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1.
Medicine (Baltimore) ; 98(40): e17411, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577753

RESUMO

Evidence on the prescription patterns of antihypertensive drug use in children and adolescents in China is scarce. A descriptive analysis of the Beijing Medical Claim Data, which covered over 95% of the urban residents, was conducted to investigate antihypertensive prescribing patterns and trends in children and adolescents aged under 18 from 2009 to 2014 in Beijing, China. An additional meta-analysis of trends in hypertension prevalence was conducted to compare trends with antihypertensive medications.A total of 11,882 patients received at least 1 prescription for antihypertensive drugs from 2009 to 2014. The number of annual antihypertensive users increased from 2009 to 2012, then declined steadily until 2014, which was consistent with the trend of the hypertension prevalence estimated from the meta-analysis. ß-receptor blockers, thiazide diuretics, and angiotensin-converting enzyme inhibitors were the 3 most commonly prescribed antihypertensive drugs. More boys took the antihypertensive drugs than girls. For users aged under 3 years, thiazide diuretics, α-receptor blockers, and angiotensin-converting enzyme inhibitors were the most prescribed drugs, while ß-receptor blockers, thiazide diuretics were the most used drugs for users above 3 years.In conclusion, antihypertensive drug prescribing for children and adolescents increased from 2009 to 2014, with different characteristics in different subgroups.


Assuntos
Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adolescente , Fatores Etários , Pequim , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão/epidemiologia , Lactente , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Fatores Sexuais , População Urbana/estatística & dados numéricos
2.
Heart Fail Clin ; 15(4): 435-445, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472879

RESUMO

Elevated blood pressure (BP) has a strong and continuous association with Stage B and C heart failure (HF) and carries the highest attributable risk for HF. Intensive treatment of hypertension is crucial, as progression from hypertension (Stage A HF) to left ventricular hypertrophy (LVH) or other structural damage (Stage B HF) is common despite therapy. Echo cardiography is the modality of choice to detect Stage B HF. Ideally, Stage B HF should be prevented. However, regression of established LVH and other structural damage is feasible and improves prognosis. Despite differences among antihypertensive agents, control of BP remains the most important goal.


Assuntos
Anti-Hipertensivos , Insuficiência Cardíaca , Hipertensão , Hipertrofia Ventricular Esquerda , Serviços Preventivos de Saúde , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Progressão da Doença , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Fatores de Risco
3.
Heart Fail Clin ; 15(4): 455-461, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472881

RESUMO

The kidney is a regulatory organ and accommodates changes in cardiac function. There is cross-talk between the kidney and the heart. In heart failure, the kidney acts as a bystander but also contributes to several maladaptive processes. The pathophysiology of worsening kidney function and its association with prognosis are discussed, as are other aspects of how worsening kidney function contributes to increased cardiovascular risk. Data suggest that morbidity and mortality reduction in people with heart failure and kidney disease requires use of a renin angiotensin system blocker, beta blocker, and mineralocorticoid receptor antagonist, as well as an SGLT 2 inhibitor.


Assuntos
Anti-Hipertensivos , Insuficiência Cardíaca , Nefropatias , Anti-Hipertensivos/classificação , Anti-Hipertensivos/farmacologia , Progressão da Doença , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Humanos , Rim/efeitos dos fármacos , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Nefropatias/prevenção & controle , Testes de Função Renal
4.
Int J Mol Sci ; 20(14)2019 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-31337127

RESUMO

Hypertension is characterized by structural and functional changes in blood vessels that travel with increased arterial stiffness, vascular inflammation, and endothelial dysfunction. Some antihypertensive drugs have been shown to improve endothelial function and reduce levels of inflammatory markers regardless of the effect of blood pressure lowering. Third-generation ß-blockers, such as nebivolol and carvedilol, because they have additional properties, have been shown to improve endothelial function in patients with hypertension. Calcium channel antagonists, because they have antioxidant effects, may improve endothelial function and vascular inflammation.The Angiotensin Receptor Blocker (ARBs) are able to improve endothelial dysfunction and vascular inflammation in patients with hypertension and other cardiovascular diseases. Angiotensin converting enzyme (ACE) inhibitors have shown beneficial effects on endothelial function in patients with hypertension and other cardiovascular diseases, however there are few studies evaluating the effect of treatment with this class on the reduction of C-reactive protein (CRP) levels. Further studies are needed to assess whether treatment of endothelial dysfunction and vascular inflammation may improve the prognosis of patients with essential hypertension.


