ABSTRACT
Objective To study the damage on organs from salt sensitivity hypertension or non-salt-sensitive hypertension and the selection of drug combination.Methods 120 hypertensive patiems including 60 cases salt-sensitive (SS) and 60 non-salt-sensitive (NSS) groups were selected in our hospital and their salt load tested.These two groups were randomly divided into two groups,each group with 30 patients,one was given felodipine and perindopril and the others were given indapamide sustained release tablets and peridopril to facilitate the 12-week treatment.Before and after the treatment,patients were tested for physiological indicators,such as sitting blood pressure,24-hour ambulatory blood pressure,insulin resistance index,comparing changes of various sub-index etc.Results Significantly different were seen in indices as fasting blood glucose and serum creatinine (P＜ 0.01),fasting insulin,left ventricular mass index,urinary albumin,body mass index,insulin resistance indices,while between the SS group and the NSS group(P＜0.05).In the SS group,when patients with various sub-indicators were using perindopril combined with indapamide treatment,the related detected indicators tended to be normal and with statistically significant differences (P＜0.05).In the NSS group,those related indexes also tended to be more normal when using felodipine combined with perindopril.However,there were statistically significant differences between the two groups (P＜0.05).Conclusion On SS hypertensive patients with target organ damages,perindopril and indapamide seemed to be more effective in NSS patients,indicating that the use of perindopril and felodipine combination,seemed to be more suitable.
ABSTRACT
The pathogenesis and evolutive pattern of Chagas disease suggests that the chronic phase should be more widely treated in order to (i) eliminate Trypanosoma cruzi and prevent new inflammatory foci and the extension of tissue lesions, (ii) promote tissue regeneration to prevent fibrosis, (iii) reverse existing fibrosis, (iv) prevent cardiomyopathy, megaoesophagus and megacolon and (v) reduce or eliminate cardiac block and arrhythmia. All cases of the indeterminate chronic form of Chagas disease without contraindications due to other concomitant diseases or pregnancy should be treated and not only cases involving children or recently infected cases. Patients with chronic Chagas cardiomyopathy grade II of the New York Heart Association classification should be treated with specific chemotherapy and grade III can be treated according to medical-patient decisions. We are proposing the following new strategies for chemotherapeutic treatment of the chronic phase of Chagas disease: (i) repeated short-term treatments for 30 consecutive days and interval of 30-60 days for six months to one year and (ii) combinations of drugs with different mechanisms of action, such as benznidazole + nifurtimox, benznidazole or nifurtimox + allopurinol or triazole antifungal agents, inhibition of sterol synthesis.