Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 106.191
Filtrar
1.
Life Sci ; 264: 118659, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33148418

RESUMEN

AIMS: During heart ischemia, the lack of oxygen in the myocardial cells causes pH and ion disturbances and cell death through opening mitochondrial permeability transition pores (mPTP). Considering the inhibitory effects of mitochondrial ATP-dependent potassium channels (mt-KATP) on these pores and anti-ischemic effects of morin, we hypothesized that it may exert its positive effects via activating mt-KATP as well as its anti-oxidative effects. MAIN METHODS: Isolated rat hearts were perfused by Krebs-Henseleit solution enriched with the morin (0.25, 0.5 and 1 mg/L) or 5-hydroxydecanoate (5-HD, a mt-KATP blocker;100 µM) or both as needed 5 min before starting regional ischemia till the first 10 min of the reperfusion period. The reperfusion was developed with Krebs-Henseleit solution 60 or 120 min respectively for biochemical evaluations (lactate dehydrogenase and malondialdehyde level) or the assessment of myocardial infarct size. During the experiments, hemodynamic functions were recorded and cardiac arrhythmias were determined. KEY FINDINGS: Our findings demonstrated that morin reduced the infarct size. Also, morin perfusion could remarkably prevent the malondialdehyde over-production during ischemia. Total ventricular ectopic beats had the same significant changes as the malondialdehyde level, in both ischemia and reperfusion phases. Morin could also relatively improve the ischemia-induced hemodynamic dysfunction. All mentioned protective effects of morin were reversed by concomitant perfusion of 5-HD. SIGNIFICANCE: Morin has protective effects against ischemic hearts through anti-oxidative effects. It also suggests a link between the cardioprotective effects of morin and mt-KATP. However, additional studies are required to prove this preliminary hypothesis.


Asunto(s)
Cardiotónicos/farmacología , Flavonoides/farmacología , Corazón/fisiología , Canales KATP/metabolismo , Mitocondrias Cardíacas/metabolismo , Animales , Presión Sanguínea/efectos de los fármacos , Corazón/efectos de los fármacos , Ventrículos Cardíacos/efectos de los fármacos , Hemodinámica/efectos de los fármacos , L-Lactato Deshidrogenasa/metabolismo , Masculino , Malondialdehído/metabolismo , Mitocondrias Cardíacas/efectos de los fármacos , Infarto del Miocardio/patología , Perfusión , Ratas Wistar , Taquicardia Ventricular/patología
2.
J Stroke Cerebrovasc Dis ; 30(1): 105413, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33160127

RESUMEN

BACKGROUND: In adult patients with moyamoya disease (MMD) underwent combined revascularization, cerebral infarction during the acute postoperative phase is common and can lead to neurological dysfunction after revascularization in MMD patients. The aim of this study was to share the experience of individualized perioperative blood pressure (BP) management for adult MMD patients in one single center. METHODS: We retrospectively reviewed 144 adult patients with MMD who underwent 186 procedures of combined revascularization at our institution from March 2013 to July 2019. Clinical features and outcomes were analyzed, in particular regarding cerebral infarction and hyperperfusion syndrome (HPS). All of the patients received individualized management perioperatively, especially about the blood pressure management according to the characteristics of moyamoya disease. RESULTS: Postoperative cerebral infarction and HPS within 14 days after revascularization were recorded. Cerebral infarction occurred in four (2.1%) procedures among four patients. No patients suffered from a malignant cerebral infarction and only one patient had permanent neurological deficits. The incidence of HPS was 10.8% and no one presented with intracranial hemorrhage. All of the symptoms were reversible without any brain parenchymal injury. CONCLUSIONS: Our findings suggest that we can decrease the incidence and extent of cerebral infarction in adult MMD patients following combined revascularization by individualized perioperative BP management.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Infarto Cerebral/prevención & control , Revascularización Cerebral , Fluidoterapia , Enfermedad de Moyamoya/cirugía , Atención Perioperativa , Adulto , Antihipertensivos/efectos adversos , Infarto Cerebral/diagnóstico por imagen , Infarto Cerebral/etiología , Infarto Cerebral/fisiopatología , Revascularización Cerebral/efectos adversos , Circulación Cerebrovascular , Femenino , Fluidoterapia/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Moyamoya/diagnóstico por imagen , Enfermedad de Moyamoya/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
3.
PLoS One ; 15(12): e0244708, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33378401

