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1.
Cardiol Clin ; 41(1): 15-24, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36368808

RESUMO

Hypertension is a leading cardiovascular risk factor in athletes. Sport-specific behaviors including nonsteroidal anti-inflammatory use, stimulant use, and unhealthy diets may promote hypertension among athletes. Strength-trained athletes may be more susceptible to hypertension than endurance-trained athletes, although this may, in part, be due to body size differences and the more potent antihypertensive effects of aerobic exercise. With confirmed hypertension, young athletes require secondary hypertension evaluation while older athletes require full cardiovascular risk stratification. Calcium channel blockers and renin-angiotensin-system inhibitors are often preferred pharmacotherapy agents. Further selection of antihypertensives must include consideration of potential side effects and legality in specific sports.


Assuntos
Hipertensão , Esportes , Humanos , Hipertensão/epidemiologia , Hipertensão/etiologia , Hipertensão/terapia , Anti-Hipertensivos/uso terapêutico , Atletas , Bloqueadores dos Canais de Cálcio/uso terapêutico
3.
J Sci Food Agric ; 103(1): 64-72, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35804485

RESUMO

BACKGROUND: Table olives are a food with a high content of bioactive compounds with cardioprotective properties, such as oleic acid, polyphenols, and pentacyclic triterpenes. Here, we investigate the effect of the intake of table olives on blood pressure (BP) and body weight in spontaneously hypertensive rats (SHR) and their normotensive controls, Wistar Kyoto (WKY) rats. 'Arbequina' table olives (3.85 g kg-1 ) were administered by gavage to SHR and WKY rats in short-term (1 day) and long-term (7 weeks) experiments. BP was measured by the tail-cuff method, and polyphenols and triterpenes were determined in olives and plasma by liquid chromatography-mass spectrometry. RESULTS: Administration of 'Arbequina' olives to WKY rats did not exert any change in BP in any of the experiments. However, in SHR, the single dose induced a transient reduction in BP of approximately 15 mmHg, from the second to the tenth hour after the administration. In the long-term assay, a similar decrease was established in the second week and was maintained throughout the experiment. Moreover, the daily administration of olives to rats did not affect their body weight when compared with controls in either the WKY rats or SHR. The determination of polyphenols and triterpenes in plasma indicated that, at the end of the experiment, only maslinic acid, oleanolic acid, hydroxytyrosol, and luteolin were found, all of them being compounds with already described capacity to decrease BP. CONCLUSION: The results suggest that the daily intake of table olives could decrease BP in hypertension without affecting body weight, indicating that table olives could contribute to improving cardiovascular health. © 2022 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.


Assuntos
Hipertensão , Olea , Ratos , Animais , Ratos Endogâmicos SHR , Anti-Hipertensivos/farmacologia , Olea/química , Ratos Endogâmicos WKY , Pressão Sanguínea , Hipertensão/tratamento farmacológico , Polifenóis/farmacologia , Polifenóis/análise , Peso Corporal , Triterpenos Pentacíclicos
4.
J Sci Food Agric ; 103(1): 428-436, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36373790

