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1.
High Blood Press Cardiovasc Prev ; 27(1): 51-59, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31916207

RESUMEN

INTRODUCTION: The most recent European guidelines on hypertension redefined office blood pressure (BP) treatment targets according to age strata and cardiovascular (CV) risk profile. AIM: To evaluate proportions of adult outpatients achieving office BP treatment targets recommended by current compared to previous hypertension guidelines. METHODS: We extracted data from medical databases of adult outpatients followed in three excellence centers in hypertension (Rome, Italy; L'Aquila, Italy; Valencia, Spain). Office BP treatment targets were defined according to either 2013 ESH/ESC guidelines (< 140/90 mmHg in non-diabetic individuals aged 18-80 years, < 150/90 mmHg in those aged ≥ 80 years, and < 140/85 mmHg in diabetic individuals), or 2018 ESC/ESH guidelines: (< 130/80 mmHg in individuals aged 18-65 years, < 140/80 mmHg in those aged 65-79 and ≥ 80 years). SCORE risk was assessed in all patients. RESULTS: From an overall sample of 14,229 adult subjects, 4049 (28.5%) resulted normotensive individuals, 3088 (21.7%) were untreated and 7092 (49.8%) treated hypertensive outpatients. Treated hypertensives showed significantly higher ESC score risk (8.3 ± 13.0% vs. 3.9 ± 8.4%; P < 0.001) and lower systolic/diastolic BP (140.6 ± 18.8/83.9 ± 11.5 vs. 148.3 ± 14.2/94.7 ± 10.1 mmHg; P < 0.001) than untreated hypertensives. Compared to previous guidelines, BP control significantly lowered in non-diabetic outpatients (n = 5847) of all age groups [18-65 years: (13.1% vs. 42.9%), 65-79 years (25.8% vs. 42.5%) and ≥ 80 years (29.1% vs. 66.0%); P < 0.001 for all comparisons]; similar reductions were observed in diabetic outpatients (n = 1245) [18-65 years (32.7% vs. 14.8%), 65-79 years (37.3% vs. 24.7%) and ≥ 80 years (47.1% vs. 27.9%); P < 0.001]. CONCLUSIONS: According to the recommended new office BP treatment targets, the proportions of treated uncontrolled hypertensive patients substantially increased. These findings should prompt a tighter application of therapeutic recommendations and, thus, highlight the need for improving hypertension management and control strategies.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Adhesión a Directriz/normas , Hipertensión/tratamiento farmacológico , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/efectos adversos , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Italia , Masculino , Persona de Mediana Edad , España , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
2.
High Blood Press Cardiovasc Prev ; 27(1): 9-17, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31975151

RESUMEN

The presence of hypertensive mediated organ damage is related to increased vascular risk and mortality and its prevention should be a therapeutic target and a surrogate marker of in/adequate blood pressure control. In old adult hypertensive patients the therapeutic target should be to prevent major cardiovascular events, but in young hypertensive subjects the focus should be pointed on preventing the development of hypertensive mediated organ damage, since most of the hard events are preceded by functional and structural tissues injury. Hypertension Guidelines of the European Society of Cardiology and European Society of Hypertension recognizes that some variables like electrocardiographic or echocardiographic left ventricle hypertrophy, chronic kidney disease or advance retinopathy, all considered as hypertensive mediated organ damage, may be modifiers of cardiovascular risk estimated by the SCORE system, and for that reason they should be screened in hypertensive patients. It is well known the problem of limited health systems financial resources in many low and even median income countries which precludes the possibilities of generalizing the search for hypertension mediated organ damage in all hypertensive patients. In these scenario the recommendation to perform a detailed screening should be critically evaluated. Some questions remained unanswered: the screening generalization of hypertensive mediated organ damage should modify the cardiovascular risk score of the patients, if its presence could modify the therapeutic approach, and as a consequence, if the treatment adjustment should prolong life expectancy and ameliorate the quality of life.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Cardiopatías/prevención & control , Hipertensión/tratamiento farmacológico , Enfermedades Renales/prevención & control , Enfermedades Vasculares/prevención & control , Antihipertensivos/efectos adversos , Diagnóstico Precoz , Cardiopatías/diagnóstico , Cardiopatías/mortalidad , Cardiopatías/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Enfermedades Renales/diagnóstico , Enfermedades Renales/mortalidad , Enfermedades Renales/fisiopatología , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/mortalidad , Enfermedades Vasculares/fisiopatología
3.
J Stroke Cerebrovasc Dis ; 29(2): 104525, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31812455

