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Divergences in antihypertensive therapy in special situations in nephrology
Lemos, Marcelo Montebello;Pedrosa, Alessandra Coelho;Tavares, Alze Pereira;Góes, Miguel ?ngelo;Draibe, Sérgio Ant?nio;Sesso, Ricardo;
Sao Paulo Medical Journal , 2008, DOI: 10.1590/S1516-31802008000100007
Abstract: context and objective: the choice of an antihypertensive drug is based on several criteria and specific situations give rise to doubt and controversy. the aim here was to evaluate physicians? approaches towards treatment with antihypertensive agents in specific situations. design and setting: cross-sectional study, at universidade federal de s?o paulo, s?o paulo. methods: a questionnaire was applied during a nephrology meeting to evaluate individual approaches towards each hypothetical clinical situation. the questionnaire consisted of five multiple-choice questions (clinical cases) concerning controversial aspects of antihypertensive therapy. results: a total of 165 questionnaires were analyzed. most participants were nephrologists (93.2%). there was a preference for angiotensin-converting enzyme (ace) inhibitors in at least two of the cases. only 57.2% of the physicians were correct in choosing beta-blockers as the first-line drugs for patients with ischemic coronary disease. moreover, 66.2% chose ace inhibitors as the first-line drugs for patients with chronic kidney disease and proteinuria. about 5% of the physicians did not follow the current recommendations for the use of ace inhibitors in diabetic patients with microalbuminuria. the most controversial question concerned the first-line drug for advanced chronic kidney disease. most physicians were correct in choosing calcium channel blockers and avoiding ace inhibitors in renovascular hypertension in the case of a patient with a single functioning kidney. conclusions: most physicians adopted the correct approach, but some had an alternative strategy for the same situations that was not based on evidence.
Efficacy and safety of combined antihypertensive therapy in patients with renoparenchymal arterial hypertension in actual clinical practice  [cached]
Rational Pharmacotherapy in Cardiology , 2009,
Abstract: im. To evaluate efficacy and safety of combined antihypertensive therapy based on ramipril, metoprolol tartrate, amlodipine bensilate and rilmenidine dihydrogen phosphate in hypertensive patients with chronic glomerulonephritis (CGN) and normal renal function.Material and methods. 136 patients (39,2±14,6 y.o.) with hypertensive type of primary CGN and with normal renal function were examined. Clinical blood pressure (BP) and 24-hour ambulatory BP monitoring (ABPM) were evaluated initially and in 12 months of antihypertensive therapy.Results. Significant decrease of clinical BP was observed in 12 months of therapy in all patients. Target BP level was reached in 37 % of patients. ABPM indices were also improved:average BP levels and hypertensive burden time decreased, speed of morning BP raise was slow down, there was a tendency to 24-hour BP rhythm improvement. Tolerability of combined therapy was good.Conclusion. The combined antihypertensive therapy based on ramipril, metoprolol tartrate, amlodipine bensilate, rilmenidine dihydrogen phosphate showed good efficacy and safety in hypertensive patients with CGN and normal renal function.
Patient adherence and the choice of antihypertensive drugs: focus on lercanidipine  [cached]
Menno T Pruijm,Marc P Maillard,Michel Burnier
Vascular Health and Risk Management , 2008,
Abstract: Menno T Pruijm, Marc P Maillard, Michel BurnierService of Nephrology and Hypertension, Department of Medicine, University Hospital, Lausanne, SwitzerlandAbstract: Despite the development of many effective antihypertensive drugs, target blood pressures are reached in only a minority of patients in clinical practice. Poor adherence to drug therapy and the occurrence of side effects are among the main reasons commonly reported by patients and physicians to explain the poor results of actual antihypertensive therapies. The development of new effective antihypertensive agents with an improved tolerability profile might help to partly overcome these problems. Lercanidipine is an effective dihydropyridine calcium channel blocker of the third generation characterized by a long half-life and its lipophylicity. In contrast to first-generation dihydropyridines, lercanidipine does not induce reflex tachycardia and induces peripheral edema with a lower incidence. Recent data suggest that in addition to lowering blood pressure, lercanidipine might have some renal protective properties. In this review we shall discuss the problems of drug adherence in the management of hypertension with a special emphasis on lercanidipine.Keywords: compliance, hypertension, calcium antagonists
Perindopril: the possibility of antihypertensive and renoprotective therapy  [cached]
O.V. Dralova,M.L. Maksimov
Rational Pharmacotherapy in Cardiology , 2011,
Abstract: Blood pressure (BP) control in patients with chronic kidney disease is one of the most pressing problems in modern cardiology and nephrology. Perindopril therapy reduces cardiovascular risk in patients with arterial hypertension and nephropathy, provides adequate BP control and target organs protection.
