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La hipertensión arterial constituye un problema de salud a escala mundial debido al aumento progresivo de su prevalencia e incidencia. Objetivo: Describir las principales características clínicas y epidemiológicas de pacientes con hipertensión arterial. Métodos: Se realizó estudio descriptivo, transversal y ambispectivo, desde abril de 2020 hasta igual mes de 2021, de 50 pacientes con hipertensión arterial asistidos en el Ambulatorio de La Morita del Área de Salud Integral Comunitaria Progreso, estado de Portuguesa, en la República Bolivariana de Venezuela. En el proceso estadístico de la información se utilizó el porcentaje como medida de resumen. Resultados: En la serie predominaron el grupo etario de 80 y más años (26,0 %), el sexo femenino (54,0 %), el tratamiento combinado (70,0 %), el consumo de café (96,0 %) y tabaco (78,0 %) como hábitos tóxicos y el infarto agudo de miocardio como principal complicación. Conclusione s: El cumplimiento del plan terapéutico indicado, el conocimiento sobre la enfermedad, la alimentación sana, la práctica frecuente de ejercicios físicos y el estilo de vida adecuado son fundamentales para mantener controlada la presión arterial y evitar la aparición de complicaciones.
Hypertension constitutes a health problem worldwide, due to the progressive increase of its prevalence and incidence. Objective: To describe the main clinical and epidemiologic characteristics of patients with hypertension. Methods: A descriptive, cross-sectional and ambispective study was carried out from April, 2020 to the same month in 2021 of 50 patients with hypertension assisted in La Morita Doctor's Office of Progreso Community Integral Health Area, Portuguese state, in the Bolivian Republic of Venezuela. In the statistical process of the information the percentage as summary measure was used. Results: In the series there was prevalence of the 80 years and over age group (26.0%), female sex (54.0%), the combined treatment (70.0%), and the consumption of coffee (96.0%) and tobacco (78.0%) as toxic habits and acute heart attack as main complication. Conclusions: The achievement of the suitable therapeutic plan, knowledge on the disease, healthy feeding, the frequent practice of physical exercises and the appropriate lifestyle are fundamental to maintain the blood pressure controlled and avoid the emergence of complications.
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VenezuelaABSTRACT
Introduction: Medication nonadherence is a significant challenge in the management of patients with hypertension. This study aimed to assess antihypertensive medication nonadherence and its associated factors in a cohort of patients with uncontrolled hypertension. Material and Methods: A cross-sectional study was conducted among 225 adult patients with uncontrolled hypertension systematically selected from attendees of the general outpatient clinic of an academic tertiary hospital in Kano, Nigeria. A structured questionnaire was used to collect data on their sociodemographic, clinical, and follow-up appointment characteristics. An 8-item medication adherence scale was used to assess medication adherence. Results: There were 155 (68.9%) females. The participants’ median age (interquartile range [IQR]) was 55 (45–63) years. Their median adherence score (IQR) was 4 (1–6) of 8, while 87.1% were non-adherent to antihypertensive medication. The duration of treatment (p = 0.009), current blood pressure (p = 0.006), and adherence to follow-up clinic appointments(p = 0.0004) were significantly associated with their median medication nonadherence scores. Conclusion: The prevalence of medication non-adherence in this population is high; however, patients who have been treated for more than 5 years, those with high blood pressure readings (Stage 2 hypertension), and those who were adherent to follow-up appointments had worse medication adherence scores than the other counterparts. These findings justify the need to extensively explore (especially those with long duration of treatment and Stage 2 blood pressure readings) and address the reasons for non-adherence to antihypertensive medication (which should include the identified associated factors), given that medication adherence is crucial in controlling hypertension and its consequences.
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Background: Hypertension is a chronic disorder and a prevalent non-communicable disease in India. With the increasing burden of hypertension, adherence to antihypertensive therapy plays a vital role to control blood pressure and preventing its complications. Therefore, this study was done in our tertiary care hospital to understand the medication adherence level in hypertension patients. Aims and Objectives: To assess adherence to antihypertensive medications in hypertensive patients using pre-tested structured questionnaire. Materials and Methods: A prospective observational study was conducted for 3 months in 100 hypertensive patients. The adherence status of patients to antihypertensive medications was assessed using an eight-item Morisky’s Medication Adherence Scale (MMAS-8). Results: Majority of the study participants in our study were >50 years (68%) and females (64%). We observed that patients taking combination therapy better adhered to medication than monotherapy. We assessed in detail the medication adherence level among study participants using MMAS-8 and analyzed the reasons for non-adherence. Conclusion: The medication adherence rate in our study was found to be moderate to high, which needs to be maintained to attain optimal clinical benefit and also to prevent hypertension-related complications.