RESUMEN

BACKGROUND: Retrospective studies on the use of Renin-Angiotensin-Aldosterone System blockade in patients with Coronavirus Disease 2019 (COVID-19) have been informative but conflicting, and prospective studies are required to demonstrate the safety, tolerability, and outcomes of initiating these agents in hospitalized patients with COVID-19 and hypertension. METHODS AND FINDINGS: This is a single center feasibility study encompassing two cohorts: (1) prospective cohort (April 21, 2020 to May 29, 2020) and (2) retrospective cohort (March 7, 2020 to April 1, 2020) of hospitalized patients with real-time polymerase chain reaction (PCR) positive SARS-CoV-2 by nasopharyngeal swab. Key inclusion criteria include BP > 130/80 and a requirement of supplemental oxygen with FiO2 of 25% or higher to maintain SpO2 > 92%. Key exclusion criteria included hyperkalemia and acute kidney injury (AKI) at the time of enrollment. Prospective cohort consisted of de novo initiation of losartan and continuation for a minimum of 7 days and assessed for adverse events (AKI, hyperkalemia, transaminitis, hypotension) and clinical outcomes (change in SpO2/FiO2 and inflammatory markers, need for ICU admission and mechanical ventilation). Retrospective cohort consisted of continuation of losartan (prior-to-hospitalization) and assessment of similar outcomes. In the prospective cohort, a total of 250 hospitalized patients were screened and inclusion/exclusion criteria were met in 16/250 patients and in the retrospective cohort, a total of 317 hospitalized patients were screened and inclusion/exclusion criteria were met in 14/317 patients. Most common adverse event was hypotension, leading to discontinuation in 3/16 (19%) and 2/14 (14%) patients in the prospective and retrospective cohort. No patients developed AKI in the prospective cohort as compared to 1/14 (7%) patients in the retrospective cohort, requiring discontinuation of losartan. Hyperkalemia occurred in 1/16 (6%) and 0/14 patients in the prospective and retrospective cohorts, respectively. In the prospective cohort, 3/16 (19%) and 2/16 (13%) patients required ICU admission and mechanical ventilation. In comparison, 3/14 (21%) required ICU admission and mechanical ventilation in the retrospective cohort. A majority of patients in both cohorts (14/16 (88%) and 13/14 (93%) patients from the prospective and retrospective cohort) were discharged alive from the hospital. A total of 9/16 (prospective) and 5/14 (retrospective) patients completed a minimum 7 days of losartan. In these 9 patients in the prospective cohort, a significant improvement in SpO2/FiO2 ratio was observed from day 1 to 7. No significant changes in inflammatory markers (initiation, peak, and day 7) were observed in either cohort. CONCLUSION: In this pilot study we demonstrate that losartan was well-tolerated among hospitalized patients with COVID-19 and hypertension. We also demonstrate the feasibility of patient recruitment and the appropriate parameters to assess the outcomes and safety of losartan initiation or continuation, which provides a framework for future randomized clinical trials.


Asunto(s)
Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéutico , Hipertensión/tratamiento farmacológico , Losartán/uso terapéutico , Anciano , Bloqueadores del Receptor Tipo 1 de Angiotensina II/efectos adversos , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Losartán/efectos adversos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Estudios Retrospectivos
4.
Cochrane Database Syst Rev ; 12: CD004022, 2020 12 12.
Artículo en Inglés | MEDLINE | ID: mdl-33314019

RESUMEN

BACKGROUND: Recent cohort studies show that salt intake below 6 g is associated with increased mortality. These findings have not changed public recommendations to lower salt intake below 6 g, which are based on assumed blood pressure (BP) effects and no side-effects. OBJECTIVES: To assess the effects of sodium reduction on BP, and on potential side-effects (hormones and lipids) SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to April 2018 and a top-up search in March 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. The top-up search articles are recorded under "awaiting assessment." SELECTION CRITERIA: Studies randomizing persons to low-sodium and high-sodium diets were included if they evaluated at least one of the outcome parameters (BP, renin, aldosterone, noradrenalin, adrenalin, cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride,. DATA COLLECTION AND ANALYSIS: Two review authors independently collected data, which were analysed with Review Manager 5.3. Certainty of evidence was assessed using GRADE. MAIN RESULTS: Since the first review in 2003 the number of included references has increased from 96 to 195 (174 were in white participants). As a previous study found different BP outcomes in black and white study populations, we stratified the BP outcomes by race. The effect of sodium reduction (from 203 to 65 mmol/day) on BP in white participants was as follows: Normal blood pressure: SBP: mean difference (MD) -1.14 mmHg (95% confidence interval (CI): -1.65 to -0.63), 5982 participants, 95 trials; DBP: MD + 0.01 mmHg (95% CI: -0.37 to 0.39), 6276 participants, 96 trials. Hypertension: SBP: MD -5.71 mmHg (95% CI: -6.67 to -4.74), 3998 participants,88 trials; DBP: MD -2.87 mmHg (95% CI: -3.41 to -2.32), 4032 participants, 89 trials (all high-quality evidence). The largest bias contrast across studies was recorded for the detection bias element. A comparison of detection bias low-risk studies versus high/unclear risk studies showed no differences. The effect of sodium reduction (from 195 to 66 mmol/day) on BP in black participants was as follows: Normal blood pressure: SBP: mean difference (MD) -4.02 mmHg (95% CI:-7.37 to -0.68); DBP: MD -2.01 mmHg (95% CI:-4.37, 0.35), 253 participants, 7 trials. Hypertension: SBP: MD -6.64 mmHg (95% CI:-9.00, -4.27); DBP: MD -2.91 mmHg (95% CI:-4.52, -1.30), 398 participants, 8 trials (low-quality evidence). The effect of sodium reduction (from 217 to 103 mmol/day) on BP in Asian participants was as follows: Normal blood pressure: SBP: mean difference (MD) -1.50 mmHg (95% CI: -3.09, 0.10); DBP: MD -1.06 mmHg (95% CI:-2.53 to 0.41), 950 participants, 5 trials. Hypertension: SBP: MD -7.75 mmHg (95% CI:-11.44, -4.07); DBP: MD -2.68 mmHg (95% CI: -4.21 to -1.15), 254 participants, 8 trials (moderate-low-quality evidence).   During sodium reduction renin increased 1.56 ng/mL/hour (95%CI:1.39, 1.73) in 2904 participants (82 trials); aldosterone increased 104 pg/mL (95%CI:88.4,119.7) in 2506 participants (66 trials); noradrenalin increased 62.3 pg/mL: (95%CI: 41.9, 82.8) in 878 participants (35 trials); adrenalin increased 7.55 pg/mL (95%CI: 0.85, 14.26) in 331 participants (15 trials); cholesterol increased 5.19 mg/dL (95%CI:2.1, 8.3) in 917 participants (27 trials); triglyceride increased 7.10 mg/dL (95%CI: 3.1,11.1) in 712 participants (20 trials); LDL tended to increase 2.46 mg/dl (95%CI: -1, 5.9) in 696 participants (18 trials); HDL was unchanged -0.3 mg/dl (95%CI: -1.66,1.05) in 738 participants (20 trials) (All high-quality evidence except the evidence for adrenalin). AUTHORS' CONCLUSIONS: In white participants, sodium reduction in accordance with the public recommendations resulted in mean arterial pressure (MAP) decrease of about 0.4 mmHg in participants with normal blood pressure and a MAP decrease of about 4 mmHg in participants with hypertension. Weak evidence indicated that these effects may be a little greater in black and Asian participants. The effects of sodium reduction on potential side effects (hormones and lipids) were more consistent than the effect on BP, especially in people with normal BP.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Dieta Hiposódica , Hipertensión/dietoterapia , Cloruro de Sodio Dietético/farmacología , Grupo de Ascendencia Continental Africana , Aldosterona/sangre , Grupo de Ascendencia Continental Asiática , Sesgo , Catecolaminas/sangre , Colesterol/sangre , Intervalos de Confianza , Epinefrina/sangre , Grupo de Ascendencia Continental Europea , Humanos , Hipertensión/etnología , Norepinefrina/sangre , Ensayos Clínicos Controlados Aleatorios como Asunto , Ingesta Diaria Recomendada , Renina/sangre , Triglicéridos/sangre
5.
Niger Postgrad Med J ; 27(4): 317-324, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33154284

