Adherencia al tratamiento y nivel de conocimiento en adultos con hipertensión arterial, Asunción 2022

Introducción: la adherencia al tratamiento y el nivel de conocimientos en pacientes con hipertensión arterial son factores claves para controlar esta afección y evitar complicaciones. Objetivos: determinar el grado de adherencia al tratamiento, el nivel de conocimientos y comorbilidades en pacientes con hipertensión arterial de un área urbana de Asunción, Paraguay, en 2022. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyeron varones y mujeres mayores de 18 años, conocidos portadores de hipertensión arterial, que residen en el barrio Sajonia entre mayo y octubre del 2022. Los datos fueron obtenidos con entrevistas realizadas casa por casa. Se midieron variables demográficas, el nivel de adherencia con el cuestionario de Morisky Green y el de conocimientos sobre la enfermedad con el cuestionario de Batalla. La investigación fue aprobada por el Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: participaron del estudio 425 sujetos, con predominio del sexo femenino (61,1%). La diabetes mellitus fue referida en 28,9% de los entrevistados. El cuestionario de Morisky Green detectó que 60% de los sujetos olvida de tomar su medicación, 25% no la toma en el horario indicado, 29% de la toma si se siente bien y 44% deja de tomarla si siente efectos indeseables. El cuestionario de Batalla halló 7% cree que la hipertensión arterial no es para toda la vida, 9% cree que la afección no se controla con dieta y medicación, y 5,8% no pudo referir al menos un órgano blanco. Conclusión: la adherencia al tratamiento de la hipertensión arterial y el nivel de conocimientos sobre esta afección no fue adecuada.

Introduction: Adherence to treatment and level of knowledge in patients with arterial hypertension are key factors to control this condition and avoid complications. Objectives: To determine the degree of adherence to treatment, the level of knowledge and comorbidities in patients with arterial hypertension in an urban area of ​​Asunción, Paraguay, in 2022. Methodology: An observational, descriptive, cross-sectional design was applied. Men and women over 18 years of age, known carriers of arterial hypertension, residing in Sajonia neighborhood between May and October 2022, were included. The data were obtained through house-to-house interviews. Demographic variables, the level of adherence with the Morisky Green test and the level of knowledge about the disease with the Batalla test were measured. The research was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: Four hundred twenty-five subjects participated in the study, predominantly female (61.1%). Diabetes mellitus was referred to by 28.9% of the interviewees. The Morisky Green test detected that 60% of the subjects forget to take their medication, 25% do not take it at the indicated time, 29% take it if they feel well, and 44% stop taking it if they feel undesirable effects. The Batalla test found that 7% believe that arterial hypertension is not for life, 9% believe that the condition is not controlled with diet and medication, and 5.8% could not refer to at least one target organ. Conclusion: Adherence to the treatment of arterial hypertension and the level of knowledge about this condition was not adequate.

Manejo de crisis hipertensiva en cirugía maxilofacial. Reporte de caso clínico / Hypertensive crisis management in maxillofacial surgery. Clinical case report

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.

Utilization pattern of antihypertensive drugs among chronic kidney disease patients in a tertiary care hospital

Background: Chronic kidney disease (CKD) exists both as a common cause of hypertension and also a complication of uncontrolled hypertension. This complex interplay of hypertension and CKD further increases the risk of adverse cardiovascular and cerebrovascular outcomes in patients with compromised renal function. Aim and Objectives: The present study tried analyze the characteristics of hypertensive CKD patients and the current antihypertensive treatment pattern in CKD patients in a tertiary care set up in Eastern India. Materials and Methods: A prospective and observational study included adult currently diagnosed CKD patients along with hypertension. Basic demographics along with medical history, blood pressure (BP) measures treatment details, and laboratory information were retrieved for each included patient, noted and analyzed statistically. Results: Around 47% patients were taking two antihypertensives, followed by 19.7% on three and 17.97% on one antihypertensive, respectively, and over 50% patients demonstrating high normal BP, followed by 25% having Grade I hypertension and around 20% having Grade II hypertension. Various classes of antihypertensives prescribed in the present study included calcium channel blockers, beta-blockers, angiotensin receptor blocker, angiotensin-converting enzyme (ACE) inhibitors, centrally acting drugs, alpha-blockers, and diuretics. Beta-blockers were found to be the most prescribed antihypertensives, being prescribed in 92.69% CKD patients. This was followed by calcium channel blockers, centrally acting drugs, alpha-blockers, angiotensin receptor blocker, diuretics, and ACE inhibitor. Utilization pattern of antihypertensive drugs among CKD patients helps with a better glimpse on the status of BP control and related renal outcomes in hypertensive CKD patients. Conclusion: Considering the interplay of hypertension and CKD, it is imperative to essentially treat hypertension robustly to ensure better cardio and renoprotection in these CKD patients. Utilization pattern of antihypertensive drugs among CKD patients helps with a better glimpse on the status of BP control and related renal outcomes in such patients. A rational multidrug antihypertensive regime can help achieve better patient outcomes in hypertensive CKD patients.