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Introducción: El consumo de medicamentos antihipertensivos se relaciona con la aparición de múltiples enfermedades bucales en los ancianos. Objetivo: Caracterizar a adultos mayores con enfermedades bucales y medicación antihipertensiva. Métodos: Se realizó una investigación observacional, descriptiva y transversal de 79 adultos mayores con enfermedades bucales y medicación antihipertensiva, asistidos en el Servicio de Estomatología del Policlínico 14 de Junio, de la provincia de Las Tunas, desde enero de 2021 hasta igual mes de 2022. Entre las variables analizadas figuraron: edad, sexo, medicamento consumido (según grupo antihipertensivo) y presencia de enfermedad bucal. Se emplearon métodos teóricos (analítico-sintético e inductivo-deductivo), empíricos (observación y encuesta) y estadísticos (estadística descriptiva). Se utilizó el porcentaje como medida de resumen. Resultados: En la serie predominaron el sexo femenino (63,3 %) y el grupo etario de 60-69 años (48,1 %). Se observó que los grupos de antihipertensivos más utilizados fueron los diuréticos tiazídicos, los inhibidores de la enzima convertidora de angiotensina y los bloqueadores de los canales de calcio, de los cuales los medicamentos más consumidos resultaron ser la hidroclorotiazida (90,0 %), el captopril (47,0 %) y el nifedipino (20,0 %), respectivamente. Asimismo, al analizar la presencia de enfermedades bucales se obtuvo una primacía de la caries dental (90,0 %), las periodontopatías (87,3 %) y la xerostomía (57,0 %). Conclusiones: Los adultos mayores con enfermedades bucales y medicación antihipertensiva, en particular las féminas y el grupo etario de 60-69 años, se caracterizaron por consumir fármacos antihipertensivos de primera generación y por presentar enfermedades bucales frecuentes.
Introduction: The consumption of antihypertensive medications is related to the emergence of multiple oral diseases in the elderly. Objective: To characterize the elderly with oral diseases and antihypertensive medication. Methods: An observational, descriptive and cross-sectional investigation was carried out of 79 elderly with oral diseases and antihypertensive medication, assisted in the Stomatology Service of 14 de Junio Polyclinic, in Las Tunas province, from January, 2021 to the same month in 2022. Among the analyzed variables we can mention: age, sex, consumed medication (according to antihypertensive group) and presence of oral disease. Theoretical methods (analytic-synthetic and inductive-deductive), empiric (observation and surveys) and statistical (descriptive statistic) were used. The percentage was used as summary measure. Results: In the series there was prevalence of the female sex (63.3 %) and the 60-69 age group (48.1 %). It was observed that the most used antihypertensive groups were the thiazidic diuretics, angiotensin-converting enzyme inhibitor and blocker of the calcium channels; among these, the most consumed medications were hydrochlorothiazide (90.0 %), captopril (47.0 %) and nifedipine (20.0 %), respectively. Also, when analyzing the presence of oral diseases a primacy of dental decay (90.0 %), periodontopaties (87.3 %) and xerostomia was obtained (57.0 %). Conclusions: Elderly with oral diseases and antihypertensive medication, in particular females and the 60-69 age group were characterized by the consumption of first generation antihypertensive drugs and the presence of frequent oral diseases.
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AgedABSTRACT
Objective: The present study aimed to investigate the relationship between brain natriuretic peptide (BNP) levels and blood pressure variability among hypertensive patients aged over 40 years. Methods: The study recruited 120 patients from a cardiology outpatient clinic who had been diagnosed with hypertension and taking antihypertensive medication for at least 6 months. Demographic and clinical information, blood pressure measurements, and blood samples were collected to measure BNP levels. The standard deviation of the mean arterial pressure over 24 hours was calculated as a measure of blood pressure variability. Linear regression was used to examine the association between BNP levels and blood pressure variability while controlling for age, sex, BMI, and medication history. Results: The study found a significant positive association between BNP levels and blood pressure variability (?=0.31, p=0.002), even after controlling for other variables. The linear regression model explained 20% of the variance in blood pressure variability (R2=0.20, F=9.52, p<0.001). Conclusion: The findings suggest that higher BNP levels are associated with increased blood pressure variability among hypertensive patients. Further studies are needed to explore the underlying mechanisms and the potential implications of this association.
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Background: Hypertension (HTN) is a serious public health problem. Good control of the disease has always been considered to be essential for reducing its morbidity and mortality. Poor adherence to treatment is the single most important reason for uncontrolled blood pressure, serious complications, and wastage of health-care resources. Aims and Objectives: This study aims to assess the antihypertensive medication adherence level among hypertensive study participants, and identify and evaluate the barriers to antihypertensive medication adherence. Materials and Methods: A hospital-based descriptive cross-sectional study was conducted in tertiary care medical college hospital in Madurai, Tamil Nadu, involving 332 patients and the collected data were presented as means (standard deviations) and percentages. Comparison of data was performed using Pearson’s Chi-square test. For all statistical analyses, commercially available computer program was used. Results: Among 332 study participants having age range of 31–78 years with a mean age of 57.49 ± 9.20 years, female (approx. 60%) were more than male (40%) participants. About 96.7% of respondents were aware that HTN could cause severe consequences with regard to their health and daily activity but more than half were taking medium salt (56.0%) and more than one-third (32.8%) were taking fatty rich diet. Only one-fourth (25.6%) had good medication adherence. Male participants (34.8%) were more adherent to medication than female (20.2%) and this was statistically significant with P = 0.003. Conclusion: Around 3/4th of study participants (72.9%) were poorly adherent to antihypertensive medication. Hence, there should be improvement in awareness for both the patients and the care providers.