Assuntos
Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Animais , Anti-Hipertensivos/classificação , Biomarcadores , Pressão Sanguínea/efeitos dos fármacos , Ensaios Clínicos como Assunto , Endotélio Vascular/fisiopatologia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Hipertensão/metabolismo , Inflamação/tratamento farmacológico , Inflamação/etiologia , Inflamação/metabolismo , Resultado do Tratamento
5.
Chest ; 155(3): 565-586, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30660783

RESUMO

BACKGROUND: Pulmonary arterial hypertension (PAH) carries a poor prognosis if not promptly diagnosed and appropriately treated. The development and approval of 14 medications over the last several decades have led to a rapidly evolving approach to therapy, and have necessitated periodic updating of evidence-based treatment guidelines. This guideline statement, which now includes a visual algorithm to enhance its clinical utility, represents the fourth iteration of the American College of Chest Physicians Guideline and Expert Panel Report on Pharmacotherapy for PAH. METHODS: The guideline panel conducted an updated systematic review to identify studies published after those included in the 2014 guideline. A systematic literature search was conducted using MEDLINE via PubMed and the Cochrane Library. The quality of the body of evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations Assessment, Development and Evaluation approach. Graded recommendations and ungraded consensus-based statements were developed and voted on using a modified Delphi technique to achieve consensus. RESULTS: Two new recommendations on combination therapy and two ungraded consensus-based statements on palliative care were developed. An evidence-based and consensus-driven treatment algorithm was created to guide the clinician through an organized approach to management, and to direct readers to the appropriate area of the document for more detailed information. CONCLUSIONS: Therapeutic options for the patient with PAH continue to expand through basic discovery, translational science, and clinical trials. Optimal use of new treatment options requires prompt evaluation at an expert center, utilization of current evidence-based guidelines, and collaborative care using sound clinical judgment.


Assuntos
Anti-Hipertensivos , Fármacos do Sistema Respiratório , Adulto , Anti-Hipertensivos/classificação , Anti-Hipertensivos/farmacologia , Técnicas de Diagnóstico do Sistema Respiratório , Monitoramento de Medicamentos/métodos , Medicina Baseada em Evidências , Tolerância ao Exercício/efeitos dos fármacos , Humanos , /etiologia , Pneumologia/métodos , Pneumologia/normas , Fármacos do Sistema Respiratório/classificação , Fármacos do Sistema Respiratório/farmacologia
6.
Aging (Albany NY) ; 10(11): 3210-3228, 2018 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-30414594

RESUMO

The discrepancy of DNA methylation age (DNAmAge) with chronological age (termed as age acceleration, AA) has been identified to be associated with many aging-related health outcomes including hypertension. Since taking antihypertensive medication (AHM) could prevent aging-related diseases caused by hypertension, we hypothesized that using AHM could also reduce the AA. We examined this hypothesis among 546 males aged 55-85 years by exploring the associations of AHM use with AA and its change rate (ΔAA) in two visits with a median follow-up of 3.86 years. Horvath DNAmAge was derived from DNA methylation profiles measured by Illumina HumanMethylation450 BeadChip and information on AHM use was collected by physician interview. A general decreasing pattern of AA was observed between the two visits. After the fully adjusting for potential covariates including hypertension, any AHM use showed a cross-sectional significant association with higher AA at each visit, as well as a longitudinal association with increased ΔAA between visits. Particularly, relative to participants who never took any AHM, individuals with continuous AHM use had a higher ΔAA of 0.6 year/chronological year. This finding underlines that DNAmAge and AA may not be able to capture the preventive effects of AHMs that reduce cardiovascular risks and mortality.


Assuntos
Envelhecimento , Anti-Hipertensivos/uso terapêutico , Metilação de DNA/fisiologia , Hipertensão/tratamento farmacológico , Idoso , Anti-Hipertensivos/classificação , Humanos
8.
BMJ ; 362: k3503, 2018 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209052

