Relatório de recomendação final para adoção de um protocolo estadual no estado de Santa Catarina complementar ao protocolo clínico e diretrizes terapêuticas do ministério da saúde para tratamento farmacológico da hipertensão pulmonar no âmbito do SUS / Final recommendation report for the adoption of a state protocol in the state of Santa Catarina complementary to the clinical protocol and therapeutic guidelines of the Ministry of Health for pharmacological treatment of pulmonary hypertension within the scope of the SUS

Este relatório refere-se à análise crítica do documento "Diagnóstico e Tratamento de Hipertensão Pulmonar'', elaborado pela ACAPTI e enviado como proposta para elaboração de Protocolo Estadual de Hipertensão Pulmonar, contemplando o tratamento farmacológico de HP grupo 1 (HAP) e grupo 4 (HPTEC). No documento encaminhado pelo demandante consta uma breve introdução e contextualização da patologia, diagnóstico clínico e exames complementares, critérios de inclusão e exclusão, especialidades médicas, estratificação de risco e seguimento, tratamento medicamentoso, algoritmo de tratamento medicamentoso, acessos aos medicamentos e centros de referência. Os itens relacionados ao diagnóstico foram mantidos neste relatório, conforme o documento enviado pelo demandante. Este relatório visa avaliar e emitir um parecer técnico embasado em evidências científicas sobre a disponibilização do medicamento Selexipague, a disponibilização da terapia combinada (Ambrisentana, Bosentana, Sildenafila, Ilopros a e Selexipague) para o tratamento da HP grupo 1 (HAP), a disponibilização do medicamento Riociguate para tratamento de HP grupo 4 (HPTEC), algoritmo de tratamento medicamentoso e fluxo de acesso aos medicamentos, para posterior elaboração de um Protocolo Estadual para a patologia solicitada. O Protocolo Estadual será elaborado complementarmente ao protocolo do Ministério da Saúde, assim, caso os medicamentos englobados nele sejam incorporados para a patologia em questão pela CONITEC, o fornecimento dos mesmos passa a ser por meio do CEAF.

Eficácia e segurança da tripla terapia com Selexipague comparada à dupla terapia para tratamento de hipertensão arterial pulmonar: revisão rápida de evidências / Effectiveness and safety of triple therapy with Selexipag compared dual therapy for treatment of pulmonary arterial hypertension: rapid response review of evidence

Selexipague e outros medicamentos de controle da Hipertensão Arterial Pulmonar grupo 1. Indicação: Tratamento de Hipertensão Arterial Pulmonar grupo 1. Pergunta: Há superioridade em eficácia e segurança da tripla terapia com selexipague, comparado a dupla terapia, disponível no SUS, no tratamento de Hipertensão Arterial Pulmonar grupo 1? Métodos: Revisão rápida de evidências (overview) de ensaios clínicos randomizados e revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada pela ferramenta risco de viés da Cochrane. Resultados: Foi selecionado um ensaio clínico randomizado, especificamente um artigo contendo análise de subgrupo de dados desse estudo. Conclusão: As evidências demonstraram redução do número de hospitalizações relacionadas à HAP e de eventos de progressão da doença no tratamento de selexipague em tripla terapia em pacientes na classe funcional II, quando comparada à dupla terapia sem selexipague. A tripla terapia é tão segura quanto a dupla terapia, pois tem riscos similares de eventos adversos e eventos adversos sérios. A tripla terapia não é diferente da dupla terapia no risco da mortalidade geral

Selexipag and other drugs for the control of Pulmonary Arterial Hypertension group 1. Indication: Treatment of Pulmonary Arterial Hypertension group 1. Question: Is there superiority in efficacy and safety of triple therapy with selexipag, compared to dual therapy, available in the SUS, in the treatment of ulmonary Arterial Hypertension group 1? Methods: Rapid review of evidence (overview) of randomized clinical trials and systematic reviews, with a bibliographic survey carried out in the PUBMED database, using a structured search strategy. Results: A randomized clinical trial was selected, specifically an article showing a subgroup analysis of data from this study. Conclusion: Evidence showed a reduction in the number of Pulmonary Arterial Hypertension related hospitalizations and disease progression events in the treatment of selexipag in triple therapy in patients in functional class II, when compared to dual therapy without selexipag. Triple therapy is as safe as dual therapy, as it has similar risks of adverse events and serious adverse events. Triple therapy is no different from dual therapy in the risk of overall mortality

Considerations on the use of antihypertensive blockers of the renin-angiotensin system in adults and children in the face of the COVID-19 pandemic / Consideraciones sobre el uso de antihipertensivos bloqueadores del sistema renina-angiotensina en adultos y niños ante la pandemia de COVID-19

