Evaluation of photobiomodulation in the salivary production of patients with hyposalivation induced by antihypertensive drugs - A blind, randomized, controlled clinical trial.

BACKGROUND: Arterial hypertension is a systemic condition that affects about 35% of the world population. The drugs that are used for its control can produce hyposalivation. This work evaluated the effect of photobiomodulation on salivary flow rate, salivary pH, total protein concentration, and calcium concentration in individuals using antihypertensive medications. MATERIAL AND METHODS: 41 subjects were randomly allocated in one of two groups: control (placebo) and photobiomodulation. The subjects had their salivary glands (20 sites) irradiated with a laser emitting at 808 nm, 4J/site once a week for 4 weeks and had their salivary flow measured before and after the whole treatment. RESULTS: The intragroup analysis (before and after treatment) shows a significant difference for both non-stimulated and stimulated salivary flow in the photobiomodulation group (p = 0.0007 and p = 0.0001, respectively). Comparing the placebo with the photobiomodulation group, significant differences were found for both non-stimulated (p = 0.0441) and stimulated salivary flow (p = 0.0441) after the treatment. No significant differences were found in pH, total protein concentration, calcium concentration. CONCLUSION: Despite the usage of drugs that influence the nervous system and typically result in a reduction of saliva production, photobiomodulation demonstrated a remarkable ability to enhance saliva production by a significant 75%.

Use of Antihypertensive Drugs and Arterial Stiffness in the Longitudinal Study of Adult Health (ELSA-Brasil).

OBJECTIVE: Evaluate the longitudinal association between BP control and the use of antihypertensive classes with arterial stiffness (AS) in Brazilian adults. METHODS: This study included 1830 participants with arterial hypertension (1092 participants with controlled BP and 738 participants with uncontrolled BP) from the Longitudinal Study of Adult Health (ELSA-Brasil). AS was assessed by pulse wave velocity (PWV) and pulse pressure (PP) at baseline and repeated after approximately 9 years. Associations between AS and BP control and the use of antihypertensives, diuretics, angiotensin-converting enzyme inhibitors (ACEI), AT1 receptor blockers (ARB), calcium channel blockers (CCB), and beta blockers (in the population with controlled BP), at baseline were investigated using linear mixed-effects models. RESULTS: Uncontrolled BP was associated with worse PWV and PP trajectory, respectively (ß = 0.026 [0.008 to 0.036] / ß = 0.273 [0.216 to 0.330]). Among the participants with controlled BP, using CCB (ß = 0.031 [0.011 to 0.051]) was associated with a worse PWV trajectory, compared to not using this class and this combination, respectively. CONCLUSION: BP control, regardless of the class of antihypertensive used is associated with a better AS trajectory, as assessed by PWV and PP. Among participants with controlled BP, the use of BCC, compared to not using this class, seems to be worse for the trajectory of PWV in individuals with arterial hypertension without cardiovascular disease. Further studies are needed to assess whether this effect results in a better prognosis for patients with arterial hypertension.

Comparative effect of antihypertensive drugs in improving arterial stiffness in adults with hypertension (RIGIPREV study). A network meta-analysis.

Aims: To synthesize and evaluate the available scientific evidence on the efficacy of antihypertensive drugs on arterial stiffness in patients with hypertension by using a network meta-analysis approach. Methods: A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different antihypertensive drugs on arterial stiffness parameters (pulse wave velocity [PWV] and augmentation index [AIx]) in adults with hypertension. Comparative evaluation of the effect of antihypertensive drugs was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between antihypertensive drugs and placebo/other antihypertensive drugs. Analyses were performed including studies of any duration and only studies longer than 6 months length. Results: Seventy-six studies were included in the main analysis and considering only studies longer than 6 months length, thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination showed a higher effect on reducing PWV, and ACEIs and ARBs on reducing AIx. Conclusion: Our research provides evidence that antihypertensive medications are an effective way to treat arterial stiffness in adults with hypertension. Based on our findings, patients with hypertension who have greater levels of arterial stiffness may benefit from using thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination. Systematic Review Registration: PROSPERO (CRD42021276360).

Effect of Different Classes of Antihypertensive Drugs on Arterial Stiffness.

PURPOSE OF REVIEW: To describe the physiological aspects of blood pressure and arterial stiffness, as well as explain how these processes are related. To review the available evidence on the effect of treatment with different classes of antihypertensive drugs on improving arterial stiffness. RECENT FINDINGS: Specific classes of antihypertensive drugs may have effects directly on improving arterial stiffness independent of lowering blood pressure. The maintenance of normal blood pressure levels is essential for the homeostasis of the whole organism; the increase in blood pressure is directly related to the increased risk of cardiovascular diseases. Hypertension is characterized by structural and functional changes in blood vessels and is associated with a more accelerated progression of arterial stiffness. Randomized clinical trials have shown that some specific classes of antihypertensive drugs can improve arterial stiffness independently of their effect on lowering brachial blood pressure. These studies show that calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors have been shown to have a better effect on arterial stiffness compared to diuretics and beta-blockers in individuals with arterial hypertension and other cardiovascular risk factors. More real-world studies are needed to assess whether this effect on arterial stiffness can improve the prognosis of patients with hypertension.