Caracterización clínica de las crisis hipertensivas en pacientes adultos hospitalizados en el Hospital Nacional de Itauguá en 2021

RESUMEN Introducción: una crisis hipertensiva se define como una elevación aguda de la presión arterial superior a 180/120 mm Hg, pudiendo esto generar complicaciones en diferentes niveles fisiopatológicos como afectación del sistema nervioso central, cardiovascular, entre otros. Objetivos: caracterizar los aspectos clínicos de las crisis hipertensivas en pacientes internados en el Departamento de urgencias del Hospital Nacional de Itauguá. Métodos: estudio observacional, descriptivo con componente analítico, de corte transversal y prospectivo, realizado en el periodo de junio a noviembre del 2021. Se incluyeron pacientes con diagnóstico clínico de crisis hipertensiva definida por presión sistólica ≥ 180 mmHg y/o presión diastólica ≥120 mmHg. La investigación fue aprobada por el Comité de Ética de la Universidad Nacional de Itapúa. Resultados: se estudiaron 140 pacientes, cuya edad promedio fue 61 ± 14 años, con predominio masculino en 54,29%. Los valores promedios de cifras tensionales mayormente elevadas fueron la presión arterial sistólica (193,5 ± 15,2 mmHg) y la presión arterial diferencial (84,5 ± 17,75 mmHg). El motivo de consulta más frecuente fue la dificultad respiratoria (19,28%). A su vez, 113 (80,71%) pacientes tenían algún tipo de comorbilidad, predominando el sobrepeso en 61 casos. En 93 pacientes (66,43%) había tratamiento antihipertensivo irregular o abandono del mismo. El tratamiento inicial predominante fue la administración de enalaprilato EV (28,58%). En 91 pacientes (65%) se detectó daño de órgano blanco, prevaleciendo el accidente cerebrovascular (29,29%). Los factores que presentaron asociación estadísticamente significativa con presentar daño de órgano blanco fueron la comorbilidad (p 0,0033, OR: 3,52) y el tratamiento irregular o abandono del mismo (p 0,00007, OR: 4,35). Conclusión: se evidenció una alta frecuencia de emergencia hipertensiva, predominio marcado del tratamiento irregular o abandono del mismo. Mas de la mitad de los pacientes con crisis hipertensivas acuden con algún daño de órgano blanco, viéndose como principales factores de riesgo asociados la comorbilidad y el tratamiento irregular o abandono del mismo.

ABSTRACT Introduction: A hypertensive crisis is defined as an acute elevation of blood pressure greater than 180/120 mmHg, which can generate complications at different pathophysiological levels such as involvement of central nervous, cardiovascular systems, among others. Objectives: To characterize the clinical aspects of hypertensive crises in patients admitted to the Emergency Service of the Hospital Nacional o Itauguá. Methods: Prospective, cross-sectional, descriptive, observational study with an analytical component, carried out from June to November 2021. Patients with a clinical diagnosis of hypertensive crisis defined by systolic pressure ≥ 180 mmHg and/or diastolic pressure ≥ 120 mmHg were included. The research study was approved by the Ethics Committee of the National University of Itapúa. Results: One hundred forty patients were studied, whose mean age was 61±14 years, with male predominance (54.29%). The mean values ​​of the most elevated blood pressure values were systolic blood pressure (193.5±15.2 mmHg) and differential blood pressure (84.5± 17.75 mmHg). The most frequent reason for consultation was respiratory distress (19.28%). Some type of comorbidity was present in 113 patients (80.71%), with overweight predominating in 61 cases. In 93 patients (66.43%) there was irregular antihypertensive treatment or medication discontinuation. The predominant initial treatment was the administration of enalaprilat IV (28.58%). Target organ damage was detected in 91 patients (65%), with cerebrovascular accident prevailing (29.29%). The factors that presented a statistically significant association with presenting target organ damage were comorbidity (p = 0.0033, OR: 3.52) and irregular treatment or treatment discontinuation (p = 0.00007, OR: 4.35). Conclusion: A high frequency of hypertensive emergency, a marked predominance of irregular treatment or its discontinuation was evidenced. More than half of the patients with hypertensive crises consulted at the emergency service with some target organ damage, and with comorbidity and irregular treatment or medication discontinuation as the main associated risk factors.

