Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease.

Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.

A Comparison of the Use of Clinical-Guideline-Recommended Antihypertensive Regimens in Mexican American, Non-Hispanic Black, and Non-Hispanic White Adults With Type 2 Diabetes and Hypertension in the United States: NHANES 2003-2012.

PURPOSE: The purpose of this study was to determine the use of clinical-guideline-recommended antihypertensive regimens among Mexican Americans (MAs) and non-Hispanic blacks and whites with type 2 diabetes and hypertension. METHODS: A secondary data analysis based on National Health and Nutrition Examination Survey 2003-2012 cohort data included 1857 noninstitutionalized civilian MA, black, and white adults with type 2 diabetes and hypertension. Unadjusted and adjusted 2-way analysis of variance models evaluated whether there was a difference in the use of recommended antihypertensive regimens across race/ethnic group. RESULTS: There was no difference in the use of recommended regimens across race/ethnic group (MAs, 79.1%; blacks, 81.7%; whites, 82.3%). Similarly, there was no difference between blood pressure goal levels and the use of recommended therapies across race/ethnicity (P = .632). Mexican Americans were least likely and blacks most likely to be on 3 or more antihypertensive drug classes (16.8% vs 28%). Furthermore, MAs were least likely to be on recommended add-on therapies such as calcium channel blockers and diuretics. CONCLUSION: Racial/ethnic medication use disparities were observed when looking at the number of antihypertensive drug classes per patient regimen, and add-on therapy use was evaluated. Along with lifestyle modifications, frequent antihypertensive regimen reassessment is necessary.

Avaliação da qualidade de comprimidos de propranolol e enalapril distribuídos no sistema público de saúde em uma cidade do sul do Brasil / Evaluation of the quality of propranolol and enalapril tablets supplied in the public health system in a southern Brazilian city

A aquisição de medicamentos no serviço público de saúde brasileiro através de licitação com critério de menor preço gera preocupação com a qualidade dos produtos distribuídos à população. O objetivo deste trabalho foi avaliar a qualidade dos comprimidos de Enalapril 10 mg e Propranolol 40 mg adquiridos através de processo licitatório e distribuídos na rede pública de saúde de um município catarinense durante o período de um ano. Foram analisados: o aspecto visual, o peso médio, a friabilidade, o teor de fármaco e o tempo de dissolução. De um total de sete lotes, cinco apresentaram desvio da qualidade. Encontraram-se irregularidades no aspecto visual, peso médio, friabilidade e teor de princípio ativo. A avaliação dos medicamentos além de assegurar que os medicamentos dispensados na rede pública possuem qualidade e que podem ser utilizados com segurança pelos pacientes é também uma ferramenta para a qualificação de fornecedores e um subsídio para o aprimoramento do processo licitatório. Sugere-se a implantação de um sistema de gestão da qualidade que inclua a qualificação de fornecedores, o aperfeiçoamento do processo de licitação, incluindo especificações claras sobre a qualidade dos medicamentos adquiridos, bem como o monitoramento da qualidade integrado a ações de farmacovigilância.

The acquisition of medication by the Brazilian public health service through bidding processes based on the lowest price criterion is a source of concern with respect to the quality of the products offered to the population. The scope of this work was to evaluate the quality of Enalapril 10 mg and Propranolol 40 mg tablets bought via the bidding process and supplied by the public health system in a city in the state of Santa Catarina, Brasil, over the course of a year. The visual aspect, weight variation, friability, drug content and dissolving time were analyzed. Out of seven lots, five presented quality deviation. Irregularities were found in the visual aspect, weight variation, friability and active ingredient. The evaluation of the quality of medication, besides ensuring the quality of the products supplied by the health system and safe usage by patients, is also a tool to evaluate medical supply companies and ensure the enhancement of the bidding process. The implementation of a management system that includes the evaluation of medical supply companies, improvement of the bidding process with clear specifications about the quality of the medicines bought are all recommended to ensure product safety.

[Evaluation of the quality of propranolol and enalapril tablets supplied in the public health system in a southern Brazilian city]. / Avaliação da qualidade de comprimidos de propranolol e enalapril distribuídos no sistema público de saúde em uma cidade do sul do Brasil.

The acquisition of medication by the Brazilian public health service through bidding processes based on the lowest price criterion is a source of concern with respect to the quality of the products offered to the population. The scope of this work was to evaluate the quality of Enalapril 10 mg and Propranolol 40 mg tablets bought via the bidding process and supplied by the public health system in a city in the state of Santa Catarina, Brasil, over the course of a year. The visual aspect, weight variation, friability, drug content and dissolving time were analyzed. Out of seven lots, five presented quality deviation. Irregularities were found in the visual aspect, weight variation, friability and active ingredient. The evaluation of the quality of medication, besides ensuring the quality of the products supplied by the health system and safe usage by patients, is also a tool to evaluate medical supply companies and ensure the enhancement of the bidding process. The implementation of a management system that includes the evaluation of medical supply companies, improvement of the bidding process with clear specifications about the quality of the medicines bought are all recommended to ensure product safety.

Comparative study of the stability of bimatoprost 0.03% and latanoprost 0.005%: a patient-use study.

