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Search Results: 1 - 10 of 12669 matches for " antihypertensive therapy "
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Magnitud, velocidad y eficacia antihipertensiva de la Nifedipina de liberación programada en microgránulos en el tratamiento de pacientes con hipertensión arterial esencial
Téllez-Méndez,R; González,M; Sánchez,M; Franco,A; Medina,G; Fernández,M; Torres,A; Pérez,H; Coronado,E; Hernández,J; Aldazoro,M; Castillo,L; Galdón,E; Durán,J; Hernández,A; Peraza,Y; Laino,N; Montilla,E;
Archivos Venezolanos de Farmacología y Terapéutica , 2004,
Abstract: the magnitude, velocity and antihypertensive effectiveness of the nifedipine liberation programmed in microgranules (nlpm) was evaluated in patients with moderate to severe hypertension. a total of one hundred and thirty five patients were evaluated during six weeks in a prospective, open, comparative and crossed study. of that group, 25.9% (n = 35) were normal patients, the remainder of them were hypertensive patients, 40% (n = 54 patients) received 30 mgrs (8am or 8pm) of nlpm and 20.7% (n = 28 patients) received 60 mgrs (8am or 8pm) of nlpm, 13.3% of the admitted patients (n = 18) were considered as failures of the medication. both doses at different schedules of the taking diminished the arterial pressures significantly (p <0.05). there were patients that reached the end point a 30 mgrs dose, this achievement was obtained from the 3rd week of medication keeping on these pressure levels until the end of the study, being the highest magnitude of reduction were: 8am pas 15.5 mmhg (12.2%), pad 12 mmhg (12.6%), pam 12.2 mmhg (10.9%) and 8pm of: pas 14.1 mmhg (9.7%), pad 9.5 mmhg (10.6%) and pam 11.2 mmhg (10.05%), on the other hand, in those who achieved the end point with the administration of 60 mgrs, reductions were observed from the 3rd week obtaining the maximum effect at the 6th week being the highest magnitude of reduction of: 8am pas 26.3 mmhg (16.34%), pad 18.5 mmhg (17.69%) and pam 20.9 mmhg (17.0%) and 8pm pas 22.5 mmhg (15.15%), pad 18 mmhg (18.1%) and pam 21.8 mmhg (18.5%). the magnitude of the antihypertensive response of the nlpm was numerically bigger with 60 mgrs than with 30 mgrs, but the response velocity was bigger with 30 mgrs maybe because the blood pressure at the beginning of the study were bigger in that group that required 60 mgrs, (p <0.05) arriving at the end of the study (6th week) to normal pressure figure, similar in both groups (p> 0.05). the heart rate in the group of 30 mgrs (8am and 8pm) showed a significant decrease after the treat
Understanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey
Nair KV, Belletti D, Doyle J, Allen R, McQueen R, Saseen J, Griend J, Patel J, McQueen A, Jan S
Patient Preference and Adherence , 2011, DOI: http://dx.doi.org/10.2147/PPA.S18481
Abstract: derstanding barriers to medication adherence in the hypertensive population by evaluating responses to a telephone survey Original Research (5289) Total Article Views Authors: Nair KV, Belletti D, Doyle J, Allen R, McQueen R, Saseen J, Griend J, Patel J, McQueen A, Jan S Published Date April 2011 Volume 2011:5 Pages 195 - 206 DOI: http://dx.doi.org/10.2147/PPA.S18481 Kavita V Nair1, Daniel A Belletti3, Joseph J Doyle3, Richard R Allen4, Robert B McQueen1, Joseph J Saseen1, Joseph Vande Griend1, Jay V Patel5, Angela McQueen2, Saira Jan2 1School of Pharmacy, University of Colorado, Aurora, CO, USA; 2Horizon Blue Cross Blue Shield of New Jersey, Newark, NJ, USA; 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 4Peakstat Statistical Services, Evergreen, CO, USA; 5Care Management International, Marlborough, MA, USA Background: Although hypertension is a major risk factor for cardiovascular disease, adherence to hypertensive medications is low. Previous research identifying factors influencing adherence has focused primarily on broad, population-based approaches. Identifying specific barriers for an individual is more useful in designing meaningful targeted interventions. Using customized telephonic outreach, we examined specific patient-reported barriers influencing hypertensive patients' nonadherence to medication in order to identify targeted interventions. Methods: A telephone survey of 8692 nonadherent hypertensive patients was conducted. The patient sample comprised health plan members with at least two prescriptions for antihypertensive medications in 2008. The telephone script was based on the "target" drug