Journal Article•
Prevención y tratamiento de la hipertensión arterial sistémica en el paciente con enfermedad arterial coronaria
01 Apr 2008-Revista Portuguesa De Pneumologia (Instituto Nacional de Cardiología Ignacio Chávez)-Vol. 78, pp 58-73
TL;DR: La asociacion entre hipertension arterial sistemica (HAS) y enfermedad arterial coronaria esta bien demostrada a traves de diversos estudios epidemiologicos.
Abstract: La asociacion entre hipertension arterial sistemica (HAS) y enfermedad arterial coronaria esta bien demostrada a traves de diversos estudios epidemiologicos. La hipertension arterial es un factor de riesgo independiente importante para el desarrollo de coronariopatia, enfermedad vascular cerebral y nefropatia. Existen avances importantes en el conocimiento de factores neurohumorales y hemodinamicos que confluyen en la fisiopatologia de la hipertension y en el desarrollo de enfermedad coronaria que permiten establecer mejores estrategias no solo de tratamiento sino tambien de prevencion, con la finalidad de disminuir la mortalidad cardiovascular. El espectro de la cardiopatia aterosclerosa es amplio y las estrategias de tratamiento de la hipertension deben adecuarse a la forma de manifestacion de la enfermedad coronaria que se presente. El tratamiento de ambas condiciones requiere de lineamientos especificos de acuerdo a las condiciones del paciente y la forma de presentacion de cada una de estas patologias
Citations
More filters
TL;DR: Estudio casi experimental pre and postest sin grupo de control, cuyo objetivo fue analizar los beneficios de un programa de ejercicio fisico con ritmo en personas con hipertension arterial dirigido por enfermeria en un municipio del Estado de Mexico.
Abstract: Estudio casi experimental pre y postest sin grupo de control, cuyo objetivo fue analizar los beneficios de un programa de ejercicio fisico con ritmo en personas con hipertension arterial dirigido por enfermeria en un municipio del Estado de Mexico. Se realizo un programa de intervencion en 110 pacientes con hipertension arterial, en 20 sesiones de ejercicio fisico con ritmo habiendo aceptado participar del estudio mediante la firma de consentimiento informado. Para el analisis de datos se utilizo como prueba de significacion x² con valor de p=0.05. Dentro del estudio intervinieron 99 mujeres; de ellas, 81.8% son amas de casa. Despues de la intervencion, la presion arterial sistolica mostro disminucion significativa en 8.28 mmHg y la presion diastolica 4.72 mmHg. El programa de ejercicio fisico con ritmo provoco efectos favorables sobre la presion arterial, como una actividad de enfermeria en su rol de educador.
8 citations
Journal Article•
TL;DR: This study aims to analyze the behavior of HRD mortality in Mexico between 1998 and 2009 and analyzes the specific rates by age and sex and standardized mortality ratio (SMR) by states and regions.
Abstract: espanolintroduccion: La hipertension arterial sistemica (HAS) es un factor de riesgo para las enfermedades cronicas. En el mundo, un 20-25% de los adultos presentan HAS, de los que el 70% vive en paises en desarrollo. La enfermedad renal cronica hipertensiva (ERCH) es una complicacion de la hipertension arterial mal controlada. El presente estudio pretende analizar el comportamiento de la mortalidad por ERCH en Mexico entre 1998-2009. Material y metodos: Estudio longitudinal, con analisis de registros secundarios a ERCH procedentes de las bases de datos suministradas por el Instituto Nacional de Estadistica, Geografia e Informatica (INEGI), donde se analizan las tasas especificas por edad y sexo, y razones estandarizadas de mortalidad (REM) por estados y regiones. Se emplean metodos de georreferenciacion estatal. Resultados: En Mexico, entre 1998 y 2009 hubo 48,823 muertes por ERCH. La tasa de mortalidad estandarizada ascendio desde 3.35/100,000 habitantes a 6.74 (p Englishintroduction: High blood pressure (HBP) is a risk factor for chronic diseases. Worldwide, 20-25% of adults have hypertension, with 70% of them living in developing countries. Hypertensive renal disease (HRD) is a complication of insufficiently controlled hypertension. This study aims to analyze the behavior of HRD mortality in Mexico between 1998 and 2009. Methods: Longitudinal study with secondary analysis of HRD records from the databases provided by INEGI, which analyzes the specific rates by age and sex and standardized mortality ratio (SMR) by states and regions. Georeferencing methods are used statewide. Results: In Mexico from 1998 to 2009 there were 48,823 deaths from HRD. The standardized mortality rate rose from 3.35/100,000 inhabitants to 6.74 (p
6 citations
TL;DR: The factors affecting the length of intensive care unit (ICU) stay in patients undergoing isolated on-pump coronary artery bypass (CABG) and effective factors on morbidity, mortality, and survival among patients with prolonged ICU stay were investigated.