Pharmacogenomics of Antihypertensive Drugs in Brazil: Recent Progress and Clinical Implications.

BACKGROUND: The available antihypertensive drugs are effective and well tolerated agents. However, only about half of patients with treated hypertension achieve appropriate blood pressure control. Genetic and non-genetic factors contribute to the interindividual variability of the therapeutic response. OBJECTIVE: This review constitutes a comprehensive update of the pharmacogenomics of antihypertensive drugs and their clinical implications in Brazil. RESULTS: Twenty-five studies explored the influence of gene variants on drug response in patients with primary, resistant, or gestational hypertension. Variants in BDKRB2, NOS3, PRKCA, and VEGFA influenced the response to enalapril in patients with primary hypertension. AGT and MMP2 variants were associated with a high risk of resistance to antihypertensive treatment, whereas NOS2 variants were related to low risk. Moreover, NAT2 slow acetylators showed an increased response to hydralazine in patients with resistant hypertension. HMOX1, NAMPT, MMP9, NOS3, and TIMP1 variants might be markers of drug responsiveness in hypertensive or preeclamptic pregnant women. Power and replication of studies, polygenic nature of the response to therapy, and treatment with multiple drugs were important challenges to identify genetic predictors of antihypertensive response in Brazil. CONCLUSION: Pharmacogenomic studies in Brazilian cohorts provide some evidence of variants, mainly in pharmacodynamics genes, which influence the response to antihypertensive drugs. However, some findings are limited by cohort size or therapeutic scheme and may be influenced by interactions with other genetic and non-genetic factors. Therefore, further investigations are needed to elucidate the contribution of pharmacogenomics to the efficacy and safety of antihypertensive therapy.

HIPERTENSÃO E DIABETES: CONCEITOS ATUAIS NA TERAPÊUTICA / HYPERTENSION AND DIABETES: CURRENT CONCEPTS IN THERAPEUTICS

Diabetes mellitus tipo 2 (DM) cursa com alta prevalência na população, acometendo cerca de 9,3% da população mundial (463 milhões de indivíduos). Devido ao crescimento dos casos e envelhecimento populacional, estima-se que o número de diabéticos será superior a 628 milhões em 2045. Dados de 2013 estimam que 6,2% da população brasileira acima dos 18 anos de idade tenham diabetes. Rápida urbanização, transição epidemiológica, fator nutricional, estilo de vida sedentário, excesso de peso, crescimento e envelhecimento populacional são fatores associados ao aumento da prevalência. Geralmente, ao tempo do diagnóstico do DM, a hipertensão arterial sistêmica (HAS) está presente em 50% dos diabéticos. O artigo discute aspectos relacionados à fisiopatogenia do diabetes e hipertensão, as metas de pressão arterial e as principais abordagens terapêuticas no tratamento da hipertensão arterial no paciente diabético, de acordo com as diretrizes mais recentes

Type 2 Diabetes mellitus presents high prevalence in the population, responding for about 9.3% in the world population (463 million individuals). Due to cases increase and aging, it is estimated that the number of diabetic subjects will be higher than 628 million in 2045. Data of 2013 show that 6,2% of Brazilian population higher 18 years-old have diabetes. Fast urbanization, epidemiological transition, nutritional factor, physical inactivity, overweight, population growth and aging are factors associated to increase of prevalence. Generally, when of diabetes diagnosis, hypertension is present in 50% of diabetic individuals. The article discusses aspects of pathophysiology of hypertension and diabetes, the targets of blood pressure and the principal therapeutic approaches of treatment of hypertension in the diabetic patient, in according to recenter guidelines

Ecotoxicity of losartan potassium in aquatic organisms of different trophic levels.

The intensive use of the antihypertensive losartan potassium (LOS) has culminated in its high occurrence in aquatic environments. However, insufficient studies had investigated its effects in non-target organisms. In this study, ecotoxicity of LOS was assessed in aquatic organisms from distinct trophic levels (Desmodesmus subspicatus, Daphnia magna, and Astyanax altiparanae). Genotoxicity was assessed by the comet assay in D. magna and A. altiparanae, and biochemical biomarkers for the fish. LOS was more toxic to D. subspicatus (EC50(72h) = 27.93 mg L-1) than D. magna (EC50 = 303.69 mg L-1). Subsequently, this drug showed to induce more DNA damage in D. magna than A. altiparanae, when exposed to 2.5 mg L-1. No significant stress responses were observed by the fish biomarkers, suggesting that higher trophic levels organisms are more tolerant to LOS toxicity. LOS showed relatively low toxic potential for a short period of exposure, but with different patterns of toxicity for the organisms from distinct trophic levels, contributing to further risk assessment of LOS.

