Respuesta de los sujetos con hipertensión arterial a los fármacos antiagregantes plaquetarios / Response of hypertensive subjects to antiplatelet drugs

Introducción: La terapia con antiagregantes plaquetarios es recomendada como prevención secundaria de eventos cardiovasculares en personas con hipertensión arterial. Sin embargo, en la práctica clínica se encuentran personas que no responden al tratamiento y presentan recurrencia de eventos vasculares. Objetivo: Evaluar la respuesta de los sujetos hipertensos a los fármacos antiagregantes plaquetarios. Material y Métodos: Estudio transversal, observacional descriptivo y comparativo, con 299 sujetos con hipertensión arterial esencial y 96 no hipertensos (como control), que estaban consumiendo antiagregantes plaquetarios. Los sujetos hipertensos fueron agrupados de acuerdo con el consumo de fármacos antihipertensivos. Se les determinó su agregación plaquetaria al colágeno en plasma, rico en plaquetas, según el Método de Born. La respuesta a la terapia antiplaquetaria se clasificó en cuatro categorías (óptima, moderada, pobre y no respuesta) de acuerdo con la agregación plaquetaria. Resultados: Se observó una ligera mejor respuesta a los antiagregantes plaquetarios, aunque no estadísticamente significativa, por parte de los hipertensos sin fármacos antihipertensivos (35,7 por ciento óptima y 42,9 por ciento moderada), en relación con los hipertensos que usaban antihipertensivos (32,7 por ciento óptima y 26,5 por ciento moderada) y los no hipertensos (30,2 por ciento óptima y 30,2 por ciento moderada). Además, se encontró que 17,7 por ciento de los sujetos no hipertensos, 14,3 por ciento de los hipertensos sin fármacos antihipertensivos y 13,2 por ciento de los hipertensos con antihipertensivos no estaban respondiendo a los antiagregantes plaquetarios. Conclusiones: La respuesta a los fármacos antiagregantes plaquetarios de los sujetos hipertensos consuman o no fármacos antihipertensivos es heterogénea y similar a la de los sujetos no hipertensos(AU)

ABSTRACT Introduction: Therapy with antiplatelet drugs is recommended as secondary prevention of cardiovascular events in people with arterial hypertension. However, in the clinical practice, there are people who do not respond to treatment and evidence a recurrence of vascular events. Objective: To evaluate the response of hypertensive patients to antiplatelet drugs. Material and Methods: Cross-sectional, observational, descriptive and comparative study that included 299 subjects with arterial hypertension and 96 non-hypertensive subjects (control group) who were taking antiplatelet drugs. The hypertensive subjects were grouped according to the consumption of antihypertensive drugs. Platelet aggregation collagen in platelet-rich plasma was determined using the turbidimetric Born's method. The response to the antiplatelet therapy was classified in four categories (good, moderate, poor and non-responsiveness) in accordance with the platelet aggregation. Results: There was a slightly better response to antiplatelet drugs, although it was not statistically significant in hypertensive subjects without antihypertensive drugs (35,7 percent good and 42,9 percent moderate) in relation to hypertensive subjects who were taking antihypertensive drugs (32,7 percent good and 26,5 percent moderate) and the non-hypertensive ones (30,2 percent good and 30,2 percent moderate).Besides, it was found that 17,7 percent of non-hypertensive subjects and 14,3 percent of the hypertensive ones without antihypertensive drugs and 13,2 percent of hypertensive subjects with antihypertensive drugs were not responding to the treatment with antiplatelet drugs. Conclusions: The response of hypertensive patients to antiplatelet drugs, either taking antihypertensive drugs or not, is heterogeneous and similar to the response of the non-hypertensive subjects(AU)

Resumen comentado de las nuevas guías de la Sociedad Europea de Cardiología, Münich 25-29 de Agosto 2018 / Summary and Comments of the New Guides of the European Society of Cardiology held in Münich (august 2018)

El Congreso 2018 de la Sociedad Europea de Cardiología publicó cuatro nuevas guías de práctica clínica sobre: Hipertensión arterial, síncope, revascularización miocárdica y enfermedad cardiovascular durante el embarazo, así como un documento de consenso sobre la Cuarta Definición Universal del Infarto del Miocardio. Esta guías resumen toda la evidencia reciente, investigación y experticia relevante a estas condiciones cardiovasculares, proveyendo un recurso vital para los profesionales en su práctica clínica diaria y se han realizado de manera más concisa y mucho más visual con ilustraciones y amplio uso de gráficas y figuras(AU)

