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1.
Kardiologiia ; 59(10): 31-38, 2019 Oct 14.
Artículo en Ruso | MEDLINE | ID: mdl-31615386

RESUMEN

Finding the best options for combined antihypertensive therapy is one of the main tasks to be solved for achieving target blood pressure (BP) and, accordingly, reduction of the risk of complications in patients with arterial hypertension (AH).Purpose of this study was to evaluate the effectiveness of the perindopril arginine/amlodipine fixed combination in patients with 1-2 degree hypertension not achieving BP control on previous therapy with sartan-containing free combinations. MATERIALS AND METHODS: In the multicenter open uncontrolled observational program AVANGARD 203 doctors in 53 cities of the Russian Federation included 658 patients who had not achieved target BP on therapy with two drugs, one of which was sartan (sartan with diuretic, calcium antagonist, ß-blocker, or moxonidine in 49%, 33%, 17%, and 1% of cases, respectively). This therapy was replaced with a fixed combination of perindopril arginine/amlodipine. Duration of observation was 3 months. RESULTS: On therapy with perindopril arginine/amlodipine, BP decreased 159.9±8.5/92.1±7.4 to 125.8±7.1/77.4±5.5 mm Hg. Target BP <140/90 mm Hg was achieved in 93.5% of patients (office measurement); target BP <135/85 mm Hg - in 83.5% of patients (home measurement). Mean 24-hour BP variability decreased from 4.4±2.9/3.0±2.0 to 3.0±2.2/2.2±1.7 mm Hg (p<0.01). Number of patients complaining of headache decreased by 2.9 times, dizziness - by 2.8 times, fatigue - by 2.3 times, irritability - by 3.0 times, sleep disturbances - by 2.3 times, dyspnea - by 3.8 times, palpitations - by 2.7 times, angina pectoris attacks - by 4.6 times. Dose of perindopril arginine/amlodipine was 10/5 mg in 36.6%, and 10/10 mg in 28.3% of cases, respectively. Number ofparticipants who dropped out ofthe study prematurely was 11 (1.6%) (1 because of adverse event). Adverse events were observed in 4 more patients (2 [0.14%] - edema of lower extremities, and 2 [0.14%] -cough), but they did not require the withdrawal of therapy. CONCLUSION: In case of ineffective combination therapy containing sartans, transfer of patients to a fixed combination of perindopril and amlodipine should be considered.


Asunto(s)
Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Hipertensión , Perindopril/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II , Presión Sanguínea , Combinación de Medicamentos , Humanos , Federación de Rusia
2.
Undersea Hyperb Med ; 46(4): 483-494, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31509904

RESUMEN

The aim of this study was to establish the effect of combined therapy with hyperbaric oxygen (HBO2) therapy and verapamil, amlodipine or nicorandil on functional recovery and oxidative stress markers after ischemia in the isolated rat heart. The study included 48 rats (Wistar albino, male gender, eight weeks old, body weight 200±50g). All animals were exposed to HBO2 treatment over 14 days. Isolated heart rats were perfused by the Langendorff retrograde method at a constant coronary pressure of 70 cm H2O. After stabilization period the hearts were divided into the following groups: HBO2 group (animals exposed to only HBO2 preconditioning); HBO2 + verapamil; HBO2 + amlodipine; andHBO2 + nicorandil (animals pretreated with HBO2 and appropriate pharmacological agent). Afterward, the hearts in all groups were subjected to 20-minute global ischemia and 30-minute reperfusion. Parameters of heart function were registered, including maximum and minimum rate of pressure development, systolic and diastolic left ventricular pressure, heart rate and coronary flow. Levels of pro-oxidants such as index of lipid peroxidation, measured as thiobarbituric acid-reactive substances, nitrites, levels of superoxide anion radicals and hydrogen peroxide were determined in coronary venous effluent. Changes in cardiac tissue were evaluated by hematoxylin and eosin staining. Obtained results clearly indicate that blockage of calcium channel or the activation of adenosine triphosphate-sensitive potassium (KATP) in combination with HBO2 prevented ischemia/reperfusion-induced cardiac deleterious effects, thus contributing to improvement of functional recovery of the heart. However, future studies are certainly necessary for better understanding the mechanisms through which combination of these two maneuvers of preconditioning triggers cardioprotection.