RESUMO

BACKGROUND: Our previous study has demonstrated that the egg-white-derived peptide RVPSL can lower blood pressure in spontaneously hypertensive rats (SHRs), but its potential action mechanism remains unclear. In this work, the underlying mechanism of the antihypertensive effects of RVPSL in SHRs was elucidated using the widely targeted kidney metabolomics approach. RESULTS: Ten SHRs were divided into two groups: SHR-Untreated group (0.9% saline) and SHR-RVPSL group (50 mg kg-1 body weight RVPSL) for 4 weeks. After 4 weeks, kidney samples were collected and widely targeted (liquid chromatography-electrospray ionization-tandem mass spectrometry) metabolomics was used to detect metabolites. Fifty-six biomarkers were identified that may be associated with hypertension. Among them, 17 biomarkers were upregulated and 39 biomarkers were downregulated. The results suggested that eight potential biomarkers were identified in kidney samples: O-phospho-l-serine, tyramine, citric acid, 3-hydroxybutyrate, O-acetyl-l-serine, 15-oxo-5Z,8Z,11Z,13E-eicosatetraenoic acid (15-oxoETE), dopaquinone and 3,3',5-triiodo-l-thyronine. These potential biomarkers mainly involved carbon metabolism, thyroid hormone signaling pathway, tyrosine metabolism and arachidonic acid metabolism. CONCLUSION: The study suggested that RVPSL may exert antihypertensive effects through upregulation of O-phospho-l-serine, 3-hydroxybutyrate and 15-oxoETE, and downregulation of tyramine, citric acid, O-acetyl-l-serine, 3,3',5-triiodo-l-thyronine and dopaquinone. The antihypertensive effects of RVPSL may be related to carbon metabolism, thyroid hormone signaling pathway, tyrosine metabolism and arachidonic acid metabolism. RVPSL exhibited a potent antihypertensive effect, and the antihypertensive effects were associated with inhibition of vascular smooth muscle cell proliferation, vascular remodeling, vascular endothelium dysfunction, restoring reactive oxygen species, oxidative stress, inflammation and immune reaction. © 2022 Society of Chemical Industry.


Assuntos
Anti-Hipertensivos , Hipertensão , Ratos , Animais , Anti-Hipertensivos/farmacologia , Ratos Endogâmicos SHR , Ácido Araquidônico , Ácido 3-Hidroxibutírico , Hipertensão/tratamento farmacológico , Metabolômica , Rim , Pressão Sanguínea , Biomarcadores , Serina , Tironinas , Tiramina , Ácido Cítrico , Carbono , Tirosina
5.
J Ethnopharmacol ; 300: 115703, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36096347

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Integrated Chinese herbal medicine (CHM) and Western Medicine (WM) treatments have been used for primary hypertension (PHTN) patients in China. Currently, there are many randomized control trials (RCTs) published regarding the effect of CHM and WM on PHTN, which indicated that combining Chinese with WM was effective and safe for PHTN when compared with WM alone, but the quality of evidence was insufficient, and there is no clear information and summary are available for these RCTs assessing the effectiveness of CHM with WM versus WM in patients with PHTN. OBJECTIVES: This systematic study and meta-analysis aimed to evaluate the effectiveness and safety of CHM combined with WM in comparison with WM in reducing systolic and diastolic blood pressure for patients with PHTN. METHODS: The information of this study was searched from electronic databases (PubMed, COCHRANE, EMBASE, Ovid, CNKI, VIP, Wanfang, and CBM). The markedly effective and effective terms were according to Guiding Principles for Clinical Research of New Chinese Medicines. Two investigators independently reviewed each trial. The Cochrane risk of bias assessment tool was used for quality assessment, and RevMan 5.4 was used for meta-analysis. RESULTS: In this study, a total of 29 studies that included 2623 patients were recorded. The study results displayed that the clinical effectiveness in the treatment of hypertension patients from the integrated medicines was considerably higher than that with WM alone, clinical effective (RR 1.23, 95% CI [1.17, 1.30], P < 0.00001), and markedly effective (ME) in the patients (RR 1.66, 95% CI [1.52, 1.80], and P < 0.00001). Random effect in SBP (MD 7.91 mmHg,[6.00, 983], P < 0.00001) and DBP (MD 5.46 mmHg, [3.88, 6.43], P < 0.00001), a subgroup analysis was carried out based on the type of intervention, duration of treatment, and CHM formulas that showed significance. Furthermore, no severe side effects were reported, and no patients stopped treatment or withdrawal due to any severe adverse events. CONCLUSION: Compared to WM alone, the therapeutic effectiveness of CHM combined with WM is significantly improved in the treatment of hypertension. Additionally, CHM with WM may safely and efficiently lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) in individuals with PHTN. However, rigorous randomized controlled trials with a large sample, high quality, long duration of treatment, and follow-up are recommended to strengthen this clinical evidence.