ESC Congress 2018 brought the release of four new ESC Clinical Practice Guidelines on: Arterial Hypertension; Syncope; Myocardial Revascularization; and Cardiovascular Diseases during Pregnancy, as well as a consensus document on the Fourth Universal Definition of Myocardial Infarction. This guidelines summarize all recent evidence, research and expertise relevant to these cardiovascular conditions and provides a vital resource for practicing healthcare professionals , made more concise and much more visual with illustrations and extensive use of graphics and figures(AU)

Relation between serum human cartilage glycoprotein and vascular endothelium of old hypertensive patients with metabolic syndrome / 中国综合临床

Objective To explore the concentration changing of human cartilage glycoprotein in elder hypertension patients with metabolic syndrome.Methods Thirty healthy people were served as control group.While 68 elder hypertension patients with metabolic syndrome were served hypertension group and they were divided into MS group and Non-MS group based on data of metabolic syndrome(MS) indicators.The serum YKL-40 concentration was measured by ELISA method,and the levels of hepatocyte growth factor(HGF),nitric oxide(NO),endothelin(ET) were also measured.Brachial artery flow mediated vasodilation(FMD) was used to assess endothelial function.Compared the difference of serum YKL-40 concentration of two groups and the relationship between YKL-40 and index of endothelial function.Results The concentration of serum YKL-40 in hypertension group was 51.8 (35.4,345.0) μg/L,higher than that of control group (33.4 (23.6,168.6)μg/L,Z =-3.156,P ＜ 0.01).The YKL-40 levels in control group,hypertemion group,Non-hypertension MS group,and hypertension MS group were 33.4 (23.6,168.6),51.8(35.4,345.0) μg/L,94.0(46.0,268.4),and 151.6(63.2,401.4) μg/L respectively,and the difference was significant.Serum YKL-40 concentration in hypertension group was higher than that of control group (Z =-3.156,P ＜ 0.01),while in hypertension MS group was higher than that of non-MS hypertension group(P =0.003).Of all study subjects,YKL-40 level was positively related to systolic blood pressure,diastolic blood pressure,body mass index,triglyceride (r =0.362,0.302,0.280,0.217,P ＜ 0.05) and was not corelate with FMD,ET,NO,HGF (P ＞ 0.05).Conclusion Serum YKL-40 concentration in patients with hypertension is related to blood pressure and not related to functional factors of vascular endothelium.

Barreiras ao tratamento da hipertensão arterial / Barriers to hypertension treatment / Barreras a lo tratamiento de la hipertensión arterial

Objetivou-se descrever as barreiras encontradas pelas pessoas portadoras de hipertensão arterial para a não adesão ao tratamento e controle dos níveis de sua pressão arterial. Estudo descritivo e transversal realizado em seis unidades básicas de saúde em Fortaleza-Ceará, Brasil, com 246 pessoas inscritas no Programa de Controle de Hipertensão Arterial há, no mínimo, um ano. Coletaram-se dados com entrevista estruturada e no prontuário eletrônico. Identificaram-se 69 pesquisados com níveis pressóricos normalizados. As principais barreiras apontadas foram: baixas condições financeiras, tratamento contínuo com muitos remédios e prática de atividade física. Concluiu-se que as barreiras ao tratamento anti-hipertensivo compreendem a pessoa adoecida, seu ambiente de vida e acesso aos cuidados de saúde.

The objective was to describe the barriers faced by people with hypertension for non compliance to treatment and control the levels of blood pressure. This is a transversal and descriptive study which was carried out in 6 basic health units in Fortaleza-Ceará, Brazil. The population consisted of 246 people enrolled in the program to Control Hypertension for at least a year. Data were collected using a structured interview and electronic chart. Of them, 69 showed normal blood pressure levels. The main barriers discovered were: poor financial condition, continuous treatment with many medicines and practice physical activity. It was concluded that barriers to the anti-hypertensive treatment include the sick people, their environment and their access to health care.

