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1.
Chin. med. j ; Chin. med. j;(24): 63-72, 2024.
Article in English | WPRIM | ID: wpr-1007587

ABSTRACT

BACKGROUND@#The 2017 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline lowered the threshold defining hypertension to 130/80 mmHg. However, how stage 1 hypertension defined using this guideline is associated with cardiovascular events in Chinese adults remains unclear. This study assessed the association between stage 1 hypertension defined by the 2017 ACC/AHA guideline and clinical outcomes in the Chinese population.@*METHODS@#Participants with stage 1 hypertension ( n = 69,509) or normal BP ( n = 34,142) were followed in this study from 2006/2007 to 2020. Stage 1 hypertension was defined as a systolic blood pressure of 130-139 mmHg or a diastolic blood pressure of 80-89 mmHg. None were taking antihypertensive medication or had a history of myocardial infarction (MI), stroke, or cancer at baseline. The primary outcome was a composite of MI, stroke, and all-cause mortality. The secondary outcomes were individual components of the primary outcome. Cox proportional hazards models were used for the analysis.@*RESULTS@#During a median follow-up of 11.09 years, we observed 10,479 events (MI, n = 995; stroke, n = 3408; all-cause mortality, n = 7094). After multivariable adjustment, the hazard ratios for stage 1 hypertension vs. normal BP were 1.20 (95% confidence interval [CI], 1.13-1.25) for primary outcome, 1.24 (95% CI, 1.05-1.46) for MI, 1.45 (95% CI, 1.33-1.59) for stroke, and 1.11 (95% CI, 1.04-1.17) for all-cause mortality. The hazard ratios for participants with stage 1 hypertension who were prescribed antihypertensive medications compared with those without antihypertensive treatment during the follow-up was 0.90 (95% CI, 0.85-0.96).@*CONCLUSIONS@#Using the new definition, Chinese adults with untreated stage 1 hypertension are at higher risk for MI, stroke, and all-cause mortality. This finding may help to validate the new BP classification system in China.


Subject(s)
Adult , Humans , United States , Antihypertensive Agents/therapeutic use , Hypertension/complications , Blood Pressure/physiology , Myocardial Infarction/drug therapy , Stroke/drug therapy , American Heart Association , China/epidemiology
2.
Medicina (Ribeirao Preto, Online) ; 57(1)out.2024. tab, ilus
Article in English | LILACS | ID: biblio-1579596

ABSTRACT

Introduction: Primary hyperaldosteronism is a leading cause of secondary arterial hypertension, affecting approximately 10% to 20% of the hypertensive population worldwide and in Brazil. This condition involves excessive aldosterone production due to factors such as adrenal adenoma, hyperplasia, or, less commonly, adrenal carcinoma and familial hyperaldosteronism. This study reports a case of resistant hypertension secondary to aldosterone-producing adenoma.Clinical Case: A 70-year-old male patient presented with episodes of dizziness, syncope, cramps, and asthenia. His medical history included resistant hypertension for over 30 years, despite treatment with five classes of antihypertensive medications. Additionally, he had a history of dyslipidemia, type 2 diabetes mellitus, non-dialysis chronic renal failure, and obstructive coronary artery disease. Physical examination showed a BMI of 29 kg/m² (overweight), mean blood pressure of 140/90 mmHg (right arm) and 150/100 mmHg (left arm), and palpable nodules in both thyroid lobes, classified as Bethesda V based on aspiration cytopathology. Subsequently, he underwent total thyroidectomy and lymph node dissection. Laboratory tests revealed high plasma aldosterone levels with suppressed renin and an elevated aldosterone-renin ratio, raising suspicion of primary hyperaldosteronism. This diagnosis was confirmed by a computed tomography scan, which identified a 1.2 cm nodule in the right adrenal gland consistent with an adenoma. The patient underwent unilateral laparoscopic adrenalectomy. Two years post-surgery, the patient's blood pressure was well-controlled with three antihypertensive medications, and his blood sugar, aldosterone, and renin levels were normal.Discussion and Conclusion: Most patients undergoing unilateral adrenalectomy for aldosterone-producing adenomas experience significant clinical improvement. Early screening and diag-nosis of primary hyperaldosteronism are crucial for effective management, reducing the risk of complications in the cardiovascular and renal systems (AU)


