Efecto antihipertensivo del valsartán: estudio multicéntrico nacional / Antihypertensive effects of valsartan: results of a national multicentric study

Background: Valsartan is an angiotensin AT1 receptor antagonist. Clinical studies have shown that this is an effective and well tolerated drug. Aim: To compare valsartan with other commonly used antihypertensives in a National multicentric study. Material and methods: Between 1997 and 1998, a pharmacological surveillance of patients with mild or moderate hypertension, coming from different regions of the country, was carried out. Patients were followed during 8 weeks. In the group treated with valsartan, the initial dose was 80 mg/day. After four weeks of therapy, and according to patientÕs response the dose of valsartan or of the other antihypertensives was modified. Results: Five hundred ninety three patients, aged 59 years old as a mean, were included in the study. Of these 434 (265 female) received valsartan and 159 (101 female) other antihypertensive drugs. Fifteen percent of patients treated with valsartan and 25 percent of patients with other medications required a dose change at four weeks, due to lack of response (p < 0.01). At week eight, 1.5 percent of patients with valsartan and 17.4 percent of patients with other medications reported adverse effects such as cough, headache, edema or flushing (p < 0.01). Conclusions: In this Chilean observational multicentric study, valsartan proved to be more effective and to cause less adverse effects than commonly used medications in hypertensive patients

Recomendaciones sobre el uso de la monitorización ambulatoria de presión arterial: documento de consenso de la Sociedad Chilena de Hipertensión / Recommendations for the use of continuous ambulatory blood pressure monitoring: consensus document of the chilean hypertension society

Continuous ambulatory blood pressure monitoring is a diagnostic technique devised as a consequence of the great variations in blood pressure measurements. It allows multiple daily measurements, nocturnal monitoring, avoids the stress of blood pressure measurements, gives a picture of pressure behavior during 24 hours and reduces observer related errors. The equipment used must be accurate and validated using international protocols. Accepted indications for continuous ambulatory blood pressure monitoring are white coat hypertension, episodic hypertension, resistance to medications and assessment of symptoms or autonomic dysfunction. Other indications with less clear cut usefulness, are high risk cardiac, renal or pregnant patients and an accurate blood pressure control. We describe equipment calibration, elements that must be considered in the reports, result interpretation and conclusions. Normal blood pressure ranges for children and pregnant women are also reported

Efecto comparativo de policosanol con dos inhibidores de la HMG-CoA reductasa en el tratamiento de la hipercolesterolemia tipo II / Comparative effects of policosanol and two HMG-CoA reductase inhibitors on type II hypercholesterolemia

Background: Policosanol is a new cholesterol lowering agent derived from sugar cane. Aim: To compare the cholesterol lowering efficacy of policosanol with HMG CoA inhibitors. Patients and methods: Patients with a LDL cholesterol over 160 mg/dl were studied. If, after 6 weeks of diet, cholesterol persisted elevated, they were doubly blind randomized to receive policosanol 10 mg/day (55 patients), lovastatin 20 mg/day (26 patients) or simvastatin 10 mg/day (25 patients). Serum cholesterol was measured again after 8 weeks of therapy. Results: Initial demographic and laboratory data were similar among treatment groups. A 24 percent LDL cholesterol reduction was obtained with policosanol, compared with a 22 percent reduction with lovastatin and a 15 percent reduction with simvastatin. HDL cholesterol significantly increased in patients on policosanol and did not change in the other treatment groups. Adverse effects of policosanol were mild and unspecific. No changes in hepatic enzymes were observed. Conclusions: Policosanol is a safe and effective cholesterol reducing agent

Punción venosa central: incidencia de complicaciones locales en pacientes con y sin efecto heparínico / Central venous punction: incidence of local complications in patients with and without heparinic effects

Por tratarse de un procedimiento invasivo la punción venosa central no está exenta de complicaciones tanto locales como generales. Existe una población de pacientes portadores de patología coronaria, que tienen indicación absoluta de infusión de heparina para lograr anticoagulación total y que debe ser mantenida incluso hasta la llegada del paciente a pabellón. Se estudió una muestra de pacientes (n=72) sometidos a cirugía cardiovascular con circulación extracorpórea (CEC) y con indicación de Swan Ganz en un período de 15 meses en forma prospectiva. Se evaluó entonces la incidencia de complicaciones locales, esto es presencia de hematomaas y hemorragias, al realizar la punción central, postcec y 24 horas postoperatorio en un gupo de pacientes (n=42) sometidos a infusión de heparina hasta su llegada a pabellón comparándola con la incidencia de complicaciones de un grupo de pacientes que no recibió heparina ev (n=32) en ningún momento del preoperatorio. No se encontró diferencias estadísticas en las complicaciones entre ambos grupos

Valor de los parámetros de la prueba ergométrica para predecir isquemia miocárdica de acuerdo a cintigrafía SPECT con Talio 201 / Predictive value of stress EKG parameters for myocardial ischemia according to 201 Thallium test

Background: Exercise EKG is used as the test of choice in the diagnosis of coronary artery disease. Classical parameters are angor and ST depression representing myocardial ischemia. Aim: To correlate exercise EKG parameters with SPECT 201Thallium to know their likelihood ratios for ischemia. Patients and methods: Two hundred seventy four patients (171 men), aged 58 years old as a mean, were studied. Of these, 23 percent had a prior myocardial infarction. The likelihood ratios for the presence of ischemia of ST depression, failure to increase blood systolic pressure, the presence of angor and its duration during stress testing were calculated according to the results of SPECT 201Thallium. Seventy one patients were also subjected to a coronary angiography. Results: Among men, likelihood ratios for the presence of angor, failure to increase systolic pressure, ST alterations and duration of angor were 6.9, 6.15, 1.77 and 1.27 respectively. Among women, the figures were 5.45, 1.77, 0.58 and 1.4 respectively. The diagnostic accuracy of SPECT 201Thallium, when correlated with the results of coronary angiography, was 85 percent. Conclusions: Among men, the best exercise EKG predictors for myocardial ischemia were the failure to increase systolic blood pressure and the presence of angor. Among women the only significant predictor was the presence of angor

Eficacia clínica y aceptabilidad de ramipril en el tratamiento de la hipertensión arterial esencial etapas 1 y 2: resultados de un estudio multicéntrico / Clinical effectiveness and tolerance of ramipril in the treatment of essential arterial hypertension level 1 and 2: results of a multicentric study

One hundred eighty eight hyoertensive patients, aged 21 to 80 years old, coming from 4 Chilean hospitals were studied. Using an open non controlled design, they were treated with placebo for two weeks and with the active drug during eight weeks, in initial doses of 2.5 mg/day that were adjusted to 5 mg/day in diastolic blood pressure did not drop below 90 mm Hg or if its reduction was less than 10 mm Hg. During the active drug treatment period, systolic blood pressure decreased from 164.8ñ7.2 to 147.3ñ4.8 mm Hg. Diastolic blood pressure dropped from 102.3ñ3.1 to 87.8ñ3.0 mm Hg. Seventy percent of patients achieved a diastolic blood pressure of less than 90 mm Hg, 56.9 percent with 2.5 mg/day and 13.8 percent with 5 mg/day. Dizziness, cough and headache were the main adverse reactions, observed in 3.7, 3.2 and 2.1 percent of patients respectively. Adherence to treatment was 98 percent. There were no changes in laboratory values during the treatment period. Ramipril is effective and well tolerated in the treatment of essential hypertension