RESUMO

OBJECTIVES: To assess how often older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment, and to identify markers of appropriateness for these intensifications. DESIGN: Retrospective cohort study. SETTING: US Veterans Administration Health System. PARTICIPANTS: Patients aged 65 years or over with hypertension admitted to hospital with non-cardiac conditions between 2011 and 2013. MAIN OUTCOME MEASURES: Intensification of antihypertensive treatment, defined as receiving a new or higher dose antihypertensive agent at discharge compared with drugs used before admission. Hierarchical logistic regression analyses were used to control for characteristics of patients and hospitals. RESULTS: Among 14 915 older adults (median age 76, interquartile range 69-84), 9636 (65%) had well controlled outpatient blood pressure before hospital admission. Overall, 2074 (14%) patients were discharged with intensified antihypertensive treatment, more than half of whom (1082) had well controlled blood pressure before admission. After adjustment for potential confounders, elevated inpatient blood pressure was strongly associated with being discharged on intensified antihypertensive regimens. Among patients with previously well controlled outpatient blood pressure, 8% (95% confidence interval 7% to 9%) of patients without elevated inpatient blood pressure, 24% (21% to 26%) of patients with moderately elevated inpatient blood pressure, and 40% (34% to 46%) of patients with severely elevated inpatient blood pressure were discharged with intensified antihypertensive regimens. No differences were seen in rates of intensification among patients least likely to benefit from tight blood pressure control (limited life expectancy, dementia, or metastatic malignancy), nor in those most likely to benefit (history of myocardial infarction, cerebrovascular disease, or renal disease). CONCLUSIONS: One in seven older adults admitted to hospital for common non-cardiac conditions were discharged with intensified antihypertensive treatment. More than half of intensifications occurred in patients with previously well controlled outpatient blood pressure. More attention is needed to reduce potentially harmful overtreatment of blood pressure as older adults transition from hospital to home.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea/efeitos dos fármacos , Sobremedicalização/prevenção & controle , Alta do Paciente/tendências , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/tendências , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pacientes Ambulatoriais , Estudos Retrospectivos , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos
9.
Br J Hosp Med (Lond) ; 79(8): 438-443, 2018 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-30070954

RESUMO

Chronic kidney disease is a global health problem that affects over 10% of adults worldwide. All doctors should have a basic knowledge of chronic kidney disease because it may complicate the management of many other medical conditions and is associated with numerous adverse outcomes. Chronic kidney disease should be regarded as a clinical syndrome rather than a specific diagnosis and attempts should always be made to identify the cause. Simple risk prediction tools have been developed to inform management decisions. Management is directed at slowing progression of chronic kidney disease and reducing the associated cardiovascular risk by treating hypertension, use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers as first-line therapy in high-risk cases, treatment with statins and lifestyle measures. Patients at high risk of rapid progression or requiring specific therapy as well as those with chronic kidney disease stage 4 or 5 should be referred to a nephrology service.


Assuntos
Doenças Cardiovasculares , Insuficiência Renal Crônica , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/epidemiologia , Tomada de Decisão Clínica , Progressão da Doença , Humanos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/terapia , Risco Ajustado/métodos , Fatores de Risco
10.
AAPS PharmSciTech ; 19(7): 3019-3028, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30062540

RESUMO

The recommended method for the biopharmaceutical evaluation of drug solubility is the shake flask; however, there are discrepancies reported about the solubility of certain compounds measured with this method, one of them is candesartan cilexetil. The present work aimed to elucidate the solubility of candesartan cilexetil by associating others assays such as stability determination, polymorphic characterization and in silico calculations of intrinsic solubility, ionized species, and electronic structures using quantum chemistry descriptors (frontier molecular orbitals and Fukui functions). For the complete biopharmaceutical classification, we also reviewed the permeability data available. The polymorphic form used was previously identified as the form I of candesartan cilexetil. The solubility was evaluated in biorelevant media in the pH range of 1.2-6.8 at 37.0°C according to the stability previously assessed. The solubility of candesartan cilexetil is pH dependent and the dose/solubility ratios obtained demonstrated the low solubility of the prodrug. The in silico calculations supported the found results and evidenced the main groups involved in the solvation, benzimidazole, and tetrazol-biphenyl. The human absolute bioavailability reported demonstrates that candesartan cilexetil has low permeability and when associated with the low solubility allows to classify it as class 4 of the Biopharmaceutics Classification System.