Effect of antihypertensive therapy on cognitive functions of patients with hypertension
Jaiswal Ashok,Bhavsar V,Jaykaran,Kantharia N
Annals of Indian Academy of Neurology , 2010,
Abstract: Objectives: Hypertension is known to be associated with cognitive decline. Many studies revealed that control of hypertension with antihypertensive therapy controls the cognitive decline associated with hypertension. While there are reports that suggest that antihypertensive drugs do not provide protection from cognitive decline, the present study is designed to evaluate the cognitive status of patients recently diagnosed as hypertensive and effect of 3 month long antihypertensive therapy on cognitive functions. Materials and Methods: A predesigned pretested questionnaire was used to collect the information. The PGI memory scale (PGIMS) was employed to assess memory function of patients. Baseline memory functions were evaluated before starting the treatment with antihypertensive and compared with the cognitive function scores of healthy volunteers. After the 3 months of treatment, cognitive functions were evaluated again by the same scale. The unpaired t-test was used to compare the cognitive functions between case and control and the paired t-test was used to compare pre- and post-treatment score. Results: This study revealed that mean scores of six subtests of cognitive functions were less in cases as compared to subjects in comparison group. After 3 months of antihypertensive therapy, scores of five sub-tests were found to be increased. Among these five subtests, four were those which were found declined at the baseline. Conclusion: This suggests that antihypertensive therapy given for 3 months improved the score of those cognitive function tests in which hypertensive patients perform poorly during recruitment and there was no deterioration of any test after 3 months of antihypertensive therapy.
Multiple Myeloma: a Nephrology Department Experience  [PDF]
Souad Mikou, Mohamed Arrayhani and Tarik Sqalli
Journal of Medical and Surgical Research , 2016,
Abstract: Introduction: Multiple myeloma (MM) is defined as a malignant proliferation of a single clone of plasma cells typically accompanied by the secretion of monoclonal immunoglobulins that are detectable in the serum or urine. Renal impairment is present in 50% of patients at diagnosis. The aim of this study is to clarify the clinical, biological and prognosis parameters in patients with renal impairment associate to MM and focus on the economic impacts. Material and Methods: This is a retrospective study of MM with renal impairment cases admitted at the nephrology department of the FEZ university hospital in a period extended from January 2010 to December 2011. The diagnosis is based on Southwest Oncology Group criteria (SWOG) and CRAB activity criteria. The outcome is evaluated according to the criteria of the International Myeloma Workings Group. Results:32 myeloma patients were enrolled for a total of 1250 admissions during a period of two years with 15 women and 17 men. The mean age is 59 ± 10 years. 81 % had impaired general condition and bone pain. 88% of cases had anemia including 1 patient with neutropenia, the acute kidney injury was found in 71% of cases, the need for dialysis was required in 25% of patients. The monoclonal peak is observed in all patients who presented in immunofixation: Ig G 57% of cases and Ig A in 28% of cases. Monoclonal plasma cell infiltration>30% occurs in 50% of cases. The cast nephropathy myeloma is sustained in 53%% of cases. The kidney biopsy is performed in 6 patients and concluded for a myeloma tubulopathy in 2 patients and amylosis in 2 patients. All patients enrolled in our series applied for diagnosis criteria according to criteria established by SWOG in all patients. 80% of patients had bulky disease at both classifications SALMON & DURIE and ISS. 94% of our patients were treated by hydration and alkalization, only 19 % received calcitonin and 53% received biphosphonates for severe hypercalcemia. 50 % of patients were proposed for ALEXANIAN Protocol while 25% were proposed to the VAD (Vincristine-Adriamicyne-Dexametasone) protocol. Renal impairment evolution is dominated by normalization of renal function in 39% of patients. The main complication in our series is infection; it occurs in 53% of cases. Mortality occurs in 44%. The main reasons of death are neurologic complications. In univariate analyisis, the risk factors of occurring death are: age> 60years, ISS stage III. 92.22% of hospitalization cost is provided by the hospital with a mean hospitalization days of 34.5 day/patient for a total of 1105 days. Conclusion: Renal involvement in the MM is common and multifactorial. The realization of kidney biopsy is not always necessary for diagnosis. Prognosis is poor due to high tumor mass (22.7% of deaths). Therapies have been directed to slow the disease progression and to prevent complications.