RESUMEN

BACKGROUND AND PURPOSE: A subset of ischemic stroke patients present with blood pressures above that considered safe for thrombolytic administration, requiring antihypertensive therapy. Guideline statements are ambivalent regarding which antihypertensive agent should be used to obtain a satisfactory blood pressure < 185/110 mm Hg prior to alteplase. METHODS: We reviewed data from consecutive patients at a single institution treated with alteplase from January 2014 to January 2019, collecting door-to-needle times, antihypertensive agent (if used), and antihypertensive-to-needle times. Patients were grouped by initial agent administered. We assessed for differences in door-to-needle times between those needing antihypertensive(s) and those who did not. Antihypertensive-to-needle times were compared across 3 antihypertensive groups (labetalol, nicardipine, and hydralazine). RESULTS: Analysis included 239 patients: 177 receiving no antihypertensive, 44 labetalol, 13 nicardipine, and 5 hydralazine. Those not administered an antihypertensive prior to alteplase had shorter door-to-needle times (52.6 minutes versus 62.1 minutes, P = .016). We found no statistical differences when comparing door-to-needle times across all groups (no med 52.6 minutes, labetalol 64.3 minutes, nicardipine 53.0 minutes, hydralazine 67.4 minutes, P = .052). No differences were found in antihypertensive-to-needle amongst the 3 antihypertensive groups (labetalol 18.75 minutes, nicardipine 12.15 minutes, hydralazine 25.40 minutes, P = .239). CONCLUSIONS: Patients requiring antihypertensives experienced slower door-to-needle times. No statistically significant changes were observed in door-to-needle times by antihypertensive used, however these results may have clinical importance. This study is limited by relatively small sample size. Pooling data from multiple institutions could provide more robust assessment and inform clinical practice.


Asunto(s)
Antihipertensivos/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Fibrinolíticos/administración & dosificación , Hipertensión/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/administración & dosificación , Anciano , Antihipertensivos/efectos adversos , Esquema de Medicación , Femenino , Fibrinolíticos/efectos adversos , Humanos , Hidralazina/administración & dosificación , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Infusiones Intravenosas , Labetalol/administración & dosificación , Masculino , Nicardipino/administración & dosificación , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Activador de Tejido Plasminógeno/efectos adversos , Resultado del Tratamiento
4.
Medicine (Baltimore) ; 98(49): e17963, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804307