Abstract: We aimed to investigate the factors affecting the length of intensive care unit (ICU) stay in patients undergoing isolated on-pump coronary artery bypass (CABG). We also aimed to evaluate effective factors on morbidity, mortality, and survival among patients with prolonged ICU stay. Between January 2002 and December 2009, a total of 1,657 patients underwent isolated on-pump CABG in our clinic. Prolonged ICU stay (>2 days) was present in 532 patient (32.1 %). Diabetes (OR 1.49, P = 0.006), hypertension (OR 1.37, P = 0.029), chronic obstructive pulmonary disease (OR 9.06, P 3 units) (OR 3.23, P = 0.007) were the independent predictive factors of prolonged ICU stay (>2 days). Postoperative mortality rate was 7 % (n = 37) and 2.3 % (n = 26) in patients with length of ICU stay >2 days and length of ICU stay ≤2 days (P 2 days (P < 0.0001). Postoperative mortality was higher in patients with prolonged ICU stay. Mean follow-up was shorter in patients with prolonged ICU stay.
1 citations
References
More filters
Journal Article•
TL;DR: Taken together with the other trials of converting enzyme inhibitors started early in acute MI, these results indicate that such therapy is generally safe and typically prevents about 5 deaths per 1000 patients treated for the first month.
232 citations
TL;DR: To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non–calcium antagonists strategy (NCAS), a Randomized, open label, blinded end point study of 22576 hypertensive CAD patients.
Abstract: THE PREVALENCE OF CORONARY artery disease (CAD) is increasing, as are major CAD risk factors (hypertension, aging, diabetes, obesity, and inactivity). Blood pressure is important in the progression of CAD, yet no large trials have evaluated blood pressure management in only patients with CAD. Thus, blood pressure management in CAD patients must be guided by data from relatively small subsets of high-risk patients from other trials. Current trends in hypertension management emphasize multidrug regimens rather than monotherapy. Combinations of antihypertensive drugs with Author Affiliations and Financial Disclosures are listed at the end of this article. Corresponding Author and Reprints: Carl J. Pepine, MD, University of Florida College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32610. Context Despite evidence of efficacy of antihypertensive agents in treating hypertensive patients, safety and efficacy of antihypertensive agents for coronary artery disease (CAD) have been discerned only from subgroup analyses in large trials. Objective To compare mortality and morbidity outcomes in patients with hypertension and CAD treated with a calcium antagonist strategy (CAS) or a non–calcium antagonist strategy (NCAS). Design, Setting, and Participants Randomized, open label, blinded end point study of 22576 hypertensive CAD patients aged 50 years or older, which was conducted September 1997 to February 2003 at 862 sites in 14 countries. Interventions PatientswererandomlyassignedtoeitherCAS(verapamil sustainedrelease) or NCAS (atenolol). Strategies specified dose and additional drug regimens. Trandolapril and/or hydrochlorothiazide was administered to achieve blood pressure goals according to guidelines from the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) of less than 140 mm Hg (systolic) and less than 90 mm Hg (diastolic); and less than 130 mm Hg (systolic) and less than 85 mm Hg (diastolic) if diabetes or renal impairment was present. Trandolapril was also recommended for patients with heart failure, diabetes, or renal impairment. Main Outcome Measures Primary: first occurrence of death (all cause), nonfatal myocardial infarction, or nonfatal stroke; other: cardiovascular death, angina, adverse experiences, hospitalizations, and blood pressure control at 24 