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The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.

The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.

The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.

The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.

The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women.

Background. Results regarding the associations between hypertension-related parameters and physical performance in older adults are conflicting. A possible explanation for these divergent results is that investigations may not have adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs). Objectives. To examine the associations between hypertension-related parameters, ACEI use, and a set of physical performance tests in very old adults. Design. Cross-sectional study from the ilSIRENTE database. Setting. Mountain community of the Sirente geographic area (L’Aquila, Abruzzo, Italy). Participants. All persons born in the Sirente area (13 municipalities) before 1 January 1924 and living in that region at the time of study were identified and invited to participate. The final sample included 364 older adults (mean age: 85.8 ± standard deviation [SD] 4.8). Measurements. Physical performance was assessed using isometric handgrip strength (IHG), walking speed (WS) at normal and fast pace, 5-time sit-to-stand test (5STS), and muscle power measures. Blood pressure (BP) was measured after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. ACEIs were categorized in centrally (ACEI-c) and peripherally (ACEI-p) acting. Blood inflammatory markers, free insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3 (IGFBP-3) were assayed. Results. Results indicated that 5STS test was significantly and negatively associated with diastolic BP values. However, significance was lost when results were adjusted for ACEI use. Participants on ACEIs were more likely to have greater specific muscle power and higher blood levels of IGFBP-3 than non-ACEI users. When participants were categorized according to ACEI subtypes, those on ACEI-p had higher blood IGF-1 levels compared with ACEI-c users. Conclusions. The main findings of the present study indicate that

Introduction: Studies on the associations between hypertension-related parameters and cognitive function, mood, and behavioral symptoms in older adults have produced mixed findings. A possible explanation for these divergent results is that investigations have not adequately adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs). Therefore, the present study examined the cross-sectional associations between hypertension-related parameters, ACEI use, and cognitive function, mood, and behavioral symptoms in very old adults. Methods: This study was conducted by analyzing the IlSIRENTE database, a prospective cohort study that collected data on all individuals aged 80 years and older residing in the Sirente geographic area (n = 364). Blood pressure (BP) was assessed after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. Cognitive function, mood, and behavioral symptoms were recorded using the Minimum Data Set Home Care instrument. Blood inflammatory markers were measured. Results: Hypertension-related parameters were significantly associated with many cognitive, mood, and behavioral parameters after adjustment for covariates. However, only the inverse association between hypertension and lesser problems with short-term memory remained significant. Participants with hypertension had lower blood concentrations of inflammatory markers in comparison to their normotensive peers. Conclusion: Findings from the present study indicate that high BP values are associated with fewer complaints about memory problems in very old adults. Furthermore, a lower concentration of inflammatory markers was found in hypertensive participants. ACEI use might affect this scenario.

BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), commonly used antihypertensive drugs, may have a protective effect against depression in older individuals, but evidence in humans is limited.AIMS: We evaluated the risk of depression, among older individuals with hypertension, comparing ACE or ARB initiators to thiazide(-like) diuretic initiators. Thiazide(-like) diuretics were used as control because these drugs are not associated with mood disorders.METHODS: We used a propensity score-matched new user cohort design with routinely collected data from general practices in England from the Clinical Practice Research Datalink database. We matched 12,938 pairs of new users of ACEIs/ARBs and thiazide(-like) diuretics with hypertension (mean age 67.6 years; 54.7% women). Follow-up time started on the date of drug initiation and ended on the date of treatment discontinuation plus 30 days, or switch to a comparator, occurrence of a study event, death, date of patient's transfer out of practice, or end of the study period. The primary outcome was a composite endpoint of treated depression and nonfatal and fatal self-harm.RESULTS/OUTCOMES: Compared to the thiazide(-like) diuretic group, ACEIs/ARBs use was not associated with a lower risk of the primary outcome (hazard ratio 0.96 (95% confidence interval: 0.79; 1.15)). Results did not differ according to lipophilicity, duration of use, and average daily dose, or class (ACEIs or ARBs).CONCLUSIONS/INTERPRETATION: New use of ACEIs or ARBs is not associated with a lower risk of depression among individuals with hypertension.

Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.

