ damage. A percentage of 84 of the patients had microalbuminuria: 66.25 ± 30.7 mg/dl); 44.9% had stage 3 chronic kidney disease: the average glomerular filtration was 59 ml/min/1.73m2; and 56.5% had left ventricular hypertrophy on echocardiography. Fundoscopy revealed that 64% of the patients had hypertensive retinopathy. Three variables were associated with an increased HR risk: microalbuminuria, hypertensive retinopathy and left ventricular hypertrophy (OR 5.7, 6.2 and 11.2, respectively). Conclusions: This study shows that the systematic testing for target organ damage, particularly in terms of albuminuria, is a simple and inexpensive tool, with a high predictive value for RH (85%), which could be useful for prioritising patients who need ABPM


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Monitorização Ambulatorial da Pressão Arterial , Retinopatia Hipertensiva/complicações , Hipertrofia Ventricular Esquerda/complicações , Anti-Hipertensivos/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Resistência a Medicamentos , Estudos Prospectivos , Estudos Transversais , Estudos de Coortes , Fatores de Risco
10.
Hipertens. riesgo vasc ; 35(4): e11-e18, oct.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-180577

RESUMO

El ictus sigue siendo una de las principales causas de muerte y discapacidad física e intelectual en el mundo. Uno de los principales problemas ante un paciente que ha sobrevivido a un ictus es la posibilidad de que vuelva a ocurrir un nuevo episodio vascular. La hipertensión arterial es el factor de riesgo vascular modificable con mayor impacto, tanto para la prevención primaria como en la recurrencia de ictus. Uno de los objetivos del Grupo para el Estudio de la Hipertensión y el Cerebro de la Sociedad Española de Hipertensión es difundir la importancia de un control estricto de la hipertensión, en aras de evitar el desarrollo de enfermedad cerebrovascular. El presente artículo revisa las últimas evidencias en relación con el tratamiento antihipertensivo y la prevención secundaria del ictus isquémico, y establece recomendaciones prácticas para todos aquellos profesionales de la salud involucrados en el cuidado de pacientes que han sufrido un ictus


Stroke continues to be one of the leading causes of death and disability in the world. One of the main problems with a patient who has survived from a stroke is the possibility of developing a new vascular episode again. Hypertension is the modifiable vascular risk factor with the greatest impact for both primary prevention and stroke recurrence. The Group for the study of Hypertension and Brain (GEHYC) from the Spanish Society of Hypertension aims to spread the importance of strict control of blood pressure in order to prevent cerebrovascular diseases. In this article, this multidisciplinary Group reviews the latest evidence regarding antihypertensive treatment and secondary prevention of ischemic stroke


Assuntos
Humanos , Hipertensão/terapia , Acidente Vascular Cerebral/prevenção & controle , Prevenção Secundária , Anti-Hipertensivos/uso terapêutico , Pressão Arterial , Sociedades Médicas/normas , Pressão Sanguínea
11.
Pharm. pract. (Granada, Internet) ; 16(3): 0-0, jul.-sept. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174796

