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1.
Int Heart J ; 62(1): 193-196, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455988
2.
Dermatol Online J ; 26(3)2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609442

RESUMO

Gel nails are a common artificial nail option. Ultraviolet (UV) nail lamps are commonly used to cure gel nails. Ultraviolet A radiation is a known mutagen that penetrates into the nail bed. Although previously reported, the role of UV nail lamps in the carcinogenesis of both keratinocyte carcinoma and melanoma remains controversial. Herein, we report a patient taking the photosensitizing agent hydrochlorothiazide who developed numerous squamous cell carcinomas on the dorsal hands and feet with a 10-year history of UV nail light exposure every 2-3 weeks.


Assuntos
Carcinoma de Células Escamosas/etiologia , Neoplasias Induzidas por Radiação/etiologia , Neoplasias Cutâneas/etiologia , Raios Ultravioleta/efeitos adversos , Idoso , Indústria da Beleza , Feminino , Pé/efeitos da radiação , Mãos/efeitos da radiação , Humanos , Hidroclorotiazida/efeitos adversos , Hidroclorotiazida/uso terapêutico , Doença de Meniere/tratamento farmacológico , Unhas , Fármacos Fotossensibilizantes/efeitos adversos , Fármacos Fotossensibilizantes/uso terapêutico , Fatores de Risco
3.
Endocrine ; 68(2): 253-254, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32346814
4.
Am J Emerg Med ; 38(6): 1299.e1-1299.e2, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32139213

RESUMO

Hypersensitivity reactions to drugs may cause very rapid physiologic derangements that can be fatal in the absence of adequate compensatory mechanisms or definitive treatment. For the most part, adverse drug reactions that progress over the course of minutes are mediated either by mast cell or complement activation. If a patient survives the acute event, appropriate long-term management requires the identification and future avoidance of the inciting drug. Here, we describe a patient who experienced two life-threatening multisystem reactions with cardiopulmonary compromise minutes after taking hydrochlorothiazide (HCTZ). The reactions were associated with systemic vascular leak resulting in hypotension and non-cardiogenic pulmonary edema.


Assuntos
Síndrome de Vazamento Capilar/etiologia , Hidroclorotiazida/efeitos adversos , Síndrome de Vazamento Capilar/complicações , Parada Cardíaca/tratamento farmacológico , Parada Cardíaca/etiologia , Humanos , Hidroclorotiazida/uso terapêutico , Masculino , Pessoa de Meia-Idade
5.
JAMA Intern Med ; 180(4): 542-551, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32065600

RESUMO

Importance: Chlorthalidone is currently recommended as the preferred thiazide diuretic to treat hypertension, but no trials have directly compared risks and benefits. Objective: To compare the effectiveness and safety of chlorthalidone and hydrochlorothiazide as first-line therapies for hypertension in real-world practice. Design, Setting, and Participants: This is a Large-Scale Evidence Generation and Evaluation in a Network of Databases (LEGEND) observational comparative cohort study with large-scale propensity score stratification and negative-control and synthetic positive-control calibration on databases spanning January 2001 through December 2018. Outpatient and inpatient care episodes of first-time users of antihypertensive monotherapy in the United States based on 2 administrative claims databases and 1 collection of electronic health records were analyzed. Analysis began June 2018. Exposures: Chlorthalidone and hydrochlorothiazide. Main Outcomes and Measures: The primary outcomes were acute myocardial infarction, hospitalization for heart failure, ischemic or hemorrhagic stroke, and a composite cardiovascular disease outcome including the first 3 outcomes and sudden cardiac death. Fifty-one safety outcomes were measured. Results: Of 730 225 individuals (mean [SD] age, 51.5 [13.3] years; 450 100 women [61.6%]), 36 918 were dispensed or prescribed chlorthalidone and had 149 composite outcome events, and 693 337 were dispensed or prescribed hydrochlorothiazide and had 3089 composite outcome events. No significant difference was found in the associated risk of myocardial infarction, hospitalized heart failure, or stroke, with a calibrated hazard ratio for the composite cardiovascular outcome of 1.00 for chlorthalidone compared with hydrochlorothiazide (95% CI, 0.85-1.17). Chlorthalidone was associated with a significantly higher risk of hypokalemia (hazard ratio [HR], 2.72; 95% CI, 2.38-3.12), hyponatremia (HR, 1.31; 95% CI, 1.16-1.47), acute renal failure (HR, 1.37; 95% CI, 1.15-1.63), chronic kidney disease (HR, 1.24; 95% CI, 1.09-1.42), and type 2 diabetes mellitus (HR, 1.21; 95% CI, 1.12-1.30). Chlorthalidone was associated with a significantly lower risk of diagnosed abnormal weight gain (HR, 0.73; 95% CI, 0.61-0.86). Conclusions and Relevance: This study found that chlorthalidone use was not associated with significant cardiovascular benefits when compared with hydrochlorothiazide, while its use was associated with greater risk of renal and electrolyte abnormalities. These findings do not support current recommendations to prefer chlorthalidone vs hydrochlorothiazide for hypertension treatment in first-time users was found. We used advanced methods, sensitivity analyses, and diagnostics, but given the possibility of residual confounding and the limited length of observation periods, further study is warranted.