BackgroundCertain classes of antihypertensive medication may have different associations with cognitive impairment.ObjectiveTo examine the association between prevalent use of antihypertensive medications that stimulate (thiazides, dihydropyridine calcium channel blockers, angiotensin type I receptor blockers) versus inhibit (angiotensin-converting enzyme inhibitors, beta-blockers, non-dihydropyridine calcium channel blockers) type 2 and 4 angiotensin II receptors on cognitive impairment among older adults residing in Veterans Affairs (VA) nursing homes for long-term care.MethodsRetrospective cohort study. Long-term care residents aged 65 + years admitted to a VA nursing home from 2012 to 2019 using blood pressure medication and without cognitive impairment at admission. Main exposure was prevalent use of angiotensin II receptor type 2 and 4-'stimulating' (N = 589), 'inhibiting' (N = 3,219), or 'mixed' (N = 1,715) antihypertensive medication regimens at admission. Primary outcome was any cognitive impairment (Cognitive Function Scale).ResultsOver an average of 5.4 months of follow-up, prevalent use of regimens containing exclusively 'stimulating' antihypertensives was associated with a lower risk of any incident cognitive impairment as compared to prevalent use of regimens containing exclusively 'inhibiting' antihypertensives (HR 0.83, 95% CI 0.74-0.93). Results for the comparison between 'mixed' versus 'inhibiting' regimens were in the same direction but not statistically significant (HR 0.96, 95% CI 0.88-1.06).ConclusionFor residents without cognitive impairment at baseline, prevalent users of regimens containing exclusively antihypertensives that stimulate type 2 and 4 angiotensin II receptors had lower rates of cognitive impairment as compared to prevalent users of regimens containing exclusively antihypertensives that inhibit these receptors. Residual confounding cannot be ruled out.

Background: Type 2 diabetes mellitus (T2DM) is associated with a high risk of vascular complications. Interestingly, cocoa flavanols (CF) can exert beneficial vascular effects in non‐dia-betic subjects. However, these effects have only been scarcely studied in T2DM. Therefore, we per-formed a study to assess the effects on vascular reactivity of a single dose of CF (790 mg) in T2DM and whether certain antihypertensive drugs may modulate these effects. Methods: 24 non‐diabetic and 11 T2DM subjects were studied in a cross‐over design. Fasting blood samples, blood pressure (BP), and arterial vasoreactivity (flow‐mediated dilation) were assessed before and 70 min after capsule ingestion. Muscle microvascular reactivity was only assessed after capsule ingestion. Age, waist‐to‐hip ratio, BP at baseline, and the use of antihypertensive drugs were regarded as covariates in a mixed models analysis. Results: CF ingestion did not affect any parameter. However, independ-ent of the type of capsules ingested, a decrease in diastolic BP by 3 mmHg (95% CI: −4.0; −2.0) and an increase in the change in brachial artery diameter (pre vs. post occlusion) by 0.06 mm (95% CI: 0.01; 0.12) were detected in the non‐diabetic group, while they remained unchanged in the T2DM group. Conclusion: No beneficial effects of CF were detected on vascular reactivity parameters in T2DM and non‐diabetic participants., SCOPUS: ar.j, info:eu-repo/semantics/published

Hypertension is a disease characterized by an increase in systolic blood pressure of more than 140mmHg and diastolic blood pressure of more than 90 mmHg. Hypertension is called the “silent killer” because it does not directly kill the sufferer but triggers other diseases such as heart attacks, strokes, and kidney failure. This study aims to determine the rationale for using antihypertensive drugs in geriatric hypertensive patients, including the right indication, the right dose, the right drug, and the right patient at the Annisa Pratama Clinic Semarang. The type of research used is descriptive non-experimental, with retrospective data collection in the form of patient medical record data; as many as 45 patients were taken as samples were analyzed based on the standard of therapy used, namely The Eight Joint National Committee (JNC VIII). The results showed that the characteristics of most respondents were at the age of 45-54, namely 25 people (55,6%), and the most respondents with stage 2 hypertension were 40 people (88,9%). The rationale for using antihypertensive drugs at the Annisa Pratama Clinic Semarang is 100% correct indication, 91,1% correct dose, 91,1% correct drugs, and 100% correct patient. The use of antihypertensive drugs in geriatric patients is appropriate according to the standard of therapy used based on JNC VIII.