RESUMEN

Background: Despite the availability of effective antihypertensive drugs, the quality of evidence regarding the best antihypertensive agent for the treatment of hypertensive emergencies in pregnancy is still poor. Aim: The aim of this study was to compare the efficacy and side effects of oral nifedipine and intravenous hydralazine for control of blood pressure (BP) in severe hypertension in pregnancy. Materials and Methods: An open-label, parallel, randomised, controlled trial of 78 pregnant women (≥28 weeks' gestation) with severe hypertension was conducted. Severe hypertension was defined as systolic BP of 160 mmHg or above and/or diastolic BP of 110 mmHg or above. They were randomly (1:1 ratio) administered oral nifedipine 20 mg or intravenous hydralazine 10 mg every 30 min up to 5 doses or until the target BP of 140-150 mmHg systolic and 90-100 mmHg diastolic was achieved. Intravenous labetalol was given if the primary treatment failed. The primary outcome measure was the number of doses needed to achieve targeted BP. The secondary outcome measures were the time needed to achieve desired BP, maternal adverse effects and perinatal outcome. Results: The sociodemographic characteristics did not differ between the two study groups. The average number of dosages (nifedipine; 1.4 ± 0.6 vs. hydralazine; 1.7 ± 0.5, P = 0.008) needed to control the BP was lower in the nifedipine arm. Time (min) taken to control the BP was similar between the groups (hydralazine; 43.7 ± 19.7 vs. nifedipine; 51.2 ± 18.9, P = 0.113). Adverse maternal and perinatal effects did not differ in the study groups. Conclusion: Oral nifedipine and intravenous hydralazine showed comparable efficacy in the BP control in the severe hypertensive disorders of pregnancy without significant difference in adverse maternal and perinatal outcomes. However, further studies are required to explore the role of these drugs in BP control during hypertensive emergencies in pregnancy. ClinicalTrials.gov: (Identification number: NCT04435210).


Asunto(s)
Hipertensión Inducida en el Embarazo/tratamiento farmacológico , Administración Oral , Antihipertensivos/efectos adversos , Presión Sanguínea/efectos de los fármacos , Femenino , Humanos , Hidralazina/farmacología , Hidralazina/uso terapéutico , Nifedipino/farmacología , Nifedipino/uso terapéutico , Nigeria , Embarazo
6.
Nat Commun ; 11(1): 5555, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33144559

RESUMEN

It is highly debated how cyclic adenosine monophosphate-dependent regulation (CDR) of the major pacemaker channel HCN4 in the sinoatrial node (SAN) is involved in heart rate regulation by the autonomic nervous system. We addressed this question using a knockin mouse line expressing cyclic adenosine monophosphate-insensitive HCN4 channels. This mouse line displayed a complex cardiac phenotype characterized by sinus dysrhythmia, severe sinus bradycardia, sinus pauses and chronotropic incompetence. Furthermore, the absence of CDR leads to inappropriately enhanced heart rate responses of the SAN to vagal nerve activity in vivo. The mechanism underlying these symptoms can be explained by the presence of nonfiring pacemaker cells. We provide evidence that a tonic and mutual interaction process (tonic entrainment) between firing and nonfiring cells slows down the overall rhythm of the SAN. Most importantly, we show that the proportion of firing cells can be increased by CDR of HCN4 to efficiently oppose enhanced responses to vagal activity. In conclusion, we provide evidence for a novel role of CDR of HCN4 for the central pacemaker process in the sinoatrial node.


Asunto(s)
Relojes Biológicos , AMP Cíclico/metabolismo , Canales Regulados por Nucleótidos Cíclicos Activados por Hiperpolarización/metabolismo , Nodo Sinoatrial/patología , Potenciales de Acción/efectos de los fármacos , Animales , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/patología , Relojes Biológicos/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Bradicardia/complicaciones , Bradicardia/patología , Carbacol/farmacología , Electrocardiografía , Femenino , Células HEK293 , Corazón/efectos de los fármacos , Corazón/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Ratones Endogámicos C57BL , Subunidades de Proteína/metabolismo , Reproducibilidad de los Resultados , Nodo Sinoatrial/fisiopatología , Nervio Vago/efectos de los fármacos , Nervio Vago/fisiopatología
7.
High Blood Press Cardiovasc Prev ; 27(6): 587-596, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33165768