Asunto(s)
Bloqueadores de los Canales de Calcio/uso terapéutico , Oxigenación Hiperbárica , Precondicionamiento Isquémico Miocárdico/métodos , Isquemia Miocárdica/terapia , Daño por Reperfusión Miocárdica/prevención & control , Bloqueadores de los Canales de Potasio/uso terapéutico , Amlodipino/uso terapéutico , Animales , Presión Sanguínea/efectos de los fármacos , Terapia Combinada/métodos , Circulación Coronaria , Corazón , Frecuencia Cardíaca/efectos de los fármacos , Precondicionamiento Isquémico Miocárdico/efectos adversos , Peroxidación de Lípido , Masculino , Miocardio/patología , Nicorandil/uso terapéutico , Estrés Oxidativo , Ratas , Ratas Wistar , Recuperación de la Función , Verapamilo/uso terapéutico
3.
BMJ Case Rep ; 12(9)2019 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-31527221

RESUMEN

A 42-year-old woman was referred from a primary care centre for severe hypertension, stage 3A chronic kidney disease and proteinuria. This was associated with a significant obstetric history of pre-eclampsia during her previous two pregnancies. Secondary hypertension was suspected and autoimmune workup was positive for anticardiolipin IgG and lupus anticoagulant. A renal biopsy showed evidence of chronic thrombotic microangiopathy, with electron microscopy features suggestive of fibrillar glomerulonephritis. The diagnosis of antiphospholipid syndrome with antiphospholipid-associated nephropathy was made. She was started on anticoagulation with warfarin, and her hypertension was controlled with lisinopril and amlodipine with subsequent improvement in proteinuria. She remains on regular follow-up to monitor for possible development of malignancy or connective tissue disease.


Asunto(s)
Síndrome Antifosfolípido/complicaciones , Hipertensión/etiología , Enfermedades Renales/etiología , Microangiopatías Trombóticas/etiología , Warfarina/uso terapéutico , Adulto , Amlodipino/uso terapéutico , Anticoagulantes/uso terapéutico , Antihipertensivos/uso terapéutico , Diagnóstico Diferencial , Quimioterapia Combinada , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Lisinopril/uso terapéutico , Microangiopatías Trombóticas/tratamiento farmacológico
4.
Hypertension ; 74(4): 1033-1040, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31476905

RESUMEN

Hypertension treatment has been implicated in falls, syncope, and orthostatic hypotension (OH), common events among older adults. Whether the choice of antihypertensive agent influences the risk of falls, syncope, and OH in older adults is unknown. ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) was a randomized clinical trial that compared the effects of hypertension first-step therapy on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). In a subpopulation of ALLHAT participants, age 65 years and older, we determined the relative risk of falls, syncope, OH, or a composite based on Centers for Medicare and Medicaid Services and Veterans Affairs claims, using Cox regression. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) on outcomes in Cox models adjusted for age, sex, and race. Among 23 964 participants (mean age 69.8±6.8 years, 45% women, 31% non-Hispanic black) followed for a mean of 4.9 years, we identified 267 falls, 755 syncopes, 249 OH, and 1157 composite claims. There were no significant differences in the cumulative incidences of events across randomized drug assignments. However, amlodipine increased risk of falls during the first year of follow-up compared with chlorthalidone (hazard ratio [95% CI]: 2.24 [1.06-4.74]; P=0.03) or lisinopril (hazard ratio [95% CI]: 2.61 [1.03-6.72]; P=0.04). Atenolol use (N=928) was not associated with any of the 3 individual or composite claims. In older adults, the choice of antihypertensive agent had no effect on risk of fall, syncope, or OH long-term. However, amlodipine increased risk of falls within 1 year of initiation. These short-term findings require confirmation. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.


Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipotensión Ortostática/epidemiología , Síncope/epidemiología , Anciano , Anciano de 80 o más Años , Amlodipino/uso terapéutico , Atenolol/uso terapéutico , Clortalidona/uso terapéutico , Femenino , Humanos , Incidencia , Masculino , Medicare , Resultado del Tratamiento , Estados Unidos
5.
Pregnancy Hypertens ; 17: 209-215, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31487643

RESUMEN

OBJECTIVE: This study aimed to evaluate the relationship between endogenous CYP3A markers and plasma amlodipine (AML) exposure and metabolism parameters in early postpartum and non-peripartum women. METHODS: Twenty-four AML-treated early postpartum women with hypertensive disorders of pregnancy and 30 non-peripartum women with essential hypertension were enrolled. Blood samples for determination of CYP3A markers including total cholesterol-adjusted 4ß-hydroxycholesterol (4ß-OHC/TC), 25-hydroxyvitamin D (25-OHD), and AML and its metabolites in plasma were collected at 24 h after the AML treatment. RESULTS: The plasma 4ß-OHC/TC in postpartum women was higher than that in non-peripartum women, while the plasma 25-OHD was lower. The postpartum women had a lower plasma AML concentration and its metabolic ratio was higher. The plasma 4ß-OHC/TC decreased as the number of days post-delivery increased. The plasma AML concentration increased as the number of days post-delivery increased, while the metabolic ratio of AML declined slightly. Tendency toward negative correlations between the plasma 4ß-OHC/TC but not 25-OHD, and AML concentration were observed in both postpartum and non-peripartum women. In both groups, the plasma 4ß-OHC/TC was correlated with the metabolic ratio of AML. CONCLUSIONS: The early postpartum women had higher plasma 4ß-OHC and AML metabolism. The plasma 4ß-OHC had positive relationships with amlodipine metabolism in both women groups. AML metabolism and plasma 4ß-OHC may be useful as CYP3A markers in early postpartum and non-peripartum women.