Hypertension is a disease characterized by an increase in systolic blood pressure of more than 140mmHg and diastolic blood pressure of more than 90 mmHg. Hypertension is called the “silent killer” because it does not directly kill the sufferer but triggers other diseases such as heart attacks, strokes, and kidney failure. This study aims to determine the rationale for using antihypertensive drugs in geriatric hypertensive patients, including the right indication, the right dose, the right drug, and the right patient at the Annisa Pratama Clinic Semarang. The type of research used is descriptive non-experimental, with retrospective data collection in the form of patient medical record data; as many as 45 patients were taken as samples were analyzed based on the standard of therapy used, namely The Eight Joint National Committee (JNC VIII). The results showed that the characteristics of most respondents were at the age of 45-54, namely 25 people (55,6%), and the most respondents with stage 2 hypertension were 40 people (88,9%). The rationale for using antihypertensive drugs at the Annisa Pratama Clinic Semarang is 100% correct indication, 91,1% correct dose, 91,1% correct drugs, and 100% correct patient. The use of antihypertensive drugs in geriatric patients is appropriate according to the standard of therapy used based on JNC VIII.

[Abstract] Objective: To update the recommendations of the Spanish Society of Neurology on primary and secondary stroke prevention in patients with arterial hypertension. Development: We proposed several questions to identify practical issues for the management of blood pressure (BP) in stroke prevention, analysing the objectives of blood pressure control, which drugs are most appropriate in primary prevention, when antihypertensive treatment should be started after a stroke, what levels we should aim to achieve, and which drugs are most appropriate in secondary stroke prevention. We conducted a systematic review of the PubMed database and analysed the main clinical trials to address these questions and establish a series of recommendations. Conclusions: In primary stroke prevention, antihypertensive treatment should be started in patients with BP levels > 140/90 mmHg, with a target BP of < 130/80 mmHg. In secondary stroke prevention, we recommend starting antihypertensive treatment after the acute phase (first 24 hours), with a target BP of < 130/80 mmHg. The use of angiotensin-II receptor antagonists or diuretics alone or in combination with angiotensin-converting enzyme inhibitors is preferable., [Resumen] Objetivo. Actualizar las recomendaciones de la Sociedad Española de Neurología para la prevención de ictus, tanto primaria como secundaria, en pacientes con hipertensión arterial. Desarrollo. Se han planteado diferentes preguntas para identificar cuestiones prácticas para el manejo de la presión arterial (PA) en prevención de ictus, analizando cuál debe ser el objetivo de control de la presión arterial y cuáles son los fármacos más adecuados en prevención primaria, cuándo iniciar el tratamiento antihipertensivo después de un ictus, cuáles son las cifras que debemos alcanzar y qué fármacos son los más adecuados en prevención secundaria de ictus. Se ha realizado una revisión sistemática en Pubmed analizando los principales ensayos clínicos para dar respuesta a estas preguntas y se han elaborado unas recomendaciones. Conclusiones. En prevención primaria se recomienda iniciar tratamiento antihipertensivo con cifras de PA > 140/90 mmHg, con un objetivo de control de PA < 130/80 mmHg. En prevención secundaria de ictus se recomienda iniciar tratamiento antihipertensivo pasada la fase aguda (primeras 24 h) con un objetivo de control de PA < 130/80 mmHg, siendo preferible el empleo de ARA-II o diuréticos solos o en combinación con IECA.

Korotkow's blood pressure level is a relatively inaccurate predictor of cardiovascular events, requiring the introduction of new diagnostic methods. In recent years, assessment of the effect on arterial stiffness has become a very important characteristic of the efficacy of antihypertensive drugs.The assessment of stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to a better definition of cardiovascular risk and is a criterion for target organ damage and the effectiveness of antihypertensive therapy. In particular, a pulse wave velocity greater than 12 m/s is a significant risk factor. Significant reductions in stiffness have been observed to a greater extent with combination therapy, predominantly for the combination of calcium antagonists and angiotensin converting enzyme inhibitors/angiotensin receptor blockers.