RESUMO

Objectives: This study was conducted to determine the source of medicines and medicine information of persons living with hypertension and diabetes in rural and urban Ghana and assessing if they are influenced by predisposing and enabling factors as defined by Andersen's behavioural model. Methods: A population based cross sectional study was conducted in four (4) rural and four (4) urban districts in the Ashanti Region of Ghana. A multistage and proportional sampling method was used in enrolling participants aged 18 years and above. A pre-tested structured questionnaire was used to collect primary data from respondents. Data collected was exported to STATA for analysis. Descriptive analysis was performed. Chi-square tests/Fisher's exact test and multinomial logistic regression models were used to establish association between variables. Results: A total of 336 self -reported persons with hypertension and diabetes were enrolled in the study with 199(59.23%) living in urban communities. The majority of participants with hypertension and diabetes living in the rural communities 77 (56.20%) were females contrasting with the male majority in urban communities 106 (53. 27%). In the rural communities, 49 (35.77%) of participants sourced medicines from the health centre while 45 (32.85%) and 35(25.55%) sourced medicines from the hospital and over the counter medicine shop (OTCMS) respectively. In the urban communities, 153 (76.88%) sourced medicines from the hospital while 33 (16.58%) sourced medicines from the pharmacy. The predisposing factor age (OR: 1.1, 95%CI 1.040-1.210) under OTCMS, age (OR 1.0, 95%CI: 1.002-1.066) under hospital and enabling factor socioeconomic status (OR: 0.3, 95%CI 0.085-0.855) under Hospital influenced participant's source of medicine in the urban communities. The results also revealed that majority of participants in both rural 99 (72.26%), and urban 164 (82.41%) communities sourced medicine information mainly from public healthcare facilities, pre-disposing factors; age (OR 1.1 95%CI 1.032-1.270) under family member, age (OR 1.1, 95%CI 1.022-1.167) under friend health professional, age (OR 1.1, 95%CI 1.050-1.147) under nearest health institution, marital status (OR: 0.004, 95%CI 0.003-0.441) under friend health Professional were found to influence participants' source of medicine information in the urban communities while in the rural communities the predisposing factor marital status (OR 10.6, 95%CI 1.044 -106.835), education (OR: 26.1, 95%CI 1.271-537.279) under friend health professional, age (OR 1.1, 95%CI 1.002-1.187), educational level (OR 30.6, 95%CI 1.718-546.668) under nearest health institution and enabling factor socio-economic status (OR 6.6, 95%CI 1.016 -43.510) under nearest health institution influenced one's source of medicine information. Conclusions: Majority of inhabitants with hypertension and diabetes in both rural and urban communities, sourced medicines and medicine information from public health institutions though a larger proportion was recorded in the urban communities. More participants in the rural communities than in the urban communities sourced medicines and medicine information from community pharmacies. Participants' source of medicine and medicine information was influenced by both predisposing and enabling factors


No disponible


Assuntos
Humanos , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Assistência Farmacêutica/organização & administração , Zona Rural , Serviços de Informação sobre Medicamentos , Informação de Saúde ao Consumidor , Diabetes Mellitus/tratamento farmacológico , Hipertensão/tratamento farmacológico , Estudos Transversais , Autorrelato , Prescrições de Medicamentos/estatística & dados numéricos , Inquéritos e Questionários , Análise Multivariada , Gana/epidemiologia
12.
Rev. esp. cardiol. (Ed. impr.) ; 71(9): 743-749, sept. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-178780

RESUMO

Introducción y objetivos: El objetivo del estudio es evaluar el efecto de aliskireno en la rigidez aórtica del paciente con síndrome de Marfan (SM). Métodos: Se reclutó a 28 pacientes con SM (media ± desviación estándar de edad, 32,6 ± 10,6 años) entre noviembre de 2009 y octubre de 2014. Todos estaban tratados con atenolol como terapia estándar con bloqueadores beta. Mediante un proceso prospectivo de aleatorización, se asignó a los participantes a tratamiento con aliskireno (150-300 mg/día vía oral) o sin tratamiento con aliskireno (controles negativos) en un diseño de etiquetado abierto. Se examinaron al inicio y a las 24 semanas la distensibilidad aórtica central y la velocidad de la onda de pulso (PWV) cuantificadas con resonancia magnética (RM), la PWV periférica, la presión aórtica central y el índice de aumento medidos por tonometría y la dilatación aórtica por ecocardiografía. El objetivo primario fue la distensibilidad aórtica central por RM. Resultados: En el análisis de la diferencia entre el examen basal y a las 24 semanas en el grupo tratado frente a los controles negativos, la distensibilidad aórtica central (general; p = 0,26) y la PWV central (0,2 ± 0,9 frente a 0,03 ± 0,7 m/s; p = 0,79) medidas con RM no fueron significativas. La presión sistólica central en la aorta era de 14 mmHg, menor en los pacientes tratados que en los controles (p = 0,09). Se observó una reducción significativa de la PWV periférica (brazo-tobillo) en el grupo tratado (-1,6 m/s) respecto a los controles (+0,28 m/s; p = 0,005). Conclusiones: En los pacientes con SM, la incorporación de aliskireno a los bloqueadores beta no mejora la rigidez de la aorta central a las 24 semanas de tratamiento