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Aim: This study evaluated the antihypertensive and antioxidant effects of hexane, ethyl acetate and methanol extracts of Persea americana and Allium sativum in experimentally-induced hypertensive Wistar rats. Study Design: Experimental Research. Place and Duration of Study: Department of Veterinary Pharmacology and Toxicology, University of Ibadan (Animal House), between May 2019 and December 2019. Methodology: The experiment was carried out in 85 rats randomly divided into 17 groups. Group 1 were normotensive rats while hypertension was induced in groups 2-16 by unilateral nephrectomy and inclusion of NaCl (1%) in drinking water. Group 17 had abdominal incision without nephrectomy (sham). Treatment groups were administered P. americana or A. sativum extracts at 20 mg/kg or 50 mg/kg dose and standard antihypertensives; lisinopril or hydrochlorothiazide. Results: Results of the experiment showed treatment of hypertensive rats with 50 mg/kg of A. sativum hexane and P. americana methanol extract caused the most significant decrease in blood pressure compared to normotensive rats. Various extracts of these two plants elevated antioxidants levels (GPx, GST, GSH and SOD) in the brain, heart, kidney and liver significantly while H2O2 and MDA were significantly decreased compared to untreated hypertensive rats. NO, an important neurotransmitter for normal endothelial function was also restored in the extract-treated rat, as a deficiency contributes greatly to the development of hypertension. Conclusion: The study concluded that P. americana and A. sativum do not only lower blood pressure. The plants also inhibited generation of free radicals by enhancing the antioxidant system and mopped up generated free radicals demonstrated by decline in H2O2 and MDA levels. These plants have been shown in this study to contain potential drug candidates which can be proposed for treatment of hypertension.
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@#Introduction: The HBC-HBP Scale is the most common scale for measuring adherence to medication in the elderly with hypertension, its Persian version has never been tested in Iran. Methods: 281 older adults with hypertension were randomly selected from health care centers in Iran during the second half-year of 2019. The demographic questionnaire and Persian, Turkmen, and Kazak versions of HBC-HBP were completed by participants. The scale structure was evaluated using goodness of fit by Exploratory and Confirmatory Factor Analysis using IBM-SPSS v.26 and AMOS v.24. Results: The mean of CVI was 0.94, indicating good content validity for HBC-HBP. Exploratory Factor Analysis revealed two subscales for HBC-HBP, collectively explaining 70% of the adherence medication variance in three versions. All item loadings were “moderate” to “excellent”, ranging from 0.38 (Moderate) to 0.95(excellent). Confirmatory Factor Analysis indicated the goodness of fit for the HBC-HBP based on the trilingual version. A high goodness of fit was sown for Turkmen, Persian, and Kazak versions of HBC-HBP. (Chi-Square=8.213, 8.354, 8.210, RMSEA=0.016, 0.013, 0.010, GFI=0.90, 0.90, 0.91, CFI=0.91, 0.90, 0.91, and AGFI=0.90, 0.91, 0.90). Cronbach’s alpha was 0.90 for the whole scale (p<0.001). The optimal cut-off point that best distinguished between adherent and non-adherent patients was 26.5. Conclusion: Results showed the validity and reliability of the trilingual versions of the HBMA for measuring adherence medication in the elderly with hypertension.
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ABSTRACT The objectives of this article are to describe the interventions carried out by the Strategic Fund of the Pan American Health Organization to facilitate access to and availability of antihypertensive medicines and devices for measuring blood pressure across the Region of the Americas as part of the HEARTS initiative, and to present the preliminary results of price analyses of antihypertensive medicines. The study methodology included a review of reports made by the Strategic Fund between 2019 and 2020, an evaluation of modalities of procurement, a review of the public procurement databases for five antihypertensive medicines, and a comparison with the price obtained by the Strategic Fund. Differences in price ranging from 20% to 99% were identified, indicating significant opportunities for savings. The study also presents interprogrammatic actions that can support the HEARTS initiative, such as the inclusion of antihypertensive medicines recommended by the World Health Organization, consolidation of regional demand and competitively-priced long-term agreements to manage the procurement of quality generic products, and the definition of technical specifications and regulatory requirements to support the procurement of devices to measure blood pressure. This mechanism will enable Member States to reduce their costs significantly, while extending treatment and diagnostic coverage to more people.