Assuntos
Anti-Hipertensivos/uso terapêutico , Clortalidona/uso terapêutico , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Anti-Hipertensivos/efeitos adversos , Clortalidona/efeitos adversos , Feminino , Humanos , Hidroclorotiazida/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
J Plast Reconstr Aesthet Surg ; 73(4): 663-672, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31843386

RESUMO

BACKGROUND: Seroma is a recognized complication encountered at the reconstructed breast and donor site after abdominal-based breast reconstruction. Seroma is caused by lymphatic channel disruption and the formation of a large space between the deep fascia during flap elevation. Surgical techniques to preserve the lymphatics and secure the closure of the donor site can reduce seroma formation. This study investigated the safety and effectiveness of the diuretic hydrochlorothiazide at reducing interstitial fluid accumulation and seroma formation during deep inferior epigastric perforator (DIEP) flap breast reconstruction. METHODS: Sixty patients with breast cancer who underwent skin- or nipple-sparing mastectomy and DIEP flap reconstruction were enrolled between August 2016 and June 2017. The patients were randomly assigned to receive either 25 mg per day of hydrochlorothiazide from the second to the twentieth day after surgery (treatment) or no diuretic (control). The clinicopathological characteristics, drainage time, and drainage volume were statistically compared between the two groups. RESULTS: The average total drainage volume at the donor site was 291 mL in the treatment group and 434 mL in the control group (p = 0.003). The differences in body mass index and flap weight between the two groups were not statistically significant (p = 0.879 and p = 0.963, respectively). No hypotension or electrolyte imbalance was noted during the follow-up. CONCLUSIONS: Intake of 25 mg per day of hydrochlorothiazide tablets effectively reduced the total abdominal drainage volume and removal time of indwelling drains. However, the adverse effects should be further investigated in a large population and multiracial cohort before using hydrochlorothiazide for seroma prevention.


Assuntos
Neoplasias da Mama/cirurgia , Diuréticos/uso terapêutico , Drenagem , Artérias Epigástricas , Líquido Extracelular , Hidroclorotiazida/uso terapêutico , Mamoplastia/métodos , Mastectomia Subcutânea , Retalho Perfurante/irrigação sanguínea , Complicações Pós-Operatórias/prevenção & controle , Seroma/prevenção & controle , Adulto , Feminino , Humanos , Pessoa de Meia-Idade
7.
J Hum Hypertens ; 33(11): 766-774, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31595024

RESUMO

Hypertension is a complex syndrome of multiple hemodynamic, neuroendocrine, and metabolic abnormalities. The goals of treatment in hypertension are to optimally control high blood pressure and to reduce associated cardiovascular morbidity and mortality using the most suitable therapy available. Hydrochlorothiazide (HCTZ) and chlorthalidone (CTLD) are with proven hypertensive effects. The topic of our meta-analysis is to compare the efficacy of HCTZ and CTLD therapy in patient with hypertension. A search of electronic databases PubMed, MEDLINE, Scopus, PsyInfo, eLIBRARY.ru was performed. We chose the random-effects method for the analysis and depicted the results as forest plots. Sensitivity analyses were performed in order to evaluate the degree of significance of each study. Of the 1289 identified sources, only nine trials directly compared HCTZ and CTLD and were included in the meta-analysis. Changes in SBP lead to WMD (95% CI) equal to -3.26 mmHg showing a slight but statistically significant prevalence of CTLD. Results from analyzed studies referring to DBP lead to WMD (95% CI) equal to -2.41 mmHg, which is also statistically significant. During our analysis, we found that there were not enough studies presenting enough data on the effect of CTLD and HCTZ on levels of serum potassium and serum sodium. Our meta-analysis has demonstrated a slight superiority for CTLD regarding blood pressure control. At the same time, the two medications do not show significant differences in their safety profile.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Clortalidona/uso terapêutico , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Anti-Hipertensivos/efeitos adversos , Clortalidona/efeitos adversos , Humanos , Hidroclorotiazida/efeitos adversos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Fatores de Risco , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(40): e17359, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577731

