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1.
Rev Med Suisse ; 16(676-7): 53-54, 2020 Jan 15.
Artículo en Francés | MEDLINE | ID: mdl-31961084

RESUMEN

After the publication of the European guidelines in 2018, the review of hypertension novelties in 2019 focuses on original publications including: watch-type wearable blood pressure monitors, the psychological profile of resistant hypertension patients, the comparison between combined antihypertensive treatment in uncontrolled hypertensive patients from sub-saharian countries and finally on the cardiovascular and renal outcomes of treatments of primary aldosteronism.


Asunto(s)
Antihipertensivos , Hipertensión , Antihipertensivos/uso terapéutico , Presión Sanguínea , Humanos , Hipertensión/tratamiento farmacológico , Riñón
2.
Medicine (Baltimore) ; 99(1): e18541, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895792

RESUMEN

Perioperative hypertension is a common occurrence in the neurosurgical population, where 60% to 90% of the patients require treatment for blood pressure (BP) control. Nicardipine and clevidipine have been commonly used in neurocritical settings. This retrospective, observational study assessed the effectivity of the administration of clevidipine after nicardipine treatment failure in neurosurgical patients.We retrospectively reviewed the medical charts of adult patients who were admitted to our neurosurgical department and received clevidipine after nicardipine treatment failure for the control of BP. The primary effectivity outcome was the comparison of the percentage of time spent at targeted SBP goals during nicardipine and clevidipine administration, respectively.A total of 12 adult patients treated with clevidipine after nicardipine treatment failure and were included for data analysis. The median number of events that required dose-titration was 20.5 vs 17 during the administration of nicardipine and clevidipine, respectively (P = .534). The median percentage of time spent at targeted SBP goal was 76.2% during the administration of nicardipine and 93.4% during the administration of clevidipine (P = .123).Our study suggests that clevidipine could be an alternative effective drug with an acceptable benefit/risk ratio in the neurosurgical population that fails to achieve BP control with nicardipine treatment.


Asunto(s)
Bloqueadores de los Canales de Calcio/administración & dosificación , Hipertensión/tratamiento farmacológico , Complicaciones Intraoperatorias/tratamiento farmacológico , Procedimientos Neuroquirúrgicos/efectos adversos , Piridinas/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Hipertensión/etiología , Complicaciones Intraoperatorias/etiología , Masculino , Persona de Mediana Edad , Nicardipino/uso terapéutico , Estudios Retrospectivos , Insuficiencia del Tratamiento , Resultado del Tratamiento
3.
JAMA ; 323(3): 248-255, 2020 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-31961420