Introduction and objectives: The aim of this study was to evaluate the effect of aliskiren on aortic stiffness in patients with Marfan syndrome (MS). Methods: Twenty-eight MS patients (mean age ± standard deviation: 32.6 ± 10.6 years) were recruited from November 2009 to October 2014. All patients were receiving atenolol as standard beta-blocker therapy. A prospective randomization process was performed to assign participants to either aliskiren treatment (150-300 mg orally per day) or no aliskiren treatment (negative control) in an open-label design. Central aortic distensibility and central pulsed wave velocity (PWV) by magnetic resonance imaging (MRI), peripheral PWV, central aortic blood pressure and augmentation index by peripheral tonometry, and aortic dilatation by echocardiography were examined initially and after 24 weeks. The primary endpoint was central aortic distensibility by MRI. Results: In analyses of differences between baseline and 24 weeks for the aliskiren treatment group vs the negative control group, central distensibility (overall; P = .26) and central PWV (0.2 ± 0.9 vs 0.03 ± 0.7 [m/s]; P = .79) by MRI were not significantly different. Central systolic aortic blood pressure tended to be lower by 14 mmHg in patients in the aliskiren treatment group than in the control group (P = .09). A significant decrease in peripheral PWV (brachial-ankle PWV) in the aliskiren treatment group (-1.6 m/s) compared with the control group (+0.28 m/s) was noted (P = .005). Conclusions: Among patients with MS, the addition of aliskiren to beta-blocker treatment did not significantly improve central aortic stiffness during a 24-week period


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Rigidez Vascular , Síndrome de Marfan/tratamento farmacológico , Atenolol/farmacocinética , Anti-Hipertensivos/farmacocinética , Síndrome de Marfan/fisiopatologia , Complacência (Medida de Distensibilidade)/fisiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Estudos de Casos e Controles , Estudos Prospectivos
14.
Hipertens. riesgo vasc ; 35(2): 77-83, abr.-jun. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-172220

RESUMO

La hipertensión arterial es el mayor factor de riesgo de muerte cardiovascular, afectando al 25% de las mujeres. Los cambios hormonales y la hipertensión arterial tras la menopáusica pueden conducir a mayor daño de órgano blanco y enfermedad cardiovascular, como el incremento de la rigidez arterial, la enfermedad coronaria, la insuficiencia cardíaca crónica y el accidente cerebrovascular. Los mecanismos fisiopatológicos involucrados en el desarrollo de la hipertensión arterial y la enfermedad vascular en la mujer menopáusica son controvertidos. Existen diferencias farmacodinámicas y farmacocinéticas en ambos sexos, la mujer presenta más tos ante los inhibidores de enzima de conversión, más calambres ante los diuréticos tiazídicos y más edema en miembros inferiores con los antagonistas cálcicos. El objetivo de esta revisión es analizar los posibles mecanismos fisiopatológicos involucrados en la hipertensión arterial después de la menopausia y una mayor comprensión de los efectos biológicos que median el envejecimiento vascular en mujeres con la pérdida de los efectos protectores de los estrógenos sobre el sistema vascular (AU)