Korotkow's blood pressure level is a relatively inaccurate predictor of cardiovascular events, requiring the introduction of new diagnostic methods. In recent years, assessment of the effect on arterial stiffness has become a very important characteristic of the efficacy of antihypertensive drugs.The assessment of stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to a better definition of cardiovascular risk and is a criterion for target organ damage and the effectiveness of antihypertensive therapy. In particular, a pulse wave velocity greater than 12 m/s is a significant risk factor. Significant reductions in stiffness have been observed to a greater extent with combination therapy, predominantly for the combination of calcium antagonists and angiotensin converting enzyme inhibitors/angiotensin receptor blockers.

Korotkow's blood pressure level is a relatively inaccurate predictor of cardiovascular events, requiring the introduction of new diagnostic methods. In recent years, assessment of the effect on arterial stiffness has become a very important characteristic of the efficacy of antihypertensive drugs.The assessment of stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to a better definition of cardiovascular risk and is a criterion for target organ damage and the effectiveness of antihypertensive therapy. In particular, a pulse wave velocity greater than 12 m/s is a significant risk factor. Significant reductions in stiffness have been observed to a greater extent with combination therapy, predominantly for the combination of calcium antagonists and angiotensin converting enzyme inhibitors/angiotensin receptor blockers.

Korotkow's blood pressure level is a relatively inaccurate predictor of cardiovascular events, requiring the introduction of new diagnostic methods. In recent years, assessment of the effect on arterial stiffness has become a very important characteristic of the efficacy of antihypertensive drugs.The assessment of stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to a better definition of cardiovascular risk and is a criterion for target organ damage and the effectiveness of antihypertensive therapy. In particular, a pulse wave velocity greater than 12 m/s is a significant risk factor. Significant reductions in stiffness have been observed to a greater extent with combination therapy, predominantly for the combination of calcium antagonists and angiotensin converting enzyme inhibitors/angiotensin receptor blockers.

Korotkow's blood pressure level is a relatively inaccurate predictor of cardiovascular events, requiring the introduction of new diagnostic methods. In recent years, assessment of the effect on arterial stiffness has become a very important characteristic of the efficacy of antihypertensive drugs.The assessment of stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to a better definition of cardiovascular risk and is a criterion for target organ damage and the effectiveness of antihypertensive therapy. In particular, a pulse wave velocity greater than 12 m/s is a significant risk factor. Significant reductions in stiffness have been observed to a greater extent with combination therapy, predominantly for the combination of calcium antagonists and angiotensin converting enzyme inhibitors/angiotensin receptor blockers.

Korotkow's blood pressure level is a relatively inaccurate predictor of cardiovascular events, requiring the introduction of new diagnostic methods. In recent years, assessment of the effect on arterial stiffness has become a very important characteristic of the efficacy of antihypertensive drugs.The assessment of stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to a better definition of cardiovascular risk and is a criterion for target organ damage and the effectiveness of antihypertensive therapy. In particular, a pulse wave velocity greater than 12 m/s is a significant risk factor. Significant reductions in stiffness have been observed to a greater extent with combination therapy, predominantly for the combination of calcium antagonists and angiotensin converting enzyme inhibitors/angiotensin receptor blockers.

Korotkow's blood pressure level is a relatively inaccurate predictor of cardiovascular events, requiring the introduction of new diagnostic methods. In recent years, assessment of the effect on arterial stiffness has become a very important characteristic of the efficacy of antihypertensive drugs.The assessment of stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to a better definition of cardiovascular risk and is a criterion for target organ damage and the effectiveness of antihypertensive therapy. In particular, a pulse wave velocity greater than 12 m/s is a significant risk factor. Significant reductions in stiffness have been observed to a greater extent with combination therapy, predominantly for the combination of calcium antagonists and angiotensin converting enzyme inhibitors/angiotensin receptor blockers.