Efficacy of different tactics for initial antihypertensive therapy  [cached]
O. A. Pleyko,A.O. Konrady
Rational Pharmacotherapy in Cardiology , 2007,
Abstract: Aim. To evaluate different tactics of initial antihypertensive therapy.Material and Methods. 120 patients with mild-to-moderate arterial hypertension were included and randomized into three groups: “A”, “B”, and “C”. 5 drugs from the main antihypertensive classes were used: indapamide, bisoprolol, amlodipine, fosinopril, and rilmenidine as well as fixed drug combination of fosinopril and hydrochlorothiazide. Patients included in group “A” received initial therapy according to individual leading pathogenic variant of hypertension. Patients from group “B” received standard stepped antihypertensive therapy with gradual dose increase and further addition of second (third) drug. Patients in group “C” were immediately administrated fixed drug combination and later added other drugs. Visits were scheduled after 2, 4, 6, 8, 10, etc weeks of treatment up to achievement of target blood pressure (BP).Results. In group “A” 33 patients (82,5%) achieved target BP after 6 visits, in group “B” — 37 patients (92,5%) after 8 visits and in group “C” — 100% of patents after 6 visits. Thus, in group “C” there was less number of visits and respectively lower number of therapy changes in order to achieve target BP. No significant discrepancies between group “A” and “B” were observed.Conclusion. Tactics of initial antihypertensive therapy with usage of fixed drug combination results in more effective and fast achievement of target BP.
Safety and tolerability of fixed antihypertensive combinations in blood pressure control: focus on olmesartan medoxomil and amlodipine combination
Ijlal Uddin, Shakil Aslam
Integrated Blood Pressure Control , 2010, DOI: http://dx.doi.org/10.2147/IBPC.S6662
Abstract: fety and tolerability of fixed antihypertensive combinations in blood pressure control: focus on olmesartan medoxomil and amlodipine combination Review (3367) Total Article Views Authors: Ijlal Uddin, Shakil Aslam Published Date November 2010 Volume 2010:3 Pages 155 - 162 DOI: http://dx.doi.org/10.2147/IBPC.S6662 Ijlal Uddin, Shakil Aslam Division of Nephrology and Hypertension, Georgetown University Hospital, Washington, District of Columbia, USA Abstract: Hypertension is a major health problem worldwide and remains underdiagnosed and undertreated. Although public awareness and control of hypertension have improved over the last decade, only one-third of hypertensive patients achieve the rather conservative blood pressure (BP) goal of <140/90 mmHg. Most hypertensive patients require more than one drug for optimum BP control. Expert panels recommend use of combination therapy with two or more medications for Stage 2 and higher hypertension and in high-risk patients. However, the use of multiple drugs reduces patient compliance. Fixed-dose combination therapy helps improve patient compliance and thus achieve the target BP. Dose titration of the individual constituent drugs is recommended before switching to an equivalent fixed-dose combination. Randomized, controlled trials have shown that the fixed-dose combination of amlodipine–olmesartan medoxomil is more effective in lowering BP than monotherapy with either of these agents, with a similar side effect profile.
Combined antihypertensive therapy in metabolic syndrome  [cached]
E.I. Mananko,E.A. Bushkova,E.M. Idrisova,A.I. Vengerovsky
Rational Pharmacotherapy in Cardiology , 2008,
Abstract: Aim. To compare effects of enalapril in combination with long-acting nifedipine or moxonidine on blood pressure (BP), myocardial mass and diastolic function of left ventricular, lipid and carbohydrate metabolism, platelet aggregation in patients with arterial hypertension (HT) and metabolic syndrome (MS).Material and methods. 50 patients with HT and MS were examined. 25 patients were treated with enalapril and long-acting nifedipine and 25 patients – with enalapril and moxonidine. 24-hour BP monitoring, echocardiography, anthropometry, lipid and carbohydrate metabolism estimation, platelet aggregation testing were performed before and 6 months after treatment.Results. Both combinations allowed to achieve target BP levels, provided cardioprotective and positive metabolic effects in most patients. The combination of enalapril and long-acting nifedipine had more significant antihypertensive effect and more prominently decreased the platelet aggregation induced by collagen. The combination of enalapril and moxonidine had more significant positive effects on carbohydrate metabolism and ADP-induced platelet aggregation.Conclusion. Enalapril in combination with long-acting nifedipine or moxonidine can be recommended for treatment of patients with HT and MS.
Innovative antihypertensive therapy in the light of completed clinical trials  [cached]
N. A. Nikolaev
Rational Pharmacotherapy in Cardiology , 2009,
Abstract: The innovative approaches to antihypertensive pharmacotherapy and advantages of modern antihypertensive drugs are discussed on the basis of randomized controlled trial. The recommendations for usage of different class of antihypertensive drugs including their combinations are presented.
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