Abstract As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients with hypertension and other cardiovascular comorbidities develop more severe coronavirus disease (COVID)-19 and are at high risk of death, a controversy arose about the use of antihypertensives as angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs). Such drugs might increase the expression of the fundamental receptor of this new infectious agent: the angiotensin-converting enzyme 2 (ACE2). Preclinical observations indicate that the increase of ACE2 expression or the activity by ACEis and ARBs leads to a greater transformation of angiotensin (Ang)-II to Ang-(1-7), which is associated with positive effects on cardiovascular and pulmonary pathophysiology. This association has been demonstrated in observational studies in patients with cardiovascular pathology and pneumonia. It has not been possible to confirm whether users of ACEis or ARBs are more infected by the new coronavirus, due to methodological issues in studies with patients infected with SARS-CoV-2. However, the use of such antihypertensive treatments in both children and adults might reduce the virulence of infection. Therefore, changes in the antihypertensive therapy of patients at risk of contracting COVID-19 are not recommended.

Resumen Los pacientes con hipertensión y otra comorbilidad cardiovascular infectados con SARS-CoV-2 desarrollan cuadros más graves de COVID-19 y con mayor frecuencia fallecen. Este hecho ha originado una controversia acerca del uso de antihipertensivos inhibidores de la enzima convertidora de la angiotensina (IECA) y de antagonistas de los receptores de la angiotensina II (ARA-II), pues tales medicamentos pueden incrementar la expresión del receptor funcional de este nuevo agente infeccioso: la enzima convertidora de la angiotensina 2 (ECA2). Las observaciones preclínicas indican que el aumento de la expresión o de la actividad de la ECA2 por uso de IECA o ARA-II conduce a una mayor transformación de angiotensina 2 a a angiotensina 1-7, la cual se asocia con efectos positivos sobre la fisiopatología pulmonar y cardiovascular. En estudios observacionales de pacientes con patología cardiovascular y neumonía se ha confirmado esta asociación. La falta de evidencia contundente debida a aspectos metodológicos en estudios con pacientes infectados con SARS-CoV-2 no permite confirmar si los usuarios de IECA o ARA-II se contagian más con el nuevo coronavirus. Sin embargo, continuar con tales medicamentos antihipertensivos, tanto en adultos como en niños, podría reducir la virulencia de la infección. Por ello, no se recomienda cambiar la terapia antihipertensiva en los pacientes susceptibles a la COVID-19.

Maternal and perinatal outcomes of pregnancies complicated by chronic hypertension followed at a referral hospital / Resultados maternos e perinatais de gestantes hipertensas crônicas acompanhadas em pré-natal especializado

Abstract Objective To assess maternal and perinatal outcomes of pregnancies in women with chronic hypertension (CH). Methods Retrospective cohort of women with CH followed at a referral center for a 5 year period (2012-2017). Data were obtained from medical charts review and described as means and frequencies, and a Poisson regression was performed to identify factors independently associated to the occurrence of superimposed preeclampsia (sPE). Results A total of 385 women were included in the present study; the majority were > than 30 years old, multiparous, mostly white and obese before pregnancy. One third had pre-eclampsia (PE) in a previous pregnancy and 17% of them had organ damage associated with hypertension, mainly kidney dysfunction. A total of 85% of the patients used aspirin and calcium carbonate for pre-eclampsia prophylaxis and our frequency of sPE was 40%, with an early onset (32.98 ± 6.14 weeks). Of those, 40% had severe features of PE, including 5 cases of HELLP syndrome; however, no cases of eclampsia or maternal death were reported. C-section incidence was high, gestational age at birth was 36 weeks, and nearly a third (115 cases) of newborns had complications at birth One third of the women remained using antihypertensive drugs after pregnancy. Conclusion Chronic hypertension is related with the high occurrence of PE, C-sections, prematurity and neonatal complications. Close surveillance and multidisciplinary care are important for early diagnosis of complications.