Assuntos
Medicamentos de Ervas Chinesas , Hipertensão , Medicina Integrativa , Anti-Hipertensivos/uso terapêutico , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Hipertensão/induzido quimicamente , Hipertensão/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
6.
Neurol India ; 70(5): 1793-1799, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36352567

RESUMO

Background and Objective: Current recommendations prescribe either nicardipine or labetalol as the first-line treatment for acute hypertension due to ease of use, availability, and low price. However, it is unclear if these drugs have different effectiveness and safety profiles. This systematic review and meta-analysis aimed to compare the efficacy and safety of labetalol and nicardipine in patients with acute stroke. Materials and Methods: MEDLINE via PubMed, Scopus, Embase, and Google Scholar databases were electronically searched for the eligible publications from inception until March 2022. All full-text journal papers in English which compared the efficacy of nicardipine with that of labetalol on lowering blood pressure (BP; or treating hypertension) in all subtypes of acute stroke were included. The Cochrane Collaboration tool was used to assess the risk of bias. Data were analyzed using specific statistical methods. Results: Following the abstract and full-text screening, this meta-analysis included five retrospective cohorts and one prospective pseudorandomized cohort. Nicardipine's effect on time at goal BP was significantly superior to that of labetalol in patients with acute stroke (0.275 standardized mean difference [SMD], 95% confidence interval [CI]: 0.112-0.438, P = 0.001). The incidence of adverse events was significantly higher in the nicardipine group than that in the labetalol group. The pooled odds ratio (OR) was 1.509 (95% CI: 1.077-2.113, I2 = 0.00%, P = 0.757). The quality of included studies was found to be low. Conclusion: More prospective, comparative trials are needed to investigate the efficacy of BP management as well as clinical outcomes in acute stroke patients receiving continuous labetalol and nicardipine infusions.


Assuntos
Hipertensão , Labetalol , Acidente Vascular Cerebral , Humanos , Labetalol/uso terapêutico , Labetalol/efeitos adversos , Nicardipino/uso terapêutico , Nicardipino/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Estudos Retrospectivos , Estudos Prospectivos , Pressão Sanguínea , Resultado do Tratamento , Hipertensão/tratamento farmacológico , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico
7.
Zhonghua Yan Ke Za Zhi ; 58(11): 890-895, 2022 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-36348525

RESUMO

Objective: To investigate the changes in the types of anti-glaucoma eye drops and daily treatment costs in 2021 compared with 2006 in China. Methods: The information of the main anti-glaucoma eye drops in 2021 was obtained from the database of Yaozhi.com. The daily cost of each eye drop was calculated by recording the number of drops in a single bottle and pricing in the national market, and the corresponding information of anti-glaucoma eye drops collected in 2006 was compared. Based on the income of Chinese residents in 2006 and 2021, the proportion of the daily cost of anti-glaucoma eye drops in the annual income of residents was analyzed. Results There were 32 kinds of anti-glaucoma eye drops in 2021, and the daily cost was 0.34 to 16.00 yuan. The daily cost is 0.34 to 6.77 yuan after removing the single-dose package. The number of drugs in 2021 was significantly higher than that in 2006 (16). In 2021, prostaglandins accounted for the highest proportion of 31.25%. There was a significant increase in the number of generic drugs, fixed formulations and preservative-free single-dose packages. In 2021, the price of imported drugs was significantly reduced, with the daily cost falling by 29.28% to 53.78% compared with 2006. In 2021, the daily cost of the most expensive drugs accounted for 12.32% and 30.85% of the daily income of urban and rural residents, respectively (5.21% and 13.05% after removing single-dose packaged drugs), which were significantly lower than 37.46% and 122.79% in 2006. Conclusions Compared with 2006, the variety of anti-glaucoma eye drops increased significantly in 2021, and the daily treatment cost and the proportion of daily income were significantly reduced.