RESUMO

INTRODUCTION: The clinical and genetic characteristics of nephrogenic diabetes insipidus (NDI) were described via assessing 2 cases of NDI patients from a Chinese family. PATIENT CONCERNS: Two patients who manifest polyuria and polydipsia were admitted to hospital for definite diagnosis. DIAGNOSIS: Water deprivation-vasopressin tests showed that the patients may possess renal-origin diabetes insipidus. All the levels of thyroid-stimulating hormone, luteinizing hormone, follicle stimulation hormone, adrenocorticotropic hormone, prolactin, and growth hormone in both patients were normal. These results were certified that both patients possess a nephropathy-type diabetes insipidus. B-mode ultrasonography and urinalysis test demonstrated that the patient's diabetes insipidus is unlikely to originate from renal organic disease. Remarkably, by nucleotide sequencing, we found a novel mutation c.414_418del in arginine-vasopressin receptor 2 (AVPR2) was related to the disease of NDI. INTERVENTIONS: Two patients were treated with oral hydrochlorothiazide and indomethacin. In addition, low salt diet and potassium supplementation throughout the patients' treatment. OUTCOMES: The clinical symptoms of 2 patients were significantly reduced after targeted therapy. CONCLUSION: A mutation in AVPR2 was discovered to be associated with NID. It provides a new target for molecular diagnosis of NDI, enabling families to undergo genetic counseling and obtain prenatal diagnoses.


Assuntos
Diabetes Insípido Nefrogênico/genética , Receptores de Vasopressinas/genética , Grupo com Ancestrais do Continente Asiático , Diabetes Insípido Nefrogênico/diagnóstico , Diabetes Insípido Nefrogênico/tratamento farmacológico , Humanos , Hidroclorotiazida/uso terapêutico , Indometacina/uso terapêutico
9.
Med Arch ; 73(3): 157-162, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31391706

RESUMO

Introduction: Hypertension is significantly contributing to global mortality and morbidity and has been identified as the most important modifiable risk factor for early development of cardiovascular diseases (CVD). Aim: The aim of this study was to investigate the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness and peripheral resistance in patients with essential hypertension using the brachial oscillometric ambulatory blood pressure monitor. Methods: This study was designed as an observational, prospective, multi centric study conducted in eight primary care centers of the Health Center of Canton Sarajevo during the period of six months. The study included 655 participants, both genders, aged between 30 and 75, who were diagnosed with hypertension according to the ESC/ESH guidelines. Participants were divided into six treatment groups based on the hypertensive drug therapy they were using; lisinopril, losartan or valsartan alone or in combination with hydrochlorothiazide (A, B and C group respectively) or combination of lisinopril, losartan or valsartan with/without hydrochlorothiazide together with amlodipine (D, E and F respectively). The participants were monitored at baseline, after 3 and 6 months (1st and 2nd follow-up). Brachial oscillometric ambulatory blood pressure monitor was used for measuring systolic (SBP), diastolic (DBP), pulse pressure (PP), pulse wave velocity (PWV) and peripheral resistance (PR). Results: SBP, DPB, PP, and PWV significantly decreased from baseline to 2nd follow-up in all treatment groups. The mean reductions in SBP were from -11.7 (95%CI; 9.3- 14.1) to -23.2 (95%CI; 18.3-28.1) mmHg and DBP reductions varied from -5.5 (95%CI; 3.9- 7.1) to -13.4 (95%CI; 7.7-19.1) mmHg. PWV decreased in all treatment groups (from -3.3% to -8.2%). Treatment regiment was not associated with significant differences in SBP, DBP, PP or PWV reductions or their values measured at 2nd follow-up. Peripheral resistance significantly decreased only in group C (p=0.011), group D (p=0.009) and group F (p=0.027). Conclusion: These data suggest that lisinopril/lisinopril + hydrochlorothiazide, losartan/losartan + hydrochlorothiazide and valsartan/valsartan + hydrochlorothiazide alone or in combination with amlodipine are equally effective and well tolerated for the reduction of both systolic and diastolic blood pressure and improve arterial stiffness in patients with essential hypertension.


