Historia de la hipertensión arterial: revisión narrativa

Introducción: La medición de la presión arterial es uno de los procedimientos más realizados en la práctica clínica. La presente revisión narrativa pretende sintetizar los aspectos relevantes que rodearon la definición de la hipertensión arterial, el recorrido histórico del tratamiento de esta y el aporte de los estudios a la disminución de la mortalidad por enfermedad cardiovascular en el tiempo. Metodología: Revisión narrativa de la historia de la hipertensión arterial, desde el reconocimiento de la presión arterial alta como un factor asociado al riesgo cardiovascular y la evolución histórica del tratamiento hasta los hallazgos significativos del estudio SPRINT, publicado en 2015. Resultados: Hasta hace aproximadamente 50 años la hipertensión arterial era conocida como una patología esencial, es decir, esta condición no siempre fue considerada como una enfermedad. El descubrimiento de la presión sanguínea ha sido atribuido a Stephen Hales, poeta, orador y sacerdote nacido en Inglaterra. La primera medición de la presión sanguínea e incidentalmente de la presión del pulso la realizó en 1733 en animales. Se describe el origen de la presión arterial, la hipertensión arterial, el camino recorrido para el reconocimiento de esta condición como enfermedad y posteriormente su tratamiento, hasta llegar al estudio SPRINT en 2015, el cual fue contundente en demostrar el beneficio de reducir la cifra de presión arterial sistólica objetivo en una población no diabética. Conclusión: Los resultados de esta revisión narrativa exponen cómo el reconocimiento de la presión arterial alta como un factor de riesgo cardiovascular permitió el avance en la investigación científica para determinar el tratamiento y las cifras de presión arterial que favorecen la reducción de la mortalidad y morbilidad por esta causa.

Background: Blood pressure measurement is one of the most performed procedures in clinical practice. This narrative review aims to expose the relevant aspects surrounding the definition of arterial hypertension, the historical path of its treatment, and the contribution of studies to the decrease in mortality due to cardiovascular disease over time. Methodology: Narrative review of the history of arterial hypertension from recognizing high blood pressure as a factor associated with cardiovascular risk to the historical evolution of treatment up to the SPRINT study published in 2015. Results: Until about 50 years ago, arterial hypertension was known as an essential pathology; this condition was not always considered a disease. The discovery of blood pressure has been attributed to Stephen Hales, a poet, orator and priest born in England. The first measurement of blood pressure and incidentally pulse pressure was made in 1733 in animals. The origin of blood pressure, arterial hypertension, and the path travelled for recognizing this condition as a disease and later its treatment until reaching the SPRINT study in 2015, which demonstrated the benefit of reducing the target systolic blood pressure figure in a non-diabetic population. Conclusion: This narrative review demonstrates that the recognition of high blood pressure as a cardiovascular risk factor allowed progress in scientific research to determine the treatment and blood pressure figures that favor the reduction of mortality and morbidity from this cause.

Treatment of HBV Cirrhosis with Fuzheng Huayu Tablet () and Entecavir: Design of a Randomized, Double-Blind, Parallel and Multicenter Clinical Trial / 中国结合医学杂志

BACKGROUND@#Antiviral therapy can lead to regression of fibrosis in chronic hepatitis B (CHB), but it has a limited effect on cirrhosis. Chinese medicines (CMs), particularly Fuzheng Huayu Tablet (, FZHY), have an antifibrotic effect in patients with CHB.@*OBJECTIVE@#To observe the safety and efficacy of adjunctive FZHY in patients with hepatitis B virus (HBV) cirrhosis, this study was designed as a randomized, placebo-controlled, double-blind, parallel assignment, multicenter trial at 20 centers in China. The total 700 naive patients will be enrolled with compensate cirrhosis due to HBV, and randomly assigned into 2 groups, receiving entecavir (0.5 mg, daily) and FZHY placebo (1.6 g, 3 times a day), or entecavir (0.5 mg, daily) and FZHY (1.6 g, 3 times a day), respectively. The primary endpoint was histological improvement at week 48. The secondary outcome is the decline values of liver fibrosis using the noninvasive methods from baseline to week 48 in each arm of the study. Adverse events such as stomach upset, headache, fatigue, dizziness, nausea will be strictly recorded.@*DISCUSSION@#Through this study, we hope to generate a solid evidence for the therapeutic strategy of HBV cirrhosis with a combination of anti-viral such as ETV and anti-fibrotic herbal product such as FZHY. Protocol version: Version 1.3, Date: 2014.12.4.@*TRIAL REGISTRATION NUMBER@#NCT02241590.