Application of β-blockers for hypertension / 中国临床药理学与治疗学

β-blockers are widely administered to patients with various cardiovascular diseases including hypertension. However, in recent years, studies have questioned or even denied the antihypertensive effect of β-blockers, which has caused confusion to cardiovascular clinicians. Based on the systematic analysis of a number of studies, the author believes that β-blockers still remain the status as the first-line antihypertensives.

Manejo terapéutico farmacológico actual en la hipertensión arterial sistémica del adulto

RESUMEN El tratamiento con agentes farmacológicos de la hipertensión arterial sistémica (HTA) produce una disminución significativa de las complicaciones cardiovasculares. La terapia antihipertensiva farmacológica produce una reducción del riesgo relativo de casi 50% en la incidencia de insuficiencia cardíaca, una reducción del riesgo relativo de ictus de hasta 40%, y de hasta 25% de reducción del riesgo relativo en el infarto de miocardio. El grado de reducción de la presión arterial, no la elección de la medicación antihipertensiva, es el principal determinante de la reducción del riesgo cardiovascular en pacientes con HTA. La terapia de combinación con fármacos de diferentes clases tiene un efecto de reducción de la presión arterial sustancialmente mayor que la duplicación de la dosis de un solo agente. Sin embargo, el riesgo de efectos adversos, costos e inconvenientes para el paciente aumentan a medida que se agregan más medicamentos antihipertensivos. El objetivo es realizar una revisión narrativa sobre el manejo terapéutico farmacológico actual de la HTA del adulto.

ABSTRACT Treatment with pharmacological agents for systemic arterial hypertension (HT) produces a significant decrease in cardiovascular complications. Pharmacologic antihypertensive therapy produces a relative risk reduction of nearly 50% in the incidence of heart failure, a relative risk reduction of stroke of up to 40%, and a relative risk reduction of up to 25% in myocardial infarction. The degree of reduction in blood pressure, not the choice of antihypertensive medication, is the main determinant of cardiovascular risk reduction in patients with HT. Combination therapy with drugs of different classes has a blood pressure lowering effect substantially greater than doubling the dose of a single agent. However, the risk of adverse effects, costs, and inconvenience to the patient increase as more antihypertensive medications are added. The objective is to carry out a narrative review on the current pharmacological therapeutic management of hypertension in adults.

Caracterização do tecido ósseo peri-implantar em ratas hipertensas e com deficiência de estrógeno, após ação sinérgica de losartan e alendronato de sódio / Characterization of peri-implant bone tissue in hypertensive and estrogen-deficient rats after the synergistic action of losartan and alendronate sodium

Introdução: Este estudo visou caracterizar morfológica e estruturalmente o tecido produzido na interface osso-implante em ratas espontaneamente hipertensas ovariectomizadas com implantes instalados em suas tíbias, e analisou como o tratamento associado de losartan sistêmico e alendronato de sódio local influenciou no reparo ósseo peri-implantar. Material e Métodos: Foram utilizadas ratas espontaneamente hipertensas (SHR) que receberam losartan (30 mg/kg, p.o.). Após uma semana, implantes de titânio tratados (Medens, Ribeirão Preto, São Paulo, Brazil) ou não com alendronato de sódio (ALE) foram instalados nas tíbias. Sessenta dias após a implantação, a estabilidade do implante foi avaliada pela medição de torque reverso, considerado como desfecho primário. A microtomografia computadorizada e a análise por confocal foram parâmetros secundários. Resultados: A ação sinérgica do losartan e do alendronato de sódio na superfície do implante aumentou o torque reverso no grupo SHR SHAM ALE. Enquanto a microtomografia também revelou maior extensão de contato entre osso e implante, volume ósseo e espessura trabecular nos animais SHR SHAM ALE. Por último, o losartan e o alendronato de sódio não alterou significativamente os parâmetros de osseointegração nas ratas ovariectomizadas. Conclusões: Os resultados apresentados sugerem que a ação sistêmica do losartan somada à atuação local do alendronato de sódio na superfície dos implantes melhoram os parâmetros de osseointegração em tíbias de ratas hipertensas e não ovariectomizadas(AU)