Adherencia terapéutica en pacientes hipertensos de un consultorio médico perteneciente al Policlínico Universitario "Joaquín de Agüero y Agüero" / Adherence to treatment in hypertansive patients from a local primary care office linked to the Policlínico Universitario "Joaquín de Agüero y Agüero" / Adesão terapêutica em hipertensos atendidos em consultório médico da Policlínica Universitária "Joaquín de Agüero y Agüero"

RESUMEN Introducción: La medicación antihipertensiva de pacientes mayores de 20 años amerita un riguroso control, que garantice un adecuado mantenimiento del estado de salud de dicho grupo poblacional. Objetivo: Analizar la adherencia terapéutica en los pacientes con hipertensión arterial del Consultorio del Médico de Familia No. 4, perteneciente al Policlínico Universitario "Joaquín de Agüero y Agüero", del municipio Camagüey. Método: Estudio observacional, descriptivo de corte transversal durante el periodo de octubre de 2020 a febrero de 2021. Se trabajó con los 98 pacientes de 20 y más años de edad, con dificultad en su control de la tensión arterial debido al incumplimiento de su tratamiento. Se midieron las variables: edad, sexo, grado de hipertensión, adherencia al tratamiento a través del test de Morisky-Green-Levine, cantidad de fármacos utilizados y los factores de la no adherencia. La información se procesó a través del paquete estadístico SPSS 25.0. Resultados: Existió un predominio de los mayores de 60 años (46,9 %), del sexo masculino en un 58,1 %, clasificados como grupo II de la hipertensión arterial (51 %). Predominaron los pacientes con una adherencia parcial terapéutica (68,3 %) según el test de Morisky-Green-Levine y con la utilización de tres fármacos como tratamiento de la enfermedad (46,9 %). Dentro de los factores más frecuentes predominaron la dificultad con la obtención del medicamento (86,7 %) y la realización de la dieta (77,5 %). Conclusiones: La no adherencia terapéutica en los pacientes hipertensos los expone a la aparición de complicaciones cardiovasculares, con la repercusión que conlleva para el individuo, la familia y la sociedad.

ABSTRACT Introduction: The antihypertensive treatment in patients with 20 or more years old requires strict controls in order to maintain their healthy life span. Objective: To assess the therapeutic adherence in patients with hypertension from the Family doctor's office No. 4, linked to the Policlínico Universitario "Joaquín de Agüero y Agüero", in Camagüey. Method: An observational, descriptive, cross-sectional study during the period from October 2020 to February 2021 was conducted. In the research 98 patients with 20 or more years old were recruited to work with. Patients with difficulties in their blood pressure control due to the noncompliance with the treatment. Variables assesed were as follow: age, sex, stage of hypertension, adherence to treatment using the Morisky-Green-Levine test, drugs used, and non-adherence factors. The information gathered was processed via SPSS statistic 25.0. Results: Patients with 60 years old (46.9%), males (58.1%), and clasified as stage 2 hypertension (51%) were predominant. Also, were predominant patients with partial therapeutic adherence (68.3%) (asper the Morisky-Green-Levine test outcomes), and patients whitch used three types of drugs to treat the illness (46.9%). The most common factors found were lack of drugs to treat the hypertension (86.7%) and the inadequate diet (77.5%). Conclusions: Non-adherence to treatment in hypertensive patients expose them to adquire any cardiovascular complication, aspect whitch affect patients themselve, family, and the society.

RESUMO Introdução: A medicação anti-hipertensiva em pacientes com mais de 20 anos exige um controle rigoroso, o que garante uma manutenção adequada do estado de saúde desse grupo populacional. Objetivo: analisar a adesão terapêutica em pacientes com hipertensão arterial no Consultório Médico de Família nº 4, pertencente à Policlínica Universitária "Joaquín de Agüero y Agüero", do município de Camagüey. Método: Estudo observacional, transversal, descritivo, de outubro de 2020 a fevereiro de 2021. Trabalhamos com 98 pacientes com idade igual ou superior a 20 anos, com dificuldade de controle da pressão arterial devido à não adesão ao tratamento. As variáveis foram mensuradas: idade, sexo, grau de hipertensão, adesão ao tratamento pelo teste de Morisky-Green-Levine, quantidade de medicamentos utilizados e fatores de não adesão. As informações foram processadas por meio do pacote estatístico SPSS 25.0. Resultados: Houve predomínio dos maiores de 60 anos (46,9%), 58,1% do sexo masculino, classificados como grupo II de hipertensão arterial (51%). Predominaram pacientes com adesão terapêutica parcial (68,3%) pelo teste de Morisky-Green-Levine e com uso de três medicamentos para tratamento da doença (46,9%). Dentre os fatores mais frequentes, predominou a dificuldade de obtenção do medicamento (86,7%) e da dieta alimentar (77,5%). Conclusões: A não adesão terapêutica em hipertensos os expõe ao aparecimento de complicações cardiovasculares, com as repercussões que isso acarreta para o indivíduo, a família e a sociedade.

Different profiles of circulating arginase 2 in subtypes of preeclampsia pregnant women.