RESUMEN

Renin angiotensin aldosterone system inhibitors (RAASi) and diuretics are among the most frequently prescribed anti-hypertensives. Individuals with chronic kidney disease (CKD) are particularly at risk for electrolyte disturbances and kidney injury but the appropriate use of lab monitoring following RAASi or diuretic initiation is uncertain in CKD.We describe the frequency and time interval of lab monitoring during initiation of RAASi and diuretics in CKD and assess whether close lab monitoring associates with one-year risk of emergency department (ED) visit or hospitalization.We evaluated an observational cohort of 8,217 individuals with stage 3-5 non-dialysis CKD newly prescribed a RAASi (52.3%) or diuretic (47.7%) from thirty-six primary care offices affiliated with Brigham and Women's Hospital and Massachusetts General Hospital between 2009 and 2011.Overall, 3306 (40.2%) individuals did not have pre-prescription labs done within 2 weeks, and 5957 (72.5%) did not have post-prescription labs done within 2 weeks which includes 524 (6.4%) individuals without post-prescription within 1 year. Close monitoring occurred in only 1547 (20.1%) and was more likely in individuals prescribed diuretics compared to RAASi (adjusted OR 1.39; 95%CI 1.20-1.62), with CKD stage 4,5 compared with stage 3 (adjusted OR 1.47; 95%CI 1.16-1.86) and with cardiovascular disease (adjusted OR 1.42; 95%CI 1.21-1.66). Close monitoring was not associated with decreased risk of ED visit or hospitalization.Close lab monitoring during initiation of RAASi or diuretics was more common in participants with cardiovascular disease and advanced CKD suggesting physicians selected high-risk individuals for close monitoring. As nearly 80% of individuals did not receive close lab monitoring there may be value in future research on electronic physician decision tools targeted at lab monitoring.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Pruebas de Función Renal/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Boston , Comorbilidad , Diuréticos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Potasio/sangre , Sistema Renina-Angiotensina/efectos de los fármacos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos
5.
Medicine (Baltimore) ; 98(49): e18134, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804323

RESUMEN

BACKGROUND: Essential hypertension is one of the most common chronic diseases in the world and a major risk factor for cardiovascular and cerebrovascular diseases. Hypertension often leads to a variety of complications, of which vascular endothelial dysfunction is an important part. Traditional Chinese medicine (TCM) combined with western medicine can significantly improve vascular endothelial function in patients with hypertension, but it has not been systematically evaluated for efficacy and safety of essential hypertension. Therefore, we aim to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of TCM combined with western medicine in improving vascular endothelial function in patients with essential hypertension. METHODS: We will search PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure Database (CNKI), Wanfang Database, China Science Journal Database (VIP Database) and China Biomedical Literature Database (CBM). Clinical trial registrations, potential grey literature, related conference abstracts, and reference lists of identified studies will also be retrieved. The electronic database will be searched for literatures published from the beginning to October 2018. Based on the heterogeneity test, data integration is performed using a fixed effect model or a random effects model. Changes in blood pressure and endothelial function will be assessed as primary outcomes. Drug use, disease progression and adverse events will be assessed as secondary outcomes. RevMan V.5.3.5 will be used for meta-analysis. RESULTS: This systematic review and meta-analysis will provide high-quality evidence from a variety of aspects, including efficacy, blood pressure, vascular endothelial function and adverse reactions, to assess the efficacy and safety of TCM combined with western medicine in patients with hypertension. CONCLUSION: This systematic review will determine whether TCM combined with western medicine provides evidence for effective intervention of vascular endothelial function in patients with essential hypertension. ETHICS AND DISSEMINATION: This systematic review and meta-analysis of randomized controlled trials does not require ethical recognition, and the results of this paper will be published in an open access, internationally influential academic journal. PROSPERO REGISTRATION NUMBER: CRD42019140743.


Asunto(s)
Antihipertensivos/uso terapéutico , Medicamentos Herbarios Chinos/farmacología , Medicamentos Herbarios Chinos/uso terapéutico , Endotelio Vascular/efectos de los fármacos , Hipertensión Esencial/tratamiento farmacológico , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Quimioterapia Combinada , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación
6.
Expert Rev Clin Pharmacol ; 12(12): 1073-1079, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31842637

RESUMEN

Introduction: Netarsudil and latanoprost ophthalmic solution (0.02%/0.005%) is indicated for intraocular pressure (IOP) lowering in open-angle glaucoma (OAG) or ocular hypertension (OHTN). The once-daily agent combines the mechanism of action for each of the individual components and provides a new avenue for long-term intraocular pressure control. This review aims to cover the agent's current efficacy and safety data and opine as to its role in glaucoma management.Areas covered: This article will cover Phase II-III clinical efficacy and safety data as well as basic science literature pertaining to the agent's mechanism of action and pharmacodynamics. In selecting articles for inclusion in this review, a literature search using the PubMed database was carried out. Cross-referencing was carried out where applicable. We did not use any date or language restrictions in electronic searches.Expert opinion: Netarsudil and latanoprost ophthalmic solution plays a pivotal role in management of individuals with OAG and OHTN. The agent may be used as first-line therapy to provide substantial IOP-lowering or when additional lowering is indicated and prostaglandins have provided insufficient IOP lowering. The once-daily dosing regimen decreases the risk of inadequate treatment due to nonadherence.