BACKGROUND: The stability of ophthalmic preparations in multidose containers is influenced by the preservative as well as the stability of the active ingredient. Unstable drugs may require refrigeration to preserve their active ingredient level and they are more likely to degrade over time, therefore becoming more susceptible to degradation based on patient mishandling. The purpose of this study was to determine the degree of molecular degradation that occurs in bimatoprost and latanoprost in a patient-use setting. METHODS: This was an open-label, laboratory evaluation of the relative stability of bimatoprost and latanoprost. Patients presently using bimatoprost (n = 31) or latanoprost (n = 34) were identified at 2 clinical sites in Brazil. Patients were instructed to use and store their drops as usual and return all used medication bottles between day 28 and day 34 after opening. RESULTS: Bimatoprost demonstrated no degradation, but latanoprost degraded at various levels. The mean age of bimatoprost was 43.0 +/- 3.4 days and the mean age of latanoprost was 43.9 +/- 2.8 days (P = .072). The mean percentage of labeled concentration was 103.7% in the bimatoprost bottles and 88.1% in the latanoprost bottles (P < 001). CONCLUSION: This study showed that bimatoprost maintained > or =100% concentration throughout the study period while latanoprost did not.

Estado gingivoperiodontal en niños trasplantados renales / Gingivo-periodontal status in kidney transplantation children

El propósito de este trabajo fue establecer las asociaciones entre el estado gingivoperiodontal, las medicaciones, momento de adquisición de la insuficiencia y tiempo de trasplante en niños trasplantados renales bajo medicación inmunosupresora. Fueron seleccionados 39 niños trasplantados renales entre 4 y 19 años de edad (X = 12.03 +- 3.71 (DS)), atendidos en el Servicio de Nefrología del Hospital Nacional Juan P. Garrahan, sin tratamiento preventivo bucal, durante los 2 años previos a la iniciación del estudio. Los indicadores evaluados fueron: momento de inicio de la insuficiencia, tiempo de transplante, tipo de donante (cadavérico/familiar), y las variables farmacológicas: inmunosupresores, antihipertensivos y corticoesteroides. Las variables clínicas registradas fueron: índice de agrandamiento gingival (McGaw)(AG), índice de placa dental (Silness y Loe)(IP), hemorragia al sondaje simplificado (HSS) y profundidad al sondaje (PS). Se calcularon media y error estándar, X2, coeficiente de correlación de Spearman, media de tiempo de transplante, distribución de frecuencia. Los resultados revelaron una HS = 0.78 +- 0.02; PS = 1.88 +- 0.11; IP = 0.78 +- 0.11; AG = 2.08 +- 0.11. El 94,9 por ciento de los pacientes observados presentó algún grado de agrandamiento gingival. Se encontraron correlaciones estadísticamente significativas entre: edad y PS; ciclosporina y PS; inmunosupresores y HS. El 94,90 por ciento de la población analizada presentó agrandamiento gingival. La profundidad de bolsa y la hemorragia al sondaje están asociadas a la medicación (AU)

Consumo e padronizaçäo de fármacos antihipertensivos na farmácia-ensino da Universidade Estadual de Maringá (FEN-UEM) / Distribution and standardization of antihypertensive medications in the pharmacy of State University of Maringá (FEN-UEM)

Com o objetivo de padronizar fármacos anti-hipertensivos na FEN-UEM, foram analisados a aquisiçäo e o consumo desses fármacos. Os dados foram coletados a partir das notas fiscais de compra das especialidades farmacêuticas anti-hipertensivas (EAH) pela referida farmácia. O estudo foi realizado no período de primeiro de janeiro de 1990 a trina e um de dezembro de 1994. Foram analisados a quantidade de EAH adquirida, o princípio ativo e a classe farmacológica. A FEN-UEM adquiriu 4.751 EAH nesse período. Houve aumento na aquisiçäo de inibidores da enzima conversora de angiotensina (63,6 por cento) e reduçäo na de diuréticos (54,2 por cento), bloquedores beta-adrenérgicos (36,3 por cento), agonistas alfa centrais (64,3 por cento) e associações (28,2 por cento). A aquisiçäo de bloqueadores de canais de cálcio foi constante nesse período. Os dados sugerem que a aquisiçäo e a dispensaçäo desses medicamentos estäo correlacionadas com a terapêutica atual, permitindo avaliar o perfil de fármacos anti-hipertensivos na Farmácia-Ensino da UEM e padronizar as EAH a serem dispensadas pelas farmácias.

Multicenter evaluation of efficacy, tolerability and safety of a new first-line antihypertensive drug, isradipine, in a Latin-American population.

Isradipine, a new antihypertensive dihydropyridine calcium antagonist, was evaluated for its efficacy, tolerability, and safety in 91 ambulatory patients who had mild-to-moderate hypertension. The design of the present study included a two-week wash-out period after confirmation of disease, followed by 12 weeks of active treatment with 2.5 mg isradipine twice daily. Patients were switched from other antihypertensive drugs, mainly diuretics and beta-blockers. The dose of isradipine remained virtually unchanged throughout the study and resulted in a mean decrease of 22 mm Hg in systolic blood pressure (SBP) (P less than .00001) and 19 mm Hg in diastolic blood pressure (DBP) (P less than .00001). Heart rate was unchanged (difference of -1 beats/min), as was the mean body weight of the study patients. Isradipine was generally well tolerated. Side effects were few and, when present, tended to diminish and eventually disappear during the treatment period. All of the clinical laboratory parameters tested and electrocardiograph intervals remained unchanged. In conclusion, these results indicate that isradipine is a novel drug which is highly effective and well tolerated in the treatment of mild to moderate hypertension in this group of patients.