RESUMEN

INTRODUCTION: Despite hypertension guidelines suggest that the most effective treatment strategy to improve blood pressure (BP) target achievement is to implement the use of combination treatment, monotherapy is still widely used in the clinical practice of hypertension. AIM: To investigate BP control under monotherapy in the setting of real-life. METHODS: We extracted data from a medical database of adult outpatients who were referred to the Hypertension Unit, Sant'Andrea Hospital, Rome (IT), including anthropometric data, CV risk factors and comorbidities, presence or absence of antihypertensive therapy and concomitant medications. Among treated hypertensive patients, we identified only those under single antihypertensive agent (monotherapy). Office BP treatment targets were defined according to 2018 ESC/ESH guidelines as: (a) < 130/80 mmHg in individuals aged 18-65 years; (b) < 140/80 mmHg in those aged > 65 years. RESULTS: From an overall sample of 7797 records we selected 1578 (20.2%) hypertensive outpatients (47.3% female, age 59.5 ± 13.6 years, BMI 26.6 ± 4.4 kg/m2) treated with monotherapies, among whom 30.5% received ACE inhibitors, 37.7% ARBs, 15.8% beta-blockers, 10.6% CCBs, 3.0% diuretics, and 2.0% alpha-blockers. 36.6% of these patients reached the conventional clinic BP goal of < 140/90 mmHg, whilst the 2018 European guidelines BP treatment targets were fulfilled only in 14.0%. In particular, 10.2% patients aged 18-65 years and 20.4% of those aged > 65 years achieved the recommended BP goals. All these proportions results significantly lower than those achieved with dual (18.2%) or triple (22.2%) combination therapy, though higher than those obtained with life-style changes (10.8%). Proportions of patients on monotherapies with normal home and 24-h BP levels were 22.0% and 30.2%, respectively, though only 5.2% and 7.3% of these patients achieved sustained BP control, respectively. Ageing and dyslipidaemia showed significant and independent positive predictive value for the achievement of the recommended BP treatment targets, whereas European SCORE resulted a negative and independent predictor in outpatients treated with monotherapies. CONCLUSIONS: Our data showed a persistent use of monotherapy in the clinical practice, though with unsatisfactory BP control, especially in light of the BP treatment targets suggested by the last hypertension guidelines.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antihipertensivos/efectos adversos , Estudios Transversales , Bases de Datos Factuales , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Roma , Resultado del Tratamiento , Adulto Joven
8.
Medicine (Baltimore) ; 99(48): e23187, 2020 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-33235079

RESUMEN

This retrospective study investigated the effect of Yiqi-Huoxue Decoction (YQHXD) on blood pressure (BP) in patients with acute ischemic stroke (AIS).A total of 72 patients with BP following AIS who received routine treatment were included in this retrospective study. Of those, 36 patients received YQHXD and were assigned to a treatment group. The other 36 patients were allocated to a control group. All patients were treated for a total of 4 months. The outcomes were assessed by systolic blood pressure (SBP), diastolic blood pressure (DBP), National Institutes of Health Stroke Scale (NIHSS) score and Barthel index scale (BIS). All outcomes were measured after 4-month treatment.After treatment, all subjects in the treatment group showed greater improvements in SBP (P < .05), DBP (P < .05), NIHSS (P < .05) score, and BIS (P < .05) than those of patients in the control group. In addition, the safety profile is similar in both groups.The findings of this study demonstrated that YQHXD may benefit on BP in patients with AIS. Future studies should focus on warranting the current results.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Isquemia Encefálica/fisiopatología , Medicamentos Herbarios Chinos/efectos adversos , Accidente Cerebrovascular/tratamiento farmacológico , Anciano , Estudios de Casos y Controles , China/epidemiología , Medicamentos Herbarios Chinos/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Accidente Cerebrovascular/patología , Resultado del Tratamiento
9.
Isr Med Assoc J ; 22(7): 404-408, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33236563

RESUMEN

BACKGROUND: Methylene blue (MB), an inhibitor of nitric oxide synthesis and its effects is a potentially effective treatment against distributive shock states such as septic shock and vasoplegic syndrome. MB has been shown to alleviate vasoplegia and promote an increase in blood pressure. It may reduce mortality. However, in the pediatric population, there are few case reports and only one controlled study on administration of MB use for vasoplegia, sepsis, or shock in general. OBJECTIVES: To summarize the experience of administering MB for vasoplegic shock in a tertiary care pediatric intensive care unit. METHODS: A retrospective chart review of seven pediatric cases treated with MB for vasoplegic shock was conducted. MB was administered as a bolus followed by continuous infusion. The authors measured blood pressure, vasopressor, and inotropic support. Patient outcome was monitored. RESULTS: The authors observed a favorable hemodynamic response with an increase in blood pressure and a reduction in vasopressor and inotropic support needed following MB administration in six patients. No side effects were observed. Three patients eventually died one to two days later, secondary to their underlying disease. CONCLUSIONS: This case series adds to the small body of evidence in the pediatric population supporting the use of MB for distributive shock states and emphasizes the need for larger, randomized trials evaluating its role in vasoplegic shock treatment.