Cost and Outcome of Medical Emergency Teams (COMET) Study. Design and Rationale of a DutchMulti-Center Study.

Aims: Description of a study protocol to analyze the effectiveness of the sequential implementation of a Rapid Response System (RRS) on the incidence of the composite endpoint of cardiac arrest, unplanned ICU admission, and mortality rates. Study Design: The COMET trial is a before-after, non-randomized multi-center trial. Place and Duration of Study: The COMET trial was held in the Netherlands in fourteen Dutch hospitals from April 2009 until November 2011. Each hospital included two surgical and two general medicine nursing wards. Methodology: Prior to the introduction of the RRS, endpoints were collected for 5 months as part of a baseline assessment. The RRS was introduced in two steps. Initially, two tools were introduced during 7 months for early detection of the deteriorating patient: the Modified Early Warning Score (MEWS) and for structured communication, the Situation-Background-Assessment-Recommendation (SBAR) tool. During the next 15 months the Rapid Response Team (RRT) was operational in addition to both the detection and communication tool. Generalized Estimating Equations (GEE) analysis of trends in outcomes will be performed. The cost description will primarily focus on the program costs associated with training and education sessions and the time invested in all consultations originating from patient care on the study wards. Conclusion: The COMET study will provide evidence on the clinical outcomes and costs of the implementation of Rapid Response System. This will include an analysis to explore the possible effect of a Rapid Response Team as add-on to the MEWS and SBAR tools for early recognition of the deteriorating patient on the nursing ward.

Multicenter Trial for Estimation of Normal Values of Echocardiographic Indices in Korea

BACKGROUND AND OBJECTIVES: There has been much need for standard normal values of echocardiographic indices in Korea. Echocardiography Council of the Korean Society of Circulation performed multicenter trial for estimation of normal values of echocardiographic indices. METHOD: In 19 university or general hospitals, echocardiographic specialists measured frequently used echocardiographic indices with the same method in healthy people. The measured indices were 36 items which involved M-mode, 2-dimensional and Doppler echocardiographic parameters. All the results were recorded on video tapes and reviewed by the review committee. The results were included for analysis only if the review committee accepted them. RESULTS: Total 371 healthy people were included. There were 189 women. Their age ranged from 3rd decades to 8th decades. Complete measurement of all the indices was done in 225 people. Left ventricular wall thickness, aorta size, left atrial size and left ventricular mass in M-mode echocardiographic measurement changed significantly with the increase of age(p<0.005). In 2-dimensional echocardiographic examination, sinotubular junction diameter of the aorta, anteroposterior & superoinferior diameters of left atrium, both ventricular outflow tract diameter and main pulmonary artery diameter changed with the increase of age(p<0.01). Diastolic dysfunction became prominent with the increase of age in Doppler examination. CONCLUSION: We conclude that these data could be used as the standard criteria for echocardiographic examination in Korea. However, age factor should be considered when they are applied because many echocardiographic indices change significantly with the increase of age.

Korean multicenter clinical trial of simvastatin ( KS-1 study ) / 대한내과학회지

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.