Background: This study aims to characterize morphologically and structurally the tissue produced at the bone-implant interface in spontaneously hypertensive ovariectomized rats that will have implants placed in their tibiae, and to analyze how the associated treatment of systemic losartan and local sodium alendronate might influence the peri-implant bone healing. Methods: They are used spontaneously hypertensive (SHR) rats that received losartan (30 mg/kg, p.o.). After one week, titanium implants treated (Medens, Ribeirão, São Paulo, Brazil) or not with sodium alendronate (ALE) were installed in the tibiae. Sixty days after implantation, implant stability was assessed by measuring the removal torque considered the primary end point. Computed tomography and confocal analysis were secondary parameters. Results: The synergistic action of losartan and sodium alendronate on the implant surface increased the reverse torque in the SHR SHAM ALE group. While microtomography also revealed a greater extent of contact between bone and implant, bone volume and trabecular thickness in SHR SHAM ALE animals. Finally, losartan and sodium alendronate did not significantly alter osseointegration parameters in ovariectomized rats. Conclusions: The results presented suggest that systemic losartan plus the local action of sodium alendronate on implants surface improves osseointegration parameters in tibias of hypertensives and non-ovariectomized rats(AU)

NO CENÁRIO ATUAL, QUAL O PAPEL DOS BETABLOQUEADORES NO TRATAMENTO DA HIPERTENSÃO? / IN THE CURRENT SCENARIO, WHAT IS THE ROLE OF BETA-BLOCKERS IN THE TREATMENT OF HYPERTENSION?

As teorias sobre a existência de receptores adrenérgicos foram descritas na literatura em meados da década de 40, sendo reconhecido anos depois que a inibição do sistema nervoso simpático por um determinado composto bloqueador beta- -adrenérgico poderia beneficiar pacientes com arritmias cardíacas e angina pectoris. Nasceram aí as primeiras substâncias bloqueadoras beta adrenérgicas não seletivas, destacando-se o propranolol. Desde então, centenas de bloqueadores beta adrenérgicos (BB) foram sintetizados e dezenas estão disponíveis em todo o mundo para uso clínico. Os mecanismos farmacológicos dos BBs são múltiplos e variam principalmente de acordo o predomínio de ação nos receptores adrenérgicos e com a lipossolubilidade, entre outros. De maneira geral, ligam-se e produzem um antagonismo competitivo e reversível nos receptores distribuídos pelo organismo. Os principais mecanismos fisiopatológicos propostos para explicar a ação medicamentosa dos BBs na hipertensão arterial sistêmica são redução do débito cardíaco, da resistência vascular periférica, do tônus vasomotor e do volume plasmático, inibição de renina, efeitos no sistema nervoso central, melhoria na adesão vascular e redefinição dos níveis de barorreceptores. Atualmente, os BBs não são preconizados como primeira linha de tratamento de hipertensão arterial sem complicações, porém eles são particularmente úteis para o tratamento da hipertensão na presença de algumas comorbidades não cardiovasculares, como a enxaqueca e o tremor essencial. Além disso, os BBs ganham destaque especial em situações cardiovasculares específicas, como angina sintomática, taquiarritmias, pós infarto agudo do miocárdio, insuficiência cardíaca com fração de ejeção reduzida e como alternativa aos inibidores da ECA ou BRA em mulheres hipertensas mais jovens que planejam engravidar. Vale ressaltar que em algumas destas situações os BBs passam a ter indicação mandatória, mesmo que não associadas à hipertensão arterial

Theories about the existence of adrenergic receptors were described in the mid-40s, being recognized years later that inhibition of the sympathetic nervous system by a beta-adrenergic blocking compound could benefit patients with cardiac arrhythmias and angina pectoris. That's how the first non-selective beta-blocking adrenergic substances appeared, highlighting propranolol. Since then, hundreds of beta-adrenergic blockers have been synthesized and dozens are available worldwide for clinical use. The pharmacological mechanisms of BBs are multiple and vary mainly according to the predominance of action in adrenergic receptors and with liposolubility. In general, they bind and produce a competitive and reversible antagonism in the receptors distributed by the organism. The main pathophysiological mechanisms proposed to explain the action of BBs in systemic arterial hypertension are reduced cardiac output, peripheral vascular resistance, vasomotor tone and plasma volume, renin inhibition, effects on the central nervous system, improvement in vascular adherence and redefinition of baroreceptor levels. Currently, BBs are not recommended as the first line of treatment for non-complicated arterial hypertension, but they are particularly useful for the treatment of hypertension in the presence of some comorbidities, such as migraine and essential tremor. Besides that, BBs gain special prominence in specific cardiovascular situations, such as symptomatic angina, tachyarrhythmias, post-acute myocardial infarction, heart failure with reduced ejection fraction and as an alternative to ACE or ARB inhibitors in younger hypertensive women planning to become pregnant. It is worth mentioning that in some of these situations BBs are mandatory, even if not associated with arterial hypertension