Introdução: O hiperaldosteronismo primário é a principal causa de hipertensão arterial secundária, com prevalência estimada entre 10% e 20% da população hipertensa mundial e no Brasil. Trata-se de uma condição caracterizada pela produção excessiva de aldosterona, que pode ser causada por adenoma, hiperplasia adrenal ou, mais raramente, carcinoma adrenal e condições hereditárias de hiperaldosteronismo familiar. O objetivo deste estudo é relatar um caso de hipetensão arterial resistente secundária a um adenoma produtor de aldosterona.Caso Clínico: Um paciente do sexo masculino, de 70 anos, apresentou episódios de tontura, síncope, câimbras e astenia. Sua história médica inclui hipertensão arterial resistente por mais de 30 anos, apesar do tratamento com cinco classes de antihipertensivos. O paciente também possui histórico de dislipidemia, diabetes mellitus tipo 2, insuficiência renal crônica não dialítica e coronariopatia obstrutiva. O exame físico revelou um IMC de 29 kg/m² (sobrepeso), pressão arterial média de 140/90 mmHg (braço direito) e 150/100 mmHg (braço esquerdo), além de nódulos palpáveis nos lobos direito e esquerdo da tireoide, classificados como Bethesda V em citopatologia aspirativa. Foi realizada, então, tireoidectomia total e esvaziamento ganglionar.Os exames laboratoriais mostraram níveis elevados de aldosterona plasmática, com renina suprimida e uma elevada relação aldosterona-renina, o que levantou a suspeita de hiperaldoste-ronismo primário. Esta suspeita foi confirmada por tomografia computadorizada, que revelou um nódulo de 1,2 cm na glândula suprarrenal direita, compatível com adenoma. O paciente foi submetido a uma suprarrenalectomia unilateral por laparoscopia. Dois anos após a cirurgia da adrenal esquerda, o paciente apresentava níveis pressóricos controlados com o uso de três clas-ses de anti-hipertensivos, e houve normalização dos níveis de potássio, aldosterona e renina.Discussão e Conclusão: A maioria dos pacientes submetidos a adrenalectomia unilateral por adenoma produtor de aldosterona experimenta uma melhora clínica significativa. O rastreamento e diagnóstico precoce são essenciais para o manejo eficaz do hiperaldosteronismo primário, ajudando a reduzir complicações cardiovasculares e renais (AU)


Subject(s)
Humans , Male , Aged , Delayed Diagnosis , Hyperaldosteronism/diagnosis , Hypertension/diagnosis , Antihypertensive Agents
3.
Rev. Ciênc. Méd. Biol. (Impr.) ; 22(1): 105-112, jun 22, 2023. tab
Article in French | LILACS | ID: biblio-1443790

ABSTRACT

Objetivo: caracterizar o acesso aos medicamentos anti-hipertensivos pelas pessoas com hipertensão arterial atendidas em uma unidade ambulatorial. Metodologia: estudo descritivo, quantitativo, desenvolvido com 103 pessoas com hipertensão arterial em uso de anti-hipertensivos. Os dados foram coletados por meio de questionário com perguntas sociodemográficas, sobre tratamento e acesso aos medicamentos anti-hipertensivos. Utilizou-se a estatística descritiva e teste qui-quadrado de Pearson ou exato de Fisher para análise dos dados. Resultados: Predominou a faixa etária de 50-69 (68,9%), sexo feminino (85,4%) e raça/cor autodeclarada preta (46,6%). Quanto ao acesso aos anti-hipertensivos, 70,9% relataram ter acesso gratuito, 60,2% os obtêm nas unidades de saúde, 65,7% não referiram dificuldades na aquisição e 86,4% que tinham acesso total. Todos os participantes que tinham dificuldade econômica também tinham dificuldade de acesso aos anti-hipertensivos. Verificou-se associação significativa entre a dificuldade de acesso aos anti-hipertensivos com forma de acesso (total ou parcial), quantidade de drogas e disponibilidade do medicamento nas farmácias (p<0,005). Conclusão: observou-se que, embora a maioria dos participantes do estudo não encontre dificuldades para obtenção dos anti-hipertensivos nas farmácias das unidades básicas de saúde, ainda assim, existe uma parcela da população sem acesso total aos anti-hipertensivos de forma gratuita, sendo essencial melhorias dos programas de fornecimento de medicamentos.


Objective: to characterize access to antihypertensive drugs by patients with arterial hypertension treated at an ambulatory unit. Methodology: descriptive, quantitative study, developed with a group of 103 people with arterial hypertension currently using antihypertensive drugs. The data were collected through a questionnaire with sociodemographic questions, with respect to treatment and access to antihypertensive drugs. Descriptive statistics and Pearson's chi-square test or Fisher's exact test were used for data analysis. Results: the age group 50-69 (68.9%), female (85.4%) and black self-declared race (46.6%) predominated. Regarding access to antihypertensive drugs, 70.9% reported having free access, 60.2% obtained them at health units, 65.7% did not mention difficulties in acquiring them and 86.4% that had full access. All participants who had economic difficulties also had difficulty accessing antihypertensive drugs. It was identified a significant association between difficulty in accessing antihypertensive drugs and the means of access (total or partial), quantity of drugs and availability of the drug in pharmacies (p<0.005). Conclusion: it was observed that, that most of the study participants did not find it difficult to obtain antihypertensive drugs in the pharmacies of basic health units, notwithstanding, there is a portion of the population without full access to antihypertensive drugs free of charge, improvements in drug supply programs are essential.