Assuntos
Anti-Hipertensivos/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Resistência Vascular/efeitos dos fármacos , Rigidez Vascular/efeitos dos fármacos , Idoso , Anlodipino/farmacologia , Anlodipino/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Artérias , Diástole/efeitos dos fármacos , Combinação de Medicamentos , Hipertensão Essencial/tratamento farmacológico , Feminino , Humanos , Hidroclorotiazida/farmacologia , Hidroclorotiazida/uso terapêutico , Lisinopril/farmacologia , Lisinopril/uso terapêutico , Losartan/farmacologia , Losartan/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Onda de Pulso , Sístole/efeitos dos fármacos , Valsartana/farmacologia , Valsartana/uso terapêutico
10.
J Hypertens ; 37(12): 2490-2497, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31373922

RESUMO

OBJECTIVES: The aim of this study was to identify associations between the smoothness index of central SBP (CSBP) and changes of ambulatory carotid femoral pulse wave velocity in response to 20-week treatments with losartan and amlodipine vs. losartan and hydrochlorthiazide combinations. METHODS: For 142 (losartan and hydrochlorthiazide: 72, losartan and hydrochlorthiazide: 70) patients examined with ambulatory central blood pressure (BP) monitoring device, we calculated smoothness indices and trough-to-peak ratios of brachial SBP, CSBP, ambulatory pulse pressure amplification (APPA), ambulatory augmentation index at heart rate 75 beats per minute (AAIx75) and ambulatory carotid femoral pulse wave velocity (AcfPWV). RESULTS: Mean age was 58.9 ±â€Š12.3 years, and women accounted for 25.9%. Changes in office SBP/DBP were not different between groups (losartan and hydrochlorthiazide: -15.2 ±â€Š15.0/-7.8 ±â€Š8.0 vs. losartan and amlodipine: -14.9 ±â€Š13.7/-9.2 ±â€Š7.5 mmHg). Reduction of 24-h CSBP was not significantly different (losartan and hydrochlorthiazide: 6.4 ±â€Š1.1 vs. losartan and amlodipine: 9.2 ±â€Š1.1 mmHg, P = 0.074). Reduction in nocturnal AcfPWV was greater in the losartan and amlodipine group (losartan and hydrochlorthiazide: 0.09 ±â€Š0.05 vs. losartan and amlodipine: 0.26 ±â€Š0.05 m/s, P = 0.0216). Intraindividual SIs for CSBP were higher in the losartan and amlodipine group (0.40 ±â€Š0.57 vs. 0.65 ±â€Š0.74, P = 0.022). In multivariable regression analysis, smoothness index of CSBP was independently associated with the losartan and amlodipine group. In model additionally considering the changes in arterial stiffness, decrease in AcfPWV instead of the treatment group was independently associated with smoothness indices. In mediation analysis, smoothness index was fully mediated by reduction in night-time AcfPWV. CONCLUSION: Losartan and amlodipine combination was superior to the losartan and hydrochlorthiazide combination in terms of achieving higher smoothness index for CSBP after 20-week treatments. The effect of losartan and amlodipine on smoothness index was fully mediated by reduction of night-time AcfPWV.


Assuntos
Anti-Hipertensivos , Pressão Sanguínea/efeitos dos fármacos , Velocidade da Onda de Pulso Carótido-Femoral , Hipertensão , Idoso , Anlodipino/administração & dosagem , Anlodipino/farmacologia , Anlodipino/uso terapêutico , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hidroclorotiazida/administração & dosagem , Hidroclorotiazida/farmacologia , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Losartan/administração & dosagem , Losartan/farmacologia , Losartan/uso terapêutico , Masculino , Pessoa de Meia-Idade
11.
J Clin Hypertens (Greenwich) ; 21(9): 1360-1369, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31444860

RESUMO

Studies aiming to associate the sodium/potassium (Na/K) ratio with hypertension use 24-hour urinary excretion as a daily marker of ingestion. The objective of this study was to evaluate the association between urinary Na/K ratio and structural and functional vascular alterations in non-diabetic hypertensive patients. In hypertensive patients (n = 72), aged between 40 and 70 years, both sexes (61% women), in use of hydrochlorothiazide, we measured blood pressure, 24-hour urine sample collection, assessment of carotid-femoral pulse wave velocity (cf-PWV, Complior), central hemodynamic parameters (SphygmoCor), and post-occlusive reactive hyperemia (PORH). The participants were divided according to the tertile of 24-hour urinary Na/K ratio. Each group contained 24 patients. Systolic blood pressure was higher in T2 (133 ± 9 vs 140 ± 9 mmHg, P = .029). C-reactive protein (CRP) presented higher values in T3 as compared to T1 [0.20(0.10-0.34) vs 1.19 (0.96-1.42) mg/dL, P < .001]. Higher values in T3 were also observed for aortic systolic pressure (aoSP) [119(114-130) vs 135(125-147) mmHg, P = .002] and cf-PWV (9.2 ± 1.6 vs 11.1 ± 1.5 m/s, P < .001). The urinary Na/K ratio presented significant correlations with proteinuria (r = .27, P = .023), CRP (r = .77, P < .001), cf-PWV (r = .41, P < .001), and post-occlusive reactive hyperemia on cutaneous vascular conductance (PORH CVC) (r = -.23, P = .047). By multivariate linear regression, it was detected an independent and significant association of cf-PWV with urinary Na/K ratio (R2  = 0.17, P < .001) and PORH CVC with CRP (R2  = 0.30, P = .010). Our data indicated that increased urinary Na/K ratio in non-diabetic hypertensive patients was associated with higher degree of inflammation, raised peripheral and central pressure levels, and changes suggestive of endothelial dysfunction and arterial stiffness.