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

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

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

Cost comparisons of five leading brands of the antihypertensive drug, Telmisartan, available in an Indian city

Background: Antihypertensive drugs have to be taken lifelong, after initiation of the treatment. Price variation can lead to huge economic burden on the patients of hypertension, especially when cost considerations are not undertaken by the prescribing physician . This study was undertaken to compare the annual cost , to the patient , of five different most commonly prescribed brands of Telmisartan 40 mg, in Kolhapur city.Methods: Authors purchased a strip of 10 tablets each of the five leading brands in one city, Kolhapur, India, of Telmisartan 40 milligram. The prices of the strip of 10 tablets of each of the five selected brands were compared. In turn the annual cost of each of these five, was compared directly as well as using percentages. The data was collected, analysed and presented.Results: The data of the cost of the preparations of five different brands of a single antihypertensive drug, Temisartan 40 milligram shows that the annual cost of the costliest among the three brands of this drug is almost three times , that of the cheapest brand, or in other words almost 300 percent that of the cheapest brand.Conclusions: the cost variation amongst the five brands was considerable. India being a country with a major chunk of the population being very price sensitive, the prescribing physician must select the brand carefully. The most costly preparation of Temisartan can significantly add to the burden on the patient’s annual budget. Thus, Pharmacoeconomics must take an important place while prescribing medicines, especially in a country like India.

Study of prescribing pattern of antihypertensive drugs in diabetic patients in a tertiary care centre, Vizianagaram, India

Background: Diabetes mellitus (DM) and Hypertension (HTN) are the two major chronic disorders frequently coexisting, with increased incidence with age. HTN is about twice as common in patients with DM. Prescribing pattern are powerful tools to ascertain the role of drugs in society. There are many variations in prescribing patterns of antihypertensive drugs in patients with HTN and DM. Since these patients requires lifelong treatment it has enormously increased the burden of patients particularly in developing countries like India. Physician needs to be more concerned while choosing drugs for the patients with HTN and DM. In a tertiary care hospital, there is a real need for drug utilization study to determine the appropriate, more safe and effective patterns of drug therapy among diabetic hypertensive patients.Methods: A Cross sectional observational study was conducted in Maharajah’s Institute of Medical Sciences from December 2016 to May 2018. A total of 360 prescriptions of the patients with hypertension and coexisting diabetes were analyzed. The prescriptions prescribed to these patients were collected, assessed and the following parameters were noted. The treatment pattern of different group of drugs for HTN with co-existing DM was evaluated. The intended work was divided into three steps: Step 1: To collect the prescriptions of hypertensive patients with DM. Step 2: To separate the prescriptions prescribing anti hypertensive Drugs. Step 3: To statistically analyze the prescriptions. Relevant information was recorded in a structured proforma & data was evaluated.Results: In this study it was found that 36% of the patients were in the age group of 51-60 years with female preponderance among diabetic hypertensive patients. 77% of patients were treated with single antihypertensive drug and 23% of patients were treated with antihypertensive drug combinations. In monotherapy, telmisartan was most commonly prescribed. In combination therapy, amlodipine and telmisartan followed by amlodipine and atenolol were used.Conclusions: In this study monotherapy was preferred compared to combination therapy and adherence to the JNC 7 guidelines was good except in case of usage of diuretics.

Study of prescription patterns of antihypertensive agents in preeclampsia patients: Central India study

Background: The main objective of this study was to evaluate prescription patterns of antihypertensives in preeclampsia patients at a tertiary care hospital in Central India.Methods: The study belongs to retrospective observational type. he study was conducted by department of Pharmacology in association of department of Obstetrics & Gynaecology department at Nkp Salve Institute of Medical Sciences & Research Centre, Lata Mangeshkar Hospital, Nagpur. Permission from Institute Ethics Committee was taken for studying the prescribing patterns of drugs. The study was conducted for a period of 6 months. Inclusion and Exclusion criteria were added.Results: The maximum number patients seen in age groups 36-41 (28.6%). The main drug prescribed in our study was Labetalol followed by methyldopa. In our study most of the patients were of moderate and mild type corresponding to 48% and 32% respectively and only 20% of patients belong to severe cases. In our study highest number of patients was seen in second gravida i.e. 33.33%.Conclusions: Labetalol was the most common anti hypertensive prescribed in pre eclampsia patients. Rationale prescribing of drugs were done.

Cost comparison of antihypertensive drugs available in India with Drugs Prices Control Order price list

Background: DPCO (Drugs Prices Control Order) price list is issued by NPPA (National Pharmaceutical Pricing Authority) each year to guide the pharmaceuticals companies for controlling the prices in India. Some drugs cost more than the DPCO list. As antihypertensive drugs are taken lifelong once diagnosis is made, price variation and costing above prescribed price cause a huge economic burden on such patients. This study was undertaken to know the number of antihypertensive drugs brands with price above the recommended DPCO price list 2017.Methods: Authors have collected the data from website medguideindia.com, CIMS (current index of medical specialties), Drug Today, and compared the listed antihypertensive drugs of various available brands in India with DPCO price list 2017. Data was entered in Microsoft excel 2010. Percentage of selling price above the DPCO price list was calculated for each drug.Results: The data of 30 formulations of 16 antihypertensive drugs was analysed. The total number of available brands of all formulations was 1365 out of which only 831 (60.88%) brands were found to have price <DPCO recommended list. 534 (39.12%) brands had price more than the recommended limit. The minimum violation of price limit was found in case of metoprolol 25mg (6.66%) and maximum price violation was observed with spironolactone 25mg and sodium nitroprusside inj 10mg/ml.Conclusions: Reassessment and monitoring for implementation of DPCO price list should be done as still large number of brands are not following the regulations and are violating the limit set by NPPA/DPCO.

Prospective study on prescribing pattern of antihypertensive drugs at a tertiary care hospital

Background: Hypertension is the leading non-communicable disease risk attributing to cardio vascular morbidity and mortality. Various reasons are socio-economic, behavioural, sedentary life style, nutritional, age, obesity and poor health maintenance. A wide range of antihypertensive drugs belonging to different pharmacological classes are available alone or in combinations. Present study was done to evaluate the prescribing pattern of antihypertensive drugs at a tertiary care hospital.Methods: A prospective, observational, non-interventional, hospital-based study was carried out in hypertensive patients attending outpatient department of General Medicine at Medical College Hospital attached to Vijayanagar Institute of Medical Sciences, Ballari. Data was collected from outpatient slip of patients in a predesigned case record form, which was analysed using descriptive statistics.Results: Among 200 patients analysed 95 (47.5%) were males and 105 (52.5%) were females, with maximum number of patients falling in the age group 61-70years. Among antihypertensives prescribed, amlodipine (78.5%) was most frequently prescribed drug. Frequently used drugs for monotherapy - amlodipine (37.5%), for two drug therapy - amlodipine + atenolol (25.5%), and for three drug therapy - amlodipine + atenolol + telmisartan (2.5%). WHO prescribing indicators: Average number of drugs per encounter is 2.38 (±1.19). Percentage of drugs prescribed by generic name is 76.47%. Percentage of drugs prescribed from essential drug list is 97.89%.Conclusions: Present study shows current trends in prescription of antihypertensives in tertiary care hospital and their rational use. Study emphasizes need for preventive and educative measures about hypertension in population.

Study on drug utilization pattern of antihypertensive medication in tertiary care hospital of Telangana, India

Background: Hypertension is leading cause of deaths in the world. It is the major risk factor for systemic disorders including cardiovascular, renal and brain disorders. A drug utilization review on antihypertensive drugs should be done to determine different classes of antihypertensive medications with respect to diagnosis. Aim was to study drug utilization pattern of antihypertensive medication in a tertiary care hospital, Telangana.Methods: A cross sectional observational study was done in the patients with hypertension for duration of one year i.e. from April 2017 to May 2018 in the department of Pharmacology at Mallareddy Narayana multispecialty hospital, suraram, Telangana. A total 130 Patients who were suffering with acute, chronic hypertension and admitted in general medicine department and undergoing antihypertensive treatment were included.Results: A Total of 130 patients with history of hypertension were included. majority of patients i.e., 46.1% (60/130) were among 51-60 years, followed by 24.6% (32/130) patients among 41-50 years., Male predominance 80/130 61.5%) compared to females 50/130 (38.4%). In the Present study, 105(80.7%) prescriptions had Monotherapy prescription and 25/130 (19.2%) has combination of two. The most frequently prescribed drug as monotherapy was Calcium Channel Blockers (CCBs) about 52.3%, Beta blockers constitute about 14.2%, and diuretics about 19%, 9.5% Angiotension Receptor Blockers (ARBs) and alpha-Adrenergic Blocker (AABs), 4.7% ACE inhibitors.Conclusions: Calcium channel blockers are the highest among the drugs that are used as monotherapy. In combination therapy, diuretic with angiotensin receptor blocker and calcium channel blocker with beta blocker are the frequently prescribed drugs.

Cost variation analysis of different brands of commonly prescribed antihypertensive drugs, available in Indian market: a pharmacoeconomic study

Background: Worldwide, Hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7% of total DALYS. Globally, the overall prevalence of hypertension in adults aged 25 and over was around 40% in 2008.Despite its benefits, treatment of hypertension is costly. Direct medical spending to treat hypertension totalled $42.9 billion in 2010, with almost half ($20.4 billion) in the form of prescription medications. Being, a silent disease, adherence to antihypertensive drugs is poor. One of the important factors of poor adherence to antihypertensives is the cost of the drugs. There is wide cost variation among different brands of the same antihypertensive drug. Clinician’s awareness of cost of therapeutics is poor. The costly brand of same generic drug is proved to be in no way superior to its economically cheaper counterpart.Methods: The minimum and the maximum cost in Rupees (INR) of a particular antihypertensive agent manufactured by various pharmaceutical companies in the same strength were noted. The cost of 10 tablets/capsules was calculated. The cost ratio and percent cost variation were calculated for each brand.Results: The cost variation observed in the present study was as high as 2337.50 % for Hydralazine. Other significantly high cost variations found in the present study were: 1315.25% (Telmisartan+Hydrochlorthiazide), 870.58% (Amlopdipine), 558.34% (Amlodipine+Atenolol), 537.68% (Valsartan), 394.44% (Metoprolol), 344.44% (Enalapril), 316.22% (Propranolol), 300% (Lisinopril), 290.90% (Carvedilol), 289% (Cilnidipine), 271.99% ( Labetolol), 268.04% (Indapamide), 256.31% (Losartan), 255.19% (Irbesartan), 226% (Methyldopa), 223.04% (Frusemide), 209.78% (Nitrendepine), 192.08% (Terazosin), 189.25% (Atenolol), 142.42% (Bisoprolol) and 120.51% (Felodipine).Conclusions: Financial constraints are a reality in almost all aspects of medicine. Doctors must consider drug costs to their patients. Increasing pharmaceutical costs negatively impacts patients. Given the increasing healthcare costs, there is growing interest in rational prescribing, which takes costs of medication into account.

Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives

Antihypertensive drugs are prescribed frequently and can cause cutaneous adverse reactions. The exact incidence and frequency of these reactions are unknown. Multiple antihypertensive drug consumption has contributed to a substantial increase in the number of cutaneous adverse reactions to them. Thus, there is a need for dermatologists and physicians to be aware of the wide range of available antihypertensives and the type of reactions that can be expected. This review article focuses on the various clinical presentations that have been implicated or associated with them. The diagnosis and management have been discussed in brief.

Tratamiento de los síntomas vasomotores en pacientes con cáncer demama: Revisión narrativa

Las mujeres con antecedentes de cáncer de mama suelen experimentar síntomas vasomotores más severos y frecuentes que la población general. Numerosos trabajos han demostrado que los síntomas vasomotores (SVM) son los efectos adversos más frecuentes de la terapia adyuvante, y que hasta 20% de las pacientes con cáncer de mama considera discontinuar el tratamiento debido a estos síntomas, a pesar de su beneficio en la reducción de la recurrencia. Mientras que la terapia sustitutiva hormonal (THM) es usada regularmente en mujeres sanas para tratamiento de los SVM, está contraindicada en pacientes con antecedente de cáncer de mama. Existen muy pocos datos clínicos sobre las intervenciones no farmacológicas, y el papel de las terapias alternativas y complementarias sigue siendo controvertido. La revisión de la literatura da cuenta de que estos agentes farmacológicos, los inhibidores de la recaptación de serotonina-norepinefrina (IRNSs), los inhibidores selectivos de la recaptación de serotonina (IRSs), los antihipertensivos y los anticonvulsivos, disminuyen la intensidad y frecuencia de los SVM, demostrando una mejoría clínicamente significativa. Sin embargo, algunos IRSSs e IRSNs son potentes inhibidores del citocromo P450 2D6 (CYP 2D6), lo que impacta en la concentración de endoxifeno, debiendo ser evitados en pacientes tratadas con tamoxifeno. Son una opción el citalopram y la venlafaxina, si bien su consecuencia sobre la recurrencia y supervivencia del cáncer de mama es controvertida. La eficacia en el tratamiento de los SVM con antidepresivos es menor que con estrógenos y hay pocas publicaciones comparando ambos tratamientos. Faltan datos sobre el lapso de la indicación. Dos fármacos antiepilépticos también han demostrado efectividad, la gabapentina y la pregabalina. Algunas investigaciones comparativas están en curso, y habrá que esperar sus resultados para individualizar cuál es el óptimo en el manejo de los síntomas menopáusicos en mujeres que han padecido cáncer de mama.