Resumo Objetivo Avaliar os resultados maternos e perinatais em gestação de mulheres com hipertensão crônica. Métodos Coorte retrospectiva de mulheres hipertensas crônicas acompanhadas em hospital de referência por 5 anos (2012-2017). Foi realizada revisão dos prontuários médicos e os resultados são descritos em médias e frequências. A regressão de Poisson foi usada para identificar os fatores independentemente associados à ocorrência de pré-eclâmpsia superajuntada. Resultados Um total de 385 mulheres foram incluídas no presente estudo, e amaioria tinha idade > 35 anos, era multípara, majoritariamente brancas e obesas antes da gravidez. Um terço teve pré-eclâmpsia em gestação anterior, e 17% apresentavam lesão de órgão-alvo associada à hipertensão, majoritariamente disfunção renal. Um total de 85% das pacientes usaram ácido acetilsalicílico e carbonato de cálcio para a profilaxia de pré-eclâmpsia, sendo que a frequência de pré-eclâmpsia superajuntada foi de 40%, com um início prematuro (32.98 ± 6.14 semanas). Destas, 40% apresentaram sinais de gravidade associados à pré-eclâmpsia, com 5 casos de síndrome HELLP; entretanto sem nenhum caso de eclampsia ou morte materna. A incidência de cesárea foi alta, comidade gestacional de 36 semanas ao parto, e umterço dos recém-nascidos tiveram complicações ao nascimento. Um terço das mulheres permaneceu usando medicamentos anti-hipertensivos ao fim da gravidez. Conclusão A hipertensão crônica se relaciona comalta prevalência de pré-eclâmpsia, cesárea, prematuridade e complicações neonatais. Vigilância e cuidado multidisciplinar são importantes para o diagnóstico precoce das complicações.

Carvedilol as primary prophylaxis for gastric variceal bleeding in portal hypertension model in rats / Carvedilol como profilaxia de sangramento em varizes gástricas em modelo de hipertensão portal em ratos

ABSTRACT Background: Portal hypertension (PH) can be measured indirectly through a hepatic vein pressure gradient greater than 5 mmHg. Cirrhosis is the leading cause for PH and can present as complications ascites, hepatic dysfunction, renal dysfunction, and esophagogastric varices, characterizing gastropathy. Aim: To evaluate the use of carvedilol as primary prophylaxis in the development of collateral circulation in rats submitted to the partial portal vein ligament (PPVL) model. Method: This is a combined qualitative and quantitative experimental study in which 32 Wistar rats were divided into four groups (8 animals in each): group I - cirrhosis + carvedilol (PPVL + C); group II - cirrhosis + vehicle (PPVL); group III - control + carvedilol (SO-sham-operated + C); group IV - control + vehicle (SO-sham-operated). After seven days of the surgical procedure (PPVL or sham), carvedilol (10 mg/kg) or vehicle (1 mL normal saline) were administered to the respective groups daily for seven days. Results: The histological analysis showed no hepatic alteration in any group and a decrease in edema and vasodilatation in the PPVL + C group. The laboratory evaluation of liver function did not show a statistically significant change between the groups. Conclusion: Carvedilol was shown to have a positive effect on gastric varices without significant adverse effects.

RESUMO Racional: A hipertensão portal (HP), medida indiretamente através do gradiente pressórico da veia hepática >5 mmHg, tem como principal causa etiológica a cirrose. Possui como complicações a ascite, disfunção hepática, disfunção renal e varizes esofagogástricas, que caracterizam o quadro de gastropatia. Objetivo: Avaliar o uso do carvedilol como profilaxia primária no desenvolvimento da circulação colateral em ratos submetidos ao modelo de ligadura parcial de veia porta (LPVP). Método: Estudo experimental qualitativo e quantitativo no qual foram utilizados 32 ratos Wistar, divididos em quatro grupos (n=8): grupo I - cirrose + carvedilol (LPVP+C); grupo II - cirrose + veículo (LPVP); grupo III - controle + carvedilol (SO - sham-operated+C); grupo IV - controle + veículo (SO - sham-operated). Após transcorridos sete dias do procedimento cirúrgico, foi administrado carvedilol (10 mg/kg) e veículo (1mL) para os respectivos grupos por sete dias consecutivos. Resultados: A análise histológica não mostrou alteração hepática em nenhum grupo e diminuição de edema e vasodilatação no grupo LPVP+C. A avaliação laboratorial da função hepática não mostrou alteração com significância estatística entre os grupos. Conclusão: Carvedilol mostrou ser fármaco com efeito positivo no sangramento das varizes gástricas e sem efeitos adversos significantes.

Influence of antihypertensive pharmacological treatment on the acute cardiovascular responses to the resistance exercise in hypertensive middle-aged women

Abstract Aim: To investigate the hypothesis that the resistance exercise (RE) may be safer if the blood pressure (BP) is properly controlled through antihypertensive pharmacological treatment in hypertensive middle-aged women. Methods: The final sample was comprised of 19 hypertensive women, with an average age of 58±5 years and a body mass index of 29±5 Kg/m2. They were divided into three groups: controlled (n=6), uncompensated (n=8), and untreated (n=5). The subjects from all groups were submitted to a test of maximal strength on extensor chair and held a session of RE (knee extension, 3x12 to 60% 1RM) and the cardiovascular response (BP and heart rate) was monitored continuously by photoplethysmography during exercise and until five minutes after exercise (recovery). Results: Systolic BP (SBP) and diastolic BP (DBP) responses were lower in the controlled group compared to the other groups (p<0.05). The heart rate was not different between groups, while the double product was lower in the controlled group compared to the untreated group (p<0.05). The SBP and DBP peaks were lower in the controlled group compared to the other groups (p<0.05). Conclusion: The BP increases significantly during RE when the hypertension is not controlled. Pharmacological control was shown to be effective in preventing the increase of BP during the performance of the RE.