RESUMEN

Importance: Renal denervation can reduce cardiac sympathetic activity that may result in an antiarrhythmic effect on atrial fibrillation. Objective: To determine whether renal denervation when added to pulmonary vein isolation enhances long-term antiarrhythmic efficacy. Design, Setting, and Participants: The Evaluate Renal Denervation in Addition to Catheter Ablation to Eliminate Atrial Fibrillation (ERADICATE-AF) trial was an investigator-initiated, multicenter, single-blind, randomized clinical trial conducted at 5 referral centers for catheter ablation of atrial fibrillation in the Russian Federation, Poland, and Germany. A total of 302 patients with hypertension despite taking at least 1 antihypertensive medication, paroxysmal atrial fibrillation, and plans for ablation were enrolled from April 2013 to March 2018. Follow-up concluded in March 2019. Interventions: Patients were randomized to either pulmonary vein isolation alone (n = 148) or pulmonary vein isolation plus renal denervation (n = 154). Complete pulmonary vein isolation to v an end point of elimination of all pulmonary vein potentials; renal denervation using an irrigated-tip ablation catheter delivering radiofrequency energy to discrete sites in a spiral pattern from distal to proximal in both renal arteries. Main Outcomes and Measures: The primary end point was freedom from atrial fibrillation, atrial flutter, or atrial tachycardia at 12 months. Secondary end points included procedural complications within 30 days and blood pressure control at 6 and 12 months. Results: Of the 302 randomized patients (median age, 60 years [interquartile range, 55-65 years]; 182 men [60.3%]), 283 (93.7%) completed the trial. All successfully underwent their assigned procedures. Freedom from atrial fibrillation, flutter, or tachycardia at 12 months was observed in 84 of 148 (56.5%) of those undergoing pulmonary vein isolation alone and in 111 of 154 (72.1%) of those undergoing pulmonary vein isolation plus renal denervation (hazard ratio, 0.57; 95% CI, 0.38 to 0.85; P = .006). Of 5 prespecified secondary end points, 4 are reported and 3 differed between groups. Mean systolic blood pressure from baseline to 12 months decreased from 151 mm Hg to 147 mm Hg in the isolation-only group and from 150 mm Hg to 135 mm Hg in the renal denervation group (between-group difference, -13 mm Hg; 95% CI, -15 to -11 mm Hg; P < .001). Procedural complications occurred in 7 patients (4.7%) in the isolation-only group and 7 (4.5%) of the renal denervation group. Conclusions and Relevance: Among patients with paroxysmal atrial fibrillation and hypertension, renal denervation added to catheter ablation, compared with catheter ablation alone, significantly increased the likelihood of freedom from atrial fibrillation at 12 months. The lack of a formal sham-control renal denervation procedure should be considered in interpreting the results of this trial. Trial Registration: ClinicalTrials.gov Identifier: NCT01873352.


Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter , Hipertensión/cirugía , Riñón/inervación , Venas Pulmonares/cirugía , Simpatectomía , Anciano , Antihipertensivos/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/prevención & control , Terapia Combinada , Resistencia a Medicamentos , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prevención Secundaria , Método Simple Ciego
4.
Herz ; 45(1): 24-29, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-31970461

RESUMEN

Cardiovascular diseases are among the leading causes of death worldwide. Apart from a few exceptions heart attack, stroke and peripheral arterial occlusive disease first occur in later adulthood. The cornerstone for these diseases, however, is already laid by accelerated vascular aging in childhood. Apart from pediatric medical preventive check-ups, the medical care of the parents should also be a reason for taking action. A detailed family history enables many conclusions to be drawn about the cardiovascular risk of the next generation This requires targeted diagnostics and appropriate interventions in childhood ranging from lifestyle measures up to pharmaceutical therapy. In this context the current guidelines on the diagnostics and treatment of hypercholesterolemia and arterial hypertension in children and adolescents are also presented.


Asunto(s)
Enfermedades Cardiovasculares , Hipercolesterolemia , Hipertensión , Estilo de Vida , Infarto del Miocardio , Adolescente , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Niño , Humanos , Hipercolesterolemia/complicaciones , Hipercolesterolemia/tratamiento farmacológico , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Factores de Riesgo
6.
Urology ; 135: e1, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31604068

RESUMEN

A 29-year-old female was referred to the urology clinic because of an incidentally found left renal mass discovered during workup for secondary erythrocytosis. Since 12 years of age, she has had headaches and poorly controlled hypertension refractory to trimodal antihypertensive therapy. Laboratory workup revealed markedly elevated aldosterone and renin levels. Computed tomography demonstrated a 3 cm left renal mass. The patient was admitted for intravenous blood pressure control. After partial nephrectomy, aldosterone and renin levels normalized. The patient was weaned off of blood pressure medications. Pathology was consistent with a juxtaglomerular cell tumor secreting renin (ie, reninoma).