Asunto(s)
Benzoatos/administración & dosificación , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Latanoprost/administración & dosificación , Hipertensión Ocular/tratamiento farmacológico , beta-Alanina/análogos & derivados , Animales , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Benzoatos/efectos adversos , Combinación de Medicamentos , Humanos , Presión Intraocular , Latanoprost/efectos adversos , Soluciones Oftálmicas , beta-Alanina/administración & dosificación , beta-Alanina/efectos adversos
7.
Undersea Hyperb Med ; 46(5): 611-618, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31683358

RESUMEN

Background: Immersion can cause immersion pulmonary edema (IPE) in previously healthy subjects. We performed a case-control study to better identify IPE risk factors. Methods: We prospectively included recreational scuba divers who had presented signs of IPE and control divers who were randomly chosen among diving members of the French Underwater Federation. We sent an anonymous questionnaire to each diver, with questions on individual characteristics, as well as the conditions of the most recent dive (controls) or the dive during which IPE occurred. Univariate logistic regressions were performed for each relevant factor. Then, multivariate logistic regression was performed. Results: Of the 882 questionnaires sent, 480 (54%) were returned from 88 cases (90%) and 392 control divers (50%). Multivariate analysis identified the following independent risk factors associated with IPE: being aged over 50 years ((OR) 3.30, (95%CI) 1.76-6.19); female sex (OR 2.20, 95%CI 1.19-4.08); non-steroidal anti-inflammatory drug (NSAID) intake before diving (OR 24.32, 95%CI 2.86-206.91); depth of dive over 20 m (OR 2.00, 95%CI 1.07-3.74); physical exertion prior to or during the dive (OR 5.51, 95%CI 2.69-11.28); training dive type (OR 5.34, 95%CI 2.62-10.86); and daily medication intake (OR 2.79, 95%CI 1.50-5.21); this latter factor appeared to be associated with hypertension in the univariate analysis. Conclusion: To reduce the risk of experiencing IPE, divers over 50 years of age or with hypertension, especially women, should avoid extensive physical effort, psychological stress, deep dives and NSAID intake before diving.


Asunto(s)
Buceo , Edema Pulmonar/etiología , Adulto , Factores de Edad , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/efectos adversos , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Estudios de Casos y Controles , Femenino , Francia , Humanos , Hipertensión/tratamiento farmacológico , Inmersión/efectos adversos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Esfuerzo Físico , Estudios Prospectivos , Recreación , Factores de Riesgo , Factores Sexuales , Encuestas y Cuestionarios/estadística & datos numéricos
8.
Undersea Hyperb Med ; 46(5): 701-707, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31683370

RESUMEN

Purpose: To report the successful treatment of postoperative posterior ischemic optic neuropathy (PION) with hyperbaric oxygen therapy and to review the current literature on the pathogenesis and treatment of PION. Observations: During an angiographic procedure at a community hospital, an elderly woman had a transient drop in blood pressure after receiving an intravenous dose of hydralazine. During recovery, the patient experienced bilateral vision loss. She was transferred to our specialty referral center for treatment with hyperbaric oxygen. We followed Table 5 in the U.S. Navy Diving Manual, the protocol for decompression sickness. Our patient's vision improved markedly immediately after the first session and continued to improve throughout the course of treatment to its completion. Follow-up ophthalmology visits found the patient's vision to be close to baseline. Conclusions and importance: PION is a rare condition. It has been difficult to determine a successful therapeutic approach because of the lack of large case-controlled studies. Hyperbaric oxygen has been used to treat other ischemic ophthalmic conditions, but there are only few reports of its use in patients with PION. Systemic steroids and antiplatelet therapy have also been used, with mixed success. In our patient, the combination of hyperbaric oxygen therapy and steroids was successful in restoring vision after postoperative PION.