Asunto(s)
Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Citocromo P-450 CYP3A/sangre , Hipertensión/tratamiento farmacológico , Preeclampsia/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Amlodipino/administración & dosificación , Antihipertensivos/administración & dosificación , Biomarcadores/sangre , Estudios de Casos y Controles , Femenino , Humanos , Hipertensión/sangre , Persona de Mediana Edad , Periodo Periparto , Preeclampsia/sangre , Embarazo , Complicaciones Cardiovasculares del Embarazo/sangre , Atención Prenatal , Adulto Joven
6.
Med Arch ; 73(3): 157-162, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31391706

RESUMEN

Introduction: Hypertension is significantly contributing to global mortality and morbidity and has been identified as the most important modifiable risk factor for early development of cardiovascular diseases (CVD). Aim: The aim of this study was to investigate the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness and peripheral resistance in patients with essential hypertension using the brachial oscillometric ambulatory blood pressure monitor. Methods: This study was designed as an observational, prospective, multi centric study conducted in eight primary care centers of the Health Center of Canton Sarajevo during the period of six months. The study included 655 participants, both genders, aged between 30 and 75, who were diagnosed with hypertension according to the ESC/ESH guidelines. Participants were divided into six treatment groups based on the hypertensive drug therapy they were using; lisinopril, losartan or valsartan alone or in combination with hydrochlorothiazide (A, B and C group respectively) or combination of lisinopril, losartan or valsartan with/without hydrochlorothiazide together with amlodipine (D, E and F respectively). The participants were monitored at baseline, after 3 and 6 months (1st and 2nd follow-up). Brachial oscillometric ambulatory blood pressure monitor was used for measuring systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV) and peripheral resistance (PR). Results: SBP, DPB, PP, and PWV significantly decreased from baseline to 2nd follow-up in all treatment groups. The mean reductions in SBP were from -11.7 (95%CI; 9.3- 14.1) to -23.2 (95%CI; 18.3-28.1) mmHg and DBP reductions varied from -5.5 (95%CI; 3.9- 7.1) to -13.4 (95%CI; 7.7-19.1) mmHg. PWV decreased in all treatment groups (from -3.3% to -8.2%). Treatment regiment was not associated with significant differences in SBP, DBP, PP or PWV reductions or their values measured at 2nd follow-up. Peripheral resistance significantly decreased only in group C (p=0.011), group D (p=0.009) and group F (p=0.027). Conclusion: These data suggest that lisinopril/lisinopril + hydrochlorothiazide, losartan/losartan + hydrochlorothiazide and valsartan/valsartan + hydrochlorothiazide alone or in combination with amlodipine are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension.


Asunto(s)
Antihipertensivos/farmacología , Presión Sanguínea/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Rigidez Vascular/efectos de los fármacos , Anciano , Amlodipino/farmacología , Amlodipino/uso terapéutico , Antihipertensivos/uso terapéutico , Arterias , Diástole/efectos de los fármacos , Combinación de Medicamentos , Hipertensión Esencial/tratamiento farmacológico , Femenino , Humanos , Hidroclorotiazida/farmacología , Hidroclorotiazida/uso terapéutico , Lisinopril/farmacología , Lisinopril/uso terapéutico , Losartán/farmacología , Losartán/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de la Onda del Pulso , Sístole/efectos de los fármacos , Valsartán/farmacología , Valsartán/uso terapéutico
7.
Drug Des Devel Ther ; 13: 2427-2436, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31413542

RESUMEN

Background: Mortality rates increase due to iron deposition in the cardiac muscles of thalassemia major (TM) patients. Iron overload cardiomyopathy could be treated with a combination therapy of an iron chelator and an L-type calcium channel blocker. We designed a randomized controlled study to assess the potential of amlodipine, alongside chelation, in reducing myocardial iron concentration in TM patients compared with a placebo. Objectives: This study aims to estimate the change in myocardial iron concentration (MIC) determined by magnetic resonance imaging after 6 months of treatment with amlodipine, as well as measuring the changes in the secondary outcomes (liver iron concentration (LIC), serum ferritin level (SF), and left ventricle ejection fraction (LVEF)) of study participants. Methods: A single, randomized, placebo-controlled trial was performed in 40 ß-Thalassemia major patients aged between 6 and 20 years old, who received either oral amlodipine 2.5-5 mg/day or a placebo, in addition to a Deferasirox chelation regimen in a 1:1 allocation ratio. Results: After 6 months, a significant reduction was noted in the MIC of patients receiving amlodipine (n=20), compared with the patients receiving the placebo (n=20). At baseline, the mean was 0.76±0.11 mg/g dry weight, while at 6 months, the mean was 0.51±0.07 mg/g dry weight (p<0.001). Also, there was a significant change in the myocardial T2* after 6 months; the amlodipine increased the myocardial T2* from 40.63±5.45 ms at baseline to 43.25±5.35 ms (p<0.001). However, amlodipine did not significantly affect the secondary outcomes by the end of the study. Conclusion: The addition of amlodipine to the standard chelation therapy in transfusion-dependent thalassemia major patients improves myocardial iron overload without increasing the adverse effects.