Assuntos
Glaucoma , Humanos , Soluções Oftálmicas/uso terapêutico , Glaucoma/tratamento farmacológico , Prostaglandinas Sintéticas/uso terapêutico , Medicamentos Genéricos/uso terapêutico , Custos de Cuidados de Saúde , Anti-Hipertensivos/uso terapêutico
8.
Zhonghua Yan Ke Za Zhi ; 58(11): 868-871, 2022 Nov 11.
Artigo em Chinês | MEDLINE | ID: mdl-36348523

RESUMO

Glaucoma is a chronic progressive sight-threatening eye disease, so most patients need long-term or even lifelong medications. The ocular surface diseases caused by the use of topical glaucoma medications seriously affect the treatment compliance, the quality of life, and the treatment effects. In order to standardize the diagnosis and treatment of topical glaucoma medications-related ocular surface diseases, to improve the ocular surface health of patients and to effectively control the progress of glaucoma, the Glaucoma Group of Ophthalmology Branch of Chinese Medical Association has formulated this consensus after serious consideration and discussion. This evidence-based consensus puts forward suggestions on the characteristics, occurrence mechanism, risk factors, diagnosis, treatment, prevention and follow-up of ocular surface diseases associated with topical glaucoma medications.


Assuntos
Glaucoma , Qualidade de Vida , Humanos , Consenso , Anti-Hipertensivos/uso terapêutico , Glaucoma/tratamento farmacológico , China , Soluções Oftálmicas/uso terapêutico , Administração Tópica
9.
BMJ Open ; 12(11): e064270, 2022 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-36375969

RESUMO

OBJECTIVES: To assess in the Italian general adult population the trends of blood pressure (BP) and prevalence of raised BP (RBP), hypertension and its control in order to evaluate population health and care, and the achievement of an RBP 25% relative reduction as recommended by the WHO at population level. DESIGN: Results comparison of health examination surveys, cross-sectional observational studies based on health examination of randomly selected age and sex stratified samples including residents aged 35-74 years. Data of the 2018/2019 survey were compared with the previous ones collected in 1998/2002 and 2008/2012. SETTING: Health examination surveys conducted in Italy within the CUORE Project following standardised methodologies. PARTICIPANTS: 2985 men and 2955 women examined in 1998/2002, 2218 men and 2204 women examined in 2008/2012 and 1031 men and 1066 women examined in 2018/2019. PRIMARY AND SECONDARY OUTCOME MEASURES: Age-standardised mean of BP, prevalence of RBP (systolic BP and/or diastolic BP ≥140/90 mm Hg), hypertension (presenting or being treated for RBP) and its awareness and control, according to sex, age class and educational level. RESULTS: In 2018/2019, a significant reduction was observed in systolic BP and diastolic BP in men (1998/2002: 136/86 mm Hg; 2008/2012: 132/84 mm Hg; and 2018/2019: 132/78 mm Hg) and women (132/82 mm Hg, 126/78 mm Hg and 122/73 mm Hg), and in the prevalence of RBP (50%, 40% and 30% in men and 39%, 25% and 16% in women) and of hypertension (54%, 49% and 44% in men and 45%, 35% and 32% in women). Trends were consistent by age and education attainment. In 2018/2019, hypertensive men and women with controlled BP were only 27% and 41%, but a significant favourable trend was observed. CONCLUSIONS: Data from 2018/2019 underlined that RBP is still commonly observed in the Italian population aged 35-74 years, however, the WHO RBP target at that time may be considered met.


Assuntos
Anti-Hipertensivos , Hipertensão , Humanos , Adulto , Masculino , Feminino , Pressão Sanguínea , Estudos Transversais , Anti-Hipertensivos/uso terapêutico , Hipertensão/complicações , Prevalência , Inquéritos Epidemiológicos
10.
Dtsch Med Wochenschr ; 147(22): 1476-1481, 2022 11.
Artigo em Alemão | MEDLINE | ID: mdl-36318911