Introduction: The antihypertensive treatment in patients with 20 or more years old requires strict controls in order to maintain their healthy life span. Objective: To assess the therapeutic adherence in patients with hypertension from the Family doctor’s office No. 4, linked to the Policlínico Universitario “Joaquín de Agüero y Agüero”, in Camagüey. Method: An observational, descriptive, cross-sectional study during the period from October 2020 to February 2021 was conducted. In the research 98 patients with 20 or more years old were recruited to work with. Patients with difficulties in their blood pressure control due to the noncompliance with the treatment. Variables assesed were as follow: age, sex, stage of hypertension, adherence to treatment using the Morisky-Green-Levine test, drugs used, and non-adherence factors. The information gathered was processed via SPSS statistic 25.0. Results: Patients with 60 years old (46.9%), males (58.1%), and clasified as stage 2 hypertension (51%) were predominant. Also, were predominant patients with partial therapeutic adherence (68.3%) (asper the Morisky-Green-Levine test outcomes), and patients whitch used three types of drugs to treat the illness (46.9%). The most common factors found were lack of drugs to treat the hypertension (86.7%) and the inadequate diet (77.5%). Conclusions: Non-adherence to treatment in hypertensive patients expose them to adquire any cardiovascular complication, aspect whitch affect patients themselve, family, and the society., Introdução: A medicação anti-hipertensiva em pacientes com mais de 20 anos exige um controle rigoroso, o que garante uma manutenção adequada do estado de saúde desse grupo populacional. Objetivo: analisar a adesão terapêutica em pacientes com hipertensão arterial no Consultório Médico de Família nº 4, pertencente à Policlínica Universitária “Joaquín de Agüero y Agüero”, do município de Camagüey. Método: Estudo observacional, transversal, descritivo, de outubro de 2020 a fevereiro de 2021. Trabalhamos com 98 pacientes com idade igual ou superior a 20 anos, com dificuldade de controle da pressão arterial devido à não adesão ao tratamento. As variáveis foram mensuradas: idade, sexo, grau de hipertensão, adesão ao tratamento pelo teste de Morisky-Green-Levine, quantidade de medicamentos utilizados e fatores de não adesão. As informações foram processadas por meio do pacote estatístico SPSS 25.0. Resultados: Houve predomínio dos maiores de 60 anos (46,9%), 58,1% do sexo masculino, classificados como grupo II de hipertensão arterial (51%). Predominaram pacientes com adesão terapêutica parcial (68,3%) pelo teste de Morisky-Green-Levine e com uso de três medicamentos para tratamento da doença (46,9%). Dentre os fatores mais frequentes, predominou a dificuldade de obtenção do medicamento (86,7%) e da dieta alimentar (77,5%). Conclusões: A não adesão terapêutica em hipertensos os expõe ao aparecimento de complicações cardiovasculares, com as repercussões que isso acarreta para o indivíduo, a família e a sociedade., Introducción: La medicación antihipertensiva de pacientes mayores de 20 años amerita un riguroso control, que garantice un adecuado mantenimiento del estado de salud de dicho grupo poblacional. Objetivo: Analizar la adherencia terapéutica en los pacientes con hipertensión arterial del Consultorio del Médico de Familia No. 4, perteneciente al Policlínico Universitario “Joaquín de Agüero y Agüero”, del municipio Camagüey. Método: Estudio observacional, descriptivo de corte transversal durante el periodo de octubre de 2020 a febrero de 2021. Se trabajó con los 98 pacientes de 20 y más años de edad, con dificultad en su control de la tensión arterial debido al incumplimiento de su tratamiento. Se midieron las variables: edad, sexo, grado de hipertensión, adherencia al tratamiento a través del test de Morisky-Green-Levine, cantidad de fármacos utilizados y los factores de la no adherencia. La información se procesó a través del paquete estadístico SPSS 25.0. Resultados: Existió un predominio de los mayores de 60 años (46,9 %), del sexo masculino en un 58,1 %, clasificados como grupo II de la hipertensión arterial (51 %). Predominaron los pacientes con una adherencia parcial terapéutica (68,3 %) según el test de Morisky-Green-Levine y con la utilización de tres fármacos como tratamiento de la enfermedad (46,9 %). Dentro de los factores más frecuentes predominaron la dificultad con la obtención del medicamento (86,7 %) y la realización de la dieta (77,5 %). Conclusiones: La no adherencia terapéutica en los pacientes hipertensos los expone a la aparición de complicaciones cardiovasculares, con la repercusión que conlleva para el individuo, la familia y la sociedad.