Assuntos
Anti-Hipertensivos/química , Anti-Hipertensivos/classificação , Benzimidazóis/química , Benzimidazóis/classificação , Biofarmácia/classificação , Compostos de Bifenilo/química , Compostos de Bifenilo/classificação , Tetrazóis/química , Tetrazóis/classificação , Animais , Disponibilidade Biológica , Biofarmácia/normas , Células CACO-2 , Humanos , Permeabilidade , Pró-Fármacos/química , Pró-Fármacos/classificação , Ratos , Solubilidade , Difração de Raios X/métodos
11.
Curr Hypertens Rep ; 20(8): 67, 2018 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-29909538

RESUMO

PURPOSE OF REVIEW: Resistant hypertension (RH) is a growing clinical condition worldwide associated with target-organ damage and poor prognosis compared to non-resistant counterparts. The purpose of this review is to perform a critical evaluation of preferable drug choices for managing RH highlighting the evidence that significant proportion of patients remained uncontrolled despite using four anti-hypertensive drugs. RECENT FINDINGS: Until recently, the fourth drug therapy was main derived from personal opinion or small interventional studies. The recent data derived from two multicentric randomized trials, namely PATHWAY-2 and ReHOT, pointed spironolactone as the preferable fourth drug therapy in patients with confirmed RH as compared to bisoprolol and doxazosin (PATHWAY-2) as well as clonidine (ReHOT). However, significant proportion of patients (especially observed in ReHOT trial that used 24-h ambulatory blood pressure monitoring) did not achieve optimal blood pressure with the fourth drug. This finding underscores the need of new approaches and treatment options in this important research area. The current evidence pointed that significant proportion of RH patients are requiring more than four drugs for controlling BP. This statement is particularly true considering the new criteria proposed by the 2017 Guidelines for diagnosing RH (> 130 × 80 mmHg). New combinations, drugs, or treatments should be tested aiming to reduce the RH burden. Based on the aforementioned multicentric trials, we proposed the first five preferable anti-hypertensive classes in the overall context of RH.


Assuntos
Anti-Hipertensivos , Quimioterapia Combinada/métodos , Hipertensão , Anti-Hipertensivos/classificação , Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Resistência a Medicamentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia
12.
Curr Hypertens Rep ; 20(8): 64, 2018 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-29892833

RESUMO

PURPOSE OF REVIEW: Chronic kidney disease (CKD) is recognized as a worldwide epidemic. Hypertension commonly coexists with CKD and its prevalence is progressively increasing as kidney function declines. RECENT FINDINGS: For patients with established CKD and/or diabetes with albuminuria, the updated hypertension guidelines have recommended a blood pressure (BP) goal < 130/80 mmHg. Blood pressure level above 130/80 mmHg in CKD patients requires lifestyle modifications and multiple antihypertensive medications. According to recent guidelines, angiotensin-converting enzyme (ACE) inhibitors should be the drugs of first choice. Angiotensin II receptor blockers (ARBs) should be used if the ACE inhibitor is not tolerated. Non-dihydropyridine CCBs consistently reduce albuminuria and slow the decline in kidney function. Dihydropyridine CCBs should not be used as monotherapy in proteinuric CKD patients but always in combination with a RAAS blocker. Diuretics are commonly used and represent the cornerstone in the management of CKD patients. All the other agents are used when treatment with the other primary agents have failed. In patients with CKD, an intensive BP goal < 130/80 mmHg has been recommended. We review current treatment options.


Assuntos
Anti-Hipertensivos/farmacologia , Hipertensão , Insuficiência Renal Crônica , Albuminúria/diagnóstico , Albuminúria/etiologia , Anti-Hipertensivos/classificação , Progressão da Doença , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Testes de Função Renal , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia
13.
Curr Hypertens Rep ; 20(8): 63, 2018 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-29892919

RESUMO

PURPOSE OF REVIEW: The concept of resistant hypertension may be changed during pregnancy by the physiological hemodynamic changes and the particularities of therapy choices in this period. This review discusses the management of pregnant patients with preexisting resistant hypertension and also of those who develop severe hypertension in gestation and puerperium. RECENT FINDINGS: The main cause of severe hypertension in pregnancy is preeclampsia, and differential diagnosis must be done with secondary or primary hypertension. Women with preexisting resistant hypertension may need pharmacological therapy adjustment. Several drugs can be used to treat severe hypertension, with exception of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. The most used drugs are methyldopa, beta-blockers, and calcium channel antagonists. There is a general agreement that severe hypertension must be treated, but there are still debates over the goals of the treatment. Delivery is indicated in viable pregnancies in which blood pressure control is not achieved with three drugs in full doses. Resistant hypertension may arise in postpartum. The management of resistant hypertension in pregnancy must regard the possible etiology, the fetal well-being, and the mother's risk. Good care is mandatory to reduce maternal mortality risk.