Hypertension is the main cardiovascular risk factor affecting 25% of women. Hormone changes and hypertension after menopause may lead to higher target organ damage and cardiovascular disease such as increased arterial stiffness, coronary diseases, chronic heart failure and stroke. The physiopathological mechanisms involved in the development of hypertension and cardiovascular diseases in menopausal women are controversial. There are pharmacokinetic and pharmacodynamic differences in both sexes, the women have more coughing when using the converting-enzyme inhibitors, more cramps when using thiazide diuretics and more oedema in the inferior limbs when using calcium antagonists. The aim of this review is to analyse possible physiopathological mechanisms involved in hypertension after menopause and to gain a better understanding of the biological effects mediated by vascular ageing in women when the level of oestrogen protective effect decreases over the vascular system (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Menopausa , Hipertensão/diagnóstico , Doenças Cardiovasculares/complicações , Fatores de Risco , Insuficiência Cardíaca/complicações , Hipertensão/complicações , Hipertensão/etiologia , Doença das Coronárias/complicações , Acidente Vascular Cerebral/epidemiologia , Hipertensão/fisiopatologia , Estrogênios/uso terapêutico , Pós-Menopausa , Anti-Hipertensivos/uso terapêutico
15.
Pharm. pract. (Granada, Internet) ; 16(2): 0-0, abr.-jun. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174791

RESUMO

Background: Hypertension is an important public health problem worldwide. There is lack of data on uncontrolled blood pressure in developing countries. Objectives: To determine the magnitude and predicting factors of uncontrolled blood pressure in hypertensive patients attending Gondar university hospital, Ethiopia. Methods: A hospital-based cross-sectional survey was conducted from July 2015 to March 2016. All hypertensive patients were followed and the blood pressure levels were measured. Binary logistic regression analysis was done to determine the predictors of uncontrolled blood pressure. A p-value of <0.05 was set at priori with 95% confidence interval to test the level of significance. Results: Of the total 578 hypertension patients, 543 (93.9%) fulfilled the study criteria and were included in the final analysis. The mean age of the participants was 55.96±14.6 years. Nearly two-third (58.2%) of the participants were females. More than one-tenth (11.4%) of the respondents had uncontrolled blood pressure. High salt intake carried six times more risk of uncontrolled blood pressure. Elderly individuals had lower risk as compared to young age group. However, comorbidities were not related with uncontrolled blood pressure. Conclusions: Blood pressure control was relatively high in the hospital studied. High salt intake was strongly linked with uncontrolled blood pressure. Individuals with high salt intake should be followed for their medication experience and disease knowledge


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Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Hipertensão/epidemiologia , Anti-Hipertensivos/uso terapêutico , Dieta Hipossódica , Etiópia/epidemiologia , Hipertensão/complicações , Resistência a Medicamentos , Fatores de Risco , Efeito Idade , Sódio na Dieta/administração & dosagem , Hipertensão/terapia , Estudos Transversais
16.
Arch. Soc. Esp. Oftalmol ; 93(6): 290-299, jun. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-174897

RESUMO

Introducción: En relación con la progresión del glaucoma, la presión intraocular (PIO) elevada es el principal factor de riesgo sobre el que se puede actuar. Las estrategias farmacológicas destinadas a reducir la PIO tienen como objetivo la reducción de la producción de humor acuoso (HA) y/o el aumento de su drenaje a través de la vía uveoescleral. Sin embargo, en la actualidad no hay ninguna estrategia farmacológica de primera elección que de forma principal esté destinada a facilitar la salida de HA por la vía convencional. La producción de óxido nítrico (NO) a nivel ocular tiene lugar en las rutas de flujo de HA y en el músculo ciliar, modulando la respuesta celular en situaciones de PIO elevada. Métodos: En esta revisión se describe el mecanismo de acción del NO endógeno así como de las nuevas moléculas donadoras de NO que se encuentran en fase de investigación. Además se incluye información acerca de los estudios preclínicos y clínicos realizados hasta la fecha con estos nuevos compuestos, discutiendo su potencial terapéutico en el tratamiento farmacológico de la hipertensión ocular en glaucoma. Resultados: La administración de compuestos donadores de NO por vía tópica oftálmica proporciona un descenso de la PIO marcado y mantenido en modelos experimentales de glaucoma y en sujetos con hipertensión ocular. Conclusiones: El mecanismo de acción de estos compuestos es novedoso y la evidencia científica muestra resultados prometedores. Sin embargo, para poder valorar su uso en terapias crónicas son necesarios más estudios que demuestren su seguridad y la eficacia a largo plazo