Introduction: Patients with type 2 diabetes mellitus are at high risk to develop vascular complications resulting in high morbidity and mortality. Cocoa flavanols are promising nutraceuticals with possible beneficial vascular effects in humans. However, limited research is currently available on the vascular effects in a diabetic population with inconsistent results. Possible reasons for this inconsistency might be heterogeneity in the given intervention (dose per time and day, single dose vs. split-dose, placebo formula) and the studied population (blood pressure at baseline, duration of diabetes, use of vasoactive antihypertensive and antidiabetic drugs, sex). Therefore, we aimed to develop a randomized, double-blinded, placebo-controlled cross-over trial to investigate whether cocoa flavanols have an acute impact on blood pressure and vascular reactivity in patients with type 2 diabetes with and without arterial hypertension. Methods and Analysis: We will include participants in four groups: (i) patients with type 2 diabetes without arterial hypertension, (ii) patients with type 2 diabetes with arterial hypertension and 1 antihypertensive drug, (iii) non-diabetic participants with essential hypertension and 1 antihypertensive drug, and (iv) healthy controls. All participants will complete the same protocol on both testing days, consuming high-flavanol cocoa extract (790 mg flavanols) or placebo. Macrovascular endothelial function (flow-mediated dilation) and blood pressure will be measured before and after capsule ingestion. Forearm muscle vasoreactivity (near-infrared spectroscopy) and brachial artery blood flow (echo-doppler) will be assessed in response to a dynamic handgrip exercise test after capsule ingestion. Data will be analyzed with a random intercept model in mixed models. Clinical Trial Registration: www.Clinicaltrials.gov, identifier: NCT03722199., SCOPUS: ar.j, info:eu-repo/semantics/published

BACKGROUND: The effect of calcium channel blockers (CCB) on mortality and ischaemic stroke risk in dementia patients is understudied. OBJECTIVES: To calculate the risk of death and ischaemic stroke in dementia patients treated with CCBs, considering individual agents and dose response. METHODS: Longitudinal cohort study with 18 906 hypertensive dementia patients from the Swedish Dementia Registry (SveDem), 2008-2014. Other Swedish national registries contributed information on comorbidities, dispensed medication and outcomes. Individual CCB agents and cumulative defined daily doses (cDDD) were considered. RESULTS: In patients with hypertension and dementia, nifedipine was associated with increased mortality risk (aHR 1.32; CI 1.01-1.73; P < 0.05) compared to non-CCB users. Patients diagnosed with Alzheimer's dementia (AD) or dementia with Lewy bodies/Parkinson's disease dementia (DLB-PDD) taking amlodipine had lower mortality risk (aHR, 0.89; CI, 0.80-0.98; P < 0.05 and aHR 0.58; CI, 0.38-0.86; P < 0.01, respectively), than those taking other CCBs. Amlodipine was associated with lower stroke risk in patients with Alzheimer's dementia compared to other CCBs (aHR 0.63; CI, 0.44-0.89; P < 0.05). Sensitivity analyses with propensity score-matched cohorts repeated the results for nifedipine (aHR 1.35; 95% CI, 1.02-1.78; P < 0.05) and amlodipine in AD (aHR, 0.87; CI, 0.78-0.97; P < 0.05) and DLB-PDD (aHR, 0.56, 95%CI, 0.37-0.85; P < 0.05). CONCLUSION: Amlodipine was associated with reduced mortality risk in dementia patients diagnosed with AD and DLB-PDD. AD patients using amlodipine had a lower risk of ischaemic stroke compared to other CCB users.

Our aim was to assess whether long-term adherence to a Mediterranean diet (MedDiet) and leisure-time physical activity (LTPA) were associated with a lower initiation of cardiovascular drug use. We studied the association between cumulative average of MedDiet adherence and LTPA and the risk of cardiovascular drug initiation in older adults at high cardiovascular risk (PREvencion con DIeta MEDiterranea trial participants) non-medicated at baseline: glucose-lowering drugs (n = 4437), antihypertensives (n = 2145), statins (n = 3977), fibrates (n = 6391), antiplatelets (n = 5760), vitamin K antagonists (n = 6877), antianginal drugs (n = 6837), and cardiac glycosides (n = 6954). One-point increases in MedDiet adherence were linearly associated with a decreased initiation of glucose-lowering (HR: 0.76 [0.71-0.80]), antihypertensive (HR: 0.79 [0.75-0.82]), statin (HR: 0.82 [0.78-0.85]), fibrate (HR: 0.78 [0.68-0.89]), antiplatelet (HR: 0.79 [0.75-0.83]), vitamin K antagonist (HR: 0.83 [0.74; 0.93]), antianginal (HR: 0.84 [0.74-0.96]), and cardiac glycoside therapy (HR: 0.69 [0.56-0.84]). LTPA was non-linearly related to a delayed initiation of glucose-lowering, antihypertensive, statin, fibrate, antiplatelet, antianginal, and cardiac glycoside therapy (minimum risk: 180-360 metabolic equivalents of task-min/day). Both combined were synergistically associated with a decreased onset of glucose-lowering drugs (p-interaction = 0.04), antihypertensive drugs (p-interaction < 0.001), vitamin K antagonists (p-interaction = 0.04), and cardiac glycosides (p-interaction = 0.01). Summarizing, sustained adherence to a MedDiet and LTPA were associated with lower risk of initiating cardiovascular-related medications.