Efecto de las variantes de CYP2C9 sobre la dosis de losartán en hipertensos chilenos / Association between cytochrome p4502c9 polymorphisms and losartan dosing in hypertensive patients

Background Losartan is widely used in many clinicals settings. Its dosage is related to the genetic characteristics of CYP2C9 enzymatic activity, which metabolizes losartan to its active form E-3174, responsible for the antihypertensive effect. Aims To identify the frequency of allelic variants CYP2C9*2 and CYP2C9*3 in hypertensive patients and to compare genotypes with a healthy Chilean population. To relate polymorphisms with the losartan dosing to obtain an optimal blood pressure. Material and Methods We studied 30 patients with controlled essential hypertension using losartan with normal liver function, and 202 healthy people. Peripheral blood DNA genotyping was performed by polymerase chain reaction to identify the polymorphisms. Allelic and genotypic frequencies were compared. Results In hypertensive patients, allelic frequencies were 0.85 (CYP2C9*1), 0.05 (CYP2C9*2) and 0.1 (CYP2C9*3). Genotypic frequencies were 73.3% (CYP2C9*1/*1), 6.7% (CYP2C9*1/*2), 16.7% (CYP2C9*1/*3) and 3.3% (CYP2C9*2/3); observing a significantly higher frequency of the allele CYP2C9*3 (p=0.041) and CYP2C9*1/*3 genotype (p=0.04). A non-significant tendency to need a larger dose of losartan was observed with the CYP2C9 * 3 allele, with an odds ratio (OR) of 1.46 (95% confidence intervals (CI) 0.01-18.64). The same tendency was observed with the need to use losartan twice a day, obtaining an OR of 5.88 (CI 0.54 -62.14). Conclusions There could be a relationship between the presence of CYP2C9 polymorphisms and the pathogenesis of hypertension. The presence of CYP2C9*3 is associated with the need for higher doses of losartan, possibly due to a decrease in the conversion of losartan to E-3174.

Falha no diagnóstico e no tratamento medicamentoso da hipertensão arterial em idosos brasileiros - Estudo FIBRA / Arterial hypertension diagnostic and drug therapy failure among Brazilian elderly - FIBRA Study

Resumo O objetivo deste estudo foi investigar prevalências de falhas no diagnóstico, no uso de anti-hipertensivos e na eficácia do tratamento medicamentoso da hipertensão, e a associação destes parâmetros com variáveis sociodemográficas, de saúde e acesso ao serviço de saúde em idosos não institucionalizados. O estudo foi descritivo, transversal, com 3478 idosos, analisados separadamente em regiões Norte/Nordeste e Sul/Sudeste. Utilizou-se a regressão múltipla de Poisson para estimar razões de prevalência brutas e ajustadas pelo tipo de serviço de saúde utilizado. Do total, 29,6% dos idosos apresentaram falhas no diagnóstico, 4,6% no uso de anti-hipertensivos e 65,3% na eficácia medicamentosa. A falha no diagnóstico associou-se ao sexo masculino, menos morbidades, ter um companheiro, raça/cor branca, ter acesso ao convênio ou serviço privado de saúde, possuir renda pessoal inferior/média e ainda trabalhar. A falha no uso de anti-hipertensivos esteve associada à renda pessoal inferior/média e trabalhar. As falhas no manejo da hipertensão são prevalentes em idosos não institucionalizados. Há necessidade de ações que minimizem os impactos negativos destas insuficiências em saúde, em um país com diferenças sociais, econômicas e étnicas.

Abstract This study aimed to investigate the prevalence of failure in hypertension diagnosis, antihypertensive drug use and drug therapy efficacy and the association of these parameters with sociodemographic, health-related and access to health services variables in community-dwelling elderly. This is a descriptive cross-sectional study with 3,478 elderly from different Brazilian regions. We used Pearson's chi-square test to verify associations between outcomes and independent variables, and Poisson multiple regression to estimate crude and adjusted prevalence ratios. Of the total, 29.6% of the elderly evidenced failure in the diagnosis, 4.6% in the use of antihypertensives and 65.3% in drug efficacy. Diagnostic failure was associated with males, presence of morbidity, having a partner, white skin color/ethnicity, having access to the health covenant or private health service, with low/medium personal income and working. Antihypertensive use failure was associated with low/medium personal income and work. Hypertension management failures are prevalent in community-dwelling elderly. There is a need for actions that minimize the negative impact of these health shortcomings, in a country burdened by social, economic and ethnic differences.