RESUMEN Los objetivos del presente artículo son describir las intervenciones realizadas por el Fondo Estratégico de Organización Panamericana de la Salud, para facilitar el acceso y disponibilidad de medicamentos antihipertensivos y dispositivos para la medición de la presión arterial a los países de la Región de las Américas en apoyo a la implementación de la Iniciativa HEARTS; y presentar los resultados preliminares de los análisis de los precios de los medicamentos antihipertensivos. La metodología del estudio incluyó la revisión de informes realizados por el Fondo Estratégico durante los años 2019-2020, la evaluación de las modalidades de adquisición y revisión de las bases de datos de compras públicas para 5 medicamentos antihipertensivos, y el análisis comparativo con el precio obtenido por el Fondo Estratégico. Se identificaron diferencias que oscilaron entre 20% y 99%, lo que evidencia oportunidades de ahorro significativas. Asimismo, se presentan las acciones interprogramáticas desarrolladas en apoyo a la Iniciativa HEARTS, entre las que se destacan la inclusión de medicamentos antihipertensivos recomendados por la Organización Mundial de la Salud; la consolidación de la demanda regional y el establecimiento de precios competitivos con acuerdos a largo plazo para gestionar la adquisición de productos genéricos de calidad; y la definición de especificaciones técnicas y requisitos regulatorios para apoyar con la adquisición de dispositivos para la medición de la presión arterial. A través de este mecanismo, los Estados Miembros pueden disminuir sus costos significativamente, extendiendo cobertura del tratamiento y diagnóstico a más personas.
RESUMO Os objetivos deste artigo são descrever as intervenções realizadas pelo Fundo Estratégico da Organização Pan-Americana da Saúde para facilitar o acesso e a disponibilidade de medicamentos anti-hipertensivos e aparelhos de medição de pressão arterial aos países da Região das Américas, em apoio à implementação da iniciativa HEARTS; e apresentar os resultados preliminares da análise dos preços dos medicamentos anti-hipertensivos. A metodologia do estudo incluiu a revisão de relatórios feitos pelo Fundo Estratégico durante os anos de 2019 e 2020, a avaliação das modalidades de aquisição e revisão dos dados de compras públicas de 5 medicamentos anti-hipertensivos e uma análise comparativa com o preço obtido pelo Fundo Estratégico. Foram identificadas diferenças que oscilaram entre 20% e 99%, o que evidencia oportunidades de economia significativas. Da mesma forma, são apresentadas as ações interprogramáticas desenvolvidas em apoio à iniciativa HEARTS, entre as quais se destacam a inclusão de medicamentos anti-hipertensivos recomendados pela Organização Mundial da Saúde; a consolidação da demanda regional e o estabelecimento de preços competitivos com acordos de longo prazo para gerenciar a aquisição de genéricos de qualidade; e a definição de especificações técnicas e requisitos regulatórios para subsidiar a aquisição de aparelhos de medição de pressão arterial. Por meio desse mecanismo, os Estados Membros podem reduzir seus custos significativamente, ampliando a cobertura de tratamento e diagnóstico para atingir mais pessoas.
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Resumen ANTECEDENTES: La trombosis del seno venoso representa el 1% de los eventos vasculares cerebrales; su incidencia es de 5 casos por cada millón de habitantes y su mortalidad es del 10%. Los senos sagital superior y venoso transversal son los más afectados. El embarazo es un factor de riesgo especial pues la trombosis se registra en el 0.01% de las gestaciones. CASO CLÍNICO: Paciente de 40 años, primigesta, con embarazo gemelar bicorial biamniótico de 33.6 semanas. Se ingresó al servicio de Urgencias debido al diagnóstico de preeclampsia con criterios de severidad, con presión arterial de 160-100 mmHg y transaminasemia. Se le indicó tratamiento antihipertensivo y sulfato de magnesio intravenoso. Se decidió la finalización del embarazo por cesárea. Al cuarto día poscesárea tuvo disminución de la fuerza en ambos brazos, pérdida del tono muscular en los miembros pélvicos, cefalea holocraneana y alteración del estado de alerta (Glasgow de 14). Mediante resonancia magnética se evidenció la oclusión del seno longitudinal superior e isquemia en la región parieto occipital izquierda. Se le administraron anticoagulantes y analgésicos con los que evolucionó adecuadamente; se dio de alta sin complicaciones. CONCLUSIONES: La trombosis del seno venoso implica un reto cuando no se tiene una alta sospecha diagnóstica en pacientes con signos y síntomas neurológicos y, más aún, cuando se agregan factores de riesgo protrombóticos, como el embarazo y el puerperio. El diagnóstico oportuno brinda la oportunidad de iniciar el tratamiento adecuado y disminuir los síntomas y comorbilidades.