Introduction: An elevated intraocular pressure (IOP) remains the main risk factor for progression of glaucoma upon which we can efficiently act. Pharmacological strategies to reduce IOP are directed towards the reduction of aqueous humour (AH) production and/or the increase in AH drainage through the uveoscleral pathway. However, there are no drugs currently available as first-line treatment to increase AH outflow primarily via the conventional route. Ocular nitric oxide (NO) production takes place in AH outflow pathways and in the ciliary muscle, modulating the cellular response to elevated IOP. Methods: This review describes the mechanism of action of endogenous NO and NO-donating compounds that are under research. It includes information regarding pre-clinical and clinical studies previously conducted with these compounds, discussing their role and therapeutic potential in the pharmacological treatment of ocular hypertens in in glaucoma. Results: The topical ocular administration of NO-donating compounds significantly lowered IOP and maintained it in animal models of glaucoma and subjects with ocular hypertension. Conclusions: The mechanism of action of these compounds is novel and scientific evidence that shows promising results. However, there is a need for more comprehensive studies to assess long-term safety and tolerability in order to properly evaluate their use in chronic therapies


Assuntos
Humanos , Doadores de Óxido Nítrico/uso terapêutico , Glaucoma/tratamento farmacológico , Pressão Intraocular , Anti-Hipertensivos/uso terapêutico , Administração Tópica , Malha Trabecular , Humor Aquoso , Hidrodinâmica
20.
Rev. esp. anestesiol. reanim ; 65(4): 225-228, abr. 2018. graf
Artigo em Espanhol | IBECS | ID: ibc-177052

RESUMO

El feocromocitoma es un tumor productor de catecolaminas y su tratamiento de elección es la adrenalectomía laparoscópica. Durante la insuflación del neumoperitoneo y la manipulación tumoral hay alto riesgo de liberación masiva de catecolaminas y crisis hipertensivas. Tras la exéresis tumoral es frecuente la hipotensión arterial grave por vasodilatación relativa y por el efecto residual de los fármacos antihipertensivos utilizados. Presentamos el caso clínico de un paciente con feocromocitoma intervenido de adrenalectomía laparoscópica. Durante la manipulación quirúrgica hubo un pico hipertensivo brusco que pudo controlarse rápidamente con clevidipino en perfusión. Tras la resección tumoral se detuvo la perfusión y no se produjo hipotensión arterial en ningún momento. El clevidipino es un nuevo antagonista del calcio intravenoso con inicio de acción rápido y vida media corta que no tiene efecto residual y no causa hipotensión tras la resección tumoral, por lo que puede ser un fármaco de primera elección esta cirugía


Pheochromocytoma is a catecholamine-producing tumour and laparoscopic adrenalectomy is its treatment of choice. During pneumoperitoneum insufflation and tumour handling there is a high risk of massive catecholamine release and hypertensive crisis. After tumour excision, severe arterial hypotension is a common effect, due to relative vasodilation and the residual effect of antihypertensive drugs. We report the case of a patient with pheochromocytoma who was treated with laparoscopic adrenalectomy. During surgical manipulation there was a sudden hypertensive peak that could be controlled quickly with clevidipine infusion. After tumour resection, clevidipine perfusion was stopped and there were no arterial hypotension episodes. Clevidipine is a new intravenous calcium antagonist with rapid onset of action and short half-life that has no residual effect and does not produce arterial hypotension after tumour resection. For these reasons, it can be a first-choice drug for this kind of surgery


Assuntos
Humanos , Masculino , Adulto , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Feocromocitoma/cirurgia , Adrenalectomia/métodos , Catecolaminas , Metanefrina/análise , Laparoscopia/métodos , Neurofibromatose 1/complicações
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