Subject(s)
Humans , Female , Middle Aged , Aged , Health Centers , Academic Medical Centers , Medication Adherence , Access to Essential Medicines and Health Technologies , Hypertension , Antihypertensive Agents , Epidemiology, Descriptive , Evaluation Studies as Topic
4.
Zhonghua Yu Fang Yi Xue Za Zhi ; (12): 614-625, 2023.
Article in Chinese | WPRIM | ID: wpr-985453

ABSTRACT

Objective: To investigate the distribution of blood pressure and analyze the associated factors of blood pressure of the elderly with type 2 diabetes in Jiangsu Province. Methods: The elderly over 60 years old participants with type 2 diabetes in the communities of Huai'an City and Changshu City, Jiangsu Province were selected in this study. They were divided into two groups: taking antihypertensive drugs and not taking antihypertensive drugs. The demographic characteristics, such as age and sex, and relevant factors were collected by questionnaire. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured by physical examination. The percentile of SBP and DBP in each age group of men and women were described. The kernel density estimation curve was used to show the blood pressure distribution. The trend of blood pressure with age was fitted by locally weighted regression. The logistic regression model was used to analyze relevant factors of blood pressure. Results: A total of 12 949 participants were included in this study, including 7 775 patients in the antihypertensive drug group and 5 174 patients in the group without antihypertensive drugs. The SBP of participants was concentrated at 140-160 mmHg, and their DBP was concentrated at 75-85 mmHg. There were significant differences in the distribution of blood pressure among the subgroups of body mass index (BMI) and rural areas whether taking antihypertensive drugs and not. For participants aged under 80 years old, the SBP showed an increasing trend with age and the DBP showed a decreasing trend with age. Age, BMI ≥24 kg/m2, fasting blood glucose ≥7.0 mmol/L, living in rural areas and no smoking were influencing factors of the elevated SBP; BMI ≥24 kg/m2, male, living in rural areas, no smoking, drinking alcohol and not receiving drug hypoglycemic treatment were influencing factors of the elevated DBP. Conclusion: The SBP of older diabetic adults in Jiangsu Province is at a high level, and the distribution of blood pressure is significantly different between men and women in taking antihypertensive drugs group. The SBP presents a rising trend and the DBP is decreasing at the age of 60-80 years. The blood pressure level of this population are mainly affected by age, BMI, urban and rural areas, smoking.


Subject(s)
Adult , Aged , Humans , Male , Female , Middle Aged , Aged, 80 and over , Blood Pressure/physiology , Diabetes Mellitus, Type 2/epidemiology , Antihypertensive Agents/therapeutic use , Smoking , Body Mass Index , Hypertension/epidemiology
5.
Zhongguo Zhong Yao Za Zhi ; (24): 4819-4824, 2023.
Article in Chinese | WPRIM | ID: wpr-1008650

ABSTRACT

Hypertension is the most important risk factor for cardiovascular disease-related deaths among urban and rural residents, and it has become a significant global public health issue. In October 2022, the Clinical Practice Guidelines for the Management of Hypertension in China(hereinafter referred to as the Practice Guidelines) were jointly released by the National Cardiovascular Center and other academic organizations. The Practice Guidelines sparked extensive discussions as they clearly lowered the diagnostic criteria for hypertension, raised the blood pressure targets for elderly patients, and proposed changes in the timing of early medication intervention. While these adjustments have some international evidence-based support, there is still debate regarding the cardiovascular benefits of intensified blood pressure control based on the existing level of evidence. Furthermore, whether the series of new standards proposed in the Practice Guidelines are suitable for the Chinese population and whether the hypertension control level in primary care in China can adapt to the new diagnostic and treatment standards require further in-depth research. In contrast to the strict blood pressure control concept emphasized in the Practice Guidelines, traditional Chinese medicine(TCM) emphasizes the concept of comprehensive prevention and treatment and holistic therapy in the treatment of hypertension, including prehypertension, hypertension, and target organ damage. In recent years, based on abundant clinical trial research and high-quality evidence-based support, the advantages of TCM in treating hypertension have gradually emerged. Previous studies by this research team have found that the pathogenesis of hypertension includes three major types: fire syndrome, fluid retention syndrome, and deficiency syndrome. TCM treatment of hypertension features stable blood pressure reduction, gentle blood pressure lowering, and long-lasting effects. In addition to blood pressure reduction, it also has effects such as reversing risk factors and protecting target organ damage. It demonstrates the characteristics of multiple targets, multiple components, and comprehensive regulation, and can be applied throughout the entire process of prevention and treatment, including prehypertension, hypertension, and target organ damage in the early, middle, and late stages of hypertension. Therefore, it has certain clinical application prospects.