Women with a history of breast cancer tend to have more severe and frequent vasomotor symptoms than the general population. Numerous studies have shown that vasomotor symptoms (VMS) are the most frequent adverse event of adjuvant therapy, and that up to 20% of breast cancer patients consider discontinuing treatment because of these symptoms, despite their benefit in the reduction of recurrence. While hormone replacement therapy (HRT) is regularly used in healthy women to treat VMS, it is contraindicated in patients with history of breast cancer. There are few clinical data on non-pharmacological interventions, and the role of alternative and complementary therapies remains controversial. The review of the literature reveals that these pharmacological agents, serotonin-norepinephrine reuptake inhibitors (SSRIs), selective serotonin reuptake inhibitors (IRSs), antihypertensives and anticonvulsants, decrease the intensity and frequency of VMS, demonstrating a clinically significant improvement. However, some IRSSs and SSRIs are potent inhibitors of cytochrome P450 2D6 (CYP 2D6), which impacts on the concentration of endoxifen and should be avoided in patients treated with tamoxifen. In this case, citalopram and venlafaxine are a better therapeutic option, although there is some controversy regarding its consequences on recurrence and survival of breast cancer. The efficacy in the treatment of VMS with antidepressants is lower than that achieved with estrogens and there are few publications comparing both treatments. Neither is clear the optimal treatment duration. Two antiepileptic drugs have also shown to be effective, gabapentin and pregabalin. Some comparative studies are in progress and it is probably necessary to wait for their results to identify the optimal option in the management of menopausal symptoms in women who have had breast cancer.

Antihypertensives in dermatology Part I - Uses of antihypertensives in dermatology

Hypertension is a global health problem. Antihypertensives are the mainstay of treatment for hypertension. Some of them were accidentally found to be useful in alopecias and infantile hemangiomas and have now become standard treatment for these conditions as well. Antihypertensives are also being studied for other dermatological indications, where they have shown promising efficacy. This review focuses on the dermatological indications for antihypertensives, discussing the drugs that have been tried, as well as their efficacy, dosage, duration of therapy, and adverse effects.

Hypotension and bradycardia before spinal anesthesia / Hipotensão e bradicardia antes da raquianestesia

Abstract I report a case of hypotension and bradycardia before spinal anesthesia in a pregnant woman with mild to moderate hypertension treated with nifedipine and methyldopa, scheduled for an elective cesarean delivery. She had the history of neurally-mediated syncopes. Two main factors (increased vagal tone and adverse effects of antihypertensive drugs) could explain the hypotension and bradycardia before spinal anesthesia. Monitoring allowed recognizing the problem and corrected it. Thus, it was avoided a disaster in anesthesia, as hemodynamic changes after spinal anesthesia, they would have joined to previous hypotension and bradycardia, which would have caused even a cardiac arrest.

Resumo Relato de um caso de hipotensão e bradicardia antes da raquianestesia em uma mulher grávida com hipertensão leve a moderada tratada com nifedipina e metildopa, programada para parto cesáreo eletivo. A paciente apresentava história de síncopes neuralmente mediadas. Dois fatores principais (aumento do tônus vagal e efeitos adversos de medicamentos anti-hipertensivos) poderiam explicar a hipotensão e bradicardia antes da raquianestesia. O monitoramento permitiu reconhecer o problema e corrigi-lo. Dessa forma, foi evitado um desastre em anestesia; assim como as alterações hemodinâmicas após a raquianestesia, esses fatores teriam se juntado à hipotensão e bradicardia anterior, o que poderia até ter causado uma parada cardíaca.