BACKGROUND AND AIMS: Preeclampsia (PE) is a gestational hypertensive disease responsible for high maternal and fetal morbidity and mortality. The increase in blood pressure is associated with a decrease in the bioavailability of nitric oxide (NO). Arginase interferes with NO production consuming L-arginine, a substrate required by endothelial NO synthase to NO formation. No previous study has quantified the circulating levels of the two arginase isoforms (arginase 1 and arginase 2) in the plasma of pregnant women with PE. Therefore, our objective is to evaluate these plasma levels in healthy pregnant women and PE with or without severe features and who respond or not to antihypertensive therapy. METHODS: We compared 29 healthy pregnant women with 56 pregnant women with PE, who were also divided into with severe features (n = 24) or without severe features (n = 32) and into responsive (n = 29) or nonresponsive to antihypertensive therapy (n = 27). We quantified the plasmatic expression of arginase 1 and arginase 2 by ELISA kits. RESULTS: While similar levels of arginase 1 were found among groups, lower arginase 2 plasma levels were found in PE without severe features and responsive to antihypertensive drugs when compared to healthy pregnant women. There was no difference between arginase 2 levels in PE with severe features and nonresponsive group when compared to healthy pregnant women. CONCLUSION: This shows different circulation profiles of arginase 2 among groups, suggesting the existence of mechanisms of arginase 2 modulation in pregnant women with PE associated with the severity of the disease and responsiveness to antihypertensive treatment.

Hipertensão resistente: análise dos estudos pathway 2 e 3 / Resistant hypertension: analysis of pathway 2 and 3 studies

A hipertensão arterial resistente (HAR) é definida quando, apesar do tratamento com pelo menos três medicações anti- -hipertensivas (incluindo um diurético) de diferentes classes a meta pressórica não é alcançada. Nesta sequência de fármacos, por muitos anos se utilizou empiricamente ou baseado em pequenos estudos, a espironolactona. Os estudos Pathway 2 e 3 vieram para corroborar a importância deste quarto fármaco, a espironolactona, como o mais eficaz em termos de potencia anti-hipertensiva, como também explicar os aspectos fisiopatológicos que levam o hipertenso a ficar resistente. Nesta revisão e análise crítica dos fármacos anti-hipertensivos na HAR destacamos os principais mecanismos envolvidos no não controle da pressão e as estratégias para um melhor controle pressórico

Resistant arterial hypertension (RAH) is defined when, despite treatment with at least three antihypertensive medications (including a diuretic) of different classes, the pressure target is not achieved. In this sequence of drugs, for many years it was used empirically or based on small studies, spironolactone. Pathway 2 and 3 studies have come to corroborate the importance of this fourth drug, spironolactone, as the most effective in terms of antihypertensive potency, as well explain the pathophysiological aspects that lead hypertensive patients to become resistant. In this review and critical analysis of antihypertensive drugs in hypertension, we highlight the main mechanisms involved in the lack of pressure control and the strategies for better pressure control

The prevalence and associated factors of nonadherence to antihypertensive medication in secondary healthcare.

PURPOSE: Non-adherence (NA) to medication is a major contributor to treatment failure in hypertensive patients. Factors of the ecological model, at family/healthcare professional, service, and system levels, are rarely evaluated as correlates of NA in hypertensive patients. METHODS: This crossectional study assessed the prevalence of and associated factors of NA to antihypertensive medication among 485 hypertensive patients upon receiving secondary healthcare. The Morisky Green Levine Scale (MGLS) measured the implementation phase of adherence, and the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA) instrument, health literacy. Multivariate analysis to NA included variables according to the levels of the ecological model. RESULTS: Most patients were female (56.3%), white (53.2%), mean age of 62.0 ± 12.6 years, illiterate (61.6%), with low health literacy (70.9%), and low income (65.4%). Uncontrolled BP was frequent (75.2%); 57.1% of patients were nonadherent. In multivariate analysis based on the ecological model, adjusted for micro, meso- and macro-level correlates, NA was associated only with variables of patient-level: low health literacy (OR 1.62, CI 1.07-2.44, p = 0.020), income ≥ two reference wages (OR 0.46, CI 0.22-0.93, p = 0.031), lack of homeownership (OR 1.99, CI 1.13-3.51, p = 0.017), sedentarism (OR 1.78, CI 1.12-2.83, p = 0.014), and complexity of treatment (number of medications taken ≥ two times/day) (OR 1.56, CI 1.01-2.41, p = 0.042). CONCLUSION: In this group of severely hypertensive patients with high cardiovascular risk, only patient-related characteristics were associated with NA. Our findings highlight the need for effective actions to optimize clinical outcomes in similar healthcare programs.