Study objectiveLack of blood pressure control is often seen in hypertensive patients concomitantly taking antituberculosis medications due to the complex drug-drug interactions between rifampin and antihypertensive drugs. Therefore, it is of clinical importance to understand the underlying mechanisms of these interactions to help formulate recommendations on the use of antihypertensive drugs in patients taking these medications concomitantly. Our objective was to assess the reliability of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to predict potential interactions between rifampin and antihypertensive drugs and thus provide recommendations on the choice of antihypertensive drugs in patients receiving rifampin.DesignEvidence-based in vitro and in vivo predictions of drug-drug interactions.Measurements and main resultsWe systematically evaluated interactions between rifampin and antihypertensive drugs using the theory of the BDDCS, taking into consideration the role of drug transporters and metabolic enzymes involved in these interactions. We provide recommendations on the selection of antihypertensive drugs for patients with tuberculosis. Antihypertensive drugs approved by the U.S. Food and Drug Administration and the China National Medical Products Administration were included in this study. The drugs were classified into four categories under the BDDCS classification. Detailed information on cytochrome P450 (CYP) enzymes and drug transporters for each antihypertensive drug was searched in PubMed and other electronic databases. This information was combined with the effects of rifampin on CYP enzymes and drug transporters, and the direction and relative extent of the potential interactions between rifampin and antihypertensive drugs were predicted. Recommendations were then made using the theory of BDDCS. A thorough systematic literature review was performed, and data from all published human studies and case reports were summarized for the

Study objectiveLack of blood pressure control is often seen in hypertensive patients concomitantly taking antituberculosis medications due to the complex drug-drug interactions between rifampin and antihypertensive drugs. Therefore, it is of clinical importance to understand the underlying mechanisms of these interactions to help formulate recommendations on the use of antihypertensive drugs in patients taking these medications concomitantly. Our objective was to assess the reliability of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to predict potential interactions between rifampin and antihypertensive drugs and thus provide recommendations on the choice of antihypertensive drugs in patients receiving rifampin.DesignEvidence-based in vitro and in vivo predictions of drug-drug interactions.Measurements and main resultsWe systematically evaluated interactions between rifampin and antihypertensive drugs using the theory of the BDDCS, taking into consideration the role of drug transporters and metabolic enzymes involved in these interactions. We provide recommendations on the selection of antihypertensive drugs for patients with tuberculosis. Antihypertensive drugs approved by the U.S. Food and Drug Administration and the China National Medical Products Administration were included in this study. The drugs were classified into four categories under the BDDCS classification. Detailed information on cytochrome P450 (CYP) enzymes and drug transporters for each antihypertensive drug was searched in PubMed and other electronic databases. This information was combined with the effects of rifampin on CYP enzymes and drug transporters, and the direction and relative extent of the potential interactions between rifampin and antihypertensive drugs were predicted. Recommendations were then made using the theory of BDDCS. A thorough systematic literature review was performed, and data from all published human studies and case reports were summarized for the