Asunto(s)
Oxigenación Hiperbárica , Neuropatía Óptica Isquémica/terapia , Complicaciones Posoperatorias/terapia , Anciano de 80 o más Años , Antihipertensivos/efectos adversos , Femenino , Humanos , Hidralazina/efectos adversos , Hipotensión/inducido químicamente , Neuropatía Óptica Isquémica/etiología , Complicaciones Posoperatorias/etiología , Recuperación de la Función
9.
Lancet ; 394(10211): 1816-1826, 2019 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-31668726

RESUMEN

BACKGROUND: Uncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in the absence of comorbid indications. Randomised trials have not further refined this choice. METHODS: We developed a comprehensive framework for real-world evidence that enables comparative effectiveness and safety evaluation across many drugs and outcomes from observational data encompassing millions of patients, while minimising inherent bias. Using this framework, we did a systematic, large-scale study under a new-user cohort design to estimate the relative risks of three primary (acute myocardial infarction, hospitalisation for heart failure, and stroke) and six secondary effectiveness and 46 safety outcomes comparing all first-line classes across a global network of six administrative claims and three electronic health record databases. The framework addressed residual confounding, publication bias, and p-hacking using large-scale propensity adjustment, a large set of control outcomes, and full disclosure of hypotheses tested. FINDINGS: Using 4·9 million patients, we generated 22 000 calibrated, propensity-score-adjusted hazard ratios (HRs) comparing all classes and outcomes across databases. Most estimates revealed no effectiveness differences between classes; however, thiazide or thiazide-like diuretics showed better primary effectiveness than angiotensin-converting enzyme inhibitors: acute myocardial infarction (HR 0·84, 95% CI 0·75-0·95), hospitalisation for heart failure (0·83, 0·74-0·95), and stroke (0·83, 0·74-0·95) risk while on initial treatment. Safety profiles also favoured thiazide or thiazide-like diuretics over angiotensin-converting enzyme inhibitors. The non-dihydropyridine calcium channel blockers were significantly inferior to the other four classes. INTERPRETATION: This comprehensive framework introduces a new way of doing observational health-care science at scale. The approach supports equivalence between drug classes for initiating monotherapy for hypertension-in keeping with current guidelines, with the exception of thiazide or thiazide-like diuretics superiority to angiotensin-converting enzyme inhibitors and the inferiority of non-dihydropyridine calcium channel blockers. FUNDING: US National Science Foundation, US National Institutes of Health, Janssen Research & Development, IQVIA, South Korean Ministry of Health & Welfare, Australian National Health and Medical Research Council.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antagonistas de Receptores de Angiotensina/efectos adversos , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Niño , Estudios de Cohortes , Investigación sobre la Eficacia Comparativa/métodos , Bases de Datos Factuales , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Medicina Basada en la Evidencia/métodos , Femenino , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Adulto Joven
10.
Invest Ophthalmol Vis Sci ; 60(14): 4548-4555, 2019 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-31675072