Construção e validação de recursos audiovisuais para motivar pessoas com hipertensão ao uso de anti-hipertensivos / Construcción y validación de recursos audiovisuales para motivar a las personas con hipertensión para utilizar antihipertensivos / Construction and validation of audiovisual resources to motivate people with hypertension to use antihypertensives

Resumo Objetivo Construir e validar comunicação audiovisual e mensagens persuasivas para motivar o uso de anti-hipertensivos. Método Estudo metodológico baseado nas crenças de pessoas com hipertensão arterial sistêmica em relação ao tratamento medicamentoso, tendo o suporte da Teoria do Comportamento Planejado. Adotaram-se os princípios de Fleming e da Persuasão para desenvolvimento da comunicação audiovisual e mensagens. 13 juízes especialistas realizaram a validação de conteúdo, analisada pelo Índice de Validade de Conteúdo. Resultados A comunicação audiovisual apresenta 3 minutos e 58 segundos de duração e 71 telas. Foram consideradas válidas 29 mensagens persuasivas ilustradas, sendo 15 positivas e 14 negativas. Conclusão e implicações para a prática A comunicação audiovisual e as mensagens persuasivas foram consideradas válidas, adequadas e com capacidade de persuasão para motivar o uso de anti-hipertensivos orais. Pesquisa de intervenção faz-se necessária para testar o efeito dos recursos audiovisuais com intenção de realizar o comportamento.

Resumen Objetivo Construir y validar la comunicación audiovisual y los mensajes persuasivos para motivar el uso de antihipertensivos. Método Estudio metodológico basado en las creencias de las personas con hipertensión arterial sistémica en relación con el tratamiento farmacológico, apoyado por la Teoría del Comportamiento Planificado. Los principios de Fleming y la Persuasión fueron adoptados para el desarrollo de la comunicación y los mensajes audiovisuales. 13 jueces expertos realizaron la validación del contenido, analizada por el Índice de Validez del Contenido. Resultados La comunicación audiovisual tiene 3 minutos y 58 segundos de duración y 71 pantallas. Se consideraron válidos 29 mensajes ilustrativos persuasivos, 15 mensajes eran positivos y 14 negativos. Conclusión e implicaciones para la práctica La comunicación audiovisual y los mensajes persuasivos se consideraron válidos, adecuados y capaces de persuadir para motivar el uso de antihipertensivos orales. La investigación de intervención es necesaria para probar el efecto de los recursos audiovisuales con la intención de llevar a cabo el comportamiento.

Abstract Objective Building and validating audiovisual communication and persuasive messages to motivate the use of antihypertensive drugs. Method Methodological study based on the beliefs of people with systemic arterial hypertension in relation to drug treatment, supported by the Theory of Planned Behavior. The principles of Fleming and Persuasion were adopted for the development of audiovisual communication and messages. 13 expert judges performed the content validation, analyzed by the Content Validity Index. Results the audiovisual communication has 3 minutes and 58 seconds in duration and 71 screens. Twenty-nine persuasive illustrated messages were considered valid, 15 positive and 14 negative messages. Conclusion and implications for practice Audiovisual communication and persuasive messages were considered valid, adequate and capable of persuasion to motivate the use of oral antihypertensives. Intervention research is necessary to test the effect of audiovisual resources with the intention of carrying out the behavior.

Clevidipine as an antihypertensive drug in three pheochromocytoma surgeries: Case series / Clevidipino como fármaco antihipertensivo en tres cirugías de feocromocitoma: Serie de casos

Abstract Introduction Laparoscopic adrenalectomy is the treatment of choice of pheochromocytoma. During the first surgical phase (pneumoperitoneum insufflation, tumor and veins handling), there is a risk of hypertensive crisis due to catecholamine release. After tumor excision, patients can suffer relative vasodilation and the residual effect of antihypertensive drugs, which results in arterial hypotension. For that reason, antihypertensive drugs used in the first phase should have a rapid onset of action, short half-life and no residual effect. Methods We report a series of three cases of patients with pheochromocytoma who were treated with laparoscopic adrenalectomy. They all received clevidipine infusion from the beginning of the surgery, before they had presented hypertension, to treat and try to minimize hypertensive peaks. Results In all patients, hypertensive peaks were controlled in a few minutes. After tumor resection, clevidipine infusion was stopped in all cases, and any patient required infusion of vasopressors. Discussion Clevidipine could be a first choice antihypertensive drug in pheochromocytoma surgery. Starting the infusion of clevidipine before the hypertensive peaks could help to make them less pronounced.

Resumen Introducción La adrenalectomía laparoscópica es el tratamiento de elección del feocromocitoma. Durante la primera fase quirúrgica (insuflación de neumoperitoneo, manipulación del tumor y de las venas implicadas), existe el riesgo de que se desencadenen crisis hipertensivas debido a la liberación de catecolaminas. Después de la extirpación del tumor, los pacientes pueden sufrir una vasodilatación relativa y el efecto residual de los fármacos antihipertensivos usados previamente, lo que resulta en hipotensión arterial. Por esa razón, los fármacos antihipertensivos utilizados en la primera fase quirúrgica deben tener rápido inicio de acción, vida media corta y mínimo efecto residual. Métodos Se describe una serie de casos de tres pacientes con feocromocitoma que fueron tratados con adrenalectomía laparoscópica. Todos recibieron infusión de clevidipino desde el comienzo de la cirugía, antes de presentar hipertensión arterial, para así intentar minimizar y tratar rápidamente los posibles picos hipertensivos. Resultados En todos los pacientes los picos hipertensivos se controlaron en pocos minutos. Después de la resección del tumor, la infusión de clevidipino se detuvo en todos los casos y ningún paciente requirió perfusión de vasopresores. Discusión El clevidipino podría ser un fármaco antihipertensivo de primera elección en la cirugía de feocromocitoma. Iniciarlo antes de que ocurran los picos hipertensivos podría ayudar a que sean más leves.