Asunto(s)
Antihipertensivos/farmacología , Hipertensión/etiología , Aparato Yuxtaglomerular/patología , Neoplasias Renales/complicaciones , Adulto , Aldosterona/sangre , Antihipertensivos/uso terapéutico , Resistencia a Medicamentos , Quimioterapia Combinada , Femenino , Humanos , Hipertensión/sangre , Hipertensión/tratamiento farmacológico , Aparato Yuxtaglomerular/diagnóstico por imagen , Aparato Yuxtaglomerular/metabolismo , Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Nefrectomía , Renina/sangre , Renina/metabolismo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
7.
Heart Fail Clin ; 16(1): 99-106, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31735319

RESUMEN

Hypertension is possibly the most powerful, modifiable risk factor for the development of heart failure. Chronic hypertension drives cardiac remodeling within the left ventricle resulting in hypertensive heart disease, which ultimately manifests as heart failure. Early detection and appropriate management are necessary to prevent heart failure as well as other cardiovascular diseases. Achieving blood pressure goals in conjunction with using evidence-based treatments can improve clinical outcomes for patients with comorbid hypertension and heart failure.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/fisiología , Insuficiencia Cardíaca/prevención & control , Hipertensión/tratamiento farmacológico , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Pronóstico
8.
J Agric Food Chem ; 68(3): 759-768, 2020 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-31841328

RESUMEN

In this study, we investigated the antihypertensive effects in vitro and in vivo of novel angiotensin-converting enzyme inhibitory (ACEI) peptides purified and identified from bovine bone gelatin hydrolysate (BGH). Thirteen ACEI peptides were identified from BGH, and among which, RGL-(Hyp)-GL and RGM-(Hyp)-GF exhibited high ACE inhibition with IC50 values of 1.44 and 10.23 µM. Molecular docking predicted that RGM-(Hyp)-GF and ACE residues of Glu384, His513, and Lys511 formed hydrogen-bonding interactions at distances of 2.57, 2.99, and 2.42 + 3.0 Å. RGL-(Hyp)-GL formed hydrogen bonds with Lys511 and Tyr523 and generated hydrogen-bonding interactions with His387 and Glu411 in the zinc(II) complexation motif at distances of 2.74 and 3.03 + 1.93 Å. The maximal decrements in systolic blood pressure in spontaneously hypertensive rats induced by one-time gavage of RGL-(Hyp)-GL and RGM-(Hyp)-GF at 30 mg/kg were 31.3 and 38.6 mmHg. RGL-(Hyp)-GL had higher enzyme degradation resistance than that of RGM-(Hyp)-GF in vitro incubation in rat plasma, and they were sequentially degraded into pentapeptides and tetrapeptides within 2 h. Our results indicate that BGH can serve as a nutritional candidate to control blood pressure.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/química , Antihipertensivos/química , Huesos/química , Gelatina/química , Péptidos/química , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/aislamiento & purificación , Animales , Antihipertensivos/administración & dosificación , Antihipertensivos/aislamiento & purificación , Presión Sanguínea/efectos de los fármacos , Bovinos , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Masculino , Simulación del Acoplamiento Molecular , Péptidos/administración & dosificación , Péptidos/aislamiento & purificación , Peptidil-Dipeptidasa A/química , Hidrolisados de Proteína/química , Ratas , Ratas Endogámicas SHR
9.
Food Chem ; 308: 125601, 2020 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-31670190

RESUMEN

The aim of this work was to analyse the hypotensive effect of amaranth protein/peptides on spontaneously hypertensive rats (SHR). The mechanism of action of these peptides was studied in vivo and ex vivo. We also tested the effect of protection against gastrointestinal digestion (GID) exerted by an O:W emulsion on the integrity of the antihypertensive peptides. All samples tested produced a decrease in blood pressure (SBP). The animals treated with emulsion (GE) and emulsion + peptide (GE+VIKP) showed the most significant reduction in the SBP (42 ±â€¯2 mmHg and 35 ±â€¯2 mmHg, respectively). The results presented suggest that after GID, a variety of peptides with biological activities were released or were resistant to this process. These peptides play a role in the regulation of the SBP by acting on plasma ACE, plasma renin and the vascular system. These results support the use of amaranth protein/peptides in the elaboration of functional foods for hypertensive individuals.