Abstract BACKGROUND: Venous sinus thrombosis accounts for 1% of cerebral vascular events; its incidence is 5 cases per million population and its mortality is 10%. The superior sagittal and transverse venous sinuses are the most affected. Pregnancy is a special risk factor since thrombosis is registered in 0.01% of pregnancies. CLINICAL CASE: A 40-year-old primigravida patient with a 33.6 week biamniotic twin pregnancy. She was admitted to the Emergency Department due to the diagnosis of preeclampsia with severity criteria, with blood pressure of 160-100 mmHg and transaminasemia. She was prescribed antihypertensive treatment and intravenous magnesium sulfate. It was decided to terminate the pregnancy by cesarean section. On the fourth post-cesarean day she had decreased strength in both arms, loss of muscle tone in the pelvic limbs, holocranial headache and altered alertness (Glasgow of 14). Magnetic resonance imaging showed occlusion of the superior longitudinal sinus and ischemia in the left parietooccipital region. He was administered anticoagulants and analgesics with which he evolved adequately; he was discharged without complications. CONCLUSIONS: Venous sinus thrombosis implies a challenge when there is no high diagnostic suspicion in patients with neurological signs and symptoms and, even more so, when prothrombotic risk factors are added, such as pregnancy and puerperium. Timely diagnosis provides the opportunity to initiate appropriate treatment and reduce symptoms and comorbidities.
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Resumo Introdução O Brasil conta com dois programas de financiamento governamental para a provisão de medicamentos, o Programa Farmácia Popular do Brasil (PFPB) e a provisão em Unidades do Sistema Único de Saúde, ambos possuindo itens em comum. Objetivo Explorar a relação entre o uso do PFPB por hipertensos e diabéticos com fatores relacionados ao atendimento nas Unidades Básicas de Saúde, à estrutura da farmácia destas Unidades e à disponibilidade dos anti-hipertensivos e antidiabéticos comuns ao PFPB e ao SUS em municípios brasileiros de médio e grande porte populacional. Método Delineamento ecológico transversal utilizando dados secundários do PFPB e do Programa Nacional de Melhoria do Acesso e Qualidade na Atenção Básica (PMAQ-AB), com dados referentes ao ano de 2012. Resultados Municípios de médio porte apresentaram uma proporção de Unidades de Saúde com disponibilidade de anti-hipertensivos e antidiabéticos superior aos de grande porte. A maioria dos respondentes do PMAQ-AB relataram disponibilidade dos anti-hipertensivos e antidiabéticos nos serviços públicos. A análise multivariada mostrou que o uso da Farmácia Popular pela população está mais relacionado às situações emergenciais e ocasionais. Conclusão Na ausência do SUS, o PFPB supre a necessidade da população para obter medicamentos, evidenciando o seu importante papel para a continuidade do tratamento de muitos indivíduos com hipertensão e diabetes.
Abstract Background Brazil has two government-funded drug supply programs, the Popular Pharmacy Program of Brazil (PFPB), and the provision in Unified Health System (SUS) units, which have items in common. Objective To explore the relationship between the use of PFPB by hypertensive and diabetic patients and factors related to care in basic health units, the pharmacy structure of units, and the availability of antihypertensive and antidiabetic agents common to PFPB and SUS in Brazilian municipalities of medium and large population sizes. Method A cross-sectional ecological study was carried out using secondary data from PFPB and the National Program for Improving Access and Quality in Primary Care (PMAQ-AB) for 2012. Results Municipalities of medium population showed a greater proportion of health units with antihypertensive and antidiabetic availability than those of large size. Most respondents at PMAQ-AB affirmed that hypertension and diabetes medications are available in public health services. The multivariate analysis showed that the use of Popular Pharmacy by the population is more related to emergency and occasional situations. Conclusion PFPB supplies the need for the population to obtain medications in the absence of SUS, evidencing an important role in the continuity of drug treatment for many individuals suffering from hypertension and diabetes.
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β-blocker is one of the commonly used anti-hypertensive drugs， and there are obvious differences in the selection of this class of drugs. Nebivolol is a third-generation β-blocker with a unique mechanism of action. This article summarizes the clinical application of nebivolol in anti-hypertensive treatment in recent years， and it is found that compared with other β-blockers， nebivolol has certain clinical treatment advantages. In addition to having a significant antihypertensive effect， it also has little impact on sexual function and heart rate of patients， and does not affect the blood glucose and lipid metabolism， so the drug is more suitable for some special groups of patients， including sexually active male hypertensive patients， hypertensive patients with complications such as type 2 diabetes mellitus and metabolic syndrome.
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Aim: Evaluation of the status of uncontrolled hypertension in diagnosed hypertensives who had been advised drug treatment in the rural areas of 6 districts in Jammu & Kashmir (J&K) and also the risk factors associated with it. Methods: The study was a cross-sectional observational study conducted between August 2020 to July 2021 in the form of health camps in six government health centres in 6 different rural districts. The camps were focussed on patients with hypertension, diabetes with or without heart disease. The areas included Machil in Kupwara, Khan Sahib in Budgam, Rajpora and Hawal in Pulwama, Rainawari in the Srinagar, Banihal in Ramban, and Jagti in Jammu. Enrolled patients were examined for body weight, blood pressure (BP), random blood sugar and serum lipid profile. The definition of hypertension was as per the eighth Joint National Committee (JNC-8) guidelines. Results: A total of 600 patients (50.1% males) were evaluated. Of these 335 (55%) had history of being diagnosed hypertension and had been recommended drugs for BP control Male: Female ratio 1:0.8.211(63.5%) of these had un controlled blood pressures on measurement. Two or more drugs had been prescribed in 65 (30.8%) patients, 34 (16%) were taking only single drug and 112(53%) were not on any drug. Uncontrolled hypertension was seen more often in age group of 40e60 years (49%), subjects more than 60 years had it in 40%. The comparison of risk factors between patients with diagnosed hypertension with those without it revealed use of tobacco, consumption of salted tea, presence of diabetes, dyslipidaemia as significant factors for the presence of uncontrolled hypertension. Conclusion: Uncontrolled hypertension in known patients prescribed drugs is highly prevalent in the rural population of J&K. Steps to mitigate this problem are needed on top priority.
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Background: Hypertension is a major non-communicable disease and a large proportion of patients are not treated adequately even though several antihypertensive drugs and various guidelines are available. Aims and Objectives: The aim of the study was to study the treatment pattern and effectiveness of the antihypertensive drugs by estimating the blood pressure (BP) control achieved based on Joint National Committee (JNC) 8 guidelines for the treatment of hypertension. Materials and Methods: In this observational study, 92 patients with primary hypertension diagnosed since 1 1/2 years were included in the study. BP at the time of diagnosis and on subsequent follow-up visits and details of antihypertensive drugs prescribed during each visit were recorded, until target BP was achieved or till the end of the study period. Wilcoxon Signed Rank test and Mann–Whitney U test were used for analyzing the dependent and independent groups, respectively. Results: Mean age of patients was 57.50 years and 54.3% of them were females. Majority received single drug (80.43%) compared to combination therapy (19.57%). Most frequently prescribed antihypertensive drug group was angiotensin receptor blockers (47.75%) followed by calcium channel blockers (41.44%) and most commonly prescribed individual drugs were losartan and amlodipine (both 25.22%). Seventy-three (79.30%) patients attained their target BP and the average time taken for the adequate control of BP was 5.67 (S.D ± 2.674) weeks. Conclusion: JNC 8 guidelines were found to be effective in this study population.
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Background: Chronopharmacology is the 搒cience dealing with the optimization of drug effects and minimization of adverse effects by timing the medications in relation to the biological rhythm.� In patients with hypertension, it is important to maintain a steady blood pressure throughout the day, which necessitates to have knowledge of chronopharmacology and drugs following it. Better understanding of the circadian rhythm and its application for drug administration serves productive utilization of drug. Aims and Objectives: This study aims to study the chronopharmacological relevance to the time of drug administration in general medicine inpatients at Gulbarga Institute of Medical Sciences, Kalaburagi. Materials and Methods: It is a prospective, non-interventional, observational study which was conducted on patients admitted in General Medicine wards at GIMS, Kalaburagi. A special pro forma was designed, and data were obtained from medical case records of patients suffering from various disorders admitted in the wards of general medicine. Demographic data, disease data, data pertaining to drug therapy, data pertaining to other comorbid illness, and adverse effects of drugs, if any, were collected. Descriptive statistics and other suitable statistical test were applied for analyzing the data. Results: A total of 110 patients who were on antihypertensive drugs and who meet the inclusion and exclusion criteria of the study were included in the study. The average age of both male and female was found to be between 45 and 68 years. Among 110 patients, 72 (65.45%) were male and 38 (34.54%) were female. In the current study, a total of 124 wide variety of antihypertensive drugs were recorded. The study of ideal time of administration of all antihypertensive drugs showed that, most of the prescription was according to chronopharmacological relevance. Conclusion: Updating the knowledge of chronopharmacology and its application in clinical practice will provide better health care. The current study highlights the importance of timing of administration of antihypertensive drugs in human health care.
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RESUMEN El choque vasodilatado o también llamado distributivo ocurre cuando las arteriolas presentan una pérdida de contractibilidad por diferentes mecanismos en donde la hipoxia y acidosis suelen ser los principales. La causa más común de este tipo de choque es la sepsis. Sin embargo, existen otras causas como las intoxicaciones con fármacos. Presentamos el manejo en la unidad de cuidados intensivos de un caso de intoxicación con fines de autoeliminación con dosis elevadas de antihipertensivos bloqueantes de canales calcio y antagonistas del receptor de angiotensina II, que requirió soporte hemodinámico y respiratorio.
ABSTRACT Vasodilated or also called distributive shock occurs when the arterioles present a loss of contractility due to different mechanisms in which hypoxia and acidosis are usually the main events. The most common cause of this type of shock is sepsis. However, there are other causes such as drug poisoning. We present the management in the intensive care unit of a case of poisoning for self-elimination purposes with high doses of antihypertensive calcium channel blockers and angiotensin II receptor antagonists, which required hemodynamic and respiratory support.
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Objetivos: Desenvolver e validar um método analítico para a análise simultânea de atorvastatina (ATO), losartana (LOS) e metformina (MTF) em formulações farmacêuticas magistrais por CLAE. Método: O método foi desenvolvido empregando o cromatógrafo a líquido modelo Dionex® Ultimate 3000, acoplado ao detector de arranjo de diodos (DAD) e a validação se deu conforme compêndios de validação internacional e nacional. Os seguintes parâmetros foram analisados: linearidade, precisão, exatidão, robustez, seletividade, LD e LQ. A separação cromatográfica foi realizada na coluna Sigma-Aldrich® C18, fase móvel MeOH:H2O (78:22 v/v), pH 3,0 e vazão de 0,3 mL-min-1, modo isocrático. As detecções foram realizadas nos comprimentos de onda de 225 nm (LOS), 236 nm (MTF) e 246 nm (ATO). Resultados: O método foi linear, com coeficientes de correlação linear (r)> 0,99 para todos os fármacos, preciso (DPR entre medidas < 2 %), exato (recuperação entre 98-102 %). As variações propostas no estudo de robustez não tiveram influência significativa nos resultados, exceto a coluna cromatográfica. O método foi seletivo, pois os excipientes não interferiram nas análises. A sensibilidade do método foi demonstrada através da determinação teórica dos LD e LQ. Conclusão: Os resultados obtidos sugerem que o método cromatográfico desenvolvido e validado nessa pesquisa poderá ser empregado nas análises de rotina dos laboratórios de controle de qualidade de medicamentos contendo esses fármacos de forma isolada ou combinados em formulações farmacêuticas de uso oral.
SUMMARY Aims: To develop and validate an analytical method for the simultaneous analysis of atorvastatin (ATO), losartan (LOS), and metformin (MTF) in pharmaceutical compounding by HPLC. Method: The method was developed using a liquid chromatograph model Dionex® Ultimate 3000, coupled to a diode array detector (DAD), and validation was carried out according to international and national validation compendiums. The following parameters were analyzed: linearity, precision, accuracy, robustness, selectivity, LD, and LQ. Chromatographic separation was performed on a Sigma-Aldrich® C18 column, mobile phase MeOH:H2O (78:22 v/v), pH 3.0, and flow rate of 0.3 mL-min-1, isocratic mode. Detections were performed at 225 nm (LOS), 236 nm (MTF), and 246 nm (ATO) wavelengths. Results: The method was linear, with linear correlation coefficients (r)> 0.99 for all drugs, precise (DPR between measurements < 2 %), accurate recovery (between 98-102 %). The variations proposed in the robustness study had no significant influence on the results, except for the chromatographic column. The method was selective, as the excipients did not interfere in the analyses. The sensitivity of the method was demonstrated through the theoretical determination of LD and LQ. Conclusion: The results obtained suggest that the chromatographic method developed and validated in this research can be used in the routine analyzes of quality control laboratories of drugs containing these drugs alone or combined in pharmaceutical formulations for oral use.
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Objetivo: caracterizar las manifestaciones bucales en pacientes con medicación anti- hipertensiva que acuden al servicio estomatológico sur del municipio Morón, Ciego de Ávila, Cuba. Métodos: se realizó un estudio observacional, descriptivo, transversal, en el período enero 2019 a enero 2020. Se trabajó con la totalidad del universo, constituido por 162 pacientes. La información se recopiló de las historias clínicas estomatológicas individuales y de una ficha de recolección de datos creada por los autores de la investigación. Se estudiaron las variables grupo de edad, sexo, grupo de medicamentos antihipertensivos, dosis del medicamento, signos y síntomas clínicos, así como enfermedades bucales. Se utilizó estadística descriptiva (frecuencias absolutas y relativas porcentuales). Resultados: el 42,6 % representó el grupo de edad 35 a 59 años y el 53,7% al sexo femenino. Se observó que 88 pacientes (54,3 %) se encontraban medicados con inhibidores de la enzima convertidora de angiotensina; de ellos, 38 en su dosis mínima. La xerostomía estuvo presente en el 59,9 % de los casos. El 63,6 % presentó caries dental como enfermedad estomatológica. Conclusiones: existió predominio de la xerostomía y la caries dental en la mayoría de los pacientes.
Objective: To characterize the oral manifestations in patients with antihypertensive medication who attend the southern dental service of the Moron municipality, Ciego de Avila, Cuba. Method: An observational, descriptive, cross-sectional study was carried out in the period from January 2019 to January 2020. We worked with the entire universe which was made up of 162 patients. The information was collected from individual dental medical records and from a data collection form created by the authors of the research. The variables age group, sex, antihypertensive drug group, dose of antihypertensive drug, clinical signs and symptoms, and oral diseases were studied. Descriptive statistics were used (absolute and relative percentage frequencies). Results: 42,6 % represented the age group 35 to 59 years and 53,7 % the female sex. It was observed that 88 (54,3 %) patients were medicated with angiotensin converting enzyme inhibitors, 38 of them at their minimum dose. Xerostomia was present in 59,9% of the cases. 63,6 % presented dental caries as a dental disease. Conclusions: There was a predominance of xerostomia and dental caries in most of the patients.