Korean multicenter clinical trial of simvastatin ( KS-1 study ) / 대한내과학회지

The aim of this study was to investigate the efficacy of simvastatin to improved lipid profiles in hypercholesterolemic Korean patients. METHODS: From 25 hospitals in Korea, 478 hypercholesterolemic patients were enrolled from November 1996 to April 1998. The inclusion criteria was hypercholesterolemia over 240 mg/dl after diet therapy for 1 month or hypercholesterolemia over 220 mg/dl in patients with definite evidence of ischemic heart disease. Simvastatin 10mg was started and doubled up to 40mg if total cholesterol level remained higher than 200 mg/dl at monthly check. Of 478 subjects, 344 patients in whom study protocol was not violated were analyzed. RESULTS: Male to female ratio was 27:73 and 47% of the subjects were in 6th decade. Hypertension, coronary artery disease, and diabetes mellitus were present in 30, 10, and 4% of the subjects. Baseline lipid profile (mean of total cholesterol-LDL-HDL-triglyceride mg/dl) was 274-185-52-188. The dose of simvastatin for 3 months was 10/10/10mg in 61% of subjects, 10/20/20mg in 21%, 10/10/20mg in 7%, and 10/20/40mg in 12%. The change of total cholesterol level(before-4wk-8wk-12wk-withdrawal 4wk) was 274-209- 205-198-250, and the maximal reduction rate was 27%. The change of LDL-cholesterol was 185-123-116-110-159, with maximal reduction rate 39%. The change of HDL-cholesterol was 52-54-56-55-54, with maximal increase rate 9%. The change of tryglyceride was 188-161- 164-162-189, with maximal reduction rate 15%. The value before/after treatment of ApoA1, ApoB, and Lp(a) was 129/129, 138/83, and 9.3/10.7, respectively. The level of LDL-cholesterol at the end of treatment was below 100mg/dl in 36% of subjects, 100-130 in 45%, 130-160 in 16%, and over 160mg/dl in 4%. The reduction rate of LDL-cholesterol was different between subjects whose LDL decreased below 100 and those whose LDL did not decrease below 130mg/dl, which suggests the existence of the individual difference of responsiveness to simvastatin. There were only 3 subjects (0.9%) who showed increase of liver enzyme over 3 times as the upper normal limit. Conclusion: Simvastatin is effective in improving lipid profiles in hypercholesterolemic Korean patients without serious side effects.

Tratamento da insuficiência cardíaca leve e moderada com captopril: estudo multicêntrico / Treatment of mild and moderate heart failure with captopril: a multicenter trial

Objetivo - Avaliar os efeitos da adiçäo de captopril, um inibidor da enzima conversora da angiotensina, ao tratamento convencional, em pacientes com insuficiência cardíaca congestiva (ICC)(, classe funcional II e III da New York Heart Association (NYHA). Métodos - Cento e quinze pacientes com ICC, 46(40%) classe funcional II e 69(60%) classe III, em uso de digital e diurético. Idades de 22 a 75 anos (média = 56,6 ñ 11); 67 do sexo masculino; 66 brancos, os restantes pretos e mulatos. A ICC tinha como causa cardiopatia hipertensiva (47 = 40,9%), cardiopatia isquêmica (27 = 23,5%), cardiopatia chagásica (20 = 17,4%), cardiomiopatia dilatada idiopática (15 = 13,0%) e outras causas (6 = 5,2%). Digital e diurético foram mantidos na mesma dosagem. Iniciou-se a terapêutica com captopril na dose de 6,25 mg, 2 a 3 vezes ao dia, aumentada gradativamente até 25 mg, 2 a 3 vezes ao dia. O período de observaçäo foi de 12 semanas. Avaliaçöes clínicas foram realizadas a cada 4 semanas e laboratoriais, no início e no final do ensaio. Resultados - A dose de captopril variou de 12,5 a 75 mg/dia, média 28,5 ñ 13,1. O tratamento associou-se a reduçäo significante (p < 0,01) dos sintomas e sinais de ICC, freqüência cardíaca e pressäo arterial sistólica e diastólica. Ao final do ensaio, 13 pacientes (11,3%) incluiam-se na classe funcional III, 50 (43,5%) na classe II e 52 (45,2%) na classe I (p < 0,01). Globalmente, 98 (85,2%) melhoraram a classe funcional e 17(14,8%) permaneceram na mesma classe (p < 0,01). Os efeitos colaterais (tontura, fadiga, tosse, hipotensäo, cefaléia) foram moderados e pouco freqüentes, näo exigindo a interrupçäo do tratamento em nenhum caso. Conclusäo - A adiçäo de captopril ao tratamento convencional, em pacientes com ICC classe II e III associou-se a melhora dos sintomas e sinais e da classe funcional, com boa tolerância

Purpose - Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class Il and III (NYHA) congestive heart failure ( CHF ). Methods - One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 ± 11); 67 were male and 66 were aucasians. The etiologies ofthe heart failure were. hypertensive heart disease 47 (40.9%), schemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idyopathic cardiomyapathy 15 ( 13,0%), and other causes 6 (5,2%). Diuretic and digitalis were mantained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. Results - The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 ± 13.1 mg day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01 ) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 ( 85.2%) patients and remained unchanged in 17 (14.8%) (p < 001) The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment Conclusion - The addition of captopril to the conventional therapy of class II and III CHF was associated with signifcant improvement of functional class and with good tolerability