RESUMO
Cardiac erosion is a rare but life-threatening complication after the interventional closure of an atrial septal defect. We present the case of a patient who developed cardiac erosion 9 years after the placement of an Amplatzer Septal Occluder. The patient presented to our hospital with symptoms of tamponade. Surgical exploration revealed a tear in the roof of the left atrium. To our knowledge, this is one of the most delayed presentations reported. In these cases, diagnosis is difficult and a level of clinical suspicion is demanded.
Assuntos
Hipertensão/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Artéria Renal/inervação , Simpatectomia/métodos , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/métodos , Doença Crônica , Procedimentos Clínicos/economia , Humanos , Hipertensão/economia , Adesão à Medicação , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Simpatectomia/economiaRESUMO
The symposium 'Current perspective on the use of calcium channel blockers in the treatment of hypertensive patients', held in Stresa (Italy) on 28th and 29th June 2018 with the participation of the main experts in the field of hypertension from all over the world, reviewed the role of calcium channel blockers in the management of hypertension. Considering the new European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines presented at the last European Society of Hypertension meeting in Barcelona in June 2018, a special attention was focused on lercanidipine. In this article, the main highlights of the symposium were summarized.
Assuntos
Bloqueadores dos Canais de Cálcio/uso terapêutico , Di-Hidropiridinas/uso terapêutico , Hipertensão/tratamento farmacológico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bloqueadores dos Canais de Cálcio/farmacologia , Di-Hidropiridinas/farmacologia , Quimioterapia Combinada , Humanos , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/tratamento farmacológico , Falência Renal Crônica/complicações , Falência Renal Crônica/tratamento farmacológico , Guias de Prática Clínica como Assunto , Medicina de PrecisãoRESUMO
Despite the improvements in the management of hypertension during the last three decades, it continues to be one of the leading causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reductions in blood pressure (BP) reduce the incidence of myocardial infarction, stroke, congestive heart failure and cardiovascular death. However, the proportion of patients who achieve the recommended BP goal (< 140/90 mmHg) is persistently low, worldwide. Poor adherence to therapy, complex therapeutic regimens, clinical inertia, drug-related adverse events and multiple risk factors or comorbidities contribute to the disparity between the potential and actual BP control rate. Previously we published a practical therapeutic platform for the treatment of hypertension based on clinical evidence, guidelines, best practice and clinical experience. This platform provides a personalised treatment approach and can be used to improve BP control and simplify treatment. It uses long-acting, effective and well-tolerated angiotensin receptor blocker (ARB) olmesartan, in combination with a calcium channel blocker amlodipine, and/or a thiazide diuretic hydrochlorothiazide. These drugs were selected based on the availability in most European Countries of single-pill, fixed formulations in a wide range of doses for both dual- and triple-drug combinations. The platform approach could be applied to other ARBs or angiotensin-converting enzyme inhibitors available in single-pill, fixed-dose combinations. Here, we present an update, which takes into account the results of the recently published studies and extends the applicability of the platform to common conditions that are often neglected or poorly considered in clinical practice guidelines.