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Oral Manifestations , Antihypertensive Agents , HypertensionABSTRACT
Introdução: O captopril (CP) é o medicamento de escolha para o tratamento da hipertensão arterial. Sua degradação leva à formação do dímero dissulfeto de captopril (DSCP), este associado a um odor forte no medicamento, podendo causar abandono do tratamento pelo paciente. Objetivo: Determinar DCSP, associar a percepção olfativa de odor de enxofre desprendido do produto e realizar a avaliação de bula de comprimidos de captopril 25 mg distribuídos pelos setores público e privado. Método: Foi verificado o desempenho do método de determinação do CP e DSCP pela Farmacopeia Brasileira 6a ed. por HPLC (DAD). Foram analisados 13 produtos de comprimidos de captopril 25 mg, sendo dois provenientes do setor público de lotes diferentes e mesmo fabricante e 11 do setor privado de diferentes fabricantes e lotes. Foram avaliados aspectos do comprimido quanto à percepção de odor, determinação de peso, identificação e teor de CP e de DSCP e análise do conteúdo da bula. Resultados: Dentre os 13, o medicamento vencido apresentou 4,4% de DSCP, os demais estavam de acordo com a especificação. Verificouse correspondência do odor de enxofre perceptível com teor de DSCP acima de 0,5%. Considerando os textos de bula sobre odor de enxofre, as constatações foram: nenhuma informação (três produtos), odor característico (dois), leve odor de enxofre (um), leve odor de enxofre sem diminuir a eficácia (sete). Conclusões: As amostras apresentaram resultados satisfatórios para os ensaios realizados. Verificou-se falta de homogeneidade nas informações das bulas sobre o odor dos comprimidos. A percepção do paciente quanto ao odor de enxofre, mesmo dentro do limite tolerado de DSCP, pode levar a não aceitação do medicamento e consequente não adesão ao tratamento da hipertensão, além de gerar prejuízos ao SUS.
Introduction: Captopril (CP) is the drug of choice for the treatment of hypertension. Its degradation leads to the formation of captopril disulfide dimer (DSCP), associated with a strong odor in the drug, which can cause the patient abandonment of treatment. Objective: To determine DCSP, associate the olfactory perception of the sulfur odor given off by the product and carry out the evaluation of the package insert for captopril 25 mg tablets distributed in the public and private sectors. Method: The performance of CP and DSCP determination method of the Brazilian Pharmacopoeia 6 ed was verified by HPLC (DAD). Thirteen products of 25 mg captopril tablets were analyzed, 2 of which came from the public sector from different batches and the same manufacturer: the other 11 came from the private sector from different batches and manufacturers. The samples were analyzed regarding appearance, odor perception, identification, weight determination, CP and DSCP content (by HPLC) and package insert content. Results: Among the 13, the expired drug had 4.4% DSCP; the others were in accordance with the specification. Correspondence of perceptible sulfur odor was established for drugs with DSCP content above 0.5%. Considering the texts on sulfur odor in the package inserts, the findings were: none information (3 products), characteristic odor (2), slight sulfur odor (1), slight sulfur odor without decreasing effectiveness (7). Conclusions: The samples showed satisfactory results for the tests performed. There was a lack of homogeneity in the information in the package inserts about odor of the tablets. The patient's perception of sulfur odor, even within the tolerated limit of DSCP, can lead to non-acceptance of the drug and consequent non- adherence to the treatment of hypertension, in addition to causing damage to the SUS.
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Introduction?There is a high prevalence of hypertension in maintenance hemodialysis patients. Information regarding prevalent pattern of antihypertensive medications will help modify it to prevent future cardiovascular morbidity and mortality. Materials and Methods?In this cross-sectional study, patients on maintenance hemodialysis, aged ?18 years visiting Nephrology outpatient department (OPD) from April 2019 to May 2020 were included. The patients were divided into two groups based on their dialysis vintage, ?12 months and >12 months. Their antihypertensive medication patterns and two-dimensional (2D) echocardiography (ECHO) findings were compared. Independent t-test was used to compare continuous variables. One-way analysis of variance was used to study the antihypertensive drug-dosing pattern in both the groups. Results?Out of 250 patients, 131 had a dialysis vintage of ?12 months, whereas 119 had a vintage of >12 months. There was no significant difference in the number of antihypertensive agents used in either of the vintage groups. Calcium channel blockers (87.02 and 89.07%, respectively, in ?12 and >12 months' vintage groups) and ? blockers (64.12 and 65.54%, respectively, in ?12 and >12 months' vintage groups) were the commonly used antihypertensive agents. Metoprolol use was higher in ?12 months' group, whereas carvedilol usage was higher in >12 months' group (p?=?0.028). Mean pill burden was more than five in both the groups. Concentric left ventricular hypertrophy was significantly more common in >12 months' group. Renin–angiotensin system (RAS) blocking agent use was limited to 3% of patients. Conclusion?This study shows a high antihypertensive pill burden in dialysis patients likely due to underlying chronic volume overload in addition to the perceived efficacy of certain class of drug in a frequent dosing pattern. Low use of RAS blocking agent was also underlined. This study highlights the need to bring about changes in the antihypertensive prescription pattern in line with the existing evidence