Subject(s)
Aged , Humans , Antihypertensive Agents/therapeutic use , China , Hypertension/drug therapy , Medicine, Chinese Traditional , Prehypertension/drug therapy , Practice Guidelines as Topic
6.
Zhongguo Zhong Yao Za Zhi ; (24): 6592-6599, 2023.
Article in Chinese | WPRIM | ID: wpr-1008858

ABSTRACT

Hypertension, a primary cause of cardiovascular and cerebrovascular events, has become a major global public health problem and caused a heavy burden of health economics on the society. In "the 20 Most Important and Most Preventable Health Problems" released by the Chinese Academy of Engineering, hypertension was ranked the second. Due to the disease complexity, many hypertension patients need to take antihypertensive drugs for life. Although significant progress has been achieved in blood pressure lowering by western medicines, the problems including adverse reactions, poor compliance due to long-term medication, and ineffective mitigation in clinical symptoms related to hypertension remain to be addressed. In the last decade, the research on traditional Chinese medicine(TCM) treatment of hypertension has received much attention and achieved remarkable progress. The TCM treatment of hypertension is the most active area of research with integrated Chinese and western medicine in China. In addition to lowering blood pressure smoothly, TCM can alleviate clinical symptoms, reverse risk factors, improve the quality of life, and protect target organs from the damage caused by hypertension. This article systematically reviews the research progress of TCM in treating hypertension in the last decade from the following four aspects: consensus on guideline, clinical trial, experimental study, and systematic review/Meta-analysis. It summarized the evidence of TCM in reducing blood pressure and clarified the mechanism of TCM in reducing blood pressure, aiming to provide a reference for the TCM diagnosis and treatment of hypertension and the development of new drugs.


Subject(s)
Humans , Antihypertensive Agents/therapeutic use , Drugs, Chinese Herbal/therapeutic use , Hypertension/drug therapy , Medicine, Chinese Traditional
7.
Zhonghua ganzangbing zazhi ; Zhonghua ganzangbing zazhi;(12): 48-80, 2023.
Article in Chinese | WPRIM | ID: wpr-970945

ABSTRACT

The population of chronic kidney disease (CKD) with hypertension in China is characterized by complex etiology, high incidence rate, low awareness and control rate. How to diagnose and treat hypertension in CKD patients properly and improve their prognosis is particularly urgent. Several clinical guidelines or expert consensus on the diagnosis, treatment and management of hypertension have been issued. Some of them involve the diagnosis and treatment of hypertension in CKD patients, but they still can not meet the demand for diagnosis and treatment of hypertension in CKD patients. Based on the situation of hypertension in CKD patients in China, the Chinese Society of Nephrology organized an expert group to formulate this guideline. This guideline systematically introduces the diagnostic criteria, epidemiology, risk factors, poor prognosis of hypertension, the purpose, timing and control goals of antihypertensive therapy in CKD patients, as well as blood pressure control goals for special populations, non drug treatment and drug treatment of hypertension. This guideline aims to further strengthen the management of hypertension in CKD patients, standardize the diagnosis and treatment standards, formulate reasonable treatment plans, effectively control hypertension, reduce complications, so as to delay the progress of kidney diseases and improve the long-term prognosis of hypertension in Chinese CKD patients.


Subject(s)
Humans , Antihypertensive Agents/therapeutic use , Hypertension/therapy , Renal Insufficiency, Chronic/therapy , Blood Pressure , Risk Factors , China/epidemiology
8.
Zhongguo Zhong Yao Za Zhi ; (24): 1982-1988, 2023.
Article in Chinese | WPRIM | ID: wpr-981418

ABSTRACT

Hypertension and its target organ damage have become a major public health problem. Sexual dysfunction is a new problem in the treatment of modern hypertension. Modern pathophysiological studies have shown that hypertension can lead to sexual dysfunction. In addition, three major hypotensive drugs represented by diuretics can also lead to sexual dysfunction. In traditional Chinese medicine(TCM), hypertension belongs to "vertigo" "headache" "head wind", etc. In the past, the understanding of the TCM pathogenesis of hypertension was mainly from the perspectives of "liver wind" and "Yang hyperactivity". However, based on the in-depth research on ancient and modern literature and medical records and many years of clinical practice, it has been identified that kidney deficiency was the key pathogenesis. Hypertension complicated with sexual dysfunction belongs to the category of kidney deficiency syndrome in TCM, especially the deficiency of kidney Yin. Previous studies by other research groups showed that Yin-enriching and kidney-tonifying method could effectively reduce blood pressure, improve sexual dysfunction, reverse risk factors, and protect target organs. This article systematically discussed the TCM understanding, modern pathophysiological mechanism, and the clinical treatment strategy of kidney-tonifying drugs(single drugs and compounds) in the treatment of hypertension complicated with sexual dysfunction in order to provide a scientific basis for kidney-tonifying method in the treatment of hypertension complicated with sexual dysfunction.