Asunto(s)
Amlodipino/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Quelantes del Hierro/uso terapéutico , Sobrecarga de Hierro/tratamiento farmacológico , Talasemia beta/tratamiento farmacológico , Adolescente , Adulto , Amlodipino/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Niño , Femenino , Humanos , Hierro/análisis , Quelantes del Hierro/administración & dosificación , Imagen por Resonancia Magnética , Masculino , Estudios Prospectivos , Adulto Joven
8.
High Blood Press Cardiovasc Prev ; 26(5): 399-404, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31463886

RESUMEN

INTRODUCTION: Polytherapy is often required to treat the comorbidity of hypertension and hyperlipidemia. Fixed-dose co-formulation, rather than free combinations, simplifies medication taking and also improves adherence to medication, which is the key for a successful management of these conditions. AIM: To determine the number of patients potentially eligible for treatment with triple fixed-dose atorvastatin/perindopril/amlodipine (CTAPA), and to estimate if an unmet medical need exists among CTAPA free combination treated patients. METHODS: This observational retrospective study was based on administrative databases of 3 Italian Local Health Units. The cohort comprised adult patients with at least one prescription of amlodipine and perindopril (either as free combination or co-formulated) and atorvastatin during 2014. Follow-up period started on the date of prescription of the 3 molecules (index date) and lasted 1 year. Adherence to CTAPA was analyzed during follow-up, by using the proportion of days covered (PDC). RESULTS: 2292 patients (9.1 per 10,000 beneficiaries) had a prescription for CTAPA as free combination. Only 1249 (54.5%) were adherent to the therapy (PDC ≥ 80%); among them, a small percentage required dosage modification. The number of patients with CTAPA increased during the study period. Discontinuation of drugs prescribed the year before interested 582 patients in 2014, and 522 in 2015. Considering the Italian national population (n = 60,782,668), it was estimated that 69,542 hypertensive patients could be eligible for fixed-dose CTAPA during 2014. CONCLUSIONS: Real-world analysis among patients with free combination therapy can be applied to estimate the eligible population for fixed combination, and to evaluate the appropriateness of their prescriptions. Moreover, fixed-dose CTAPA could effectively improve adherence, which was calculated to be low in the free combination cohort.


Asunto(s)
Amlodipino/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Atorvastatina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/uso terapéutico , Dislipidemias/tratamiento farmacológico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipertensión/tratamiento farmacológico , Perindopril/uso terapéutico , Anciano , Biomarcadores/sangre , Bases de Datos Factuales , Quimioterapia Combinada , Dislipidemias/sangre , Dislipidemias/diagnóstico , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Italia , Lípidos/sangre , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
9.
Int J Mol Med ; 43(4): 1900-1910, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30816438

RESUMEN

To study the effect and molecular mechanisms of amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing on the treatment methods of renal failure and hypertension. A total of 60 cases of renal failure hypertension were randomly divided into the Control group and the Treatment group. The control group was treated with amlodipine besylate, while the treatment group was treated with amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing. A rat model of renal failure hypertension was established. Rats were divided into the sham group, model group, NC group (treated with amlodipine besylate) and treatment group (treated with amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing). Rats were given drugs at 10­20 weeks of age to observe their general condition and detect changes of blood pressure, blood biochemical indices and urine index. The pathological changes of renal tissue were examined by hematoxylin and eosin staining, and the expression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase (MMP)9 were detected by immunohistochemistry. Reverse transcription­quantitative polymerase chain reaction was used to determine mRNA expression of phosphoinositide 3­kinase (PI3K), protein kinase B (AKT) and endothelin (ET)­1 and western blotting was used to detect the expression of phosphorylated (p)­PI3K/PI3K, p­AKT/AKT and p­nuclear factor (NF)­κB p65/NF­κB p65 protein. Systolic and diastolic blood pressures in Treated group patients were significantly lower compared with in Control group patients. The systolic and diastolic blood pressure of rats were significantly decreased and blood urea nitrogen (BUN), carbapenem­resistant Enterobacteriaceae (CRE), N­acetyl­ß­D­glucosaminidase (NAG), urine protein (UP) and blood urea protein (BUP), contents were significantly decreased following amlodipine besylate treatment. The expression of VEGF and matrix metallopeptidase 9 protein were significantly decreased, but the expression of PI3K, AKT mRNA and p­PI3K/PI3K, p­AKT/AKT protein were significantly increased. ET­1 mRNA and p­NF­κB p65/NF­κB protein were significantly increased. The pathological alterations of renal tissue were improved and the pathological changes of glomerulus, tubule and interstitium were alleviated. Amlodipine besylate combined with acupoint application of traditional Chinese medicine nursing can effectively reduce the systolic pressure and diastolic pressure of patients, and improve the symptoms and signs of patients, which may be associated with the regulation of the expression of PI3K/AKT pathway, so as to regulate the expression of BUN, CRE, UP, BUP and NAG.


