RESUMO
Cardiovascular disease and death are major life-threatening problems in patients with atheromatous peripheral arterial disease (PAD). This review focuses on management of hypertension in the context of cardiovascular risk in patients with PAD. PAD is underdiagnosed and hypertension in PAD is often poorly managed. Current evidence supports a low threshold for blood pressure treatment in PAD and intensive blood pressure control to reduce the high risk of cardiovascular disease and death in patients with PAD. Optimal treatment targets should be <140/85 mmHg, with the lower target of <130/80 mmHg in the presence of diabetes mellitus or chronic renal disease. Class-specific selection of anti-hypertensive treatments in PAD should be based on caution in relation to co-existing renovascular disease and indications and contraindications based on other significant co-morbidity. There is a pressing need for primary end-point studies targeted specifically at patients with PAD. In particular, prospective studies in PAD are needed to obtain evidence for benefits from specific blood pressure classes of treatment as well as the optimal blood pressure treatment target level. These studies should consider impact in PAD of different demographic, risk factor, and co-morbidity profiles.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Doenças Cardiovasculares/prevenção & controle , Hipertensão/tratamento farmacológico , Seleção de Pacientes , Doenças Vasculares Periféricas/complicações , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Medicina Baseada em Evidências , Humanos , Hipertensão/complicações , Hipertensão/etiologia , Hipertensão/fisiopatologia , Estilo de Vida , Doenças Vasculares Periféricas/tratamento farmacológico , Doenças Vasculares Periféricas/fisiopatologia , Guias de Prática Clínica como Assunto , Prevalência , Resultado do TratamentoRESUMO
Twenty-three substituted 3,4-dihydro-4-oxoquinazolines or 3,4-dihydro-4-oxoazaquinazolines have been synthesized utilizing 2-amino-3-cyano-4,5-dimethylfuran and methyl acrylate as precursors for synthesis of the required substituted anthranilates. Six additional azaquinazolones were synthesized from 2-aminonicotinic or 3-aminopicolinic acid for comparison studies. All compounds were evaluated in mice with the maximal electroshock (MES) seizure and pentylenetetrazol (sc Met) seizure threshold tests for potential anticonvulsant activity and in the rotorod test to evaluate neurotoxicity. Nine of the twenty-nine compounds in the series demonstrated anticonvulsant action. The azaquinazolones were found to possess the most significant activity.