Se ha objetivado describir los impedimentos encontrados por las personas portadoras de hipertensión arterial para la no adhesión al tratamiento y control de los niveles de su presión arterial. Estudio descriptivo y transversal realizado en seis unidades básicas de salud en Fortaleza-Ceará-Brasil, con 246 personas inscriptas en el Programa de Controle de Hipertensão Arterial hace un año. Se colectaron datos con entrevista estructurada y en el prontuario electrónico. Se identificaron 69 pesquisados con niveles de presión normalizados. Las principales barreras apuntadas fueron: bajas condiciones financieras, tratamiento continuo con muchos remedios y práctica de actividad física. Se concluyó que las barreras al tratamiento anti hipertensión comprenden la persona enferma, su ambiente de vida y acceso a los cuidados de salud.

Clinical observation on proteinuria treatment in hypertension and type 2 diabetes with enalaprilat joint losartan / 中国基层医药

ObjectiveTo observe clinical effect of proteinuria treatment in hypertension and type 2 diabetes with enalaprilat joint losartan. Methods72 cases of hypertension and type 2 diabetes with proteinuria patients were divided into two groups randomiy,losartan and enalaprilat combination for the treatment group( n =36) ,losartan alone for the observation group( n =36) ,treatment 14 weeks. Observed two groups of blood pressure and 24h after treatment urinary albumin excretion rate. ResultsTwo groups of blood pressure than before treatment were reduced significantly(P ＜ 0.05), but after treatment between the two groups, the difference was not statistically significant (P ＞ 0.05 ).Two groups of patients after 14 weeks treatment, average 24h urine albumin excretion rate form( 105.2 ± 27.3 ) μg/min, ( 110. 3 ± 28.0) μg/min fell to(72.6 ± 26.5 ) μg/min, ( 87.5 ± 24.9 ) μg/min ( P ＜ 0. 01 ), the treatment group reduced more significant(P ＜0.05). ConclusionEnalaprilat joint losartan treatment at the same time,the effective step-down pressure, could improve the type 2 diabetes patients with early renal damage, and it suggested the early renal damage patients should be combined antihypertensive therapy as soon as possible.

Serum Collagen and Arterial Stiffness in Hypertensive Patients / 中华高血压杂志

Objective To investigate the relationship between serum of type Ⅲ collagen and arterial compliance in hypertensive patients.Methods One hundred fifty-eight in-patients of hypertension were enrolled.All subjects underwent laboratory measurements including serum PⅢNP,blood-lipid,glucose and high sensitivity C-reactive protein.Carotid to femoral pulse wave velocity(PWVcf),C1 and C2 were measured by a Complior Colson device and DO-2020.Results(1)PWVcf positively correlated with serum PⅢNP(P

Ligation of pericardial vein under vidio-assisted thoracoscopy (VATS) combined with gasless laparoscopic-assisted splenectomy and lower part of lung covered by omentum majus for the treatment of portal hypertention (a report of 12 cases) / 中国微创外科杂志

Objective To study the application of VATS and gasless laparoscopy to the treatment of portal hepertension Methods 12 operations of the splenectomy combined with ligation of pericardial vein and lower part of lung covered by omentum majus were performed throngh the thoracoscopy and laparascopy Results All of the 12 operations were successful. The procedures lasted (2.5～5.2) hours with mean time being 3.3 hours. Gastrointestinal function recovered in (48-72) hours after operation. The duration of hospitalization was (9～11)days. No postoperative thoracic and abdominal cavity complications were found. The average duration of hospitalization after operation was 10.3 days.12 cases were followed up for 2 month to 4 years and no rebleeding was found. Conclusions The procedures including ligation of pericardial vein under VATS combined with gasless laparoscopy assisted splenectomy and lower part of lung covered by omentum majus for the treatment of portal hypertension is passable.

Doxazosin in the treatment of hypertension.

Eifhteen mild to moderate hypertensive patients were treated with doxazosin once a day. Dosage was adjusted every two weeks to obtain diastolic blood pressure < 90 mmHg. After ten weeks of treatment mean blood pressure was reduced from 171/107 mmHg to 166/100 mmHg, HDL-cholesterol was increased from 40 mg/dL to 45 mg/dL (P<0.05) with the mean daily dose of doxazosin of 6.1 mg. Cardiovascular disease risk was reduced 19.1% from the baseline. Doxazosin used once a day is well tolerated and suitable for mild hypertension.