RESUMO
BACKGROUND: Achieving adequate blood pressure (BP) control often requires more than one antihypertensive agent. The purpose of this study was to determine whether a fixed-dose formulation of losartan (LOS) plus hydrochlorothiazide (HCTZ) (LOS/HCTZ) is effective in achieving a greater BP lowering in patients with uncontrolled hypertension. METHODS: The study was a prospective, multicenter, observational trial exploring the antihypertensive effect of a single tablet of LOS 50 mg/HCTZ 12.5 mg. A total of 228 patients whose BP had previously been treated with more than one antihypertensive agents without having achieved BP goal below 130/80 mmHg enrolled in the study. RESULTS: A significant decrease in systolic and diastolic BP was observed in both clinic and home measurement after switching from the previous treatment to LOS/HCTZ. There was a significant decrease in both B-type natriuretic peptide (BNP) and urinary albumin creatinine (Cr) excretion ratio (ACR), especially in patients with elevated values. In contrast, there was a significant increase in serum Cr concentration in conjunction with a decrease in estimated glomerular filtration rate (eGFR). Overall serum uric acid (UA) concentration increased, whereas in patients with hyperuricemia there was a significant reduction in this value. CONCLUSION: Switching to LOS/HCTZ provides a greater reduction in clinic and home BP in patients with uncontrolled hypertension. This combination therapy may lead to cardio-, reno protection and improve UA metabolism.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Losartan/uso terapêutico , Adulto , Idoso , Determinação da Pressão Arterial , Creatinina/urina , Combinação de Medicamentos , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/metabolismo , Hipertensão/fisiopatologia , Hiperuricemia , Japão , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Estudos Prospectivos , Resultado do Tratamento , Ácido Úrico/sangue , Adulto JovemRESUMO
Emphysematous cystitis is a rare condition characterized by air formation in and around the bladder wall by gas-forming organisms. Although diabetes mellitus and chronic urinary infection, which are frequently encountered in patients with endstage renal disease (ESRD), are predisposing factors for this entity, emphysematous cystitis is actually not common in ESRD patients. Here we provide the first report of a hemodialysis patient who developed typical emphysematous cystitis. Unlike other cases, the emphysematous cystitis recurred after discontinuation of urinary drainage and antibiotic therapy. The possible reason that this case is of a less common type that is more refractory than the other cases, and the method by which patients with ESRD are commonly treated, are discussed. Not anuric but rather oliguric diabetic patients, even after long-term hemodialysis, are the patients at risk for emphysematous cystitis.
Assuntos
Cistite/complicações , Enfisema/complicações , Falência Renal Crônica/complicações , Idoso , Cistite/diagnóstico por imagem , Cistite/patologia , Enfisema/diagnóstico por imagem , Enfisema/patologia , Feminino , Humanos , Radiografia , Recidiva , Diálise Renal , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologiaRESUMO
Defluorination of PTFE by alkyllithium/electron-donating solvents such as N,N,N',N'-tetramethylethylenediamine (TMEDA), hexamethylphosphoramide (HMPA) was studied by means of spectroscopy such as ESR, 7Li- and 13C-NMR, XPS, UV-Vis and IR. Based on the experimental results, it was concluded that an electron from radical species, which was generated in the alkyllithium/electron-donating solvent, was transferred onto PTFE molecule so as to eliminate fluorine atoms from the PTFE and to form carbon-centered radicals on the PTFE; concomitantly, the alkyl group of the alkyllithium was transferred onto the PTFE. Combined with the experimental results of the phenyllithium/HMPA system, mechanism of the fluorine atom elimination reactions from PTFE by the radical species is discussed.
Assuntos
Fluorocarbonos/química , Solventes/química , Alcanos/química , Carbono/química , Cristalização , Elétrons , Radicais Livres/química , Hidrogênio/química , Lítio/química , Estrutura Molecular , Peso Molecular , Análise EspectralRESUMO
The authors present a case of acquired reactive perforating collagenosis developed in a nondiabetic hemodialysis patient, who was treated successfully with allopurinol. Treatment of acquired reactive perforating collagenosis is difficult and often ineffective. The patient had been unresponsive to conventional treatments, but the pruritus was controlled, and skin lesions subsequently resolved after the treatment with allopurinol. Possible mechanisms of allopurinol treatment for acquired reactive perforating collagenosis are discussed.