Asunto(s)
Puntos de Acupuntura , Amlodipino/uso terapéutico , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Medicina China Tradicional , Insuficiencia Renal/complicaciones , Insuficiencia Renal/tratamiento farmacológico , Transducción de Señal , Amlodipino/farmacología , Animales , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Hipertensión/sangre , Hipertensión/fisiopatología , Riñón/efectos de los fármacos , Riñón/patología , Masculino , Metaloproteinasa 9 de la Matriz/metabolismo , Persona de Mediana Edad , Fosfatidilinositol 3-Quinasas/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas Endogámicas SHR , Insuficiencia Renal/sangre , Insuficiencia Renal/fisiopatología , Transducción de Señal/efectos de los fármacos , Resultado del Tratamiento , Factor A de Crecimiento Endotelial Vascular/metabolismo
10.
Pediatrics ; 143(4)2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30842257

RESUMEN

OBJECTIVES: Clinicians prescribe antihypertensive medication to children with primary hypertension, but without data to define a particular choice as first-line therapy. A one-size-fits-all approach may not be appropriate for these patients. Our aim was to develop a personalized approach to hypertension treatment, using repeated ambulatory blood pressure monitoring (ABPM) in n-of-1 trials (single-patient randomized crossover trials). METHODS: Children undergoing hypertension management at a single pediatric referral center were offered participation in an n-of-1 trial with repeated ABPM to compare 3 commonly used medications. The medication producing the greatest blood pressure reduction, and without unacceptable side effects, was selected as the preferred therapy for the individual. RESULTS: Forty-two children agreed to participate; 7 were normotensive without medication; and 3 failed to complete one treatment cycle. Of the remaining 32 patients, lisinopril was preferred for 16, amlodipine for 8, hydrochlorothiazide for 4, and 4 had uncontrolled blood pressure on maximum doses of monotherapy. In conservative Bayesian analyses, the proportion of patients who preferred lisinopril was 49% (95% credible interval [CrI]: 32% to 69%), 24% (95% CrI: 12% to 41%) preferred amlodipine, and 12% (95% CrI: 4% to 26%) preferred hydrochlorothiazide. The preferred therapy for the majority (67%) of African American participants was lisinopril. Unacceptable side effects were reported in 24% of assessments for hydrochlorothiazide, 16% for lisinopril, and 13% for amlodipine. CONCLUSIONS: No single medication was preferred for more than half of hypertensive children. n of-1 trials with repeated ABPM may promote better informed and individualized decisions in pediatric hypertension management.


Asunto(s)
Amlodipino/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial/métodos , Hidroclorotiazida/uso terapéutico , Hipertensión/tratamiento farmacológico , Lisinopril/uso terapéutico , Medicina de Precisión , Centros Médicos Académicos , Adolescente , Antihipertensivos/uso terapéutico , Teorema de Bayes , Determinación de la Presión Sanguínea/métodos , Niño , Estudios Cruzados , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Masculino , Prioridad del Paciente , Texas , Resultado del Tratamiento
11.
Kardiologiia ; 59(1): 22-27, 2019 Jan 27.
Artículo en Ruso | MEDLINE | ID: mdl-30710985

RESUMEN

In a group of 32 patients with combined ischemic heart disease (IHD) and arterial hypertension (AH) we studied dynamics of parameters of blood pressure and ECG 24-hour monitoring, as well as ultrasound structural and functional parameters of left and right ventricles during 3-month therapy with fixed dose combination of perindopril arginine (10.0 mg) and amlodipine (5.0 mg). The obtained results demonstrated significant positive effect of this combination on the geometry, structure and diastolic function of both left and right ventricles, as well as confirmed its high antiischemic and antihypertensive effects.