associated with greatest nonadherence (medication possession ratio [MPR] <80%) during the four-month period preceding the survey. Results: The response rate was 28.2% of the total sample, representing 63.8% of commercial members and 37.2% of Medicare members. Mean age was 63.4 years. Mean MPR was 61.0% for the target drug. Only 58.2% of Medicare respondents and 60.4% of commercial respondents reported "missing a dose of medication". The primary reason given was "forgetfulness" (61.8% Medicare, 60.8% commercial), followed by "being too busy" (2.7% Medicare, 18.5% commercial) and "other reasons" (21.9% Medicare, 8.1% commercial) including travel, hospitalization/sickness, disruption of daily events, and inability to get to the pharmacy. Prescription copay was a barrier for less than 5% of surveyed patients. Conclusion: Our findings indicate that events interfering with daily routine had a significant impact on adherence. Medication adherence appears to be a patterned behavior established through the creation of a routine and a reminder system for taking the medication. Providers should assess patients' daily schedules and medication-taking competency to develop and promote a medication routine.
Debate: Does it matter how you lower blood pressure?
Michael H Alderman
Trials , 2000, DOI: 10.1186/cvm-1-2-069
Abstract: Does it matter how blood pressure is lowered? Of course it does, but the focus of concern varies according to one's perspective. Clinicians worry about pharmacologic choices. Public health practitioners worry about interventions to change behavior.Blood pressure is a physical sign that reflects the pressure exerted on the arterial wall, and is determined by the circulatory volume, the force of cardiac contraction, and the tonic state of the arterial vessels. Genes and environment, operating through a variety of neuronal, hormonal, and cellular mechanisms, together determine the status of each of these components. The integrated product of these multiple factors is a blood pressure level that reflects the sum total of a variety of individual mechanisms. Moreover, many of these mechanisms are also involved both in blood pressure control and in the maintenance of vascular structure and function. Thus, perturbation of these mechanisms may either elevate blood pressure or stimulate vascular disease, or both. Presumably, the strokes and heart attacks that occur with greater frequency in those with elevated blood pressure are most likely to occur when both blood pressure and vasculotoxic mechanisms are affected.From a clinical perspective, the salient point is that the height of pressure directly relates to cardiovascular disease occurrence. In fact, there is a quantitatively predictable, linear relationship between the height of the pressure and the likelihood of both heart attack and stroke. This has perhaps best been described through the meta-analysis of multiple observational studies presented by MacMahon et al [1]. Most authorities, but not all, now accept the reality that there is no threshold level by which it is possible to separate persons with normal from those with abnormal pressures, but the observed relationship is best understood as reflecting a continuous risk. Nevertheless, on the basis of clinical trial experience, and by convention, an arbitrary divide h
Danger of alcohol for patients with arterial hypertension during antihypertensive therapy
M.P. Savenkov,M.K. Danilova,S.N. Ivanov,A.M. Savenkova
Rational Pharmacotherapy in Cardiology , 2008,
Abstract: Aim. To develop a test on tolerability of small alcohol doses (SAD), to study hemodynamic and vestibular changes induced by SAD during mono- and combined antihypertensive therapy.Material and methods. 30 healthy volunteers and 292 patients with arterial hypertension 1-2 stages were involved in the study. Tolerance to SAD was estimated in untreated hypertensive patients (n=77), patients receiving one (n=218), two (n=46) and three (n=28) antihypertensive drugs. Tolerance to SAD was evaluated by blood pressure changes as well as change of upright body balance and subjective sensations of the patient.Results. Hypotension and circulatory vestibular disorders can be induced by alcohol consumption during antihypertensive therapy. These disorders appear more often due to peripheral vasodilators as well as combined antihypertensive therapy.Conclusion. It is necessary to inform the patient about risk of alcohol taking and necessity to restrict of its dose during antihypertensive therapy.