RESUMEN

Purpose: To determine the association of statins, five classes of antihypertensive medications, and proton pump inhibitors with (1) primary open-angle glaucoma (POAG) progression and (2) conversion of POAG suspects to POAG. Methods: We retrospectively investigated the records of a cohort with POAG cases and suspects from the Groningen Longitudinal Glaucoma Study. To quantify visual field (VF) deterioration in cases, we used the rate of progression of the mean deviation (MD). Suspects were considered to have converted at the time point after which two consecutive VF tests for at least one eye were abnormal (glaucoma hemifield test outside normal limits). Progression and conversion were analyzed with quantile and logistic regression, respectively, with the systemic medications as predictors, controlling for age, sex, body mass index, pretreatment IOP, corneal thickness, and baseline MD. The multivariable models were built with and without IOP intervention. Results: No systemic medications were associated with POAG progression in the final IOP/treatment-adjusted or unadjusted model. However, angiotensin II receptor blockers (ARBs) appeared to slow progression in older patients (b = 0.014, P = 0.0001). Angiotensin-converting enzyme inhibitors (ACEIs) were significantly associated with a decrease in POAG suspect conversion in both the IOP/treatment-adjusted and -unadjusted model (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.79, P = 0.012; OR=0.24, 95% CI 0.07-0.78, P = 0.021, respectively), as were ARBs (OR 0.12, 95% CI 0.01-0.98, P = 0.014; OR 0.11, 95% CI 0.01-0.87, P = 0.005, respectively). Conclusions: No overall association of VF progression with systemic medication was found; ARBs delayed progression in older patients. ACEIs and ARBs were associated with lower risk of suspect conversion. The pathophysiology of this relationship is to be disentangled.


Asunto(s)
Antihipertensivos/uso terapéutico , Glaucoma de Ángulo Abierto/diagnóstico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Anciano , Antihipertensivos/efectos adversos , Progresión de la Enfermedad , Femenino , Alemania , Glaucoma de Ángulo Abierto/inducido químicamente , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Presión Intraocular/efectos de los fármacos , Presión Intraocular/fisiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Nivel sin Efectos Adversos Observados , Hipertensión Ocular/inducido químicamente , Hipertensión Ocular/diagnóstico , Hipertensión Ocular/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Tonometría Ocular , Trastornos de la Visión/inducido químicamente , Trastornos de la Visión/diagnóstico , Pruebas del Campo Visual , Campos Visuales/efectos de los fármacos , Campos Visuales/fisiología
11.
Presse Med ; 48(11 Pt 1): 1261-1264, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31735525

RESUMEN

The impact of antihypertensive drugs on blood pressure does not differ according to the sex. There are women-specific conditions or medical conditions encountered more frequently among womens that guide the selection of therapy such as a desire to become pregnant, a pregnancy, a polycystic ovarian syndrome, breast cancer, osteoporosis or migraine.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Factores de Edad , Antihipertensivos/efectos adversos , Presión Sanguínea/efectos de los fármacos , Neoplasias de la Mama/inducido químicamente , Femenino , Humanos , Trastornos Migrañosos , Osteoporosis/complicaciones , Osteoporosis/tratamiento farmacológico , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Embarazo , Factores Sexuales , Espironolactona/efectos adversos
12.
Rev Cardiovasc Med ; 20(3): 139-151, 2019 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-31601088