Physical Exercise Combined with Antihypertensive Drug Therapy on Left Ventricular Hypertrophy: Systematic Review and Meta-Analysis.

INTRODUCTION: Physical exercise and antihypertensive drugs contribute to reduce or prevent hypertensive heart disease (HHD). The effect on blood pressure (BP) of both combined therapy is well documented, but not for the left ventricular (LV) function. AIM: A systematic review and meta-analysis was conducted for LV biomarkers analysis regarding to HHD on subjects treated with antihypertensive drugs combined with physical exercise practice. METHODS: The search was conducted on the Pubmed, Bireme, Lilacs, Central (Cochrane) and Science direct databases, comprising undetermined period of time, including randomized studies comparing trained and sedentary subjects, both treated with antihypertensive drugs. We analyzed the influence of combined therapy on echocardiogram parameters and BP. A significance level of 5% and 95% CI was considered for all outcomes. RESULTS: Five studies (N = 1738) were included in meta-analysis. Combined therapy decreased significantly LV mass (CI - 21.63 to - 1.81, N = 783) and heart rate (HR; CI - 4.23 to - 1.59, N = 1738), compared to antihypertensive drugs alone. There was a trend to decrease LV mass index (LVMI; CI - 5.57 to 0.71, N = 1674), systolic BP (CI - 2.47 to 1.23, N = 1674) and diastolic BP (CI - 2.16 to 0.28, N = 1674), a trend to increase of ejection fraction (EF; 95% CI - 0.50 to 2.12, N = 783) and LV end-diastolic diameter (CI - 0.85 to 0.92, N = 847) was similar. CONCLUSION: The antihypertensive therapy combined with physical exercise practice can reduce LV mass and HR. Therefore, combined therapy prescription should be considered for prevention and treatment of LV hypertrophy of hypertensive subjects.

Control of blood pressure levels in patients with premature coronary artery disease: Results from the Genetics of Atherosclerotic Disease study.

High blood pressure (BP) is the major cardiovascular-risk factor for coronary artery disease (CAD), principally in young patients who have an important and increasing socioeconomic burden. Despite the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), recommended BP target <140/90 mm Hg for patients with stable CAD, in 2017 the American College of Cardiology and the American Heart Association (ACC/AHA) updated BP target to <130/80 mm Hg. We aimed to analyze the prevalence of BP control in patients with premature CAD using both criteria. In addition, antihypertensive therapy, lifestyle, clinical, and sociodemographic characteristics of the patients were evaluated in order to identify factors associated with the achievement of BP targets. The present study included 1206 patients with CAD diagnosed before 55 and 65 years old in men and women, respectively. Sociodemographic, clinical, and biochemical data were collected. The results indicate that 85.6% and 77.5% of subjects with premature CAD achieved JNC-7 non-strict and ACC/AHA strict BP target, respectively. Consistently, number of antihypertensive drugs and hypertension duration >10 years were inversely associated with BP targets, whereas total physical activity and smoking were directly associated with BP targets, regardless of BP criteria. Considering that age, gender, and hypertension duration are non-modifiable cardiovascular-risk factors, our results highlight the need for more effective strategies focused on increase physical activity and smoking cessation in young patients with CAD. These healthier lifestyles changes should favor the BP target achievement and reduce the socioeconomic and clinical burden of premature CAD.

Respuesta de los sujetos con hipertensión arterial a los fármacos antiagregantes plaquetarios / Response of hypertensive subjects to antiplatelet drugs

Introducción: La terapia con antiagregantes plaquetarios es recomendada como prevención secundaria de eventos cardiovasculares en personas con hipertensión arterial. Sin embargo, en la práctica clínica se encuentran personas que no responden al tratamiento y presentan recurrencia de eventos vasculares. Objetivo: Evaluar la respuesta de los sujetos hipertensos a los fármacos antiagregantes plaquetarios. Material y Métodos: Estudio transversal, observacional descriptivo y comparativo, con 299 sujetos con hipertensión arterial esencial y 96 no hipertensos (como control), que estaban consumiendo antiagregantes plaquetarios. Los sujetos hipertensos fueron agrupados de acuerdo con el consumo de fármacos antihipertensivos. Se les determinó su agregación plaquetaria al colágeno en plasma, rico en plaquetas, según el Método de Born. La respuesta a la terapia antiplaquetaria se clasificó en cuatro categorías (óptima, moderada, pobre y no respuesta) de acuerdo con la agregación plaquetaria. Resultados: Se observó una ligera mejor respuesta a los antiagregantes plaquetarios, aunque no estadísticamente significativa, por parte de los hipertensos sin fármacos antihipertensivos (35,7 por ciento óptima y 42,9 por ciento moderada), en relación con los hipertensos que usaban antihipertensivos (32,7 por ciento óptima y 26,5 por ciento moderada) y los no hipertensos (30,2 por ciento óptima y 30,2 por ciento moderada). Además, se encontró que 17,7 por ciento de los sujetos no hipertensos, 14,3 por ciento de los hipertensos sin fármacos antihipertensivos y 13,2 por ciento de los hipertensos con antihipertensivos no estaban respondiendo a los antiagregantes plaquetarios. Conclusiones: La respuesta a los fármacos antiagregantes plaquetarios de los sujetos hipertensos consuman o no fármacos antihipertensivos es heterogénea y similar a la de los sujetos no hipertensos(AU)