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.
Antihypertensive Drug and Inner Ear Perfusion: An Otologist’s Point of View
Antonio Pirodda
Pharmaceuticals , 2009, DOI: 10.3390/ph2020044
Abstract: A number of labyrinthine disorders with sensorineural hearing loss, vertigo, and tinnitus are known to occur to young people without vascular risk factors, thus being classified as “idiopathic” in the absence of satisfactory explanations; in the last decade, this phenomenon has found a reliable explanation by the adverse effect of a sharp decrease of blood pressure values followed by an abnormal vasomotor regulation. This model may not only be applied to healthy subjects, but even had some confirmation in conditions possibly affecting hemodynamic changes, such as heart failure or treated hypertension. In particular, the results of a recent study on the impact of different antihypertensive therapies, which was analyzed by monitoring the onset or enhancement of tinnitus as a symptom of inner ear sufferance, unequivocally demonstrated an increased prevalence of tinnitus in subjects submitted to more “aggressive” treatments. This seems in agreement with recent observations about the model of fluid homeostasis of the inner ear, and suggests, when possible, to resort to treatments with modulatory effects in order to maintain a steady perfusion to the labyrinth thus protecting its function.
Implications of recent hypertension trials for the generalist physician: whom do we treat, and how?
Lee Green
Trials , 2000, DOI: 10.1186/cvm-1-1-022
Abstract: These are exciting times for physicians interested in the treatment of hypertension, with new and important data emerging regularly. Translating the excitement into better outcomes for large numbers of patients, however, means placing the new information in the hands of generalist physicians (family physicians and general internists), and making the information clear enough to be usable rather than baffling. Hypertension practice guidelines should accomplish this information placement, but recent guidelines based on the most recent evidence reach conflicting conclusions in some ways [1,2,3]. The conflict centers around two key issues: does it matter how blood pressure is lowered?; and are there subsets of patients who benefit from antihypertensive drugs at lower pressures than we have conventionally believed, or who do not benefit unless pressures are higher than we have believed?Two recent trials offer what appears to be confusing guidance on the first question. STOP-2 [4] compared newer and older antihypertensive agents, and concluded that there were no substantial differences in outcomes among them. This finding lends credence to the conventional view that blood pressure is the factor that matters, and lowering it by any means that has acceptably low side effect rates is the appropriate approach. Not long after the publication of STOP-2, however, the doxazocin arm of the ALLHAT trial was terminated because of an excessive rate of development of congestive heart failure compared with thiazides [5], suggesting that how blood pressure is lowered may indeed matter in terms of outcomes achieved. What is the primary care physician to make of these developments?The 'pressure is what counts' view is attractive. It offers simplicity, and great flexibility in clinical choices: any treatment that reduces pressures and is acceptable to patients is a good treatment for hypertension. It is tempting to think that the ALLHAT findings may be an anomaly, or perhaps specific to dox
Exercise testing in hypertensive patients taking different angiotensin-converting enzyme inhibitors
Carreira, Maria Angela M. Q.;Tavares, Leandro R.;Leite, Rafaela F.;Ribeiro, Jamila C.;Santos, Ant?nio C.;Pereira, Karla G.;Velarde, Guilhermo C.;Nóbrega, Antonio Claudio L.;
Arquivos Brasileiros de Cardiologia , 2003, DOI: 10.1590/S0066-782X2003000200002
Abstract: objective: to compare blood pressure response to dynamic exercise in hypertensive patients taking trandolapril or captopril. methods: we carried out a prospective, randomized, blinded study with 40 patients with primary hypertension and no other associated disease. the patients were divided into 2 groups (n=20), paired by age, sex, race, and body mass index, and underwent 2 symptom-limited exercise tests on a treadmill before and after 30 days of treatment with captopril (75 to 150 mg/day) or trandolapril (2 to 4 mg/day). results: the groups were similar prior to treatment (p<0.05), and both drugs reduced blood pressure at rest (p<0.001). during treatment, trandolapril caused a greater increase in functional capacity (+31%) than captopril (+17%; p=0.01) did, and provided better blood pressure control during exercise, observed as a reduction in the variation of systolic blood pressure/met (trandolapril: 10.7±1.9 mmhg/u vs 7.4±1.2 mmhg/u, p=0.02; captopril: 9.1±1.4 mmhg/u vs 11.4±2.5 mmhg/u, p=0.35), a reduction in peak diastolic blood pressure (trandolapril: 116.8±3.1 mmhg vs 108.1±2.5 mmhg, p=0.003; captopril: 118.2±3.1 mmhg vs 115.8±3.3 mmhg, p=0.35), and a reduction in the interruption of the tests due to excessive elevation in blood pressure (trandolapril: 50% vs 15%, p=0.009; captopril: 50% vs 45%, p=0.32). conclusion: monotherapy with trandolapril is more effective than that with captopril to control blood pressure during exercise in hypertensive patients.