Validação do questionário "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) / Validation of the "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) questionnaire

Resumo Este trabalho adaptou transculturalmente o questionário espanhol "Conocimiento del Paciente sobre sus Medicamentos" (CPM-ES-ES) para uso no Brasil. Ele mede o grau de conhecimento sobre medicamentos por meio de 11 perguntas. Oitenta pacientes ≥ 80 anos foram investigados e com 39 também foi entrevistado o cuidador. A avaliação das equivalências conceitual e de item considerou o conceito de conhecimento e as perguntas que o medem como pertinentes. A equivalência semântica foi obtida pela correspondência de significado denotativo e conotativo dos itens. O estudo da equivalência de mensuração incluiu análise fatorial e o cálculo de estimativas de validade e confiabilidade. Semelhante ao questionário original, a análise de componentes principais identificou 4 componentes, porém, em 2 deles houve diferenças nos itens incluídos. Uma pergunta foi removida desta análise devido à sua inadequação amostral. O conhecimento sobre medicamentos esteve correlacionado à complexidade da prescrição r = -0,22, p = 0,046. O conhecimento sobre anti-hipertensivos esteve correlacionado à sua adesão r = 0,70, p < 0,001, e ao controle da pressão arterial rb = 0,46, p = 0,029. A versão adaptada apresentou equivalência funcional de modo que pode ser usada no contexto brasileiro.

Abstract This work cross-culturally adapted the Spanish questionnaire `Patients' knowledge about their medications ("Conocimiento del Paciente sobre sus Medicamentos" - CPM-ES-ES) for use in Brazil. It measures the level of medication knowledge by means of 11 questions. Eighty patients ≥ 80 years were investigated and in 39 cases the caregivers were interviewed. The evaluation of conceptual and item equivalences considered the concept of knowledge and the questions that assess it as pertinent. Semantic equivalence was obtained by the correspondence in the denotative and connotative meaning of items. The study of measurement equivalence included factorial analysis and the calculation of validity and reliability estimates. As with the original questionnaire, principal component analysis identified 4 components, however, in 2 of them there were differences regarding included items. One question was removed from this analysis due to its sample inadequacy. Medication knowledge was correlated with medication regimen complexity r = -.22, p = .046. Medication knowledge of antihypertensives was correlated with their adherence r = .70, p < .001, and blood pressure control rb = .46, p = .029. The adapted version revealed functional equivalence, therefore it can be used in the Brazilian context.

Hipertensión arterial en la infancia: recomendaciones para su diagnóstico y tratamiento. Parte 2 Rama de Nefrología Infantil, Sociedad Chilena de Pediatría / Blood hypertension in children: guideliness for diagnosis and treatment. Part 2 Pediatric Nephrology Branch, Chilean Pediatric Society

Resumen: La hipertensión arterial (HTA) en niños y adolescentes es una importante patología, de reservado pronóstico, asociada a factores modificables y no modificables. La prevalencia estimada es de apro ximadamente un 3,5%, la cual va aumentando progresivamente con la edad. El método ideal para su diagnóstico es la medición de la presión arterial (PA) con instrumentos auscultatorios. De acuerdo a la Academia Americana de Pediatría (AAP) la PA debe ser medida en niños mayores de 3 años una vez al año, y en niños menores de 3 años, si presentan factores de riesgo. Una vez confirmada la HTA, la evaluación debe dirigirse hacia la detección de una enfermedad causal y/o a la búsqueda de factores de riesgo asociados a una HTA primaria. El objetivo del tratamiento de la HTA primaria y secundaria en pediatría es lograr un nivel de PA que disminuya el riesgo de daño de los órganos blanco. Las opciones terapéuticas incluyen: tratamiento según etiología específica, no farmacológico y farmacológico. En esta Guia se presenta la posición de la Rama de Nefrología de la Sociedad Chile na de Pediatría con el objetivo de orientar a pediatras y nefrólogos infantiles en correcto manejo de la HTA en la infancia. En esta segunda parte se presentan las recomendaciones sobre el tratamiento antihipertensivo, haciendo énfasis en los cambios de estilo de vida.