Assuntos
Anti-Hipertensivos , Hipertensão , Pré-Eclâmpsia/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Anti-Hipertensivos/classificação , Anti-Hipertensivos/farmacologia , Resistência a Medicamentos , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Conduta do Tratamento Medicamentoso , Gravidez , Complicações Cardiovasculares na Gravidez/fisiopatologia , Transtornos Puerperais/fisiopatologia
14.
Can J Cardiol ; 34(5): 526-531, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29731014

RESUMO

We present Hypertension Canada's inaugural evidence-based Canadian recommendations for the management of hypertension in pregnancy. Hypertension in pregnancy is common, affecting approximately 7% of pregnancies in Canada, and requires effective management to reduce maternal, fetal, and newborn complications. Because of this importance, these guidelines were developed in partnership with the Society of Obstetricians and Gynaecologists of Canada with the main common objective of improving the management of women with hypertension in pregnancy. Guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children are published separately. In this first Hypertension Canada guidelines for hypertension in pregnancy, 7 recommendations for the management of nonsevere and severe hypertension in pregnancy are presented. For nonsevere hypertension in pregnancy (systolic blood pressure 140-159 mm Hg and/or diastolic blood pressure 80-109 mm Hg), we provide guidance for the threshold for initiation of antihypertensive therapy, blood pressure targets, as well as first- and second-line antihypertensive medications. Severe hypertension (systolic blood pressure ≥ 160 mm Hg and/or diastolic blood pressure ≥ 110 mm Hg) requires urgent antihypertensive therapy to reduce maternal, fetal, and newborn adverse outcomes. The specific evidence and rationale underlying each of these guidelines are discussed.


Assuntos
Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Complicações Cardiovasculares na Gravidez , Serviços Preventivos de Saúde/métodos , Adulto , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/classificação , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitorização Ambulatorial da Pressão Arterial/métodos , Canadá , Prática Clínica Baseada em Evidências , Feminino , Promoção da Saúde/métodos , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/terapia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Medição de Risco/métodos
15.
Can J Cardiol ; 34(5): 506-525, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29731013

RESUMO

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.


Assuntos
Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/prevenção & controle , Hipertensão , Serviços Preventivos de Saúde/métodos , Adulto , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/classificação , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitorização Ambulatorial da Pressão Arterial/métodos , Canadá , Doenças Cardiovasculares/etiologia , Criança , Prática Clínica Baseada em Evidências , Feminino , Promoção da Saúde/métodos , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/terapia , Masculino , Medição de Risco/métodos
17.
J Clin Hypertens (Greenwich) ; 20(2): 248-254, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29397581

RESUMO

Hypertension has been associated with atherosclerosis and cardiovascular disease. Carotid intima media thickness is increased in hypertensive patients. But, the correlation between carotid intima media thickness and antihypertensive agents is still uncertain. Therefore, we investigated carotid intima media thickness based on types of antihypertensive agents. 1809 patients were enrolled in this study and it showed that 1079 hypertensive patients had thicker carotid intima media thickness than non-hypertensive patients, with carotid intima media thicknesses of (0.72 ± 17 mm vs 0.64 ± 15 mm, P < .001), (0.31 ± 0.07 mm vs 0.30 ± 0.06 mm, P < .001), and (0.41 ± 0.13 mm vs 0.35 ± 0.12 mm, P < .001). Additionally, hypertensive patients on beta-blockers also had thicker carotid intima media thickness than the non-beta-blocker group, with carotid intima media thicknesses of (0.74 ± 0.18 mm vs 0.71 ± 0.16 mm, P = .018), (0.33 ± 0.09 mm vs 0.31 ± 0.07 mm, P = .029), and (0.43 ± 0.13 mm vs 0.40 ± 0.13 mm, P = .035). Multivariate analysis showed that carotid intima thickness was only correlated with beta-blockers (odds ratio = 2.489, confidence interval = 1.183-5.239, P = .016); however, this study showed that beta-blocker could be associated with increased carotid wall thickness as well.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Artérias Carótidas , Hipertensão/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Artérias Carótidas/diagnóstico por imagem , Artérias Carótidas/efeitos dos fármacos , Artérias Carótidas/patologia , Espessura Intima-Media Carotídea , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Medição de Risco/métodos , Fatores de Risco , Ultrassonografia/métodos
18.
Hypertension ; 71(4): 681-690, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29463627