Subject(s)
Humans , Antihypertensive Agents/therapeutic use , Medicine, Chinese Traditional , Hypertension/drug therapy , Blood Pressure , Risk Factors , Drugs, Chinese Herbal/therapeutic use
9.
Health Sciences Journal ; : 12-19, 2023.
Article in English | WPRIM | ID: wpr-984390

ABSTRACT

INTRODUCTION@#Hypertension is a key modifiable risk factor for myocardial infarction and stroke, yet medication adherence remains low. The ongoing COVID-19 pandemic has further complicated the management of chronic diseases like hypertension. This study aimed to explore the correlation between the patient-doctor relationship and medication adherence among hypertensive Filipinos aged 40-65 years in the Greater Manila Area during the pandemic.@*METHODS@#A cross-sectional study was conducted involving 131 hypertensive Filipino participants. Data were collected through an online survey, assessing participant demographic and medical profiles, medication adherence using the Hill-Bone Compliance Scale (HBCS), and the patient-doctor relationship using the Physician-Doctor Relationship Questionnaire-9 (PDRQ-9).@*RESULTS@#Approximately half of the participants demonstrated good adherence to hypertension medication. A weak but significant positive correlation was found between overall medication adherence and the patient-doctor relationship. The duration of anti-hypertensive drug intake also showed a weak positive correlation with medication adherence. Factors such as comorbidities and type of consultation did not significantly impact medication adherence.@*CONCLUSION@#This study emphasizes the significance of the patient-doctor relationship in medication adherence among hypertensive Filipinos during the COVID-19 pandemic. Enhancing communication and trust between patients and physicians can potentially improve medication adherence and overall disease management.


Subject(s)
COVID-19 , Hypertension , Medication Adherence , Perception , Antihypertensive Agents
10.
Curationis ; Curationis;46(1): 1-7, 2023. figures, tables
Article in English | AIM | ID: biblio-1413746

ABSTRACT

Background: The worldwide phenomenon of teenage pregnancy among 13­9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. Objective: The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. Methods: As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Results: Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Conclusion: Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).


Subject(s)
Humans , Female , Adolescent , Pregnancy Complications , Pregnancy in Adolescence , Maternal Mortality , Hypertension, Pregnancy-Induced , Postpartum Period , Blood Pressure , Antihypertensive Agents
11.
Acta odontol. Colomb. (En linea) ; 13(1): 91-103, 20230000. tab, tab, ilus, ilus, ilus, ilus, ilus, ilus
Article in Spanish | LILACS | ID: biblio-1425222

ABSTRACT

Introducción: un aumento marcado de la tensión arterial puede llevar a una crisis hipertensiva, que consiste en una elevación considerable de la tensión arterial (>180 mmHg en sístole y >120 mmHg en diástole). De no ser tratada, puede llevar a la pérdida progresiva de la conciencia, así como provocar daños irreversibles a algún órgano blanco, por ejemplo, el hígado, el riñón o el cerebro. Se puede clasifcar en urgencia o emergencia hipertensiva. Así, una urgencia hipertensiva se presenta cuando el paciente cuenta con cifras elevadas en la tensión arterial sin provocar daño a un órgano blanco y, en contraparte, una emergencia hipertensiva cumple con las cifras que se mencionaron, pero incluye daño a un órgano blanco. Objetivo: presentar un caso clínico, en el cual, durante la extracción quirúrgica de una aguja fracturada, en el período transoperatorio, el paciente sufre síncope vasovagal, con un aumento marcado de la tensión arterial (179/119 mmHg). Conclusión: este fue un diagnóstico intraoperatorio de crisis hipertensiva y la paciente recibió un tratamiento médico temprano por parte del servicio de urgencias médicas, lo cual resultó en una evolución trans y postoperatoria adecuada.


A marked increase in blood pressure can lead to a hypertensive crisis, it can be classifed as an urgency or hypertensive emergency, which consists of a considerable increase in blood pressure (> 180 mmHg in systole and> 120 mmHg in diastole) and that, not being treated can lead to progressive loss of consciousness, as well as cause irreversible damage to the liver, kidney or brain. The objective of this article is to present a clinical case that during the surgical extraction of a fractured needle, in the intraoperative period the patient sufers vasovagal syncope, with a marked increase in blood pressure (179/119 mmHg), intraoperative diagnosis of crisis hypertensive, receiving early medical treatment from the emergency medical service, resulting in an adequate trans and postoperative evolution.


Subject(s)
Humans , Middle Aged , Surgery, Oral , Emergencies , Hypertension , Blood Pressure , Antihypertensive Agents
13.
Rev. Nac. (Itauguá) ; 14(2): 67-82, jul.-dic. 2022.
Article in Spanish | LILACS, BDNPAR | ID: biblio-1410692

ABSTRACT

Introducción:existe una sospecha sobre la relación bidireccional entre la apnea obstructiva del sueño (AOS) y la hipertensión arterial (HTA). Ambas ejercen una acción sinérgica sobre desenlaces cardiovasculares porlo quees trascendente ponderar la prevalencia de riesgo para AOS en los hipertensos. En este último grupo también hemos investigado la tasa de adherencia a los fármacos prescritos. Metodología:mediante un estudio de casos y controles y con la aplicación del cuestionario STOP-BANG se han discriminado las categorías de riesgo para apnea de sueño en las dos cohortes. Para el análisis de la adherencia a fármacos antihipertensivos se utilizó el cuestionario abreviado de Morisky. Resultados:se incluyeron a 590 individuos (295 casos y 295 controles. Se observó alto riesgo para AOS en el grupo de hipertensos (36,6%) comparado con el 14,2% del grupo control. Por otro lado, el sexo masculino OR 7,77 (IC95% 4,33-13,84), la obesidad OR 5,03 (IC95% 3,11-8,13) y la HTA OR 4,31 (IC95% 2,64-7,03) se ponderan significativos en un modelo de ajuste logístico aquí estudiado. El 61,69% de los hipertensos refería adherencia al tratamiento farmacológico prescrito. Discusión:el tamizaje de AOS es factible con un cuestionario aplicable en la práctica clínica diaria. De la probabilidad clínica pre-test hay que partir hacia métodos diagnósticos específicos para el diagnóstico de AOS, enfatizando casos de HTA resistente, HTA nocturna y HTA enmascarada. Se deberían realizar estudios locales que nos ayuden a comprender las causas de la falta de adherencia a fármacos antihipertensivos en una fracción importante de los individuos con HTA


Introduction:there is a suspicion about the bidirectional relationship between obstructive sleep apnea (OSA) and arterial hypertension (AHT). Both have a synergistic action on cardiovascular outcomes, so it is important to assess the prevalence of risk for OSA in hypertensive patients. In this last group we have also investigated the rate of adherence to prescribed drugs.Metodology:through a case-control study and with the application of the STOP-BANG questionnaire, the risk categories for sleep apnea in the two cohorts have been discriminated. For the analysis of adherence to antihypertensive drugs, the abbreviated Morisky questionnaire was used. Results:590 individuals were included (295 cases and 295 controls. A high risk for OSA was observed in the hypertensive group (36.6%) compared to 14.2% in the control group. On the other hand, the male sex OR 7.77 (95%CI 4.33-13.84), obesity OR 5.03 (95%CI 3.11-8.13) and hypertensionOR4.31(95%CI 2.64-7.03) they areweighted significant in a logistic adjustment model studied here.61.69% of hypertensive patients reported adherence to the prescribed pharmacological treatment.Discussion:OSA screening is feasible with a questionnaire applicable in daily clinical practice. From the pre-test clinical probability, specific diagnostic methods for the diagnosis of OSA must be started, emphasizing cases of resistant AHT, nocturnal AHT, andmasked AHT. Local studies should be carried out to help us understand the causes of non-adherence to antihypertensive drugs in a significant fraction of individuals with AHT


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Risk Assessment , Sleep Apnea, Obstructive , Sleep Apnea, Obstructive/epidemiology , Treatment Adherence and Compliance , Obesity , Paraguay/epidemiology , Surveys and Questionnaires , Waist-Hip Ratio , Hypertension , Antihypertensive Agents
14.
Acta odontol. Colomb. (En linea) ; 12(2): 52-60, Jul-Dec. 2022. tab, tab, graf, tab, tab
Article in Spanish | LILACS | ID: biblio-1397170

ABSTRACT

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.


Subject(s)
Oral Manifestations , Antihypertensive Agents , Hypertension
15.
Rev. méd. Maule ; 37(1): 53-60, jun. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1397628

ABSTRACT

Hypertension in black patients is usually more frequent and associated with higher morbidity and mortality. Due to demographic changes in the Chilean population, dealing with this group of patients has become more frequent. The case of a young Haitian patient with severe hypertension and target organ damage is presented.


Subject(s)
Humans , Male , Adult , Cardiovascular Diseases/diagnosis , Hypertension/diagnosis , Hypertension/drug therapy , Blood Pressure Determination , Prevalence , Black People , Hypertension/complications , Hypertension/physiopathology , Hypertension/epidemiology , Antihypertensive Agents
17.
Rev. bras. hipertens ; 29(1): 14-18, 10 març. 2022. tab
Article in Portuguese | LILACS, CONASS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-1367456

ABSTRACT

ABSTRACT Clinical case of a female patient referred to our Institution at the age of seven years old with Systemic Arterial Hypertension. The patient had been severely obese since she was 4 years old and high blood pressure levels were detected in several medical consultations a few months ago. She has a history of prematurity, a sedentary lifestyle, and an inadequate diet, in addition to a family history of obesity and high blood pressure. We discussed the investigation of the etiology, the presence of target organ lesions, and the treatment of arterial blood pressure in youth. In the follow-up, there was adequate control of blood pressure after initiation of angiotensin-converting enzyme inhibitor, with great difficulty in weight reduction. Even under nutritional guidelines and reinforcement regarding lifestyle changes, the patient had a weight gain of 25 kilos. We report this case in view of the significant increase in the prevalence of Systemic Arterial Hypertension in children and adolescents. There are multifactorial aspects to the development of this scenario, largely associated with an inadequate lifestyle. The difficulties related to its management and the presence of comorbidities, especially obesity, highlight the need for a multidisciplinary approach so that the evolution of the patient's condition becomes as desired.


RESUMO Caso clínico de uma paciente do sexo feminino, encaminhada a nossa Instituição aos sete anos de idade por provável Hipertensão Arterial Sistêmica. A paciente apresentava obesidade grave desde os quatro anos e há alguns meses foram detectadas medidas de pressão arterial elevadas em várias consultas médicas. Tem antecedentes de prematuridade, sedentarismo e dieta inadequada, além de história familiar também de obesidade e hipertensão arterial. Discutimos as condutas quanto a investigação da etiologia, da presença de lesões de órgãos alvo e do tratamento. Na evolução, houve controle adequado da pressão arterial após início de inibidores da enzima de conversão da angiotensina, mas grande dificuldade na redução do peso. Ao longo do seguimento, mesmo sob orientações nutricionais e reforço quanto a modificações do estilo de vida, a paciente apresentou ganho ponderal de 25 quilos. Relatamos este caso atendendo a necessidade de discussão do tema frente ao aumento significativo da prevalência de HAS em crianças e adolescente. Existem aspectos multifatoriais para o desenvolvimento da hipertensão arterial na infância, em grande parte associada a um estilo de vida inadequado. As dificuldades relacionadas ao seu manejo a presença de comorbidades, em especial da obesidade, ressaltam a necessidade de uma abordagem multiprofissional para que a evolução do quadro da paciente venha a ser o desejado.


Subject(s)
Humans , Female , Child , Sedentary Behavior , Pediatric Obesity , Hypertension/drug therapy , Antihypertensive Agents/therapeutic use
18.
Arq. bras. cardiol ; Arq. bras. cardiol;118(3): 614-622, mar. 2022. tab
Article in English, Portuguese | LILACS | ID: biblio-1364355

ABSTRACT

Resumo Fundamento Aparentemente, a pior resposta a algumas classes de anti-hipertensivos, especialmente inibidores da enzima conversora da angiotensina e bloqueadores de receptor de angiotensina, pela população negra, explicaria, pelo menos parcialmente, o pior controle da hipertensão entre esses indivíduos. Entretanto, a maioria das evidências vêm de estudos norte-americanos. Objetivos Este estudo tem o objetivo de investigar a associação entre raça/cor da pele autorrelatadas e controle de PA em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil) utilizando várias classes de anti-hipertensivos em monoterapia. Métodos O estudo envolveu uma análise transversal, realizada com participantes da linha de base do ELSA-Brasil. O controle de pressão arterial foi a variável de resposta, participantes com valores de PA ≥140/90 mmHg foram considerados descontrolados em relação aos níveis de pressão arterial. A raça/cor da pele foi autorrelatada (branco, pardo, negro). Todos os participantes tiveram que responder perguntas sobre uso contínuo de medicamentos. A associação entre o controle de PA e raça/cor da pele foi estimada por regressão logística. O nível de significância adotado nesse estudo foi de 5%. Resultados Do total de 1.795 usuários de anti-hipertensivos em monoterapia na linha de base, 55,5% se declararam brancos, 27,9%, pardos e 16,7%, negros. Mesmo depois de padronizar em relação a variáveis de confusão, negros em uso de inibidores da enzima conversora de angiotensina (IECA), bloqueadores de receptor de angiotensina (BRA), diuréticos tiazídicos (DIU tiazídicos) e betabloqueadores (BB) in monoterapia tinham controle de pressão arterial pior em comparação a brancos. Conclusões Os resultados deste estudo sugerem que, nesta amostra de brasileiros adultos utilizando anti-hipertensivos em monoterapia, as diferenças de controle de pressão arterial entre os vários grupos raciais não são explicadas pela possível eficácia mais baixa dos IECA e BRA em indivíduos negros.


Abstract Background It seems that the worst response to some classes of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, on the part of the Black population, would at least partially explain the worse control of hypertension among these individuals. However, most of the evidence comes from American studies. Objectives This study aims to investigate the association between self-reported race/skin color and BP control in participants of the Longitudinal Study of Adult Health (ELSA-Brasil), using different classes of antihypertensive drugs in monotherapy. Methods The study involved a cross-sectional analysis, carried out with participants from the baseline of ELSA-Brasil. Blood pressure control was the response variable, participants with BP values ≥140/90 mmHg were considered out of control in relation to blood pressure levels. Race/skin color was self-reported (White, Brown, Black). All participants were asked about the continuous use of medication. Association between BP control and race/skin color was estimated through logistic regression. The level of significance adopted in this study was of 5%. Results Of the total of 1,795 users of antihypertensive drugs in monotherapy at baseline, 55.5% declared themselves White, 27.9% Brown, and 16.7% Black. Even after adjusting for confounding variables, Blacks using angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB), thiazide diuretics (thiazide DIU), and beta-blockers (BB) in monotherapy had worse blood pressure control compared to Whites. Conclusions Our results suggest that in this sample of Brazilian adults using antihypertensive drugs in monotherapy, the differences in blood pressure control between different racial groups are not explained by the possible lower effectiveness of ACEIs and ARBs in Black individuals.


Subject(s)
Humans , Adult , Hypertension/drug therapy , Hypertension/epidemiology , Antihypertensive Agents/therapeutic use , Antihypertensive Agents/pharmacology , United States , Blood Pressure , Brazil , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Calcium Channel Blockers/therapeutic use , Cross-Sectional Studies , Longitudinal Studies , Angiotensin Receptor Antagonists/therapeutic use , Race Factors
19.
Rev. Univ. Ind. Santander, Salud ; 54(1): e502, Enero 2, 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1407040

ABSTRACT

Resumen Introducción: La hipertensión arterial sistémica (HTA) constituye el principal factor de riesgo para morbilidad y mortalidad cardiovascular a nivel global, afecta a todas las edades, sin distinción de género y etnicidad. Su tratamiento continúa constituyendo un reto, dada la persistencia del pobre control, especialmente en países como Colombia. Objetivo: Mostrar la evidencia disponible respecto al tratamiento actualizado de la HTA y la elección certera de los agentes antihipertensivos acorde con la individualidad de cada paciente. Asimismo, consolidar y comparar el efecto hipotensor de cada agente antihipertensivo más usado. Metodología: Se realizó una búsqueda avanzada con los términos DeCS y MeSH: hipertensión, agentes antihipertensivos, hipertensión esencial y terapia combinada, en los motores de búsqueda PubMed, Clinical Key, Lilacs, Scielo. Un total de 109 artículos se seleccionaron para elaborar en la presente revisión de la literatura. Conclusiones: La individualización del manejo de la HTA lleva al reconocimiento de los distintos fenotipos, la presencia de complicaciones, el examen físico, el género y la raza como puntos fundamentales para elegir el agente antihipertensivo más adecuado que permita alcanzar las metas de control y propenda por la reducción y prevención de las complicaciones derivadas de un control no óptimo.


Abstract Introduction: Systemic arterial hypertension (HT) constitutes the main risk factor for cardiovascular morbidity and mortality at a global level, affecting all ages regardless of gender and ethnicity. Its treatment continues to be a challenge, given the persistence of poor control, especially in countries like Colombia. Objective: To show the available evidence regarding the updated treatments of HT and the correct choice of antihypertensive agents according to the individual needs of each patient. Likewise, to consolidate and compare the hypotensive effect of the most used antihypertensive agents. Methodology: An advanced search was carried out with the terms DeCS and MeSH: Hypertension, antihypertensive agents, Essential Hypertension and Combination Therapy through the search engines PubMed, Clinical Key, Lilacs, Scielo. A total of 109 articles were selected to prepare the present literature review. Conclusions: An individualized hypertension treatment plan leads to the recognition of the different phenotypes, the presence of complications, the gender, and race, which are fundamental aspects to consider when choosing the appropriate antihypertensive agents. These findings allow for the achievement of the desired blood pressure target and leads to reduction and prevention of complications derived from suboptimal control.


Subject(s)
Humans , Male , Female , Essential Hypertension , Hypertension , Antihypertensive Agents
20.
Florianópolis; Secretaria de Estado da Saúde; 20220000. 127 p il. color..
Monography in Portuguese | LILACS, CONASS, ColecionaSUS, SES-SC | ID: biblio-1415287

ABSTRACT

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.


Subject(s)
Humans , Unified Health System , Hypertension, Pulmonary/drug therapy , Antihypertensive Agents/administration & dosage , State Government , Clinical Protocols , Practice Guidelines as Topic
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