Asunto(s)
Amlodipino/uso terapéutico , Hipertensión , Isquemia Miocárdica , Perindopril/uso terapéutico , Antihipertensivos , Presión Sanguínea , Combinación de Medicamentos , Humanos , Hipertensión/tratamiento farmacológico
12.
BMJ Case Rep ; 12(2)2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30755423

RESUMEN

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity described by Hinchey et al in late 90's, characterised by variable associations of seizure activity, consciousness impairment ranging from confusion to coma, headaches, visual abnormalities, nausea/vomiting and focal neurological signs. Common causes are accelerated hypertension, eclampsia, preeclampsia, cytotoxic drug use and autoimmune diseases like systemic lupus erythematosus.We report a case of PRES in a 62-year-old female patient due to hypercalcemia secondary to vitamin D toxicity on treatment with calcium supplements and vitamin D for secondary hypoparathyroidism. She had seizures and visual defects on presentation which recovered completely with treatment of hypercalcemia.


Asunto(s)
Calcio en la Dieta/efectos adversos , Hipercalcemia/complicaciones , Hipercalcemia/diagnóstico , Hipoparatiroidismo/tratamiento farmacológico , Síndrome de Leucoencefalopatía Posterior/inducido químicamente , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Vitamina D/efectos adversos , Amlodipino/uso terapéutico , Calcio en la Dieta/administración & dosificación , Suplementos Dietéticos , Femenino , Fluidoterapia , Humanos , Persona de Mediana Edad , Síndrome de Leucoencefalopatía Posterior/terapia , Convulsiones/inducido químicamente , Resultado del Tratamiento , Trastornos de la Visión/inducido químicamente , Vitamina D/administración & dosificación
13.
BMC Nephrol ; 20(1): 1, 2019 01 03.
Artículo en Inglés | MEDLINE | ID: mdl-30606155

RESUMEN

BACKGROUND: Drug-induced nephrotic syndrome (NS) can be resolved by eliminating the causative agents. However, patients with metastatic cancer have not been previously reported to achieve complete recovery from anticancer drug-induced NS after discontinuation of treatment, because many patients die of cancer progression before NS is restored. CASE PRESENTATION: A 67-year-old man presented with edema of both lower extremities. He received pazopanib therapy for recurrent metastatic renal cell carcinoma (mRCC) for 17 months. Laboratory examinations revealed 7484.58 mg/day of 24-h urine protein, 434 mg/dL of serum cholesterol, and 2.9 g/dL of serum albumin. He was diagnosed with NS, and pazopanib treatment was discontinued. Four months later, he completely recovered from NS. He was then treated with temsirolimus and nivolumab sequentially for > 26 months. Pazopanib was re-introduced following disease progression, and demonstrated antitumor effects for 7 months without NS recurrence. CONCLUSION: Pazopanib-induced NS can occur late in patients with mRCC, and its subsequent discontinuation can enable patients to completely recover from its adverse effects. Moreover, pazopanib treatment may be re-introduced without the recurrence of NS.


Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/secundario , Neoplasias Pulmonares/secundario , Síndrome Nefrótico/inducido químicamente , Neoplasias Pancreáticas/secundario , Inhibidores de Proteínas Quinasas/uso terapéutico , Pirimidinas/uso terapéutico , Sulfonamidas/uso terapéutico , Anciano , Amlodipino/uso terapéutico , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/efectos adversos , Antihipertensivos/uso terapéutico , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/cirugía , Terapia Combinada , Nefropatías Diabéticas/complicaciones , Dihidropiridinas/efectos adversos , Dihidropiridinas/uso terapéutico , Sustitución de Medicamentos , Edema/etiología , Everolimus/uso terapéutico , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Fallo Renal Crónico/complicaciones , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Masculino , Nivolumab/uso terapéutico , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Neumonectomía , Inhibidores de Proteínas Quinasas/administración & dosificación , Inhibidores de Proteínas Quinasas/efectos adversos , Pirimidinas/administración & dosificación , Pirimidinas/efectos adversos , Sirolimus/análogos & derivados , Sirolimus/uso terapéutico , Sulfonamidas/administración & dosificación , Sulfonamidas/efectos adversos , Sunitinib/uso terapéutico
14.
Vet Ophthalmol ; 22(2): 161-167, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29667738

RESUMEN

PURPOSE: To investigate factors associated with long-term visual outcome in cats with hypertensive chorioretinopathy. ANIMALS STUDIED: Eighty-eight client-owned cats diagnosed with hypertensive chorioretinopathy. PROCEDURE: Medical records from cats with systemic hypertension and associated retinal lesions were reviewed. RESULTS: Most cats (61%) were blind in both eyes at presentation. Presence of menace response at last follow-up evaluation was positively correlated with presence of menace response at presentation (P = .0025), time to complete retinal reattachment (P < .0001), and gender (P = .0137). Seventy-six of 132 eyes (57.6%) that were blind at presentation regained some vision following treatment. At the time of last evaluation, 101/176 eyes (60%) had a positive menace response, while 34/46 (74%) eyes with a follow-up of >6 months had a positive menace response. Eyes that had a menace response at presentation were 17 and 37 times more likely to have a menace response at last examination compared to eyes blind for less than 2 weeks and eyes blind greater than 2 weeks, respectively. Female cats were overrepresented (62.5% of cases), and male cats were 4.2 times more likely to be visual at time of last examination compared to female cats. CONCLUSIONS: With treatment, the prognosis for long-term vision in cats with hypertensive chorioretinopathy, even following complete retinal detachment, is good.