Asunto(s)
Enfermedad Crítica , Azul de Metileno/administración & dosificación , Choque Séptico/tratamiento farmacológico , Choque/tratamiento farmacológico , Presión Sanguínea/efectos de los fármacos , Niño , Preescolar , Resultado Fatal , Femenino , Humanos , Lactante , Recién Nacido , Israel , Masculino , Estudios Retrospectivos , Vasoplejía/tratamiento farmacológico
10.
Life Sci ; 263: 118713, 2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-33157091

RESUMEN

AIMS: Our study was designed to explore the function and mechanism of taxifolin on glucose metabolism and water-salt metabolism in kidney with metabolic syndrome (MS) rats. MAIN METHODS: Spontaneous hypertensive rats were induced by fructose to establish MS model. Systolic blood pressure (SBP) and homeostasis model assessment of insulin resistance (HOMA-IR) were measured after 7 weeks of continuous administration with taxifolin. Kidney injury indices and histopathological evaluation were done. The apoptosis rate of primary kidney cells was detected by flow cytometry. Insulin signaling pathway related proteins and renal glucose transport-related proteins were detected by western blotting. We assessed the effects of taxifolin on sodium water retention and renin-angiotensin-aldosterone system (RAAS) in MS rats. We examined not only changes in urine volume, osmotic pressure, urinary sodium and urinary chloride excretion, but also the effects on NA+/K+-ATPase and RAAS indicators. We also detected changes in inflammatory factors by immunohistochemical staining and immunofluorescence. In vitro experiment, high glucose and salt stimulated NRK-52E cells. By adding the PI3K inhibitor (wortmannin) to inhibit the PI3K, the effects of inhibiting the PI3K/AKT signaling pathway on glucose metabolism, water-sodium retention and inflammatory response were discussed. KEY FINDINGS: Taxifolin effectively reversed SBP, HOMA-IR, the kidney indices and abnormal histopathological changes induced by MS. Besides, taxifolin called back the protein associated with the downstream glucose metabolism pathway of PI3K/AKT. It also inhibited overactivation of RAAS and inflammatory response. In vitro experiments have demonstrated that the PI3K/AKT signaling pathway plays an important role in this process. SIGNIFICANCE: Taxifolin can improve homeostasis of glucose, inhibit overactivation of RAAS and reduce inflammatory response by PI3K/AKT signaling pathway.


Asunto(s)
Glucosa/metabolismo , Insulina/metabolismo , Síndrome Metabólico/tratamiento farmacológico , Quercetina/análogos & derivados , Animales , Presión Sanguínea/efectos de los fármacos , Modelos Animales de Enfermedad , Resistencia a la Insulina , Riñón/citología , Riñón/metabolismo , Masculino , Síndrome Metabólico/fisiopatología , Fosfatidilinositol 3-Quinasas/metabolismo , Proteínas Proto-Oncogénicas c-akt/metabolismo , Quercetina/farmacología , Ratas , Ratas Endogámicas SHR , Ratas Endogámicas WKY , Sistema Renina-Angiotensina/efectos de los fármacos , Transducción de Señal/efectos de los fármacos , Sodio/metabolismo , Agua/metabolismo , Equilibrio Hidroelectrolítico/efectos de los fármacos
11.
Niger J Clin Pract ; 23(11): 1590-1597, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33221787

RESUMEN

Background: Hypertension is one of the commonest cause of chronic kidney disease (CKD) in Nigerians. We describe blood pressure (BP) control and kidney disease markers in patients with hypertension as part of measures to curb the burden of this chronic debilitating disease. Methods: Patients with hypertension in the main tertiary hospitals in three states in north central Nigeria were evaluated for indicators of CKD, including proteinuria and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Patients had their early morning first void urine tested for proteinuria using Combi-10 test strips. eGFR was estimated using the MDRD equation. Results: A total of 1063 subjects (63.1% females and 36.8% males) with a mean age of 55 ± 11 years were studied. Diabetes mellitus (DM) was present in 214 (20.6%) and 422 (39.7%) had optimal BP control. The median duration of hypertension was 6 years (range 1-44 years). Proteinuria occurred in 130 (12.2%), while 212 (19.9%) had reduced eGFR and 46 (4.3%) had proteinuria and reduced eGFR. The use of calcium channel blockers [adjusted odds ratio (AOR): 0.70, 95% Confidence Interval (CI) 0.50-0.99] and the use of more than two antihypertensive medications (AOR: 0.62, 95% CI 0.40-0.96) were associated with reduced odds of optimal BP control. Male sex (AOR: 1.75, 95% CI 1.14-2.70) and the use of renin-angiotensin-aldosterone system blocking medications (AOR: 2.07, 95% CI 1.18-3.64) were independently associated with proteinuria while DM (AOR: 1.69, 95% CI 1.06-2.55) and treatment with more than two medications (AOR: 1.86, 95% CI 1.09-3.17) were more likely to have reduced eGFR. Conclusion: A large proportion of hypertensive patients in north-central Nigeria have poorly controlled BP. Kidney damage is common among these patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Riñón/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Adulto , Anciano , Antihipertensivos/efectos adversos , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea , Estudios Transversales , Femenino , Tasa de Filtración Glomerular , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Proteinuria/epidemiología , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo
12.
BMJ ; 371: m4080, 2020 11 18.
Artículo en Inglés | MEDLINE | ID: mdl-33208355