Trastornos hipertensivos del embarazo
Vázquez Vigoa,Alfredo; Reina Gómez,Goliat; Román Rubio,Pedro; Guzmán Parrado,Roberto; Méndez Rosabal,Annerys;
Revista Cubana de Medicina , 2005,
Abstract: the hypertensive disorders of pregnancy are important medical problems that explain a great number of maternal and fetal complications. preeclampsia is the most severe of the hypertensive complications of pregnancy and it may be catastrophic if it is not treated or if it evolves towards eclampsia. the adequate treatment requires to have in mind the normal changes of arterial hypertension and of the intravascular volume taking place during pregnancy. preeclampsia is characterized by an extreme vasoconstriction, increase of the vascular reactivity and decrease of the intravascular volume. the greatest challenge is to face the treatment, due to the fact that two lives are at risk and that no studies of prolonged surveillance have been conducted with the different antihypertensive drugs. in this review, a treatment is proposed and the fundamental therapeutic guidelines are discussed based on the correct utilization of the main milestones of antihypertensive therapy with efficacy and recognized safety, inlcuding methyldopa, hydralazine, a and b blockers (labetalol), calcium antagonists and betablockers.
Effect of angiotensin II blockade on central blood pressure and arterial stiffness in subjects with hypertension
Michel E Safar
International Journal of Nephrology and Renovascular Disease , 2010, DOI: http://dx.doi.org/10.2147/IJNRD.S6664
Abstract: t of angiotensin II blockade on central blood pressure and arterial stiffness in subjects with hypertension Review (3071) Total Article Views Authors: Michel E Safar Published Date December 2010 Volume 2010:3 Pages 167 - 174 DOI: http://dx.doi.org/10.2147/IJNRD.S6664 Michel E Safar Université Paris Descartes, Assistance Publique-H pitaux de Paris, H tel-Dieu Centre de Diagnostic et de Thérapeutique, Paris, France Abstract: In hypertension, the blood pressure curve may be divided into two sets of components. The first set is mean arterial pressure, steady flow, and vascular resistance, thus acting on small arteries; the second set refers to large arteries, hence to pulse pressure, arterial stiffness, and wave reflections. The angiotensin-converting enzyme (ACE) inhibitor perindopril not only reduces mean arterial pressure but also acts specifically on pulse pressure. The effect on pulse pressure predominates on central rather than peripheral (brachial) large arteries, reducing aortic stiffness and most wave reflections. Such hemodynamic changes are not observed with standard -blockade, which reduces aortic stiffness and brachial systolic and pulse pressure but not central pulse pressure and wave reflections. In hypertensive subjects, perindopril and other ACE inhibitors seem to predict more consistently the reduction of cardiovascular events, mainly of cardiac origin, than standard -blockers alone. This effect is associated with the important biochemical finding that mechanotransductions of angiotensin and -blockade are markedly different, acting in the former specifically on the α5 1 integrin complex and on the fibronectin ligand of arterial vessels.
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