Assuntos
Hipertensão/metabolismo , Hipertensão/fisiopatologia , Potássio/urina , Sódio/urina , Adulto , Idoso , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Proteína C-Reativa/análise , Velocidade da Onda de Pulso Carótido-Femoral/métodos , Estudos Transversais , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Hidroclorotiazida/uso terapêutico , Hiperemia/epidemiologia , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Proteinúria/epidemiologia , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Coleta de Urina/métodos , Rigidez Vascular/fisiologia
12.
Hypertension ; 74(3): 614-622, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31327267

RESUMO

Selection of antihypertensive treatment according to self-defined ethnicity is recommended by some guidelines but might be better guided by individual genotype rather than ethnicity or race. We compared the extent to which variation in blood pressure response across different ethnicities may be explained by genetic factors: genetically defined ancestry and gene variants at loci known to be associated with blood pressure. We analyzed data from 5 trials in which genotyping had been performed (n=4696) and in which treatment responses to ß-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blocker, thiazide or thiazide-like diuretic and calcium channel blocker were available. Genetically defined ancestry for proportion of African ancestry was computed using the 1000 genomes population database as a reference. Differences in response to the thiazide diuretic hydrochlorothiazide, the ß-blockers atenolol and metoprolol, the angiotensin-converting enzyme inhibitor lisinopril, and the angiotensin receptor blocker candesartan were more closely associated to genetically defined ancestry than self-defined ethnicity in admixed subjects. A relatively small number of gene variants related to loci associated with drug-signaling pathways (KCNK3, SULT1C3, AMH, PDE3A, PLCE1, PRKAG2) with large effect size (-3.5 to +3.5 mm Hg difference in response per allele) and differing allele frequencies in black versus white individuals explained a large proportion of the difference in response to candesartan and hydrochlorothiazide between these groups. These findings suggest that a genomic precision medicine approach can be used to individualize antihypertensive treatment within and across populations without recourse to surrogates of genetic structure such as self-defined ethnicity.


Assuntos
Afro-Americanos/genética , Anti-Hipertensivos/uso terapêutico , Grupo com Ancestrais do Continente Europeu/genética , Loci Gênicos/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Hipertensão/genética , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Hipertensivos/farmacologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Ensaios Clínicos como Assunto , Feminino , Variação Genética/efeitos dos fármacos , Humanos , Hidroclorotiazida/uso terapêutico , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Resultado do Tratamento , Estados Unidos
13.
J Hypertens ; 37(10): 1950-1958, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31145177

RESUMO

BACKGROUND: Thiazide diuretics and particularly hydrochlorothiazide were recently linked to an increased risk of skin cancer, which was attributed to the photosensitizing properties of these drugs. Given the widespread use of thiazide diuretics, a potential skin cancer promoting effect would impose an important public health concern. OBJECTIVE: To critically appraise in a narrative review, the association between use of thiazide and thiazide-like diuretics and risk of skin cancer. METHODS: We evaluated chemical structures and photosensitizing potential of selected thiazide and thiazide-like diuretics. Moreover, we searched PubMed up to December 2018 for observational studies assessing the association between use of thiazide or thiazide-like diuretics and risk of skin cancer. Study quality was assessed for major methodological biases. RESULTS: Commonly used thiazide and thiazide-like diuretics carry resonating structural components, such as sulfonamide groups that contribute to their photosensitizing activity. Overall, 13 observational (9 case-control, 4 cohort) studies assessed the association between use of different thiazide or thiazide-like diuretics and risk of several skin cancer types. Of those, nine studies showed positive associations ranging from 3% increased risk for bendroflumethiazide and basal cell carcinoma to 311% increased risk for thiazide diuretics and squamous cell carcinoma. All studies had important design-related methodological limitations including potential confounding by indication, detection bias, and time-window bias. CONCLUSION: Commonly used thiazide and thiazide-like diuretics have photosensitizing potential, and some observational studies with important methodological limitations have linked their use to an increased risk of skin cancer. Well designed observational studies are needed to provide more solid evidence on this possible association.