RESUMEN

OBJECTIVE: To study whether treatment recommendations based on age and ethnicity according to United Kingdom (UK) clinical guidelines for hypertension translate to blood pressure reductions in current routine clinical care. DESIGN: Observational cohort study. SETTING: UK primary care, from 1 January 2007 to 31 December 2017. PARTICIPANTS: New users of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), calcium channel blockers (CCB), and thiazides. MAIN OUTCOME MEASURES: Change in systolic blood pressure in new users of ACEI/ARB versus CCB, stratified by age (< v ≥55) and ethnicity (black v non-black), from baseline to 12, 26, and 52 week follow-up. Secondary analyses included comparisons of new users of CCB with those of thiazides. A negative outcome (herpes zoster) was used to detect residual confounding and a series of positive outcomes (expected drug effects) was used to determine whether the study design could identify expected associations. RESULTS: During one year of follow-up, 87 440 new users of ACEI/ARB, 67 274 new users of CCB, and 22 040 new users of thiazides were included (median 4 (interquartile range 2-6) blood pressure measurements per user). For non-black people who did not have diabetes and who were younger than 55, CCB use was associated with a larger reduction in systolic blood pressure of 1.69 mm Hg (99% confidence interval -2.52 to -0.86) relative to ACEI/ARB use at 12 weeks, and a reduction of 0.40 mm Hg (-0.98 to 0.18) in those aged 55 and older. In subgroup analyses using six finer age categories of non-black people who did not have diabetes, CCB use versus ACEI/ARB use was associated with a larger reduction in systolic blood pressure only in people aged 75 and older. Among people who did not have diabetes, systolic blood pressure decreased more with CCB use than with ACEI/ARB use in black people (reduction difference 2.15 mm Hg (-6.17 to 1.87)); the corresponding reduction difference was 0.98 mm Hg (-1.49 to -0.47) in non-black people. CONCLUSIONS: Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older. For black people without diabetes, CCB new use was associated with numerically greater reductions in blood pressure than ACEI/ARB compared with non-black people without diabetes, but the confidence intervals were overlapping for the two groups. These results suggest that the current UK algorithmic approach to first line antihypertensive treatment might not lead to greater reductions in blood pressure. Specific indications could be considered in treatment recommendations.


Asunto(s)
Factores de Edad , Antihipertensivos/uso terapéutico , Grupos Étnicos/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Atención Primaria de Salud/estadística & datos numéricos , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Bloqueadores de los Canales de Calcio/uso terapéutico , Femenino , Humanos , Hipertensión/etnología , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Resultado del Tratamiento , Reino Unido
13.
J Clin Hypertens (Greenwich) ; 22(11): 1974-1983, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33006442

RESUMEN

Hypertension is proved to be associated with severity and mortality in coronavirus disease 2019 (COVID-19). However, little is known about the effects of pre-admission and/or in-hospital antihypertension treatments on clinical outcomes. Thus, this study aimed to investigate the association between in-hospital blood pressure (BP) control and COVID-19-related outcomes and to compare the effects of different antihypertension treatments. This study included 2864 COVID-19 patients and 1628 were hypertensive. Patients were grouped according to their BP during hospitalization and records of medication application. Patients with higher BP showed worse cardiac and renal functions and clinical outcomes. After adjustment, subjects with pre-admission usage of renin-angiotensin-aldosterone system (RAAS) inhibitors (HR = 0.35, 95%CI 0.14-0.86, P = .022) had a lower risk of adverse clinical outcomes, including death, acute respiratory distress syndrome, respiratory failure, septic shock, mechanical ventilation, and intensive care unit admission. Particularly, hypertension patients receiving RAAS inhibitor treatment either before (HR = 0.35, 95%CI 0.13-0.97, P = .043) or after (HR = 0.18, 95%CI 0.04-0.86, P = .031) admission showed a significantly lower risk of adverse clinical outcomes than those receiving application of other antihypertensive medicines. Furthermore, consecutive application of RAAS inhibitors in COVID-19 patients with hypertension showed better clinical outcomes (HR = 0.10, 95%CI 0.01-0.83, P = .033) than non-RAAS inhibitors users. We revealed that COVID-19 patients with poor BP control during hospitalization had worse clinical outcomes. Compared with other antihypertension medicines, RAAS inhibitors were beneficial for improving clinical outcomes in COVID-19 patients with hypertension. Our findings provide direct evidence to support the administration of RAAS inhibitors to COVID-19 patients with hypertension before and after admission.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Sistema Renina-Angiotensina/efectos de los fármacos , /efectos de los fármacos , Anciano , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Determinación de la Presión Sanguínea/métodos , Determinación de la Presión Sanguínea/estadística & datos numéricos , /epidemiología , Estudios de Casos y Controles , China/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/complicaciones , Hipertensión/mortalidad , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , /genética
14.
Am J Clin Nutr ; 112(6): 1584-1598, 2020 12 10.
Artículo en Inglés | MEDLINE | ID: mdl-33022695

RESUMEN

BACKGROUND: Many systematic reviews and meta-analyses have assessed the efficacy of dietary patterns on blood pressure (BP) lowering but their findings are largely conflicting. OBJECTIVE: This umbrella review aims to provide an update on the available evidence for the efficacy of different dietary patterns on BP lowering. METHODS: PubMed and Scopus databases were searched to identify relevant studies through to June 2020. Systematic reviews with meta-analyses of randomized controlled trials (RCTs) were eligible if they measured the effect of dietary patterns on systolic (SBP) and/or diastolic blood pressure (DBP) levels. The methodological quality of included systematic reviews was assessed by A Measurement Tool to Assess Systematic Review version 2. The efficacy of each dietary pattern was summarized qualitatively. The confidence of the effect estimates for each dietary pattern was graded using the NutriGrade scoring system. RESULTS: Fifty systematic reviews and meta-analyses of RCTs were eligible for review. Twelve dietary patterns namely the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Nordic, vegetarian, low-salt, low-carbohydrate, low-fat, high-protein, low glycemic index, portfolio, pulse, and Paleolithic diets were included in this umbrella review. Among these dietary patterns, the DASH diet was associated with the greatest overall reduction in BP with unstandardized mean differences ranging from -3.20 to -7.62 mmHg for SBP and from -2.50 to -4.22 mmHg for DBP. Adherence to Nordic, portfolio, and low-salt diets also significantly decreased SBP and DBP levels. In contrast, evidence for the efficacy of BP lowering using the Mediterranean, vegetarian, Paleolithic, low-carbohydrate, low glycemic index, high-protein, and low-fat diets was inconsistent. CONCLUSION: Adherence to the DASH, Nordic, and portfolio diets effectively reduced BP. Low-salt diets significantly decreased BP levels in normotensive Afro-Caribbean people and in hypertensive patients of all ethnic origins. This review was registered at PROSPERO as CRD42018104733.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Dieta , Enfoques Dietéticos para Detener la Hipertensión , Hipertensión/dietoterapia , Humanos
15.
Lancet Neurol ; 19(11): 899-907, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33098800