RESUMEN

Effective therapy of hypertension represents a key strategy for reducing the burden of cardiovascular disease and its associated mortality. The significance of voltage dependent L-type Ca²âº channels to Ca²âº influx, and of their regulatory mechanisms in the development of heart disease, is well established. A wide variety of L-type Ca²âº channel inhibitors and Ca²âº antagonists have been found to be beneficial not only in the treatment of hypertension, but also in myocardial infarction and heart failure. Over the past two decades, another class of Ca²âº channel - the voltage independent store-operated Ca²âº channel - has been implicated in the regulation and fine tuning of Ca²âº entry in both cardiac and smooth muscle cells. Store-operated Ca²âº channels are activated by the depletion of Ca²âº stores within the endoplasmic/sarcoplasmic reticulum, or by low levels of cytosolic Ca²âº, thereby facilitating agonist-induced Ca²âº influx. Store-operated Ca²âº entry through this pivotal pathway involves both stromal interaction molecule (STIM) and Orai channels. Different degrees of changes in these proteins are considered to promote Ca²âº entry and hence contribute to the pathogenesis of cardiovascular dysfunction. Several blockers of store-operated Ca²âº channels acting at the level of both STIM and Orai channels have been shown to depress Ca²âº influx and lower blood pressure. However, their specificity, safety, and clinical significance remain to be established. Thus, there is an ongoing challenge in the development of selective inhibitors of store-operated Ca²âº channels that act in vascular smooth muscles for the improved treatment of hypertension.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/uso terapéutico , Canales de Calcio Activados por la Liberación de Calcio/antagonistas & inhibidores , Hipertensión/tratamiento farmacológico , Músculo Liso Vascular/efectos de los fármacos , Moléculas de Interacción Estromal/antagonistas & inhibidores , Vasodilatadores/uso terapéutico , Animales , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Canales de Calcio Tipo L/efectos de los fármacos , Canales de Calcio Tipo L/metabolismo , Canales de Calcio Activados por la Liberación de Calcio/metabolismo , Señalización del Calcio/efectos de los fármacos , Humanos , Hipertensión/metabolismo , Hipertensión/fisiopatología , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/fisiopatología , Miocitos del Músculo Liso/efectos de los fármacos , Miocitos del Músculo Liso/metabolismo , Moléculas de Interacción Estromal/metabolismo , Resultado del Tratamiento , Vasodilatadores/efectos adversos
16.
Am J Case Rep ; 20: 1434-1439, 2019 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-31563918

RESUMEN

BACKGROUND Blood pressure (BP) is not routinely screened in children in clinical practice. Renal cell carcinoma (RCC) is a rare cause of renal hypertension and accounts for less than 0.3% of all childhood tumors. The clinical manifestation of hypertension in children requires a high index of suspicion, as does RCC, which can have many different manifestations. CASE REPORT We report the case of a 10-year-old girl with 1-year history of persistent symptoms of recurrent episodes of headache and excessive sweating and a 6-months history of weight loss and loss of appetite. She was repeatedly managed as having malaria in the center where she was referred, without recovery. Persistent high BP was discovered in our center, which ranged between 180/120 and 200/120 mmHg. This was not controlled by 3 different classes of drugs. Abdominal ultrasonography showed a right kidney with a well circumscribed lower pole mass with internal echoes, compressing the pelvicalyceal system. Abdominal computed tomography revealed a huge, circumscribed, expansile, isodense mass arising from the renal cortex in the lower pole of the right kidney. Intraoperative findings included a mass seen at the lower pole of the right kidney with histology diagnosis of RCC. Other laboratory tests were normal. To date, the patient remains normotensive and symptom-free after nephrectomy. CONCLUSIONS The nonspecific clinical manifestation found in this case show the need for hypertension screening in children. The resolution of symptoms after nephrectomy confirms RCC as the underlying cause of symptoms, making this case a unique presentation.


Asunto(s)
Carcinoma de Células Renales/diagnóstico por imagen , Errores Diagnósticos , Hipertensión/etiología , Neoplasias Renales/diagnóstico por imagen , Antihipertensivos/efectos adversos , Carcinoma de Células Renales/complicaciones , Niño , Resistencia a Múltiples Medicamentos , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Neoplasias Renales/complicaciones , Malaria , Tomografía Computarizada por Rayos X
18.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31511269

RESUMEN

A 2.5-year-old boy with a history of (transient) congenital hyperinsulinism was admitted to the paediatric ward with recurrent hypoglycaemia. Diazoxide 5 mg/kg/day and hydrochlorothiazide 2 mg/kg/day were initiated. After increasing the dose of diazoxide to 10 mg/kg/day, the child developed mild rectal bleeding, petechiae, epistaxis and haematemesis. Blood screening showed severe thrombocytopaenia. Diazoxide and hydrochlorothiazide were stopped, and his platelet count normalised. Drug rechallenge was positive. Drug-induced immune thrombocytopaenia was diagnosed.