RESUMO

TREATMENT GOALS IN DIABETIC NEPHROPATHY: A new classification of patients with diabetes mellitus into so-called clusters can be used to assess the risk of developing diabetic nephropathy. Up to date treatment of patients with diabetic nephropathy includes not only glycemic control, but focuses on a holistic approach with prevention of (progression of) secondary diabetic complications and reduction of the patient's cardiovascular mortality. COMPONENTS OF TREATMENT OF DIABETIC NEPHROPATHY: To achieve this treatment goals, it requires comprehensive management of the patient to implement lifestyle interventions (regarding diet, physical activity, weight loss, smoking cessation) and selection of the medication with the greatest individual benefit. DIETARY RECOMMENDATIONS IN DIABETIC NEPHROPATHY: Part of lifestyle intervention is adherence to a dietary regimen that has again been shown in recent studies to be relevant in inhibiting progression of chronic kidney disease and reducing cardiovascular risk. In particular, this includes protein restriction with preference for plant sources of protein, and salt restriction. USE OF MEDICATION CLASSES WITH PROVEN CARDIORENAL BENEFITS: Adjustment of drug therapy is no longer based on antihyperglycemic effects alone, but takes into account inhibition of progression of nephropathy and cardiac risk, as well as support of body weight control. For this purpose, in addition to RAAS inhibitors from the field of antihypertensives, the antidiabetic classes of SGLT2 inhibitors and GLP-1 receptor agonists as well as the non-steroidal aldosterone antagonist finerenone are now available.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Humanos , Nefropatias Diabéticas/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Estilo de Vida , Diabetes Mellitus Tipo 2/tratamento farmacológico
11.
JAMA ; 328(18): 1849-1861, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36346411

RESUMO

Importance: Hypertension, defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg, affects approximately 116 million adults in the US and more than 1 billion adults worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and death. Observations: First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption. The BP-lowering effects of individual lifestyle components are partially additive and enhance the efficacy of pharmacologic therapy. The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk. First-line drug therapy for hypertension consists of a thiazide or thiazidelike diuretic such as hydrochlorothiazide or chlorthalidone, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker such as enalapril or candesartan, and a calcium channel blocker such as amlodipine and should be titrated according to office and home SBP/DBP levels to achieve in most people an SBP/DBP target (<130/80 mm Hg for adults <65 years and SBP <130 mm Hg in adults ≥65 years). Randomized clinical trials have established the efficacy of BP lowering to reduce the risk of CVD morbidity and mortality. An SBP reduction of 10 mm Hg decreases risk of CVD events by approximately 20% to 30%. Despite the benefits of BP control, only 44% of US adults with hypertension have their SBP/DBP controlled to less than 140/90 mm Hg. Conclusions and Relevance: Hypertension affects approximately 116 million adults in the US and more than 1 billion adults worldwide and is a leading cause of CVD morbidity and mortality. First-line therapy for hypertension is lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption. When drug therapy is required, first-line therapies are thiazide or thiazidelike diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers.


Assuntos
Anti-Hipertensivos , Doenças Cardiovasculares , Hipertensão , Adulto , Humanos , Antagonistas de Receptores de Angiotensina/farmacologia , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Bloqueadores dos Canais de Cálcio/farmacologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Diuréticos/uso terapêutico , Hidroclorotiazida/uso terapêutico , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/mortalidade , Hipertensão/terapia , Potássio/uso terapêutico , Redução de Peso
13.
Sci Rep ; 12(1): 19007, 2022 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-36347923