RESUMEN

BACKGROUND: Results from the Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive control of systolic blood pressure significantly reduced the occurrence of mild cognitive impairment, but not probable dementia. We investigated the effects of intensive lowering of systolic blood pressure on specific cognitive functions in a preplanned substudy of participants from SPRINT. METHODS: SPRINT was an open-label, multicentre, randomised controlled trial undertaken at 102 sites, including academic medical centres, Veterans Affairs medical centres, hospitals, and independent clinics, in the USA and Puerto Rico. Participants were adults aged 50 years or older with systolic blood pressure higher than 130 mm Hg, but without diabetes, history of stroke, or dementia. Participants were randomly assigned (1:1) to a systolic blood pressure goal of less than 120 mm Hg (intensive treatment) versus less than 140 mm Hg (standard treatment). All major classes of antihypertensive agents were included. A subgroup of randomly assigned participants including, but not limited to, participants enrolled in an MRI substudy was then selected for a concurrent substudy of cognitive function (target 2800 participants). Each individual was assessed with a screening cognitive test battery and an extended cognitive test battery at baseline and biennially during the planned 4-year follow-up. The primary outcomes for this substudy were standardised composite scores for memory (Logical Memory I and II, Modified Rey-Osterrieth Complex Figure [immediate recall], and Hopkins Verbal Learning Test-Revised [delayed recall]) and processing speed (Trail Making Test and Digit Symbol Coding). SPRINT was registered with ClinicalTrials.gov, NCT01206062. FINDINGS: From Nov 23, 2010, to Dec 28, 2012, 2921 participants (mean age 68·4 years [SD 8·6], 1080 [37%] women) who had been randomly assigned in SPRINT were enrolled in the substudy (1448 received intensive treatment and 1473 received standard treatment). SPRINT was terminated early due to benefit observed in the primary outcome (composite of cardiovascular events). After a median follow-up of 4·1 years (IQR 3·7-5·8), there was no between-group difference in memory, with an annual decline in mean standardised domain score of -0·005 (95% CI -0·010 to 0·001) in the intensive treatment group and -0·001 (-0·006 to 0·005) in the standard treatment group (between-group difference -0·004, 95% CI -0·012 to 0·004; p=0·33). Mean standardised processing speed domain scores declined more in the intensive treatment group (between-group difference -0·010, 95% CI -0·017 to -0·002; p=0·02), with an annual decline of -0·025 (-0·030 to -0·019) for the intensive treatment group and -0·015 (-0·021 to 0·009) for the standard treatment group. INTERPRETATION: Intensive treatment to lower systolic blood pressure did not result in a clinically relevant difference compared with standard treatment in memory or processing speed in a subgroup of participants from SPRINT. The effect of blood pressure lowering might not be evident in specific domains of cognitive function, but instead distributed across multiple domains. FUNDING: National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Aging, National Institute of Neurological Disorders and Stroke, and the Alzheimer's Association.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Cognición/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Pruebas de Estado Mental y Demencia , Anciano , Anciano de 80 o más Años , Antihipertensivos/farmacología , Presión Sanguínea/fisiología , Monitoreo Ambulatorio de la Presión Arterial/métodos , Monitoreo Ambulatorio de la Presión Arterial/tendencias , Cognición/fisiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/prevención & control , Disfunción Cognitiva/psicología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/psicología , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Estados Unidos/epidemiología , United States Department of Veterans Affairs/tendencias
16.
J Clin Neurosci ; 79: 149-153, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33070886

RESUMEN

The aim of this study was to evaluate arterial stiffness in schizophrenia patients. 28 male patients were included. The intima-media thickness (IMT) of the vessels were taken using high-resolution ultrasonography system. The mean carotid IMT and the mean femoral IMT values of the study group were found to be statistically significantly higher than the values of the control group. As the duration of the disease increased, there was an increase in the carotid IMT, carotid elastic modulus and femoral IMT, whereas there was a decrease in carotid and femoral diastolic wall stress in patients. No statistically significant differences were observed between the groups' carotid and femoral compliance, distensibility and elastic modulus values. The mean systolic arterial blood pressure in the patient group was determined to be lower than that of the control group. The mean diastolic wall stress values in the carotid and femoral arteries were determined to be lower than those of the control group. There was no relationship between antipsychotic dose, blood pressure and arterial stiffness parameters. Schizophrenia patients are more prone to develop arterial stiffness by atherosclerosis either with the effect of the nature of the disease itself or antipsychotic treatment. But evaluation with more parameters (carotid and femoral compliance, distensibility and elastic modulus) did not indicate any difference from the control group in respect of arterial stiffness. Antipsychotic treatment may play a protective role in terms of arterial stiffness by causing a decrease in systolic arterial pressure and carotid and femoral diastolic wall stress.