Abstract: Hypertension (HTN) in children and adolescents is an important pathology, of, guarded prognosis, associated with modifiable and non-modifiable factors. The estimated prevalence is around 3.5% which increases progressively with age. The ideal method for its diagnosis is the measurement of blood pressure (BP) with auscultatory instruments. According to the American Academy of Pedia trics (AAP), BP should be measured in children older than three years of age once a year, and in children younger than three years of age if they present risk factors. Once the HTN is confirmed, the evaluation should be directed towards the detection of a causative disease and/or the search for risk factors associated with a primary HTN. The objective of treating primary and secondary HTN in pediatrics is to achieve a BP level that decreases the risk of target organ damage. Therapeutic op tions include treatment according to specific etiology, non-pharmacological and pharmacological one. This paper presents the position of the Chilean Society of Pediatrics Nephrology Branch with the aim of guiding pediatricians and pediatric nephrologists in the correct management of HTN in childhood. In this second part, recommendations on antihypertensive treatment are presented with an emphasis on lifestyle changes.

Circulating microparticles and central blood pressure according to antihypertensive strategy

OBJECTIVES: This prospective, randomized, open-label study aimed to compare the effects of antihypertensive treatment based on amlodipine or hydrochlorothiazide on the circulating microparticles and central blood pressure values of hypertensive patients. METHODS: The effects of treatments on circulating microparticles were assessed during monotherapy and after the consecutive addition of valsartan and rosuvastatin followed by the withdrawal of rosuvastatin. Each treatment period lasted for 30 days. Central blood pressure and pulse wave velocity were measured at the end of each period. Endothelial, monocyte, and platelet circulating microparticles were determined by flow cytometry. Central blood pressure values and pulse wave velocity were recorded at the end of each treatment period. RESULTS: No differences in brachial blood pressure were observed between the treatment groups throughout the study. Although similar central blood pressure values were observed during monotherapy, lower systolic and diastolic central blood pressure values and early and late blood pressure peaks were observed in the amlodipine arm after the addition of valsartan alone or combined with rosuvastatin. Hydrochlorothiazide-based therapy was associated with a lower number of endothelial microparticles throughout the study, whereas a higher number of platelet microparticles was observed after rosuvastatin withdrawal in the amlodipine arm. CONCLUSIONS: Despite similar brachial blood pressure values between groups throughout the study, exposure to amlodipine was associated with lower central blood pressure values after combination with valsartan, indicating a beneficial interaction. Differences between circulating microparticles were modest and were mainly influenced by rosuvastatin withdrawal in the amlodipine arm.

Association between follow-up in health services and antihypertensive medication adherence / Asociación entre seguimiento en servicios de salud y adhesión terapéutica antihipertensiva / Associação entre acompanhamento em serviços de saúde e adesão terapêutica anti-hipertensiva

ABSTRACT Objective: To analyze the association between the characteristics of follow-up in health services and adherence to antihypertensive medication in patients with cardiovascular disease. Method: Analytical study carried out with 270 patients suffering from hypertension and hospitalized due to cardiovascular complications. Data collection occurred between November 2015 and April 2016, involving sociodemographic variables, presence of self-reported diabetes, accessibility and use of health services, blood pressure levels and medication adherence (analyzed through the Morisky-Green Test). Results: The rate of adherence to antihypertensive therapy was 63.0%. Enrollment in the Hiperdia program had no statistical significance to medication adherence. People who attended at least between 4 and 6 nursing consultations throughout the data collection period (p = 0.02) had better adherence. Conclusion: The study's findings provide support for the reorientation of health services and their public policies towards improving adherence to antihypertensive therapeutics.

RESUMEN Objetivo: Analizar la asociación entre las características del seguimiento en servicios de salud y la adhesión al tratamiento antihipertensivo en pacientes con enfermedad cardiovascular. Método: Estudio analítico, realizado con 270 pacientes con hipertensión internados por la ocurrencia de complicación cardiovascular. La recolección de datos ocurrió entre noviembre de 2015 y abril de 2016. Se analizaron variables sociodemográficas, presencia de diabetes autorreferida, condiciones de acceso y utilización de servicios de salud, niveles de presión arterial y adhesión terapéutica a través de la prueba de Morisky-Green. Resultados: La tasa de adhesión terapéutica antihipertensiva identificada fue del 63,0%. El registro en el programa Hiperdia no presentó significancia estadística con la adhesión. Esta medida fue mejor en aquellos que asistieron entre 4 y 6 consultas de enfermería en el año (p=0,02). Conclusión: Los hallazgos proporcionan subsidios para la reorientación de los servicios de salud y sus políticas públicas para la ampliación de la adhesión terapéutica antihipertensiva.