ABSTRACT Introduction: Therapy with antiplatelet drugs is recommended as secondary prevention of cardiovascular events in people with arterial hypertension. However, in the clinical practice, there are people who do not respond to treatment and evidence a recurrence of vascular events. Objective: To evaluate the response of hypertensive patients to antiplatelet drugs. Material and Methods: Cross-sectional, observational, descriptive and comparative study that included 299 subjects with arterial hypertension and 96 non-hypertensive subjects (control group) who were taking antiplatelet drugs. The hypertensive subjects were grouped according to the consumption of antihypertensive drugs. Platelet aggregation collagen in platelet-rich plasma was determined using the turbidimetric Born's method. The response to the antiplatelet therapy was classified in four categories (good, moderate, poor and non-responsiveness) in accordance with the platelet aggregation. Results: There was a slightly better response to antiplatelet drugs, although it was not statistically significant in hypertensive subjects without antihypertensive drugs (35,7 percent good and 42,9 percent moderate) in relation to hypertensive subjects who were taking antihypertensive drugs (32,7 percent good and 26,5 percent moderate) and the non-hypertensive ones (30,2 percent good and 30,2 percent moderate).Besides, it was found that 17,7 percent of non-hypertensive subjects and 14,3 percent of the hypertensive ones without antihypertensive drugs and 13,2 percent of hypertensive subjects with antihypertensive drugs were not responding to the treatment with antiplatelet drugs. Conclusions: The response of hypertensive patients to antiplatelet drugs, either taking antihypertensive drugs or not, is heterogeneous and similar to the response of the non-hypertensive subjects(AU)

Adherence to antihypertensive drug treatment in Argentina: A multicenter study.

Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence-MMAS score of 8; medium adherence-MMAS scores of 6 to <8; and low adherence-MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.

Control adecuado de la presión arterial en adultos con medicación antihipertensiva de dos Unidades de Salud Familiar de Luque y Fernando de la Mora, Paraguay, 2018

RESUMEN Introducción: la reducción de la presión arterial es una meta en el tratamiento de la hipertensión arterial primaria. Objetivos: determinar la frecuencia de control adecuado de la hipertensión arterial en adultos en tratamiento antihipertensivo de las Unidades de Salud Familiar de Luque y Fernando de la Mora, Paraguay. Metodología: estudio observacional, transversal, prospectivo, con componentes analíticos realizado en pacientes adultos hipertensos tratados en dos Unidades de Salud Familiar durante agosto y septiembre 2018. Se evaluaron variables sociodemográficas y clínicas. Se consideró presión arterial adecuada a todo valor <140/90 mm Hg. Resultados: se incluyeron 149 sujetos, con edad media 60±12 años, 68% del sexo femenino, 42% con sobrepeso-obesidad, 32% eran portadores de diabetes mellitus. Todos recibían tratamiento farmacológico antihipertensivo. El control adecuado de la hipertensión arterial se observó en 55%. Conclusiones: el control adecuado de la hipertensión arterial en pacientes adultos de dos Unidades de Salud Familiar fue 55%. Los antihipertensivos más usados fueron los inhibidores de enzima convertidora de angiotensina y los antagonistas de los receptores de angiotensina II.

ABSTRACT Introduction: The reduction of blood pressure is a goal in the treatment of primary arterial hypertension. Objectives: To determine the frequency of adequate control of arterial hypertension in adults under antihypertensive treatment at the Family Health Units of Luque and Fernando de la Mora, Paraguay. Methodology: Observational, cross-sectional, prospective study with analytical components performed in adult hypertensive patients treated in two Family Health Units during August and September 2018. Sociodemographic and clinical variables were evaluated. Adequate blood pressure was considered at any value <140/90 mm Hg. Results: One hundred forty nine subjects were included, with a average age of 60±12 years, 68% were women, 42% with overweight-obesity, and 32% were carriers of diabetes mellitus. All were receiving antihypertensive drug treatment. Adequate control of arterial hypertension was observed in 55%. Conclusions: The adequate control of hypertension in adult patients of two Family Health Units was 55%. The most commonly used antihypertensives were angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists.

