Recomendaciones para la detección y el tratamiento del anciano con hipertensión arterial / Recommendations for diagnosis and treatment of aged hypertensives

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Estudio de farmacovigilancia para evaluar la seguridad y la efectividad del tratamiento con losartán: efectos a largo plazo de losartán solo o en combinación sobre la uricemia / Pharmacovigilance study of the safety and effectiveness of losartan therapy: long-term effects of losartan alone or in combination on uricemia

Introducción: se evalúa la acción del tratamiento con losartán sobre la uricemia, en pacientes hipertensos en el medio comunitario. Material y método: estudio de farmacovigilancia, observacional, prospectivo, multicéntrico, no aleatorizado, abierto, de 1 año de seguimiento. Centros de atención primaria de Ávila, Burgos, León, Palencia, Salamanca, Valladolid y Zamora. Se incluyó a 275 pacientes de 67,5 años, con hipertensión arterial, no diabéticos y diabéticos (n = 19), a los que se trató con losartán, 50 mg/día. A las 8 semanas se aumentaba a 100 mg/día si era preciso. Si a las 24 semanas la presión arterial (PA) persistía elevada, se añadía hidroclorotiazida, 25 mg. Se procedió a la toma de sangre para uricemia, creatinina, electrolitos, glucemia, colesterol y triglicéridos al comienzo y a las 48 semanas de tratamiento. Resultados: la uricemia disminuyó significativamente en el grupo de pacientes tratados con losartán y losartán + tiazidas. El 30% de los pacientes recibió 50 mg de losartán, el 14%, 100 mg y el 56%, losartán + tiazida. La PA media ± desviación estándar varió desde 166 ± 29 mmHg de sistólica y 96 ± 19 mmHg, al comienzo del estudio, a 145 ± 23 mmHg de sistólica y 83 ± 18 mmHg de diastólica al finalizarlo. La creatinina, el sodio, el potasio, la glucemia, el colesterol y los triglicéridos no sufrieron deterioro durante el año de seguimiento. Conclusiones: el losartán es un fármaco seguro, con pocos efectos secundarios y que, tras 1 año de seguimiento, disminuye la uricemia sin deterioro del perfil lipídico, hidrocarbonato ni renal. Se postula como fármaco de primera elección en hipertensos mayores con hiperuricemia

Objectives: to evaluate the effect of losartan therapy on uricemia in patients with hypertension in the community setting. Design: observational, prospective, multicenter, nonrandomized, open-label pharmacovigilance study with a 1-year follow-up. Setting: primary care centers in Avila, Burgos, Leon, Palencia, Salamanca, Valladolid, and Zamora (Spain). Patients and method: two hundred seventy-five men and women (mean age 67.5 years), without diabetes (n = 256) and with diabetes (n = 19), treated with 50 mg/day of losartan were included. If high blood pressure (BP) (> 140/90 mmHg) was uncontrolled at 8 weeks, the dose was increased to 100 mg/day. If BP continued to be high at 24 weeks, hydrochlorothiazide (25 mg) was added. BP was measured after the patient had been sitting for 7 minutes with a mercury manometer and phase V Korotkoff's sound as the reference point. Blood samples were drawn for analysis of uricemia, creatinine, electrolytes, glycemia, cholesterol, and triglycerides at the beginning of the study and after 48 weeks' treatment. Results: uricemia significantly decreased in the group of patients treated with losartan and losartan + thiazides. Thirty percent of the patients received 50 mg of losartan, 14% received 100 mg and 56% received losartan + thiazide. Systolic BP was reduced from 166 (SD 29) mmHg at the beginning of the study to 145 (SD 23) at the end of the study. Diastolic BP was reduced from 96 (SD 19) mmHg to 83 (SD 18) mmHg. No negative effects on creatinine, sodium, potassium, glycemia, cholesterol or triglyceride values were found during the 1-year follow-up. Conclusions: losartan is a safe drug with few adverse effects. After a 1-year follow-up, it reduces uricemia without producing negative effects on lipid, carbohydrate or renal profiles. Therefore, it could be used as a first-line drug in elderly patients with hypertension and hyperuricemia

Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure.

Plasma renin activity, plasma aldosterone levels and renal tubular capacity to excrete hydrogen ions were studied in 13 patients suffering from diabetes mellitus with a creatinine clearance of less than 40 ml/min. The results were compared with those obtained in a control group, in a group of nondiabetic subjects with chronic renal failure (CRF) and in a group of diabetic patients without CRF. Twelve of the thirteen diabetic patients with CRF had data characteristic of hyporeninemic hypoaldosteronism associated with type IV renal tubular acidosis. On comparing the results with those of the other two groups of patients, it was observed that the manifestations of the latter two groups considered separately were different from those of the problem group, although in the diabetic patients with normal glomerular filtration rate (GFR) hyporeninism but not hypoaldosteronism was present accompanied by a lower net acid excretion (p less than 0.001) due to a lower excretion of NH4 (p less than 0.05) and titratable acid (p less than 0.001) when the patients were challenged with an NH4Cl overload. We believe that a conjunction of diabetes and renal failure is necessary for the diabetic patients with a decrease in GFR to show hyporeninemic hypoaldosteronism and type IV tubular acidosis.

Pharmacokinetics of phosphomycin during haemofiltration.

The pharmacokinetics of phosphomycin were studied in 10 adult patients with terminal renal impairment during a 4 h haemofiltration session. A single i.v. dose of 30 mg/kg of the antibiotic was administered to each patient at the beginning of the haemofiltration session. The half-life of the slow disposition phase (t 1/ 2z ) showed an average value of 4.05 +/- 1.77 h, much lower than that established in patients who did not undergo any purification techniques. Serum phosphomycin concentrations at the input and the output of the haemofilter at the end of the session were, respectively, 26.65 and 19.13 micrograms/ml. During haemofiltration, 64.90% of the original dose was eliminated. In this kind of patient we recommend a dose of 30 mg/kg at the beginning and at the end of each haemofiltration session for interfiltration periods of 48 h.