Asunto(s)
Amaranthus/química , Antihipertensivos/farmacología , Hipertensión/tratamiento farmacológico , Péptidos/farmacología , Sistema Renina-Angiotensina/efectos de los fármacos , Animales , Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Masculino , Péptidos/uso terapéutico , Proteínas de Plantas/farmacología , Proteínas de Plantas/uso terapéutico , Ratas , Ratas Endogámicas SHR
10.
J Sci Food Agric ; 100(1): 315-324, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31525262

RESUMEN

BACKGROUND: In order to utilize tilapia skin gelatin hydrolysate protein, which is normally discarded as industrial waste in the process of fish manufacture, we study the in vivo and in vitro angiotensin-I-converting enzyme (ACE) inhibitory activity of the peptide Leu-Ser-Gly-Tyr-Gly-Pro (LSGYGP). The aim was to provide a pharmacological basis of the development of minimal side effects of ACE inhibitors by comparative analysis with captopril in molecular docking. RESULTS: This peptide from protein-rich wastes showed excellent ACE inhibitory activity (IC50  = 2.577 µmol L-1 ) and exhibited a mixed noncompetitive inhibitory pattern with Lineweaver-Burk plots. Furthermore, LSGYGP and captopril groups both showed significant decreases in blood pressure after 6 h and maintained good digestive stability over 4 h. Molecular bond interactions differentiate competitive captopril upon hydrogen bond interactions and Zn(II) interaction. The C-terminal Pro generates three interactions (hydrogen bonds, hydrophilic interactions and Van der Waals interactions) in the peptide and effectively interacts with the S1 and S2 pockets of ACE. CONCLUSION: LSGYGP, with an IC50 value of 2.577 µmol L-1 , has an antihypertensive effect in spontaneously hypertensive rats. Through comparison with captopril, this study revealed that LSGYGP may be a potential food-derived ACE inhibitory peptide and could act as a functional food ingredient to prevent hypertension. © 2019 Society of Chemical Industry.


Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/química , Antihipertensivos/química , Captopril/química , Hipertensión/tratamiento farmacológico , Péptidos/química , Secuencia de Aminoácidos , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/metabolismo , Animales , Antihipertensivos/administración & dosificación , Antihipertensivos/metabolismo , Presión Sanguínea/efectos de los fármacos , Captopril/administración & dosificación , Cíclidos , Digestión , Proteínas de Peces/química , Tracto Gastrointestinal/metabolismo , Humanos , Enlaces de Hidrógeno , Interacciones Hidrofóbicas e Hidrofílicas , Hipertensión/metabolismo , Hipertensión/fisiopatología , Cinética , Masculino , Simulación del Acoplamiento Molecular , Péptidos/metabolismo , Péptidos/farmacología , Peptidil-Dipeptidasa A/química , Peptidil-Dipeptidasa A/metabolismo , Hidrolisados de Proteína/química , Hidrolisados de Proteína/metabolismo , Ratas , Ratas Endogámicas SHR
11.
Wien Klin Wochenschr ; 131(Suppl 6): 489-590, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31792659

RESUMEN

Elevated blood pressure remains a major cause of cardiovascular disease, disability, and premature death in Austria, with suboptimal rates of detection, treatment and control also in recent years. Management of hypertension is a common challenge for physicians with different spezializations. In an attempt to standardize diagnostic and therapeutic strategies and, ultimately, to increase the rate of patients with controlled blood pressure and to decrease the burden of cardiovascular disease, 13 Austrian medical societies reviewed the evidence regarding prevention, detection, workup, treatment and consequences of high blood pressure in general and in various clinical scenarios. The result is presented as the first national consensus on blood pressure. The authors and societies involved are convinced that a joint national effort is needed to decrease hypertension-related morbidity and mortality in our country.


Asunto(s)
Antihipertensivos , Enfermedades Cardiovasculares , Hipertensión , Antihipertensivos/uso terapéutico , Austria , Presión Sanguínea , Enfermedades Cardiovasculares/prevención & control , Consenso , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico
12.
Georgian Med News ; (295): 93-101, 2019 Oct.
Artículo en Ruso | MEDLINE | ID: mdl-31804207

RESUMEN

This a review article that describes the most important pharmacokinetic parameters of ß-blockers that determinate clinical importance of this group of medications, pharmacodynamics effects of this group and representative medications from the ß-blocker class. We substantiated the use of ß-blockers for cardio-vascular diseases using evidence base approach and founds of pharmacokinetic and pharmacodynamics effects.


Asunto(s)
Antagonistas Adrenérgicos beta , Hipertensión , Isquemia Miocárdica , Antagonistas Adrenérgicos beta/farmacología , Humanos , Hipertensión/tratamiento farmacológico , Isquemia Miocárdica/tratamiento farmacológico
13.
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
14.
Lakartidningen ; 1162019 Dec 23.
Artículo en Sueco | MEDLINE | ID: mdl-31873937

RESUMEN

Night-time blood pressure is an independent prognostic marker for cardiovascular disease. Evening dosing of antihypertensive agents can reduce night-time blood pressure and restore night-time blood pressure dipping pattern. In the Hygia Chronotherapy Trial, evening dosing of antihypertensive agents was compared to morning dosing, with dramatic effects on cardiovascular events and total mortality. We review possible limitations of the Hygia trial, including aspects of randomization, allocation concealment, outcome reporting and imbalance between groups. Based on these limitations, the trial should be interpreted with caution and future studies should be awaited before changing clinical practice.


Asunto(s)
Antihipertensivos , Hipertensión , Antihipertensivos/administración & dosificación , Presión Sanguínea , Determinación de la Presión Sanguínea , Ensayos Clínicos como Asunto , Relación Dosis-Respuesta a Droga , Humanos , Hipertensión/tratamiento farmacológico
15.
Zhongguo Zhong Yao Za Zhi ; 44(22): 4896-4904, 2019 Nov.
Artículo en Chino | MEDLINE | ID: mdl-31872598

RESUMEN

Previous studies of Dendrobium officinale on anti-hypertension effect always focused only on the blood pressure,while polysaccharides of D. officinale( DOP) have been traditionally considered as one of the main effective substances. This study aimed to evaluate the effect of ethanol extract from D. officinale( DOE) on blood pressure,Glu and lipid profile in metabolic hypertensive rats induced by comprehensive dietary factors,and elucidate the composition of effective fractions from DOE. A metabolic hypertension model of rat induced by high-sugar,high-fat diet and alcohol drinking was adopted to evaluate the effect of DOE on hypertension and other metabolic disorders. Blood pressure,Glu and lipid profile were detected to find the features and differences of DOE and DOP on metabolic hypertension. Furthermore,DOE was separated with three different common solvents according to the polarity. Along with blood pressure,Glu,UA and lipid profile,hemorheology,oxidative index and aortas structure changes were adopted to evaluate the comprehensive effects of the most effective fractions on metabolic hypertension. Finally,HPLC-DAD-MS was adopted to identify the components of the most effective fraction. The SBP and Glu of models were decreased significantly after administration of DOE and DOP for 6 weeks,while TG in DOE groups also reduced dramatically. The DOE was separated with ether,n-butanol respectively and named NAF,NBF and NCF. SBP,TG,Glu,UA of model rats were decreased significantly after 4 weeks administration with NBF. The level of MDA in serum was down-regulated,while GSH-Px and T-AOC were up-regulated obviously after 12 weeks.And the blood viscosity also obviously decreased,with less collagen deposition of aortas by Masson's trichrome staining. NBF was mainly composed of phenols and flavone C-glycosides,whose aglycone was apigenin,and monosaccharide was connected to C-6 and C-8. Ethanol extract from D.officinale has an positive effect in alleviating hypertension and metabolic disorders in metabolic hypertension. Medium polarity fraction was the effective fraction of alcohol extraction from D. officinale,and mainly composed of phenols and flavone C-glycosides.


Asunto(s)
Dendrobium , Hipertensión/tratamiento farmacológico , Extractos Vegetales/uso terapéutico , Animales , Presión Sanguínea , Etanol , Extractos Vegetales/farmacología , Ratas
16.
Medicine (Baltimore) ; 98(51): e18471, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31861026

RESUMEN

This study aimed to compare the Hamilton anxiety rating/Hamilton depression rating (HAMA/HAMD) scale scores and blood pressure (BP) goal achievement associated with the use of valsartan-amlodipine single-pill combinations (SPCs) versus valsartan and amlodipine combination in adult hypertensive patients.A total of 476 hypertensive patients were randomly assigned into the SPC (valsartan-amlodipine) and control (valsartan and amlodipine combination) groups. All patients had an uncontrolled BP (160-179/100-109 mm Hg). BP goal was <140/90 mm Hg. Cox proportional hazards regression analysis was used to analyze the likelihood of HAMA/HAMD scales, SPCs, control group, and daily dosage number. Kaplan-Meier analysis was used to estimate the rates of BP goal achievement over time among the 2 groups.A total of 476 patients were included in the study, and 439 patients completed the follow-up and received the index drug therapy. There was a significant difference in BP between the 2 groups on days 28, 42, and 56. Patients who received SPCs had a significantly higher rate of BP goal achievement over time (P = .000). The average HAMD scores in the SPC and control groups were 5.54 and 5.49 and 6.06 and 6.21 on days 28 and 56, respectively. The average HAMA scores in the SPC and control groups were 7.41 and 7.13 and 7.90 and 8.01 on days 28 and 56, respectively. The means of HAMD and HAMA scores were 5.826 and 7.614, respectively. The higher the HAMA/HAMD scores, the lower was the BP goal achievement. The number of drugs taken by the patients was associated with the HAMA and HAMD scores. There was no significant difference between HAMA scores of patients taking 1 tablet daily (7.22 ±â€Š1.885) and those taking two-tablets daily (7.38 ±â€Š1.953) (P = .408). However, when these scores were compared to those of patients taking 4 tablets daily (8.08 ±â€Š2.285), a significant difference was observed (P = .000, P = .000).Hypertensive patients treated with valsartan-amlodipine SPCs were significantly more likely to achieve BP goal and have lesser HAMA/HAMD scores compared to patients treated with valsartan and amlodipine combination.


Asunto(s)
Combinación Amlodipino y Valsartán/uso terapéutico , Antihipertensivos/administración & dosificación , Ansiedad/prevención & control , Depresión/prevención & control , Hipertensión/tratamiento farmacológico , Combinación Amlodipino y Valsartán/farmacología , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Hipertensión/psicología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
17.
Kardiologiia ; 59(11): 56-65, 2019 Dec 11.
Artículo en Ruso | MEDLINE | ID: mdl-31849300

RESUMEN

Blood pressure variability (BPV) is the fluctuations of blood pressure over a certain period of time under the influence of various factors. The issue of increased BPV is of particular clinical importance due to high predictive value of this parameter as a risk factor for fatal and non-fatal cardiovascular, cerebrovascular and renal events. It is proved that in the BPV increasing, the key role is played by impairments in arterial baroreflexes, which, in turn, are mediated by increased vascular stiffness, impact of angiotensin II and the sympathetic nervous system, endothelial dysfunction, nitric oxide deficiency and aging, including the vascular aging. Antihypertensive drugs that targeting largest amount of pathophysiological mechanisms in BPV increasing have a most advantages in correcting excessive pressure fluctuations. In this regard such drugs are perindopril and amlodipine, which can eliminate almost the entire spectrum of increased BPV causes and, therefore, optimally reduce the cardiovascular risk.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión , Presión Sanguínea , Determinación de la Presión Sanguínea , Humanos , Hipertensión/tratamiento farmacológico
18.
Kardiologiia ; 59(12): 64-71, 2019 Dec 11.
Artículo en Ruso | MEDLINE | ID: mdl-31849313