Assuntos
Hidroclorotiazida/efeitos adversos , Hipertensão/tratamento farmacológico , Neoplasias Cutâneas/etiologia , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos , Humanos , Hidroclorotiazida/uso terapêutico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico
14.
Am J Hypertens ; 32(8): 752-758, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-30977777

RESUMO

BACKGROUND: Liddle syndrome (LS) is an autosomal dominant disorder caused by single-gene mutations of the epithelial sodium channel (ENaC). It is characterized by early-onset hypertension, spontaneous hypokalemia and low plasma renin and aldosterone concentrations. In this study, we reported an LS pedigree with normokalemia resulting from a novel SCNN1G frameshift mutation. METHODS: Peripheral blood samples were collected from the proband and eight family members for DNA extraction. Next-generation sequencing and Sanger sequencing were performed to identify the SCNN1G mutation. Clinical examinations were used to comprehensively evaluate the phenotypes of two patients. RESULTS: Genetic analysis identified a novel SCNN1G frameshift mutation, p.Arg586Valfs*598, in the proband with LS. This heterozygous frameshift mutation generated a premature stop codon and deleted the vital PY motif of ENaC. The same mutation was present in his elder brother with LS, and his mother without any LS symptoms. Biochemical examination showed normokalemia in the three mutation carriers. The mutation identified was not found in any other family members, 100 hypertensives, or 100 healthy controls. CONCLUSIONS: Our study identified a novel SCNN1G frameshift mutation in a Chinese family with LS, expanding the genetic spectrum of SCNN1G. Genetic testing helped us identify LS with a pathogenic mutation when the genotypes and phenotype were not completely consistent because of the hypokalemia. This case emphasizes that once a proband is diagnosed with LS by genetic testing, family genetic sequencing is necessary for early diagnosis and intervention for other family members, to protect against severe cardiovascular complications.


Assuntos
Canais Epiteliais de Sódio/genética , Mutação da Fase de Leitura , Hipertensão/genética , Síndrome de Liddle/genética , Potássio/sangue , Adolescente , Idoso , Amilorida/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea , Criança , Combinação de Medicamentos , Feminino , Predisposição Genética para Doença , Hereditariedade , Humanos , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Síndrome de Liddle/sangue , Síndrome de Liddle/diagnóstico , Síndrome de Liddle/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Resultado do Tratamento , Adulto Jovem
15.
Diabetes Care ; 42(4): 693-700, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30894383

RESUMO

OBJECTIVE: Sodium-glucose cotransporter (SGLT)-2 inhibitors lower clinic and ambulatory blood pressure (BP), possibly through their natriuretic action. However, it remains unclear whether this BP-lowering effect is dose dependent and different from that of low-dose hydrochlorothiazide. The purpose of this meta-analysis was to quantify the association of the dose with response of ambulatory BP to SGLT-2 inhibition and to provide comparative evaluation with low-dose hydrochlorothiazide. RESEARCH DESIGN AND METHODS: PubMed/MEDLINE, Embase, and Cochrane database of clinical trials from inception of each database through 22 August 2018. Randomized controlled trials (RCTs) reporting treatment effects of SGLT-2 inhibitors on ambulatory BP. We extracted data on the mean difference between the active treatment and placebo groups in change from baseline (CFB) of ambulatory systolic and diastolic BP. RESULTS: We identified seven RCTs (involving 2,381 participants) comparing SGLT-2 inhibitors with placebo. Of these, two RCTs included low-dose hydrochlorothiazide as active comparator. CFB in 24-h systolic BP between SGLT-2 inhibitor and placebo groups was -3.62 mmHg (95% CI -4.29, -2.94) and in diastolic BP was -1.70 mmHg (95% CI -2.13, -1.26). BP lowering with SGLT-2 inhibition was more potent during daytime than during nighttime. The CFB in ambulatory BP was comparable between low-dose and high-dose subgroups and was similar to that for low-dose hydrochlorothiazide. Eligible RCTs did not evaluate cardiovascular outcomes/mortality. CONCLUSIONS: This meta-analysis shows that SGLT-2 inhibitors provoke an average reduction of systolic/diastolic BP 3.62/1.70 mmHg in 24-h ambulatory BP. This BP-lowering effect remains unmodified regardless of the dose of SGLT-2 inhibitor and is comparable with BP-lowering efficacy of low-dose hydrochlorothiazide.