months. Results At 24 months, in the CAS group, 6391 patients (81.5%) were taking verapamil sustained release; 4934 (62.9%) were taking trandolapril; and 3430 (43.7%) were taking hydrochlorothiazide. In the NCAS group, 6083 patients (77.5%) were taking atenolol; 4733 (60.3%) were taking hydrochlorothiazide; and 4113 (52.4%) were taking trandolapril. After a follow-up of 61835 patient-years (mean, 2.7 years per patient), 2269 patients had a primary outcome event with no statistically significant difference between treatment strategies (9.93% in CAS and 10.17% in NCAS; relative risk [RR], 0.98; 95% confidence interval [CI], 0.90-1.06). Two-year blood pressure control was similar between groups. The JNC VI blood pressure goals were achieved by 65.0% (systolic) and 88.5% (diastolic) of CAS and 64.0% (systolic) and 88.1% (diastolic) of NCAS patients. A total of 71.7% of CAS and 70.7% of NCAS patients achieved a systolic blood pressure of less than 140 mm Hg and diastolic blood pressure of less than 90 mm Hg. Conclusion The verapamil-trandolapril–based strategy was as clinically effective as the atenolol-hydrochlorothiazide–based strategy in hypertensive CAD patients.
227 citations
TL;DR: It is speculated that inhibition of the renin-angiotensin system may ameliorate injury following radiation by accelerating fibrinolysis and ECM degradation, at least in part, via suppression of PAI-1 expression.
196 citations
TL;DR: The most favorable rate of progression of coronary atherosclerosis is observed in patients whose BP falls within the "normal" JNC-7 category, which suggests that in patients with coronary artery disease, the optimal BP goal may be substantially lower than the <140/90 mm Hg level.
193 citations
TL;DR: It is already clear that RAAS blockade is an essential part of blocking progression along the cardiovascular continuum, and clinical trials of angiotensin II receptor blockers and ACE inhibitors have demonstrated the essential validity of this hypothesis.
Abstract: A progressive chain of pathophysiological events links cardiovascular risk factors to clinical manifestations of disease and life-threatening cardiovascular events. This chain--the cardiovascular continuum--underlies cardiovascular disease and holds the key to its prevention and treatment. Progressive tissue damage can result in morbidity from congestive heart failure, end-stage heart disease, nephrotic proteinuria and dementia and, eventually, death from cardio- or cerebrovascular causes. The renin-angiotensin-aldosterone system (RAAS) is involved at all stages of the cardiovascular continuum, because the effector molecules of the RAAS, angiotensin II in particular, have direct pathobiological effects on a variety of tissues, including the endothelium, vascular smooth muscle and the renal mesangium. Clinical trials of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors have demonstrated the essential validity of this hypothesis. Interruption of the RAAS has been shown to reduce cardiovascular morbidity and mortality in patients with left ventricular hypertrophy, heart failure and post-myocardial infarction, as well as renal disease in patients with type 2 diabetes. Key questions remain, however. What are the clinical effects of combination ARB and ACE inhibitor treatment? How will combinations of RAAS blockade with other agents, such as statins, affect the cardiovascular continuum? Answers to these questions will require well-planned, adequately powered clinical trials, such as the Programme of Research tO evaluate Telmisartan End-organ proteCTION (PROTECTION) and the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) programmes. However, it is already clear that RAAS blockade is an essential part of blocking progression along the cardiovascular continuum.
191 citations