Asunto(s)
Antihipertensivos/efectos adversos , Diazóxido/efectos adversos , Hidroclorotiazida/efectos adversos , Trombocitopenia/inducido químicamente , Preescolar , Quimioterapia Combinada/efectos adversos , Epistaxis/inducido químicamente , Hematemesis/inducido químicamente , Humanos , Hiperinsulinismo/congénito , Hiperinsulinismo/tratamiento farmacológico , Masculino , Enfermedades del Recto/inducido químicamente
19.
Clin Adv Periodontics ; 9(1): 24-28, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-31490034

RESUMEN

INTRODUCTION: Pemphigus vulgaris (PV) is a relatively rare, potentially life-threatening autoimmune disease that, in most cases, has an unknown etiology. Medications for hypertension have been linked to the onset and exacerbation of PV-like symptoms. The diagnosis of medication-related PV can be challenging because it has an identical appearance to the clinical and histologic appearance of idiopathic PV and cases may not resolve after discontinuation of the drug. CASE PRESENTATION: We present a case of an elderly patient with gingival and cutaneous erosions, who underwent several medical and dental consultations without an appropriate diagnosis. After biopsy and a thorough review of her medical history, metoprolol was suspected as the offending agent. After consulting with her cardiologist, metoprolol was discontinued, and a complete resolution of all lesions resulted. CONCLUSIONS: To our knowledge, the current case is the first reported case of metoprolol-induced PV in the English-language literature. As such, it highlights the potential of medication involvement in some immune-mediated diseases. Because the oral mucosa is often the first site of involvement in PV, knowledge of drug-related PV is crucial in the diagnosis, treatment, and management of dental patients.


Asunto(s)
Antihipertensivos , Metoprolol , Pénfigo , Anciano , Antihipertensivos/efectos adversos , Biopsia , Femenino , Humanos , Metoprolol/efectos adversos , Mucosa Bucal/efectos de los fármacos , Pénfigo/inducido químicamente
20.
Am J Health Syst Pharm ; 76(1): 13-16, 2019 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31381098

RESUMEN

PURPOSE: Use of the vasodilator midodrine for the treatment of treprostinil-induced hypotension is reported. SUMMARY: Intradialytic hypotension is a common complication of dialysis that increases patient mortality due to suboptimal ultrafiltration and interruption of hemodialysis. Midodrine is an α1 vasoconstrictor commonly used for the treatment of pulmonary arterial hypertension (PAH) and intradialytic hypotension. The safety of midodrine dosing at greater than 30 mg daily has not been established to date. A 49-year-old African-American man with a history of PAH and end-stage renal disease (ESRD) was receiving hemodialysis (HD) 3 times weekly. Subcutaneous treprostinil infusions were initiated for PAH, subsequently causing hypotension, with predialysis blood pressure values as low as 60/50 mm Hg. During a 6-month follow-up period, 38 of 62 dialysis sessions were interrupted or discontinued due to severe intradialytic hypotension. Counteraction of treprostinil effects was achieved by increasing the total daily midodrine dose from 30 mg to 90 mg over 6 months, with no remarkable adverse effects. In previously reported cases, maximum midodrine daily doses of 30 mg in nondialysis patients and 25 mg in patients with ESRD receiving hemodialysis were reported. The patient described here received a total daily dose of 90 mg, including 60 mg administered in divided doses for daily maintenance and 30-mg intradialytic doses; this was the highest daily midodrine dose reported to date. CONCLUSION: A 49-year-old patient tolerated 60-mg daily doses of midodrine along with 30-mg intradialytic doses for the management of treprostinil-induced hypotension and prevention of HD interruption, without adverse effects.


Asunto(s)
Antihipertensivos/efectos adversos , Epoprostenol/análogos & derivados , Hipotensión/tratamiento farmacológico , Midodrina/administración & dosificación , Diálisis Renal/efectos adversos , Relación Dosis-Respuesta a Droga , Epoprostenol/efectos adversos , Humanos , Hipotensión/etiología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , /tratamiento farmacológico
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