Assuntos
Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Monitorização Ambulatorial da Pressão Arterial , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Neurology ; 92(13): e1435-e1446, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30814321

RESUMO

OBJECTIVE: To assess whether long-term treatment with candesartan/hydrochlorothiazide, rosuvastatin, or their combination can slow cognitive decline in older people at intermediate cardiovascular risk. METHODS: The Heart Outcomes Prevention Evaluation-3 (HOPE-3) study was a double-blind, randomized, placebo-controlled clinical trial using a 2 × 2 factorial design. Participants without known cardiovascular disease or need for treatment were randomized to candesartan (16 mg) plus hydrochlorothiazide (12.5 mg) or placebo and to rosuvastatin (10 mg) or placebo. Participants who were ≥70 years of age completed the Digit Symbol Substitution Test (DSST), the modified Montreal Cognitive Assessment, and the Trail Making Test Part B at baseline and study end. RESULTS: Cognitive assessments were completed by 2,361 participants from 228 centers in 21 countries. Compared with placebo, candesartan/hydrochlorothiazide reduced systolic blood pressure by 6.0 mm Hg, and rosuvastatin reduced low-density lipoprotein cholesterol by 24.8 mg/dL. Participants were followed up for 5.7 years (median), and 1,626 completed both baseline and study-end assessments. Mean participant age was 74 years (SD ±3.5 years); 59% were women; 45% had hypertension; and 24% had ≥12 years of education. The mean difference in change in DSST scores was -0.91 (95% confidence interval [CI] -2.25 to 0.42) for candesartan/hydrochlorothiazide compared with placebo, -0.54 (95% CI -1.88 to 0.80) for rosuvastatin compared with placebo, and -1.43 (95% CI -3.37 to 0.50) for combination therapy vs double placebo. No significant differences were found for other measures. CONCLUSIONS: Long-term blood pressure lowering with candesartan plus hydrochlorothiazide, rosuvastatin, or their combination did not significantly affect cognitive decline in older people. CLINICALTRIALSGOV IDENTIFIER: NCT00468923. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for older people, candesartan plus hydrochlorothiazide, rosuvastatin, or their combination does not significantly affect cognitive decline.


Assuntos
Anti-Hipertensivos/uso terapêutico , Benzimidazóis/uso terapêutico , Disfunção Cognitiva/epidemiologia , Hidroclorotiazida/uso terapêutico , Hipolipemiantes/uso terapêutico , Rosuvastatina Cálcica/uso terapêutico , Tetrazóis/uso terapêutico , Idoso , Cognição , Combinação de Medicamentos , Feminino , Humanos , Masculino
17.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30842257

RESUMO

OBJECTIVES: Clinicians prescribe antihypertensive medication to children with primary hypertension, but without data to define a particular choice as first-line therapy. A one-size-fits-all approach may not be appropriate for these patients. Our aim was to develop a personalized approach to hypertension treatment, using repeated ambulatory blood pressure monitoring (ABPM) in n-of-1 trials (single-patient randomized crossover trials). METHODS: Children undergoing hypertension management at a single pediatric referral center were offered participation in an n-of-1 trial with repeated ABPM to compare 3 commonly used medications. The medication producing the greatest blood pressure reduction, and without unacceptable side effects, was selected as the preferred therapy for the individual. RESULTS: Forty-two children agreed to participate; 7 were normotensive without medication; and 3 failed to complete one treatment cycle. Of the remaining 32 patients, lisinopril was preferred for 16, amlodipine for 8, hydrochlorothiazide for 4, and 4 had uncontrolled blood pressure on maximum doses of monotherapy. In conservative Bayesian analyses, the proportion of patients who preferred lisinopril was 49% (95% credible interval [CrI]: 32% to 69%), 24% (95% CrI: 12% to 41%) preferred amlodipine, and 12% (95% CrI: 4% to 26%) preferred hydrochlorothiazide. The preferred therapy for the majority (67%) of African American participants was lisinopril. Unacceptable side effects were reported in 24% of assessments for hydrochlorothiazide, 16% for lisinopril, and 13% for amlodipine. CONCLUSIONS: No single medication was preferred for more than half of hypertensive children. n of-1 trials with repeated ABPM may promote better informed and individualized decisions in pediatric hypertension management.