RESUMO

The aim of this study is to compare spironolactone versus clonidine as the fourth drug in patients with resistant hypertension in a multicenter, randomized trial. Medical therapy adherence was checked by pill counting. Patients with resistant hypertension (no office and ambulatory blood pressure [BP] monitoring control, despite treatment with 3 drugs, including a diuretic, for 12 weeks) were randomized to an additional 12-week treatment with spironolactone (12.5-50 mg QD) or clonidine (0.1-0.3 mg BID). The primary end point was BP control during office (<140/90 mm Hg) and 24-h ambulatory (<130/80 mm Hg) BP monitoring. Secondary end points included BP control from each method and absolute BP reduction. From 1597 patients recruited, 11.7% (187 patients) fulfilled the resistant hypertension criteria. Compared with the spironolactone group (n=95), the clonidine group (n=92) presented similar rates of achieving the primary end point (20.5% versus 20.8%, respectively; relative risk, 1.01 [0.55-1.88]; P=1.00). Secondary end point analysis showed similar office BP (33.3% versus 29.3%) and ambulatory BP monitoring (44% versus 46.2%) control for spironolactone and clonidine, respectively. However, spironolactone promoted greater decrease in 24-h systolic and diastolic BP and diastolic daytime ambulatory BP than clonidine. Per-protocol analysis (limited to patients with ≥80% adherence to spironolactone/clonidine treatment) showed similar results regarding the primary end point. In conclusion, clonidine was not superior to spironolactone in true resistant hypertensive patients, but the overall BP control was low (≈21%). Considering easier posology and greater decrease in secondary end points, spironolactone is preferable for the fourth-drug therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01643434.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Clonidina , Hipertensão , Espironolactona , Adulto , Idoso , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/classificação , Monitorização Ambulatorial da Pressão Arterial/métodos , Clonidina/administração & dosagem , Clonidina/efeitos adversos , Monitoramento de Medicamentos/métodos , Resistência a Medicamentos , Quimioterapia Combinada/métodos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Espironolactona/administração & dosagem , Espironolactona/efeitos adversos , Resultado do Tratamento
20.
Hypertension ; 71(4): 585-591, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29483224

RESUMO

Primary aldosteronism (PA) causes cardiovascular damage in excess to the blood pressure elevation, but there are no prospective studies proving a worse long-term prognosis in adrenalectomized and medically treated patients. We have, therefore, assessed the outcome of PA patients according to treatment mode in the PAPY study (Primary Aldosteronism Prevalence in Hypertension) patients, 88.8% of whom were optimally treated patients with primary (essential) hypertension (PH), and the rest had PA and were assigned to medical therapy (6.4%) or adrenalectomy (4.8%). Total mortality was the primary end point; secondary end points were cardiovascular death, major adverse cardiovascular events, including atrial fibrillation, and total cardiovascular events. Kaplan-Meier and Cox analysis were used to compare survival between PA and its subtypes and PH patients. After a median of 11.8 years, complete follow-up data were obtained in 89% of the 1125 patients in the original cohort. Only a trend (P=0.07) toward a worse death-free survival in PA than in PH patients was observed. However, at both univariate (90.0% versus 97.8%; P=0.002) and multivariate analyses (hazard ratio, 1.82; 95% confidence interval, 1.08-3.08; P=0.025), medically treated PA patients showed a lower atrial fibrillation-free survival than PH patients. By showing that during a long-term follow-up adrenalectomized aldosterone-producing adenoma patients have a similar long-term outcome of optimally treated PH patients, whereas, at variance, medically treated PA patients remain at a higher risk of atrial fibrillation, this large prospective study emphasizes the importance of an early identification of PA patients who need adrenalectomy as a key measure to prevent incident atrial fibrillation.


Assuntos
Adrenalectomia , Anti-Hipertensivos , Fibrilação Atrial , Tratamento Conservador , Hiperaldosteronismo , Hipertensão , Adrenalectomia/efeitos adversos , Adrenalectomia/métodos , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/estatística & dados numéricos , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/etiologia , Tratamento Conservador/efeitos adversos , Tratamento Conservador/métodos , Feminino , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/epidemiologia , Hiperaldosteronismo/fisiopatologia , Hiperaldosteronismo/cirurgia , Hipertensão/sangue , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipertensão/terapia , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sistema Renina-Angiotensina/efeitos dos fármacos , Tempo
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