RESUMO Objetivo: Analisar a associação entre as características do acompanhamento em serviços de saúde e a adesão ao tratamento anti-hipertensivo em pacientes com doença cardiovascular. Método: Estudo analítico, realizado com 270 pacientes com hipertensão internados pela ocorrência de complicação cardiovascular. A coleta de dados ocorreu entre novembro de 2015 e abril de 2016. Analisaram-se variáveis sociodemográficas, presença de diabetes autorreferida, condições de acesso e utilização de serviços de saúde, níveis de pressão arterial e adesão terapêutica por meio do Teste de Morisky-Green (TMG). Resultados: A taxa de adesão terapêutica anti-hipertensiva identificada foi de 63,0%. O cadastro no programa Hiperdia não apresentou significância estatística com a adesão. Esta medida foi melhor naqueles que compareceram entre 4 e 6 consultas de enfermagem no ano (p=0,02). Conclusão: Os achados fornecem subsídios para a reorientação dos serviços de saúde e suas políticas públicas para a ampliação da adesão terapêutica anti-hipertensiva.

Consumo de antihipertensivos en el Hospital Manuel Fajardo. 2013-2017 / Consumption of antihypertensive drugs in Manuel Fajardo Hospital. 2013-2017

Introducción: La Hipertensión Arterial es el factor de riesgo más frecuente de infarto agudo de miocardio, enfermedad cerebrovascular, insuficiencia cardíaca y otras afecciones. Objetivo: Caracterizar el consumo intrahospitalario de medicamentos antihipertensivos en el Hospital Clínico Quirúrgico Manuel Fajardo en el período comprendido entre 2013 y 2017. Material y Métodos: Se realizó un estudio observacional descriptivo, de corte transversal sobre el consumo intrahospitalario de antihipertensivos. El universo estuvo determinado por todos los antihipertensivos que tuvieron indicación facultativa intrahospitalaria en los años comprendidos. Resultados: Se consumió un total de 301 616 unidades de drogas antihipertensivas. El Enalapril fue el antihipertensivo más consumido con 126 306 unidades, representando 41.89 por ciento del consumo total de antihipertensivos en el período, siendo además el más empleado en todos los años del estudio. El mayor costo lo representó el Enalapril para un total de 31 576.50 CUP. Conclusiones: Los antihipertensivos más empleados fueron el Enalapril, la Clortalidona y el Amlodipino. El Enalapril fue el más consumido en todos los años estudiados, mientras que la Clortalidona estuvo entre los tres más empleados en todos esos años. En cuanto a la repercusión económica del consumo de los antihipertensivos más empleados, el Enalapril fue el más costoso, seguido por el Amlodipino(AU)

Introduction: Arterial hypertension is the most frequent risk factor associated with acute myocardial infarction, cerebrovascular disease, heart failure, and other conditions. Objective: To characterize the intra-hospital consumption of antihypertensive drugs at Manuel Fajardo Hospital throughout the period between 2013 and 2017. Material and Methods: An observational, descriptive, cross-sectional study of the intra-hospital consumption of antihypertensive drugs was carried out. The universe was determined by all the antihypertensive drugs that had intra-hospital medical prescription during the period studied. Results: A total of 301.616 units of antihypertensive drugs were used. Enalapril was the most consumed drug with 126.306 units, representing 41.89 percent of the total consumption of antihypertensive drugs during the period; also being the most used drug for the entire years of the study. The increased cost was represented by Enalapril for a total of 31.576.50 Cuban pesos (CUP). Conclusions: The most used antihypertensive drugs were Enalapril, Chlorthalidone and Amlodipine. Enalapril was the most consumed drug in all the years studied, whereas Chlorthalidone was one of the three most commonly used. Regarding economical repercussion of the most consumed antihypertensive drugs, Enalapril was the most expensive one, followed by Amlodipine(AU)

Uso de drogas antiglaucomatosas em pacientes com glaucoma severo: quantas são necessarias para controle da doenca? / Use of antiglaucomatous drugs in patients with severe glaucoma: how many are necessary to control the disease?