RESUMEN

Resistant and refractory arterial hypertensions are two distinct clinical phenotypes of uncontrolled arterial hypertension (AH), which differ in their sensitivity to antihypertensive drug therapy. The review presents data obtained in clinical studies devoted to elucidating the involvement of disorders of neurohormonal status and renal function in the formation of resistant and refractory arterial hypertension, to and the development of new approaches to increasing the effectiveness of antihypertensive therapy in these patient's populations. The results of these studies have shown that in patients with uncontrolled arterial hypertension, despite prolonged intake ≥ 3 antihypertensive drugs with different mechanisms of action, including a diuretic, excess sodium reabsorption persists in the distal segments of nephron due to increased aldosterone activity and sympathetic nervous system hyperactivity. In this regard, special attention has been paid to the data of PATHWAY-2, PATHWAY-3 and ReHOT trials that in patients with resistant AH tested the clinical efficacy of spironolactone, amiloride, and antiadrenergic drugs bisoprolol, doxazosin and clonidine, suppressing activity of the sympathetic nervous system.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión , Bisoprolol , Humanos , Hipertensión/tratamiento farmacológico , Riñón , Espironolactona
19.
Presse Med ; 48(12): 1445-1455, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31761607

RESUMEN

The Hormonal assessment of Arterial Hypertension (HTA) is an important part of the balance of resistant hypertension. This assessment - going well beyond the search for primary hyperaldosteronism (PHA) - requires a rigorous methodology and a robust experience of the nursing team within a dedicated unit: the HTA Day Hospital. If all the conditions are met and the assessment carried out well, it will allow a significant profitability since in this resistant hypertensive population it will detect a particular mechanism or secondary hypertension in 70% of patients. Since the diagnosis of PHA is essentially biological, the proper execution of the various stages of the assessment is essential to its documentation.


Asunto(s)
Técnicas de Diagnóstico Endocrino , Hormonas/análisis , Hipertensión/diagnóstico , Aldosterona/análisis , Aldosterona/sangre , Antihipertensivos/uso terapéutico , Análisis Químico de la Sangre/métodos , Análisis Químico de la Sangre/normas , Diagnóstico Diferencial , Técnicas de Diagnóstico Endocrino/normas , Resistencia a Medicamentos/efectos de los fármacos , Hormonas/sangre , Humanos , Hiperaldosteronismo/diagnóstico , Hipertensión/sangre , Hipertensión/tratamiento farmacológico , Hipertensión/etiología , Renina/análisis , Renina/sangre
20.
Presse Med ; 48(12): 1520-1526, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31761608

RESUMEN

Non-adherence to antihypertensive treatment is one of the critical contributors to sub-optimal blood pressure control. The French Society of Hypertension remembered that urine and serum biochemical detection of antihypertensive drugs could be useful in a patient with resistant hypertension. Talking to a patient with biochemically confirmed non-adherence to blood pressure-lowering therapy and repeating them improved adherence to drugs. Despite its usefulness, biochemical detection of antihypertensive drugs is not routinely effective in France as they are not reimbursed by French Medical Care, except in patients attending hospitals. The list of blood pressure-lowering drugs able to be biochemically detected in France and their modalities are recorded here.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Cumplimiento de la Medicación/estadística & datos numéricos , Antihipertensivos/economía , Presión Sanguínea/efectos de los fármacos , Formas de Dosificación , Costos de los Medicamentos , Francia/epidemiología , Humanos , Hipertensión/economía
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