RESUMO

The study aimed to estimate the prevalence and associated factors of undiagnosed hypertension (HTN) among adults in the Central African Republic (CAR). In the cross-sectional 2017 CAR (Bangui and Ombella M'Poko) STEPS survey, 3265 persons aged 25 to 64 years (non-pregnant and with complete blood pressure measurement), responded to an interview, biomedical and physical, including blood pressure, measurements. Undiagnosed HTN was classified as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg among adults who had never been told by a doctor or other health worker that they had raised blood pressure or hypertension and had not been taking antihypertensive medication. Binary logistic regressions are used to estimate factors associated with undiagnosed HTN. Among those with HTN (N = 1373), the proportion of undiagnosed HTN was 69.8% and 30.2% diagnosed HTN. In the adjusted logistic regression analysis, male sex (AOR: 2.12, 95% CI 1.39-3.23), current tobacco use (AOR: 1.58, 95% CI 1.03-2.42), and high physical activity (AOR: 1.93, 95% CI 1.00-3.71) were positively associated, and age (AOR: 0.75, 95% CI 0.59-0.96), and underweight (AOR: 0.58, 95% CI 0.37-0.90) were inversely associated with undiagnosed HTN. In addition, among men, ever screened for glucose (AOR: 0.07, 95% CI 0.02-0.27) was negatively associated with undiagnosed HTN, and among women, married or cohabiting (AOR: 1.20, 95% CI 1.00-1.44), current heavy drinking (AOR: 1.41, 95% CI 1.04-1.91) were positively associated with undiagnosed HTN. Seven in ten of the adult population with HTN had undiagnosed HTN in CAR. Efforts should be reinforced to screen for HTN in the general population.


Assuntos
Hipertensão , Adulto , Humanos , Masculino , Feminino , Prevalência , Estudos Transversais , República Centro-Africana/epidemiologia , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Fatores de Risco
14.
PLoS One ; 17(11): e0276781, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36350810

RESUMO

Hypertension appears to be one of the commonest comorbidities in COVID-19 patients, although whether hypertensive individuals have a higher risk of severe COVID-19 compared with non-hypertensives is unclear. It is also unclear whether the absolute level of systolic blood pressure, or the type of anti-hypertensive medication is related to this risk. Analyses were conducted using data from the UK Biobank and linked health records. Logistic regression models were fitted to assess the impact of hypertension, systolic blood pressure (SBP) and medications on the risk of severe COVID-19. 16,134 individuals tested positive for severe acute respiratory syndrome-coronavirus, 22% (n = 3,584) developed severe COVID-19 and 40% (n = 6,517) were hypertensive. Hypertension was associated with 22% higher odds of severe COVID-19 (Odds ratio (OR) 1.22; 95% confidence interval (CI) 1.12, 1.33), compared with normotension after adjusting for confounding variables. In those taking anti-hypertensive medications, elevated SBP showed a dose-response relationship with severe COVID-19 (150-159mmHg versus 120-129mmHg (OR 1.91; 95% CI 1.44, 2.53), >180+mmHg versus 120-129mmHg (OR 1.93; 95% CI 1.06, 3.51)). SBP <120mmHg was associated with greater odds of severe COVID-19 (OR 1.40; 95% CI 1.11, 1.78). Angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers were not associated with altered risk of severe COVID-19. Hypertension is an important risk factor for COVID-19. A better understanding of the underlying mechanisms is warranted in case of more severe strains or other viruses in the future.


Assuntos
COVID-19 , Hipertensão , Humanos , Anti-Hipertensivos/efeitos adversos , COVID-19/epidemiologia , Bancos de Espécimes Biológicos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Antagonistas de Receptores de Angiotensina/efeitos adversos , Reino Unido/epidemiologia , Estudos Retrospectivos
15.
BMC Prim Care ; 23(1): 280, 2022 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352363