Asunto(s)
Antihipertensivos/uso terapéutico , Enfermedades de los Gatos/tratamiento farmacológico , Enfermedades de la Coroides/veterinaria , Hipertensión/veterinaria , Retinopatía Hipertensiva/tratamiento farmacológico , Retinopatía Hipertensiva/veterinaria , Amlodipino/uso terapéutico , Animales , Benzazepinas/uso terapéutico , Ceguera/veterinaria , Gatos , Enfermedades de la Coroides/tratamiento farmacológico , Enfermedades de la Coroides/etiología , Femenino , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Retinopatía Hipertensiva/etiología , Masculino , Pronóstico , Resultado del Tratamiento , Visión Ocular
15.
Clin Exp Hypertens ; 41(3): 244-254, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29781736

RESUMEN

This study aimed to compare the real-world effectiveness of valsartan and non renin-angiotensin system (non-RAS) agent monotherapy on the incidence of new on-set diabetes (NOD) in Chinese hypertensive patients. It was based on an electronic Health Recording System database from Minhang District of Shanghai. Hypertensive patients aged ≥18 years continuously taking either valsartan or non-RAS agent monotherapy for >12 months were included. Hazard ratios (HR) of NOD events were estimated using propensity score matching method and multivariate regression. Of 29295 patients, there were 2107 in valsartan group, 21397 in CCB group, 4094 in ß-blockers group and 1697 in diuretics group. Two-year follow-up revealed NOD rates of 11.09 and 14.22 per 100 persons per year in valsartan and non-RAS inhibitor groups (HR = 0.77, 95% confidence interval 0.65-0.93, P = 0.006), respectively. Among non-RAS agents, CCB group had the highest incidence of NOD (21.72 per 100 persons per year). Comparisons between CCB sub-groups revealed the highest NOD incidence for nifedipine, followed by amlodipine and felodipine. NOD incidences in ß-blockers and diuretics groups (11.70 and 10.50 per 100 persons per year, respectively) were not significantly different from valsartan group. Compared with non-RAS inhibitors, particularly CCBs, valsartan could significantly reduce the incidence of NOD.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Valsartán/uso terapéutico , Adolescente , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Anciano , Amlodipino/uso terapéutico , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , China , Angiopatías Diabéticas/tratamiento farmacológico , Diuréticos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
J Hypertens ; 37(1): 116-124, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29995697

RESUMEN

AIM: Progression of chronic kidney disease (CKD) may be accelerated by tissue hypoxia due to impaired blood supply. This could be induced by small artery narrowing resulting in abnormally high intrarenal vascular resistance (RVR). We investigated whether a reduction in RVR achieved by adding vasodilating medical therapy (AVT) is superior to adding nonvasodilating medical therapy (AnonVT) regarding tissue oxygenation and preservation of kidney function. METHODS: Eighty-three grade 3 and 4 CKD patients [estimated glomerular filtration rate (GFR) 34.6 ml/min per 1.73 m] were randomized to either AVT with amlodipine and/or renin angiotensin blockade or AnonVT with the nonvasodilating beta-blocker metoprolol. Investigations were performed at baseline and after 18 months of therapy. Systemic vasodilation was documented in the forearm vasculature using resting venous occlusion plethysmography. GFR was measured as Chrome-EDTA plasma clearance. Using MRI, renal artery blood flow was measured for calculation of RVR and for estimating renal oxygenation (R2*). RESULTS: AVT and AnonVT achieved as planned similar blood pressure levels throughout the study. At follow-up, resistance had decreased by 7% (P < 0.05) and RVR by 12% (P < 0.05) in the AVT group, whereas in the AnonVT group, resistance increased by 39% (P < 0.01), whereas RVR remained unchanged. At follow-up, no significant differences in cortical or medullary R2* values between AVT and AnonVT were observed, and the GFR decline was similar in the two groups (3.0 vs. 3.3 ml/min per 1.73 m). CONCLUSION: Long-term intensified vasodilation treatment reduced peripheral and RVR, but this was not associated with improvement of R2* or protection against loss of kidney function in CKD patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Insuficiencia Renal Crónica , Vasodilatadores/uso terapéutico , Amlodipino/uso terapéutico , Angiotensinas/uso terapéutico , Progresión de la Enfermedad , Tasa de Filtración Glomerular , Humanos , Pruebas de Función Renal , Metoprolol/uso terapéutico , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/fisiopatología , Resistencia Vascular
17.
Sleep Breath ; 23(1): 227-233, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29951886