Resumo Introdução: O glaucoma e a principal causa de cegueira irreversivel no Brasil. Ate o momento nao se dispoe de uma droga ideal para o controle da pressao intraocular (PIO), geralmente necessitando associar dois ou mais medicamentos hipotensores, com frequentes instilacoes diarias e ma aderencia ao tratamento. Objetivos: Descrever quantitativa e qualitativamente as drogas usadas para controle da PIO e a eficacia do tratamento na prevencao da cegueira. Métodos: Estudo transversal retrospectivo, atraves de revisao de 420 prontuarios de portadores de Glaucoma severo acompanhados no ambulatorio do Hospital Emilio Carlos, de Catanduva-SP, de janeiro/2014 a dezembro/2016. As variaveis analisadas foram: idade, acuidade visual e medicamentos antiglaucomatosos utilizados: topicos (colirios) e sistemicos. Resultados: A media de idade dos participantes foi 62,99±16,29 anos. Foram detectados 68 casos de cegueira, sendo que 3 pacientes (0,7%)perderam a visao no tempo investigado, com referencias a periodos sem tratamento/subdose/instilacao indevida/uso de 3 ou 4 colirios. Em 73,3% dos casos conseguiu-se estabilizacao da PIO com o uso de um (38,1%) ou no maximo 02 (35,2%) colirios associados. Houve correlacao significativa entre o no de combinacoes de hipotensores topicos e o no de pacientes em uso de Acetazolamida. O medicamentomais usado foi o Maleato de Timolol (67,1%). Conclusões: Na maioria dos pacientes a PIO foi controlada com 1 ou 2 colirios associados; pequena porcentagem dos casos evoluiu para cegueira; muito provavelmente a evolucao para perda de visao foi decorrente da complexidade e ma aderencia ao tratamento.

ABSTRACT Introduction: Glaucoma is the main cause of irreversible blindness in Brazil. To date, there is no ideal drug for the control of intraocular pressure (IOP), usually requiring the combination of two or more hypotensive drugs, with frequent daily instillations and poor adherence to treatment. Objectives: To describe quantitatively and qualitatively the drugs used to control IOP and the efficacy of treatment in the prevention of blindness. Methods: A retrospective cross-sectional study was carried out through a review of 420 medical records of patients with severe Glaucoma who were followed up at the Emílio Carlos Hospital outpatient clinic in Catanduva, SP, from January 2014 to December 2016. The analyzed variables were: age, visual acuity and antiglaucomatous drugs used: topical (eye drops) and systemic. Results:The mean age of participants was 62.99 ± 16.29 years. Sixty-eight cases of blindness were detected, and three patients (0.7%) lost vision at the time investigated, with references to periods without treatment / subdose / improper instillation / use of 3 or 4 eye drops. In 73.3% of the cases, IOP stabilization was achieved with one (38.1%) or at most 02 (35.2%) associated drops. There was a significant correlation between the number of combinations of topical hypotensive agents and the number of patients taking acetazolamide. The drugmostused was Timolol (67.1%). Conclusions: In the majority of patients IOP was controlled with 1 or 2 associated eye drops; small percentage of cases evolved into blindness; most likely the evolution to loss of vision was due to the complexity and poor adherence to the treatment.

Fixed-dose combination therapy to improve hypertension treatment and control in Latin America / Terapia de combinación a dosis fija para mejorar el tratamiento y el control de la hipertensión en América Latina

Abstract Hypertension is a major risk factor for cardiovascular disease. Its prevalence is increasing worldwide, and is more common in low and middle-income countries. The effectiveness of hypertension treatment is determined by health cost, awareness, and patients' compliance with the treatment. People worldwide with an adequate control of hypertension correspond to a very small percentage in low and medium income countries as the Latin America ones. Between the causes to explain these are the low availability, affordability and adherence to treatment with multiple pills. It has been proposed that fixed dose combination therapy could improve the availability, affordability, adherence and control of hypertension. This article aims to review the evidence, showing that fixed dose combination can improve adherence, decrease health cost and improve control of hypertension. Improvement in hypertension control with fixed dose combination could make an important contribution to efforts to fight against the global cardiovascular morbidity and mortality. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen La hipertensión es un factor de riesgo importante para el desarrollo de enfermedades cardiovasculares. Su prevalencia está aumentando en todo el mundo, y es más común en los países de medianos a bajos ingresos. La eficacia del tratamiento de la hipertensión está determinada por el costo, el conocimiento y la adherencia de los pacientes con el tratamiento. El control adecuado de la hipertensión corresponde a un porcentaje muy pequeño en países de medianos a bajos ingresos como los países de América Latina. Entre las causas para explicar esto se encuentran la baja disponibilidad, asequibilidad y adherencia al tratamiento con múltiples medicamentos antihipertensivos. Se ha propuesto que la terapia combinada a dosis fija podría mejorar la disponibilidad, asequibilidad, adherencia y control de la hipertensión. Este artículo tiene como objetivo revisar la evidencia que demuestra que la combinación de dosis fija puede mejorar la adherencia, disminuir los costos de salud y mejorar el control de la hipertensión. La mejoría en el control de la hipertensión con terapia de combinación a dosis fija podría aportar una importante contribución a los esfuerzos para combatir la morbilidad y la mortalidad cardiovascular a nivel mundial. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).