RESUMO

BACKGROUND: Older patients using antihypertensive medication may experience Adverse Drug Events (ADEs), and thus benefit from deprescribing. The lack of a practical protocol may hamper deprescribing. Therefore, we aimed to develop a deprescribing protocol, based on a review of literature, combined with a feasibility test in a small number of patients. METHODS: A deprescribing protocol for general practitioners was drafted and tested in older patients using multiple antihypertensive medication in a single arm intervention. Patients were included if they were 75 years or older, were using two or more antihypertensives, had at least one ADE linked to antihypertensive medication and deprescribing was considered to be safe by their general practitioner. The primary outcome was the percentage of patients for whom one or more antihypertensive drugs were stopped or reduced in dose after 12 months of follow up while maintaining safe blood pressures. Secondary outcomes were the proportion of patients reporting no ADEs after 12 months and the number of deprescribed antihypertensives. Patient's opinions on deprescribing and enablers and barriers for study participation were also collected. RESULTS: Nine general practitioners included 14 patients to deprescribe antihypertensive medication using the deprescribing protocol. After 12 months antihypertensive drug use was lowered in 11 patients (79%). These patients had a mean systolic blood pressure increase of 16 mmHg and a mean diastolic blood pressure increase of 8 mmHg. Nine patients (64%) reported experiencing no ADEs anymore after twelve months. The mean number of deprescribed antihypertensives was 1.1 in all patients and 1.4 (range: 0.5 to 3.5) in patients who successfully lowered their medication. At baseline, being able to use less medication was the most frequently mentioned enabler to participate in this study. The most frequently mentioned positive experience at the end of the study was using less medication, which was in line with the most mentioned enabler to participate in this study. CONCLUSION: A protocol for deprescribing antihypertensives in older patients was considered feasible, as it resulted in a substantial degree of safe deprescribing in this pilot study. Larger studies are needed to demonstrate the effect and safety of deprescribing antihypertensives in older patients.


Assuntos
Desprescrições , Medicina Geral , Humanos , Idoso , Anti-Hipertensivos/uso terapêutico , Projetos Piloto , Estudos de Viabilidade , Literatura de Revisão como Assunto
16.
FP Essent ; 522: 25-33, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36374636

RESUMO

Hypertensive disorders in pregnancy (HDP) represent a spectrum of disease that affect women through pregnancy and the immediate postpartum period. These conditions are associated with significant morbidity and mortality during and after pregnancy and have been linked to cardiovascular disease later in life. The HDP spectrum includes gestational hypertension (HTN), preeclampsia, eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, chronic HTN, and chronic HTN with superimposed preeclampsia. Low-dose aspirin is recommended as a preventive drug after 12 weeks' gestation in women who are at high risk of preeclampsia. In HDP, close blood pressure (BP) monitoring, laboratory evaluation, and fetal assessment are warranted. Labetalol and nifedipine extended release are first-line oral antihypertensives for outpatient BP management of chronic HTN; labetalol, hydralazine, and nifedipine immediate release are used for hospitalized patients. HDP may develop or progress in the postpartum period; continued vigilance is important in the puerperium.


Assuntos
Hipertensão Induzida pela Gravidez , Labetalol , Pré-Eclâmpsia , Gravidez , Humanos , Feminino , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Labetalol/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/prevenção & controle , Nifedipino/uso terapêutico , Anti-Hipertensivos/uso terapêutico
17.
FP Essent ; 522: 8-12, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36374633

RESUMO

Blood pressure (BP) screening using an office-based measurement is recommended for adults 18 years and older without a history of hypertension. If abnormal, the BP measurement should be repeated twice with the average of those final two readings used to determine the BP category. Home BP monitoring and ambulatory BP monitoring are beneficial in patients for whom there is a concern for masked or white-coat hypertension. Guidelines differ regarding the BP cutoff used for the diagnosis of hypertension. Lifestyle modifications are the foundation of hypertension management with the Dietary Approaches to Stop Hypertension (DASH) diet being the most effective dietary modification. First-line pharmacotherapy should include one or more of the following: an angiotensin-converting enzyme inhibitor, an angiotensin receptor blocker, a dihydropyridine calcium channel blocker, and a thiazide or thiazidelike diuretic. Compared with standard BP control, intensive BP control (ie, systolic BP less than 120 mm Hg) leads to a decrease in atherosclerotic cardiovascular disease and all-cause mortality in patients with elevated risk but increases adverse effects, including hypotension, electrolyte abnormalities, acute kidney injury, and syncope.


Assuntos
Hipertensão , Adulto , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Monitorização Ambulatorial da Pressão Arterial , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Pressão Sanguínea , Bloqueadores dos Canais de Cálcio/uso terapêutico , Anti-Hipertensivos/uso terapêutico
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