Asunto(s)
Esquizofrenia/patología , Rigidez Vascular , Adulto , Antipsicóticos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Arterias Carótidas/efectos de los fármacos , Arterias Carótidas/patología , Grosor Intima-Media Carotídeo , Humanos , Masculino , Persona de Mediana Edad , Esquizofrenia/tratamiento farmacológico , Ultrasonografía , Rigidez Vascular/efectos de los fármacos , Rigidez Vascular/fisiología
17.
Medicine (Baltimore) ; 99(43): e22288, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120732

RESUMEN

INTRODUCTION: Dexmedetomidine and midazolam have become important approaches for the sedation of dental surgery. However, the comparison of these 2 drugs for the sedation of dental surgery has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of dexmedetomidine versus midazolam for dental surgery. METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of dexmedetomidine versus midazolam on dental surgery are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. Meta-analysis is performed using the random-effect model. RESULTS: Five RCTs and 420 patients are included in the meta-analysis. Compared with midazolam intervention for dental surgery, dexmedetomidine intervention has similar lowest SpO2, lowest heart rate and lowest systolic blood pressure, duration of surgery, and total volume of local anesthetic, but is associated with stable and reduced lowest diastolic blood pressure. CONCLUSIONS: Similar benefits of dexmedetomidine and midazolam intervention are observed for the sedation of dental surgery in terms of SpO2, heart rate, systolic blood pressure, and the volume of local anesthetic, but dexmedetomidine may result in more stable diastolic blood pressure.


Asunto(s)
Dexmedetomidina/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Midazolam/uso terapéutico , Procedimientos Quirúrgicos Orales , Anestésicos Locales/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Diástole/efectos de los fármacos , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Tempo Operativo , Oxígeno/sangre , Sístole/efectos de los fármacos
18.
Toxicol Lett ; 335: 28-36, 2020 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-33091562

RESUMEN

Endotoxic manifestations are diminished in female populations due to immune boosting actions of sex steroids. Considering that tobacco constituents including nicotine inhibit estrogen synthesis, we tested the hypothesis that nicotine exposure unveils cardiovascular anomalies of endotoxemia in female rats. Studies were undertaken in conscious female rats treated with i.v. lipopolysaccharide (LPS, 10 mg/kg) in absence and presence of nicotine. In contrast to no effects for LPS when used alone, dose-related decreases in blood pressure (BP) and serum estrogen were noted in endotoxic rats treated consequently with nicotine (25, 50, or 100 µg/kg i.v.). Signs of cardiac autonomic dysfunction appeared in LPS/nicotine-treated rats such as (i) decreased time-domain indices of heart rate variability (HRV), e.g. standard deviation of R-R intervals (SDNN) and root mean square of successive differences in R-R interval durations (rMSSD), and (ii) reduced total power of the frequency spectrum and shifted cardiac sympathovagal balance toward sympathetic dominance. Nicotine reversed the LPS-evoked modest rises in serum TNFα and IL-1ß while had no effect on associated arterial baroreflex dysfunction, inferring no roles for inflammation or baroreflexes in LPS-nicotine interaction. Estrogen or aminoguanidine (iNOS inhibitor), but not pentoxifylline (TNFα inhibitor), abolished LPS/nicotine hypotension. Together, nicotine acts probably via reducing estrogen availability to uncover nitric oxide-dependent hypotension and autonomic dysregulation in endotoxic female rats.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Endotoxemia/inducido químicamente , Estrógenos/sangre , Frecuencia Cardíaca/efectos de los fármacos , Corazón/efectos de los fármacos , Nicotina/toxicidad , Óxido Nítrico/sangre , Animales , Sistema Nervioso Autónomo/efectos de los fármacos , Barorreflejo/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Sinergismo Farmacológico , Endotoxemia/sangre , Endotoxemia/inmunología , Endotoxemia/fisiopatología , Endotoxinas/toxicidad , Femenino , Corazón/inervación , Interleucina-1beta/sangre , Ratas , Ratas Wistar , Factor de Necrosis Tumoral alfa/sangre
19.
J Stroke Cerebrovasc Dis ; 29(12): 105401, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33096498

RESUMEN

BACKGROUND AND PURPOSE: There are limited data evaluating the characteristics of apparent treatment-resistant hypertension (aTRH) among stroke survivors in sub-Saharan Africa. We aimed to conduct a comparative analysis of the frequency and factors associated with aTRH among stroke survivors and stroke-free individuals with hypertension in Ghana. METHODS: Cross-sectional multicenter study involving five hospitals in Ghana conducted between July 2015 and June 2018. Clinic-based blood pressure was measured using a standardized protocol and antihypertensive medications assessed via review of medical records and inspection of pills. aTRH was defined as either office BP ≥140/90mmHg on ≥3 classes of antihypertensive medications or on ≥4 antihypertensive medications regardless of BP. Multivariate logistic regression models were constructed to assess for associations between aTRH and co-variates. RESULTS: Mean age of stroke survivors (n=1,169) was 59.3±13.3 years vs 58.4±12.4 years among stroke-free hypertensives (n=2,758), p=0.06. Among stroke survivors on ≥4 antihypertensive medications 18.1% had BP on a target of <140/90 mmHg and only 8.7% had BP <130/80mmHg. Prevalence of aTRH was 45.3%(95% CI: 42.4-48.2) among stroke survivors and 19.9%(18.4-21.4) among stroke-free hypertensives, p<0.0001. All stroke types were associated with aTRH with adjusted odds ratio (95% CI): hemorrhagic stroke 4.56(3.34-6.23), sub-arachnoid hemorrhage 4.10(1.70-9.90), ischemic stroke 2.85(2.32-3.50), and untyped stroke 1.92(1.41-2.60). Other predictors of aTRH were age <60 years, receiving care at a tertiary facility, and diabetes mellitus. CONCLUSIONS: Most stroke survivors encountered in this multisite study in Ghana had resistant hypertension. Tailored interventions are needed to mitigate the risk of recurrent adverse cardiovascular events in these patients.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Resistencia a Medicamentos , Hipertensión/epidemiología , Accidente Cerebrovascular/epidemiología , Sobrevivientes , Anciano , Estudios Transversales , Quimioterapia Combinada , Femenino , Ghana/epidemiología , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/mortalidad , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/terapia
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA