Eritema fijo pigmentado generalizado por ARAII / Generalized fixed pigmented erythema due to ARBS

RESUMEN El eritema fijo pigmentado es una toxicodermia que puede afectar la piel o las mucosas. Tiende a recurrir en las mismas localizaciones tras la administración repetida del agente desencadenante. Los principales grupos farmacológicos asociados han sidoanalgésicos, antiepilépticos y AINES. Clínicamente, hayaparición de placaseritemato-edematosas redondas u ovaladas, definidas. Existen diferentes variantes;la generalizada es una de las menos frecuentes. Se reporta el caso de un paciente de mediana edad, quien presentó un cuadro deeritema fijo pigmentadogeneralizado, asociado al uso de ARA II. Es el primer caso reportado de esta patología secundaria al uso de dicho grupo farmacológico.

SUMMARY Pigmented fixed erythema is a toxicoderma, it can affect the skin or mucous membranes. It tends to recur in the same locations after repeated administration of the triggering agent.1 The main associated pharmacological groups have been: analgesics, antiepileptics and NSAIDs. Clinically, there is the appearance of defined round or oval erythematous-edematous plaques. There are different variants, the generalized is one of the least frequent. The case of a middle-aged patient is reported, who presented a generalized fixed pigmented erythema, associated with ARBS, it is the first reported case of this pathology secondary to the use of said pharmacological group.

Current status of blood pressure control in elderly hypertensive patients under the antihypertensive standard recommended by Chinese experts / 中华老年心脑血管病杂志

Objective To analyze the antihypertensive compliance rate,drug use and complication distribution among very old hypertensive inpatients under the antihypertensive standard of 150/90 mm Hg in our country(1 mm Hg=0.133 kPa).Methods A total of 409 hospitalized patients aged ≥80 years and diagnosed with hypertension in all departments of Air Force Medical Center of PLA were enrolled,and according to their clinical outcomes,they were divided into intensive antihypertensive group(106 cases,SBP＜130 mm Hg),standard antihypertensive group(155 ca-ses,SBP 130-149 mm Hg)and non-standard blood pressure group(148 cases,SBP ≥150 mm Hg).The status of blood pressure control was analyze in each group.Results When 150/90 mm Hg was used as the blood pressure standard,25.9％were in the intensive blood pressure group,37.9％were in the standard blood pressure group,36.2％were in the non-standard blood pressure group.The proportion of patients aged＞90 years was significantly lower in the non-standard blood pressure group than the intensive antihypertensive group and the standard anti-hypertensive group(4.1％vs 7.5％and 12.3％,P＜0.05).The ratio of single-drug therapy was significantly higher in the standard antihypertensive group than the intensive antihypertensive group(46.5％vs 32.1％,P＜0.05),and that of dual combination therapy was obviously higher in the intensive antihypertensive group than the standard antihypertensive group(35.8％vs 22.6％,P＜0.05).The proportions of heart damage and cerebrovascular damage were significantly higher(43.4％vs 21.9％,26.4％vs 14.8％),and the proportion of complicated retinopathy was notably lower(11.3％vs 23.9％)in the intensive antihypertensive group than the standard antihypertens-ive group(P＜0.05).Conclusion For very old hypertensive patients in our country,it is more sci-entific and practical to use 150/90 mm Hg as the starting standard for blood pressure reduction.Intensified blood pressure reduction increases cardiovascular and cerebrovascular damages in them instead.

Research progress on combined treatment of physical exercise and anti-hypertensive drugs for hypertension in elderly people / 中华老年医学杂志

Hypertension has a high prevalence in China, and the predominant reliance on drug treatment consumes enormous medical resources.Physical exercise is the only widely-accepted nonpharmacologic therapy for hypertension and is potentially cost-effective.How to incorporate exercise into a prescription for rational treatment of hypertension is a topic that needs to be addressed.This review examines the research progress on the treatment of hypertension combining physical exercise with anti-hypertensive drugs in elderly people, aiming to provide some information and options to promote personalized treatment strategies for hypertension in elderly people.

Effect of amlodipine/benazepril tablets on blood pressure and cardiac function in older adults with hypertension complicated by coronary heart disease / 中国基层医药

Objective:To investigate the effect of amlodipine/benazepril tablets on blood pressure control and cardiac function improvement in older adult patients with hypertension complicated by coronary heart disease.Methods:A randomized controlled clinical study was conducted on 98 older adult patients with hypertension complicated by coronary heart disease who were diagnosed and treated at Liaoning Jinqiu Hospital between February 2020 and February 2022. The patients were randomly divided into an observation group and a control group, with 49 patients in each group using a random lottery method. The control group was treated with amlodipine tablets, while the observation group was treated with amlodipine/benazepril tablets for 3 months. Blood pressure levels and cardiac function improvement were compared between the two groups.Results:Prior to treatment, there were no statistically significant differences in diastolic blood pressure, systolic blood pressure, cardiac function indices, and inflammatory factor levels between the two groups (all P > 0.05). After treatment, the observation group exhibited lower levels of diastolic blood pressure and systolic blood pressure [(88.74 ± 4.26) mmHg, (125.47 ± 6.23) mmHg, 1 mmHg = 0.133 kPa] compared with the control group [(95.71 ± 4.55) mmHg, (134.28 ± 6.10) mmHg, t = 7.07, 7.82, both P < 0.001]. After treatment, the observation group showed lower levels of endothelin 1 and higher levels of nitric oxide compared with the control group ( t = 5.02, 4.96, both P < 0.05). After treatment, the observation group demonstrated lower left ventricular end-systolic diameters [(44.04 ± 3.26) mm vs. (48.58 ± 3.19) mm, t = 6.96, P < 0.001], lower left ventricular end-diastolic diameters [(52.07 ± 4.11) mm vs. (60.12 ± 4.30) mm, t = 9.47, P < 0.001], and higher levels of left ventricular ejection fraction [(54.08 ± 3.06)% vs. (47.50 ± 3.22)%, t = 10.36, P < 0.001] compared with the control group. The levels of tumor necrosis factor-alpha, interleukin-6, and C-reactive protein in the observation group were significantly lower than those in the control group ( t = 5.53, 12.48, 13.45, all P < 0.001). Conclusion:Amlodipine/benazepril tablets are effective in facilitating the recovery of cardiac and vascular endothelial function in older adult patients with hypertension complicated by coronary heart disease. Furthermore, they improve blood pressure control and mitigate the inflammatory response in the body.

Effect of intensive blood pressure control after successful endovascular therapy on outcomes in patients with anterior circulation stroke: a multicentre, open-label, blinded-endpoint, randomized controlled trial / 国际脑血管病杂志

Objective:To compare the effects of intensive and standard blood pressure control on the outcomes of patients with acute ischemic stroke in the anterior circulation who have successfully recanalized after endovascular therapy (EVT).Methods:A multicenter, open-label, blinded-endpoint, randomized controlled design was used. Patients with anterior circulation stroke received EVT and successfully recanalized in Nanjing First Hospital, Nanjing Medical University and several branch hospitals from July 2020 to October 2022 were prospectively included. They were randomly divided into the intensive blood pressure control group (target systolic blood pressure [SBP] 100-120 mmHg) or the standard blood pressure control group (target SBP 121-140 mmHg). The blood pressure of both groups needs to achieve the target within 1 h and maintain for 72 h. The primary outcome endpoint was outcome at 90 d, and the good outcome was defined as a score of 0-2 on the modified Rankin Scale. Secondary outcome endpoints included early neurological improvement, symptomatic intracranial hemorrhage (sICH) within 24 h, and death and serious adverse events within 90 d.Results:A total of 120 patients were included, including 63 in the intensive blood pressure control group and 57 in the standard blood pressure control group. There was no statistically significant difference in baseline characteristics between the two groups. The SBP at 72 h after procedure was 122.7±8.1 mmHg in the intensive blood pressure control group and 130.2±7.4 mmHg in the standard blood pressure control group, respectively. There were no significantly differences in the good outcome rate (54.0% vs. 54.4%; χ2=0.002, P=0.963), the early neurological improvement rate (45.2% vs. 34.5%; χ2=1.367, P=0.242), the incidence of sICH (6.3% vs. 3.5%; P=0.682), mortality (7.9% vs. 14.0%; χ2=1.152, P=0.283) and the incidence of serious adverse events (12.7% vs. 15.8%; χ2=0.235, P=0.628) at 90 d between the intensive blood pressure control group and the standard blood pressure control group. Conclusion:In patients with anterior circulation stroke and successful revascularization of EVT, early intensive blood pressure control don’t improve clinical outcomes and reduce the incidence of sICH.

Trombosis de seno venoso en paciente en puerperio mediato. Reporte de caso / Venous sinus thrombosis in a patient during the immediate puerperium. Case report

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.

Moving toward improved access to medicines and health technologies for cardiovascular disease / Avanzando para mejorar el acceso a los medicamentos y tecnologías sanitarias para las enfermedades cardiovasculares / Avançando para melhorar o acesso a medicamentos e tecnologias de saúde para as doenças cardiovasculares

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.

Choque vasopléjico por envenenamiento con amlodipino y losartán

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.

Hipertensión arterial en paciente de raza negra: a propósito de un caso / Hypertension in a black patient: a purpose of a case

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.

Bloqueadores do Receptor de Angiotensina Avaliados por Medida de Consultório e Residencial da Pressão Arterial. Estudo TeleMRPA / Angiotensin Receptor Blockers Evaluated by Office and Home Blood Pressure Measurements. TeleHBPM Study

Resumo Fundamento O tratamento adequado e a obtenção das metas na hipertensão arterial são importantes na redução dos desfechos cardiovasculares. Objetivos Descrever os bloqueadores do receptor de angiotensina (BRA) em monoterapia ou combinação dupla e a taxa de controle da hipertensão arterial. Métodos Estudo transversal que avaliou pacientes em uso de BRA entre 2017 e 2020. Foram excluídos aqueles em uso de três ou mais anti-hipertensivos. As variáveis analisadas foram: sexo, idade, índice de massa corporal, medidas válidas da medida residencial da pressão arterial (MRPA); pressão arterial sistólica (PAS) e diastólica (PAD) obtidas pela MRPA e de forma casual; variabilidade pressórica; classe dos anti-hipertensivos e dos BRAs. Foram utilizados testes de t pareado, qui-quadrado e Fisher, além de sobreposição dos intervalos de confiança de 95% com nível de significância de 5% (p < 0,05). Resultados Foram selecionados 17.013 pacientes; destes, 12.813 preencheram os critérios, dos quais 62,1% eram do sexo feminino. O número médio de medidas válidas foi de 23,3 (±2,0), com médias para a PAS de 126,8±15,8 mmHg e 133,5±20,1 mmHg (p < 0,001) e para a PAD de 79,1±9,7 mmHg e 83,6±11,9 mmHg (p < 0,001) pela MRPA e medida casual, respectivamente. Losartana foi o BRA mais utilizado e o que apresentou comportamentos mais elevados da pressão arterial. As combinações de BRA com diuréticos ou com antagonistas de canal de cálcio tiveram menores valores de pressão arterial. Conclusões Losartana foi utilizada em mais da metade dos pacientes, apesar de ser a menos eficiente na redução e no controle da pressão arterial.

Abstract Background Adequate treatment of arterial hypertension and achieving arterial hypertension goals in are important in reducing cardiovascular outcomes. Objectives To describe angiotensin receptor blockers in monotherapy or double combination therapy and the rate of arterial hypertension control. Methods This cross-sectional study evaluated patients who were using angiotensin receptor blockers between 2017 and 2020. Those using three or more antihypertensive drugs were excluded. The analyzed variables included sex, age, body mass index, valid home blood pressure monitoring (HBPM) measurements, casual and HBPM systolic and diastolic blood pressure measurements, blood pressure variability, and antihypertensive and angiotensin receptor blocker class. Paired t, chi-square, and Fisher's exact tests were used, as well as overlapping 95% confidence intervals and a significance level of 5% (p < 0.05). Results Of 17,013 patients, 12,813 met the inclusion criteria, 62.1% of whom were female. The mean number of valid measurements was 23.3 (SD, 2.0). The mean HBPM and casual measurements for systolic blood pressure were 126.8 (SD, 15.8) mmHg and 133.5 (SD, 20.1) mmHg (p <0.001), respectively, while those for diastolic blood pressure were 79.1 (SD, 9.7 mmHg) and 83.6 (SD, 11.9) mmHg (p <0.001), respectively. Losartan was the most common angiotensin receptor blocker and resulted in the highest blood pressure values. Combinations of angiotensin receptor blockers with diuretics or calcium channel antagonists resulted in lower blood pressure values. Conclusions More than half of the patients used losartan, although it was the least efficient drug for reducing and controlling blood pressure.

Diferenças Raciais no Controle da Pressão Arterial em Usuários de Anti-Hipertensivos em Monoterapia: Resultados do Estudo ELSA-Brasil / Racial Differences in Blood Pressure Control from Users of Antihypertensive Monotherapy: Results from the ELSA-Brasil Study

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.

Hipertensión arterial esencial: ¿cuál agente antihipertensivo elegir? / Essential hypertension: which antihypertensive agent to choose?

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.

Blood pressure management of acute ischemic stroke / 国际脑血管病杂志

Hypertension plays a unique role in the pathogenesis and outcomes of acute ischemic stroke. Therefore, blood pressure management, especially blood pressure regulation in acute stage, is of great significance for the treatment of acute ischemic stroke. However, there is no unified antihypertensive scheme for acute stroke. This article reviews the related research progress of blood pressure management in acute ischemic stroke.

Developing population-based hypertension control programs / Creación de programas de control de la hipertensión basados en la población / Desenvolvimento de programas de controle da hipertensão de base populacional

ABSTRACT Hypertension remains the leading cause of cardiovascular disease globally despite the availability of safe and effective treatments. Unfortunately, many barriers exist to controlling hypertension, including a lack of effective screening and awareness, an inability to access treatment and challenges with its management when it is treated. Addressing these barriers is complex and requires engaging in a systematic and sustained approach across communities over time. This analysis aims to describe the key elements needed to create an effective delivery system for hypertension control. A successful system requires political will and supportive leadership at all levels of an organization, including at the point of care delivery (office or clinic), in the health care system, and at regional, state and national levels. Effective screening and outreach systems are necessary to identify individuals not previously diagnosed with hypertension, and a system for follow up and tracking is needed after people are diagnosed. Implementing simple protocols for treating hypertension can reduce confusion among providers and increase treatment efficiency. Ensuring easy access to safe, effective and affordable medications can increase blood pressure control and potentially decrease health care system costs. Task-sharing among members of the health care team can expand the services that are delivered. Finally, monitoring of and reporting on the performance of the health care team are needed to learn from those who are doing well, disseminate ideas to those in need of improvement and identify individual patients who need outreach or additional care. Successful large-scale hypertension programs in different settings share many of these key elements and serve as examples to improve systems of hypertension care delivery throughout the world.

RESUMEN A pesar de la disponibilidad de tratamientos seguros y efectivos, la hipertensión sigue siendo la principal causa de enfermedad cardiovascular a nivel mundial. Lamentablemente, el control de la hipertensión enfrenta muchos obstáculos, como la falta de detección y concientización efectivas, la incapacidad de acceder al tratamiento y los retos que plantea su manejo cuando se recibe tratamiento. Resulta complejo abordar estos obstáculos; se debe adoptar un enfoque sistemático y sostenido en todas las comunidades a lo largo del tiempo. El presente análisis tiene como objetivo describir los elementos clave necesarios para crear un sistema de atención eficaz para el control de la hipertensión. Un sistema adecuado precisa voluntad política y un liderazgo que brinde apoyo en todos los niveles de una organización, incluido el punto donde se presta la atención (consultorio o clínica), el sistema de atención de salud y a nivel regional, estatal y nacional. Se necesitan sistemas efectivos de detección y de alcance comunitario para encontrar a las personas sin diagnóstico previo de hipertensión, así como un sistema para el seguimiento y la localización una vez han sido diagnosticadas. La aplicación de protocolos simples para tratar la hipertensión puede reducir la confusión entre los proveedores y aumentar la eficiencia del tratamiento. Garantizar un acceso fácil a medicamentos seguros, efectivos y asequibles puede aumentar el control de la presión arterial y potencialmente disminuir los costos para el sistema de atención de salud. La distribución de tareas entre los miembros del equipo de atención de salud permite expandir los servicios que se prestan. Finalmente, es necesario dar seguimiento al desempeño del equipo de atención de salud y presentar información al respecto, a fin de aprender de las buenas prácticas, difundir ideas entre quienes necesitan mejorar y determinar a cuáles pacientes se debe llegar y cuáles necesitan atención adicional. Los programas de hipertensión a gran escala con buenos resultados en diferentes entornos comparten muchos de estos elementos clave y sirven como ejemplos para mejorar la atención de la hipertensión en todo el mundo.

RESUMO A hipertensão continua sendo a principal causa de doenças cardiovasculares no mundo, apesar da disponibilidade de tratamentos seguros e eficazes. Infelizmente, existem muitas barreiras para o controle da hipertensão, incluindo a falta de rastreamento e a conscientização eficazes, a incapacidade de acesso ao tratamento e desafios de conduta clínica quando ela é tratada. A abordagem dessas barreiras é complexa e requer um enfoque sistemático e sustentado em diferentes comunidades ao longo do tempo. Esta análise tem como objetivo descrever os elementos-chave necessários para criar um sistema eficaz de prestação de intervenções para o controle da hipertensão. Um sistema de sucesso requer vontade política e liderança que o apoie em todos os níveis de uma organização, inclusive no ponto da prestação de cuidados (consultório ou clínica), no sistema de saúde e nos níveis regional, estadual e nacional. Sistemas eficazes de triagem e acolhida são necessários para identificar indivíduos com hipertensão não diagnosticada, e um sistema de acompanhamento e rastreamento após o diagnóstico se faz igualmente necessário. A implementação de protocolos simples para o tratamento da hipertensão pode reduzir a confusão entre os profissionais de saúde e aumentar a eficiência do tratamento. Garantir o fácil acesso a medicamentos seguros, eficazes e acessíveis pode aumentar o controle da pressão arterial e potencialmente diminuir os custos do sistema de saúde. A divisão de tarefas entre os integrantes da equipe de saúde pode expandir os serviços prestados. Finalmente, é necessário monitorar e informar acerca do desempenho da equipe de saúde para aprender com aqueles que estão indo bem, disseminar ideias para aqueles que precisam melhorar e identificar pacientes individuais que precisam de ajuda ou cuidados adicionais. Programas bem-sucedidos de controle da hipertensão em larga escala em diferentes ambientes compartilham muitos desses elementos-chave e servem como exemplos para melhorar os sistemas de atenção à hipertensão em todo o mundo.

Avanzando para mejorar el acceso a los medicamentos y tecnologías sanitarias para las enfermedades cardiovasculares / Moving toward improved access to medicines and health technologies for cardiovascular disease / Avançando para melhorar o acesso a medicamentos e tecnologias de saúde para as doenças cardiovasculares

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.

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 drugs and devices for measuring blood pressure in the countries of the Region of the Americas, supporting implementation of the HEARTS initiative; and to present the preliminary results of price analyses of antihypertensive drugs. The study methodology included a review of reports made by the Strategic Fund during 2019-2020, evaluation of modalities of procurement, a review of the public procurement databases for five antihypertensive drugs, and a comparison with the price obtained by the Strategic Fund. Differences ranging from 20% to 99% were identified, indicating significant opportunities for savings. Interprogrammatic actions in support of the HEARTS initiative are also presented, such as the inclusion of antihypertensive drugs recommended by the World Health Organization; consolidation of regional demand and establishment of competitive prices with 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. Through this mechanism, Member States can reduce their costs significantly, enabling them to extend treatment and diagnostic coverage to more people.

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.

Prevalence of insulin resistance among hypertensive patients undergoing antihypertensive therapy

Background:Hypertensive patients undergoing antihypertensive therapy are more prone to insulin resistance (IR). Thus, it is essential to monitor its prevalence, metabolic consequences and to individualize antihypertensive therapy to negate its potential adverse effects. Therefore, the presented study assessed the prevalence of IR among hypertensive patients undergoing antihypertensive therapy. Methodology:This prospective study involved 200 patients of either sex, diagnosed with essential hypertension, and undergoing treatment. Data regarding age, gender, medical history, body mass index (BMI), and waist circumference were collected. Laboratory investigations for fasting blood sugar levels, serum fasting Insulin levels, lipid profile, and glycosylated hemoglobin were performed. Homeostatic model assessment of IR (HOMAIR) was calculated. Statistical analysis was performed by using R software (Version. 3.6.0).Results:The prevalence of IR in hypertensive nondiabetic patients was 39%. The mean age and BMI of patients were 58.70 ± 16.64 year and 23.10 ± 2.57 kg/m2, respectively. The mean fasting blood sugar levels were 108.24 ± 20.99 mg/ dl. The mean HOMAIR levels were >2.8. IR was more in users of beta-blockers than in angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers, as a significant association was observed between the class of hypertensive drugs and presence of IR (P< 0.05). Asignificant association (P< 0.05) was observed between the duration of hypertension and IR indicated by HOMAIR >2.5 in patients on beta-blockers and on ACE inhibitors. Conclusion:Antihypertensive drugs like beta-blockers decrease insulin sensitivity in hypertensive patients leading to increased prevalence of IR

Factores asociados a la no-adherencia al tratamiento farmacológico antihipertensivo en pacientes de un hospital del seguro social / Factors associated with non-adherence to antihypertensive treatment in patients with social security

Introducción: La falta de adherencia a la terapia antihipertensiva contribuye directamente a que los pacientes coexistan con hipertensión, desencadenando mayor riesgo de morbilidad y mortalidad. Así, la falta de adherencia al tratamiento se convierte en una de las principales causas de hipertensión no controlada en la población. Evaluamos los factores asociados a la no-adherencia al tratamiento antihipertensivo en pacientes de cardiología de un hospital de EsSalud en San Juan de Lurigancho-Lima, durante el 2017. Material y Métodos: Estudio analítico-transversal, se incluyeron pacientes que acudieron a consultorio externo de cardiología con historia previa de hipertensión esencial y se excluyeron hipertensión secundaria por otras causas biológicas. Se utilizó el Test de Morisky-Green Morisky Medication Adherence Scale (MMAS-4) para evaluar la no-adherencia al tratamiento antihipertensivo. Resultados: De los 270 participantes de estudio, el 69% (n=185) eran adultos mayores de 65 años, 46% (n=124) varones y el 76% (n=118) tenían pareja estable. Entre los antecedentes clínicos, el 60% (n=122) reportó diagnóstico clínico de hipertensión arterial, el 30% (n=80) de diabetes mellitus tipo II y el 27% (n=73) no-adherencia al tratamiento. Los factores asociados a la no-adherencia de tratamiento fueron sexo masculino (ORa: 0,45, IC95% 0,20-1,04), trabajador independiente (ORa:3,88, IC95% 1,51-9,97), IMC mayor de 30 (ORa:0,23, IC95% 0,07-0,70). Conclusiones: en los pacientes con diagnóstico de hipertensión esencial existen factores de riesgo modificables y no modificables asociados a la no-adherencia al tratamiento. Se deben considerar estos factores para implementar estrategias de tamizaje y focalizar las intervenciones para adherir a los pacientes renuentes a su tratamiento.

Background:Lack of adherence to antihypertensive therapy contributes directly to patients coexisting with hypertension, triggering increased risk of morbidity and mortality. Thus, nonadherence to treatment becomes one of the main causes of uncontrolled hypertension in the population. We evaluated the factors associated with non-adherence to antihypertensive treatment in cardiology patients of an EsSalud hospital in San Juan de Lurigancho-Lima, during 2017. Material and Methods: Analytical-crossover study, patients attending cardiology outpatient clinic with previous history of essential hypertension were included and secondary hypertension due to other biological causes were excluded. The Morisky-Green Morisky Medication Adherence Scale (MMAS-4) was used to assess non-adherence to antihypertensive treatment. Results: Of the 270 study participants, 69% (n=185) were adults older than 65 years, 46% (n=124) were male and 76% (n=118) had a stable partner. Among the clinical history, 60% (n=122) reported clinical diagnosis of arterial hypertension, 30% (n=80) of type II diabetes mellitus and 27% (n=73) non-adherence to treatment. Factors associated with non-adherence to treatment were male sex (ORa: 0.45, 95%CI 0.20-1.04), self-employed (ORa:3.88, 95%CI 1.51-9.97), BMI greater than 30 (ORa:0.23, 95%CI 0.07-0.70). Conclusions: in patients with a diagnosis of essential hypertension there are modifiable and non-modifiable risk factors associated with non-adherence to treatment. These factors should be considered in order to implement screening strategies and target interventions to adhere to treatment in reluctant patients.

Desabastecimiento de antidiabéticos y antihipertensivos en el contexto de la crisis por la COVID-19 en Perú

Introducción: Un adecuado abastecimiento de medicamentos en los establecimientos de salud aumentará la posibilidad de un adecuado control de la hipertensión y la diabetes. Objetivo: Determinar el desabastecimiento de antidiabéticos y antihipertensivos a nivel nacional en el contexto de la crisis por COVID-19. Material y métodos: Análisis del "Sistema integrado de suministro de medicamentos e insumos médicos quirúrgicos" (SISMED) entre el 13 de junio y 15 de julio del 2020, de acuerdo a la lista del "Petitorio nacional único de medicamentos de medicamentos esenciales" (PNUME) del Ministerio de Salud. Resultados: Entre el 16 % y 24% de las regiones están totalmente desabastecidos en al menos un antidiabético y 4 % y 96 % en al menos un antihipertensivo. El antidiabético más desabastecido fue la Metformina de 500 mg y los antihipertensivos más desabastecidos fueron Labetalol 5 mg/ml iny, Atenolol 50 mg tab y Carvedilol 6.25 mg tab. El desabastecimiento fue porcentualmente mayor en hospitales y los institutos especializados en comparación con centros y puestos de salud según región geográfica. Conclusiones: Existe un desabastecimiento de antihipertensivos y antidiabéticos en los establecimientos de salud, el cual es heterogéneo en las diferentes regiones del Perú.

Introduction: An adequate supply of medicines in health establishments will increase the possibility of adequate control of hypertension and diabetes. Objective: To determine the supply of antidiabetic and antihypertensive drugs at the national level in the context of the crisis by COVID-19. Material y methods: Analysis of the "Sistema Integrado de Suministro de Medicamentos e Insumos Médicos Quirúrgicos" (SISMED) Database, between June 13th and July 15th, 2020, according to the "National list for medicines of essential medicines" (PNUME) of Ministry of health. Results: Between 16% and 24% of the departments have a total shortage of at least one antidiabetic, and 4% and 96% of at least one antihypertensive. The most depleted antidiabetic was Metformin 500 mg, and the most depleted antihypertensive drugs were Labetalol 5 mg / ml iny, Atenolol 50 mg tab and Carvedilol 6.25 mg tab. The percentage of distribution was higher in hospitals and specialized institutes in comparison with primary health facilities. Conclusions: There is a shortage of antihypertensive and antidiabetic drugs in health centers in Peru.