Recomendaciones latinoamericanas para el manejo de la hipertensión arterial en adultos (RELAHTA 2)

RESUMEN Se presenta la segunda parte de las recomendaciones latinoamericanas para el manejo de la Hipertensión Arterial (HTA) en adultos. En una primera fase se han descripto los aspectos más relevantes de la epidemiología, aspectos fisiopatológicos, cómo hacer diagnóstico, pautas terapéuticas, urgencias y emergencias hipertensivas, poblaciones especiales, hipertensión refractaria y la aplicación de las guías en la vida real. En esta segunda parte, se emiten recomendaciones respondiendo a preguntas específicas para prevención primaria, secundaria, terciaria y cuaternaria. En general pocas recomendaciones al respecto del manejo de la hipertensión arterial surgen desde la clínica médica/ medicina interna, a pesar de dos situaciones: la mayoría de los pacientes con hipertensión arterial son evaluados y manejados por los clínicos, y la clínica médica es la especialidad que permite la mirada holística e integrada de los problemas de salud del adulto, permitiendo agregar el enfoque biográfico al biológico, comprender e interpretar no solo el problema de salud sino sus causas y consecuencias (que muchas veces suelen corresponder a diferentes parénquimas, lo cual en el modelo fragmentado haría transitar al paciente por distintas especialidades). El bajo porcentaje de pacientes hipertensos controlados obliga a todos los profesionales involucrados en el manejo de los mismos a optimizar recursos y detectar problemas que se asocien a un control deficitario como la sub utilización del tratamiento farmacológico, baja tasa de pacientes tratados con estrategia combinada (la mayoría de los pacientes actualmente recibe monoterapia), falta de prescripción adecuada de los cambios en el estilo de vida, baja adherencia terapéutica e inercia clínica. En la presente publicación se presentan recomendaciones efectuadas por especialistas en clínica médica / medicina interna para el manejo de la hipertensión arterial en adultos, respondiendo preguntas de prevención primaria, secundaria, terciaria, y cuaternaria.

ABSTRACT The second part of the Latin American recommendations for the management of Arterial Hypertension (HTA) in adults is presented. In a first phase, the most relevant aspects of epidemiology, physiopathological aspects, how to diagnose, therapeutic guidelines, hypertension emergencies, special populations, refractory hypertension and the application of guides in real life have been described. In this second part, recommendations are issued answering specific questions for primary, secondary, tertiary and quaternary prevention. In general, few recommendations regarding the management of arterial hypertension arise from the medical clinic / internal medicine, despite two situations: the majority of patients with hypertension are evaluated and managed by the clinicians, and the medical clinic is the specialty that allows the holistic and integrated look of the health problems in adults, allowing to add the biographical approach to the biological, to understand and interpret not only the health problem but its causes and consequences (which often correspond to different parenchyma, which in the fragmented model would make the patient move through different specialties). The low percentage of controlled hypertensive patients forces all the professionals involved in the management of them to optimize resources and detect problems that are associated with a deficit control such as the under utilization of pharmacological treatment, low rate of patients treated with combined strategy (the most patients currently receive monotherapy), lack of adequate prescription of changes in lifestyle, low therapeutic adherence and clinical inertia. This publication presents recommendations made by specialists in medical clinic/internal medicine for the management of hypertension in adults, answering primary, secondary, tertiary and quaternary prevention questions.

The Newly Synthesized Pyrazole Derivative 5-(1-(3 Fluorophenyl)-1H-Pyrazol-4-yl)-2H-Tetrazole Reduces Blood Pressure of Spontaneously Hypertensive Rats via NO/cGMO Pathway.

The search for new antihypertensive drugs has grown in recent years because of high rate of morbidity among hypertensive patients and several side effects that are associated with the first-line medications. The current study sought to investigate the antihypertensive effect of a newly synthesized pyrazole derivative known as 5-(1-(3 fluorophenyl)-1H-pyrazol-4-yl)-2H-tetrazole (LQFM-21). Spontaneously hypertensive rats (SHR) were used to evaluate the effect of LQFM-21 on mean arterial pressure (MAP), heart rate (HR), renal vascular conductance (RVC), arterial vascular conductance (AVC), baroreflex sensitivity (BRS) index, and vascular reactivity. Acute intravenous (iv) administration of LQFM-21 (0.05, 0.1, 0.2, and 0.4 mg kg-1) reduced MAP and HR, and increased RVC and AVC. Chronic oral administration of LQFM-21 (15 mg kg-1) for 15 days reduced MAP without altering BRS. The blockade of muscarinic receptors and nitric oxide synthase by intravenous infusion of atropine and L-NAME, respectively, attenuated cardiovascular effects of LQFM-21. In addition, ex vivo experiments showed that LQFM-21 induced an endothelium-dependent relaxation in isolated aortic rings from SHR. This effect was blocked by guanylyl cyclase inhibitor (ODQ) and L-NAME. These findings suggest the involvement of muscarinic receptor and NO/cGMP pathway in the antihypertensive and vasodilator effects of LQFM-21.