Assuntos
Anlodipino/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/métodos , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Lisinopril/uso terapêutico , Medicina de Precisão , Centros Médicos Acadêmicos , Adolescente , Anti-Hipertensivos/uso terapêutico , Teorema de Bayes , Determinação da Pressão Arterial/métodos , Criança , Estudos Cross-Over , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Masculino , Preferência do Paciente , Texas , Resultado do Tratamento
18.
J Endourol ; 33(6): 469-474, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30909741

RESUMO

Purpose: To reduce the high recurrence rate of nephrolithiasis, patients are routinely prescribed secondary chemoprevention therapy with alkali citrate (Alkasolve®; Sam-On Ltd) for uric acid stones and hypocitraturia or hydrochlorthiazide (Disothiazide®; Dexcel Ltd) for hypercalciuria. However, data on adherence to these regimens are limited. The aim of this study was to assess rates of long-term adherence to alkali citrate and hydrochlorothiazide and reasons for nonadherence. Materials and Methods: Patients on follow-up for kidney stone disease at a dedicated tertiary stone clinic, from 2010 to 2016, were asked to complete a telephone survey on adherence to secondary prevention medications and reasons for nonadherence. Compliance was also verified by actual drug distribution as reported through a computerized monitoring system. Results: The cohort included 356 patients with mean age of 58 years, 199 (64% men, 36% women) treated with alkali citrate and 143 (68% men, 32% women) treated with hydrochlorothiazide. Adherence rates were 42% in the alkali citrate group and 52% in the hydrochlorothiazide group (p = 0.05). The main reason for noncompliance in the alkali citrate group (22%) was the number of pills needed to be taken daily. Adverse drug effects were the most common reason for noncompliance in the hydrochlorothiazide group (24%) and in 10% of the alkali citrate group (p < 0.0005). Adherence was poorer in younger patients who did not regularly take other medications than in older patients with other chronic diseases and polypharmacy. Conclusions: About half the patients with clear metabolic abnormalities who were prescribed secondary chemoprevention with hydrochlorothiazide and alkali citrate failed to adhere to the prescribed regimen. Reasons for noncompliance differed between both drugs. The findings of this study may help clinicians to identify patients at risk for nonadherence and suggests potential means to improve compliance rates.


Assuntos
Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Adesão à Medicação , Prevenção Secundária/métodos , Adulto , Idoso , Ácido Cítrico/uso terapêutico , Feminino , Humanos , Hidroclorotiazida/uso terapêutico , Israel , Masculino , Pessoa de Meia-Idade , Recidiva , Adulto Jovem
19.
BMJ Case Rep ; 12(2)2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30755424

RESUMO

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterised by the appearance of erythematous plaques and papules with overlying non-follicular pinpoint pustules. Drugs are the cause of AGEP in approximately 90% of cases. The most common causes include anti-infective agents (aminopenicillins, quinolones, antibacterial sulfonamides and terbinafine), antimalarials and diltiazem. To the best of our knowledge, to date there has only been one report of hydrochlorothiazide-induced AGEP. There has never been a case report of losartan-induced AGEP. Here, we present a case of AGEP that is the second case purportedly caused by hydrochlorothiazide.


Assuntos
Pustulose Exantematosa Aguda Generalizada/patologia , Anti-Infecciosos/efeitos adversos , Oftalmopatias/tratamento farmacológico , Hidroclorotiazida/efeitos adversos , Impetigo/tratamento farmacológico , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Administração Tópica , Idoso de 80 Anos ou mais , Anti-Infecciosos/uso terapêutico , Betametasona/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Oftalmopatias/patologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hidroclorotiazida/uso terapêutico , Impetigo/patologia , Metoprolol/uso terapêutico , Resultado do Tratamento
20.
Heart Fail Rev ; 24(3): 343-357, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30645721

RESUMO

Blood pressure (BP) is a complex trait that is regulated by multiple physiological pathways and include but is not limited to extracellular fluid volume homeostasis, cardiac contractility, and vascular tone through renal, neural, or endocrine systems. Uncontrolled hypertension (HTN) has been associated with an increased mortality risk. Therefore, understanding the genetics that underpins and influence BP regulation will have a major impact on public health. Moreover, uncontrolled HTN has been linked to inter-individual variation in the drugs' response and this has been associated with an individual's genetics architecture. However, the identification of candidate genes that underpin the genetic basis of HTN remains a major challenge. To date, few variants associated with inter-individual BP regulation have been identified and replicated. Research in this field has accelerated over the past 5 years as a direct result of on-going genome-wide association studies (GWAS) and the progress in the identification of rare gene variants and mutations, epigenetic markers, and the regulatory pathways involved in the pathophysiology of BP. In this review we describe and enhance our current understanding of how genetic variants account for the observed variability in BP response in patients on first-line antihypertensive drugs, amlodipine and hydrochlorothiazide.


Assuntos
Anlodipino/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Hidroclorotiazida/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/genética , Variantes Farmacogenômicos/genética , Adulto , Anlodipino/farmacocinética , Anti-Hipertensivos/farmacocinética , Feminino , Genoma Humano/genética , Estudo de Associação Genômica Ampla , Humanos , Hidroclorotiazida/farmacocinética , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética
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