RESUMEN

PURPOSE: ß-Blocker use has been controversial for a long time in the management of hypertensive patients with obstructive sleep apnea (OSA). The aim of present study was to compare the effects of metoprolol on BP lowering with amlodipine in hypertensive OSA patients. METHODS: Hypertensive subjects with OSA were randomly assigned to metoprolol and amlodipine groups, receiving 12 weeks of oral either metoprolol (47.5 mg once daily) or amlodipine (5 mg once daily) treatment. At baseline and after the 12-week treatment period, 24-h ambulatory blood pressure monitoring was performed in both groups. RESULTS: Both of metoprolol and amlodipine treatments significantly lowered 24-h blood pressure (BP) (from 143/88 to 132.3/81.6 mmHg; from 141.3/84.5 to 133.7/80.8 mmHg), daytime BP (from 146/90.2 to 136.4/84.6 mmHg; from 145.1/87.6 to 138.2/84.1 mmHg), and nighttime BP (from 139.1/83.9 to 125.7/76.2 mmHg; from 134.5/78.5 to 125.8/74.1 mmHg) (all P < 0.05). But there were no significant differences between the groups in BP variability (P > 0.05). Besides, metoprolol significantly reduced daytime heart rate (HR) (P < 0.05), while 24-h and nighttime HR values had no remarkable changes compared with baseline (P > 0.05). CONCLUSIONS: Metoprolol had similar therapeutic effects on BP lowering as amlodipine and could not decrease HR during the nighttime in hypertensive patients with OSA.


Asunto(s)
Amlodipino/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Metoprolol/uso terapéutico , Apnea Obstructiva del Sueño/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Amlodipino/efectos adversos , Monitoreo Ambulatorio de la Presión Arterial , Estudios de Cohortes , Comorbilidad , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipertensión/complicaciones , Masculino , Metoprolol/efectos adversos , Persona de Mediana Edad , Polisomnografía , Estudios Prospectivos , Apnea Obstructiva del Sueño/complicaciones
18.
Am J Med ; 132(2): 172-174, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30240679

RESUMEN

The US Food and Drug Administration recently granted an approved indication for the first fixed-dose combination antihypertensive (amlodipine) and nonsteroidal anti-inflammatory drug (celecoxib) for treatment of comorbid hypertension and osteoarthritis. This review summarizes available data on this combination product, to be marketed as Consensi (Kitov Pharmaceuticals, Ltd, Tel Aviv, Israel), and discusses its potential place in therapy.


Asunto(s)
Amlodipino/uso terapéutico , Celecoxib/uso terapéutico , Hipertensión/tratamiento farmacológico , Osteoartritis/tratamiento farmacológico , Amlodipino/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Antihipertensivos/administración & dosificación , Antihipertensivos/uso terapéutico , Celecoxib/administración & dosificación , Humanos
19.
J Atheroscler Thromb ; 26(5): 442-451, 2019 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-30249940

RESUMEN

AIM: The prospective, randomized, multicenter Myocardial Ischemia Treated with Percutaneous Coronary Intervention and Plaque Regression by Lipid Lowering & Blood Pressure Controlling assessed by Intravascular Ultrasonography (MILLION) study demonstrated that combined treatment with atorvastatin and amlodipine enhanced coronary artery plaque regression. Although the baseline high-sensitive C-reactive protein (hs-CRP) reportedly plays an important role in atherogenesis, few data exist regarding the relationship between hs-CRP and plaque regression in patients receiving a combined atorvastatin and amlodipine therapy. METHODS: A total of 68 patients (male, 55; mean age, 64.2 years) with baseline and follow-up 3-dimensional intravascular ultrasound examinations in the MILLION study were stratified by baseline hs-CRP level quartiles. The serial measurements of lipid, blood pressure, and percentage changes in the plaque volume were compared between the groups, and the factors associated with the percentage change in the plaque volume were assessed. RESULTS: There were no significant between-group differences in the extent of change in low-density lipoprotein cholesterol (LDL-C) or systolic and diastolic blood pressure after 18-24 months of treatment. The percentage change in the plaque volume showed a linear association with the baseline hs-CRP (p for trend <0.05); however, there was no correlation with changes in LDL-C or systolic and diastolic blood pressure. In the multiple regression analysis, the baseline hs-CRP level was independently associated with the percentage change in the plaque volume (ß=0.29, p=0.022). CONCLUSIONS: Coronary plaque regression was associated with the baseline hs-CRP level in patients treated with a combined lipid- and blood pressure-lowering therapy.


Asunto(s)
Amlodipino/uso terapéutico , Atorvastatina/uso terapéutico , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Enfermedad de la Arteria Coronaria/prevención & control , Anciano , Antihipertensivos/uso terapéutico , Enfermedad de la Arteria Coronaria/sangre , Femenino , Estudios de Seguimiento , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos
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