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1.
Rev Med Suisse ; 15(668): 1946-1949, 2019 Sep 23.
Artigo em Francês | MEDLINE | ID: mdl-31643156

RESUMO

High blood pressure is a major risk factor for cardiovascular disease, leading to a high and increasing rate of morbidity and mortality with our current lifestyle. This is therefore a real public health problem. About 20 % of refractory hypertension is caused by a poor drug intake. The new 2018 European recommendations for high blood pressure emphasize the importance of improving patients' therapeutic adherence. To achieve that, the general practitioner must promote a bio-psycho-social approach, targeted to patient empowerment and to develop multidisciplinarity with the other care providers. Concerning the medication, physicians are encouraged to use combination therapies in a single pill.


Assuntos
Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/psicologia , Adesão à Medicação , Atenção Primária à Saúde , Combinação de Medicamentos , Humanos , Adesão à Medicação/psicologia
2.
Rev Med Suisse ; 14(618): 1588-1592, 2018 Sep 12.
Artigo em Francês | MEDLINE | ID: mdl-30226655

RESUMO

The prevalence of high blood pressure is increasing and expanding preventive and treatment measures may be useful. Some data in the literature suggest that meditation can play a role not only in stress management but also in blood pressure control and cardiovascular disease prevention. Mechanisms involved may be based on the regulation of emotional and biological responses to stress, by regulation of the autonomous nervous system. This approach is available to everyone interested, has no adverse effects and is not related to any particular religious beliefs.


Assuntos
Hipertensão , Meditação , Adulto , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Hipertensão/terapia , Estresse Psicológico
3.
Rev Med Suisse ; 13(574): 1576-1579, 2017 Sep 13.
Artigo em Francês | MEDLINE | ID: mdl-28905546

RESUMO

Hypertension in people of African descent presents an increased prevalence, an earlier and more severe target organ damage and is harder to control compared to other ethnicities. Preeclampsia and gestational hypertension are more frequent in black women. The physiological phenomenon of night time blood pressure dipping is often blunted. The low renin hypertension phenotype seems to be caused by an increase in sodium retention at renal level. The treatment of choice is calcium channel blockers and thiazide diuretics along with a renin-angiotensin-aldosterone blocker for kidney protection. Addition of spironolactone or amiloride is advised for resistant hypertension. A diet poor in sodium and rich in potassium is recommended.


Assuntos
Grupo com Ancestrais do Continente Africano , Hipertensão , Pressão Sanguínea , Feminino , Humanos , Hipertensão/etnologia
4.
Rev Med Suisse ; 13(546): 148-151, 2017 Jan 18.
Artigo em Francês | MEDLINE | ID: mdl-28703513

RESUMO

Ideally, our clinical practices and decisions should be based on evidence derived from randomized clinical trials. Yet, we often have to determine the potential side effects (including interactions) of drugs that we prescribed using other level of evidence; clinical trials being obviously not appropriate for such situations. Results from observational studies published in 2016 should be of interest to primary care physicians. In this review, we present six of them. Once the limitations of these non-interventional studies acknowledged, primary care physicians should consider these results and be particularly attentive when prescribing these drugs.


Assuntos
Medicina Geral/tendências , Doença Iatrogênica , Intenção , Medicina Interna/tendências , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Medicina Geral/métodos , Humanos , Doença Iatrogênica/epidemiologia , Medicina Interna/métodos , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/tendências , Resultado do Tratamento
6.
Int J Gen Med ; 9: 221-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27445502

RESUMO

BACKGROUND: Iron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution. OBJECTIVE: The aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland. METHODS: All patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review. RESULTS: Out of 1,671 patients, 93 were treated for iron deficiency. Median patients' age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 µg/L (standard deviation 13.3 µg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases. CONCLUSION: There was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning.

7.
J Med Case Rep ; 10: 95, 2016 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-27075033

RESUMO

BACKGROUND: Heatstroke is a life-threatening condition defined by failure of heat load dissipation, resulting in a core temperature higher than 40 °C (104 °F) associated with neurological dysfunction. Topiramate may cause anhidrosis, potentially resulting in heatstroke, as reported especially in children. CASE PRESENTATION: A 57-year-old Caucasian man was admitted to the emergency room in a febrile comatose state. After a complete workup ruling out the usual etiologies of such a condition, we assumed the hypothesis of a heatstroke caused by topiramate, recently prescribed for essential tremor. CONCLUSIONS: Topiramate-related heatstroke has been described in children but must be recognized in adults as well. Outcomes may range from total clinical recovery to persistent neurological dysfunction or death. The prescription of topiramate and the follow-up of adult patients under this medication should include an evaluation of hypohidrosis, especially in contexts of high temperature.


Assuntos
Anticonvulsivantes/efeitos adversos , Tremor Essencial/tratamento farmacológico , Frutose/análogos & derivados , Golpe de Calor/induzido quimicamente , Frutose/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Topiramato
8.
Rev Med Suisse ; 12(530): 1502-1506, 2016 Sep 14.
Artigo em Francês | MEDLINE | ID: mdl-28677923

RESUMO

Food in industrialized countries is rich in processed products with a high sodium and low potassium content. There is abundant evidence in the literature depicting the relationship between a high daily sodium/potassium intake ratio and the high prevalence of arterial hypertension in modern societies. There is also increasing evidence suggesting a blood pressure lowering effect of potassium, especially in cases of high sodium intake or in patients with increased salt sensibility. Our dietary advice for the prevention and treatment of hypertension should follow a thorough evaluation of our patients' daily nutritional habits and should not only focus on sodium intake but also aim for a balanced sodium/potassium uptake.


Assuntos
Hipertensão/dietoterapia , Potássio/administração & dosagem , Cloreto de Sódio na Dieta/administração & dosagem , Pressão Sanguínea , Comportamento Alimentar , Humanos , Sódio/administração & dosagem
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