Introduction: Therapy with antiplatelet drugs is recommended as secondary prevention of cardiovascular events in people with arterial hypertension. However, in the clinical practice, there are people who do not respond to treatment and evidence a recurrence of vascular events.Objective: To evaluate the response of hypertensive patients to antiplatelet drugs.Material and Methods: Cross-sectional, observational, descriptive and comparative study that included 299 subjects with arterial hypertension and 96 non-hypertensive subjects (control group) who were taking antiplatelet drugs. The hypertensive subjects were grouped according to the consumption of antihypertensive drugs. Platelet aggregation collagen in platelet-rich plasma was determined using the turbidimetric Born's method. The response to the antiplatelet therapy was classified in four categories (good, moderate, poor and non-responsiveness) in accordance with the platelet aggregation.Results: There was a slightly better response to antiplatelet drugs, although it was not statistically significant in hypertensive subjects without antihypertensive drugs (35,7 % good and 42,9% moderate) in relation to hypertensive subjects who were taking antihypertensive drugs (32,7 % good and 26,5 % moderate) and the non-hypertensive ones (30,2 % good and 30,2 % moderate).Besides, it was found that 17,7 % of non-hypertensive subjects and 14,3 % of the hypertensive ones without antihypertensive drugs and 13,2 % of hypertensive subjects with antihypertensive drugs were not responding to the treatment with antiplatelet drugs.Conclusions: The response of hypertensive patients to antiplatelet drugs, either taking antihypertensive drugs or not, is heterogeneous and similar to the response of the non-hypertensive subjects., Introducción: La terapia con antiagregantes plaquetarios es recomendada como prevención secundaria de eventos cardiovasculares en personas con hipertensión arterial. Sin embargo, en la práctica clínica se encuentran personas que no responden al tratamiento y presentan recurrencia de eventos vasculares.Objetivo: Evaluar la respuesta de los sujetos hipertensos a los fármacos antiagregantes plaquetarios.Material y Métodos: Estudio transversal, observacional descriptivo y comparativo, con 299 sujetos con hipertensión arterial esencial y 96 no hipertensos (como control), que estaban consumiendo antiagregantes plaquetarios. Los sujetos hipertensos fueron agrupados de acuerdo con el consumo de fármacos antihipertensivos. Se les determinó su agregación plaquetaria al colágeno en plasma, rico en plaquetas, según el Método de Born. La respuesta a la terapia antiplaquetaria se clasificó en cuatro categorías (óptima, moderada, pobre y no respuesta) de acuerdo con la agregación plaquetaria.Resultados: Se observó una ligera mejor respuesta a los antiagregantes plaquetarios, aunque no estadísticamente significativa, por parte de los hipertensos sin fármacos antihipertensivos (35,7 % óptima y 42,9 % moderada), en relación con los hipertensos que usaban antihipertensivos (32,7 % óptima y 26,5 % moderada) y los no hipertensos (30,2 % óptima y 30,2 % moderada). Además, se encontró que 17,7 % de los sujetos no hipertensos, 14,3 % de los hipertensos sin fármacos antihipertensivos y 13,2 % de los hipertensos con antihipertensivos no estaban respondiendo a los antiagregantes plaquetarios.Conclusiones: La respuesta a los fármacos antiagregantes plaquetarios de los sujetos hipertensos consuman o no fármacos antihipertensivos es heterogénea y similar a la de los sujetos no hipertensos.

Objective: To study the impact of aceclofenac on antihypertensive action of amlodipine and ramiprilin hypertensive patients with osteoarthritis in an open label case control prospective study. Methods: This was an open label case control prospective study. Hypertensive patients on either amlodipine or Ramipril were included in control groups. A total of 120 patients were included in the study and divided into 4 groups: Group A- Hypertensivepatients on Ramipril; Group B – Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Ramipril; Group C– Hypertensive patients on Amlodipine and Group D- Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Amlodipine. Results: At the end of the first month (phase I), the ramipril subgroup in the control group had a mean systolic blood pressure of 136.73±3.80 which was an 8.19% decrease from the baseline and it was found significant (p<0.05). The systolic blood pressure measurements at the end of the second month (phase II) in the control groups revealed further fall in mean systolic blood pressure. The cases of osteoarthritis on aceclofenacand ramiprilshowedan increase in BP. The mean Systolic BP was 159.2 ± 5.816.An increase of 9.74%from the base line and 16.09% was noted at the end of phase-I (P<0.5). Patients on aceclofenac and amlodipine in contrast showed a fall in BP from base line in phase 0 and their mean systolic blood pressure at positive in of second month of phase-II was 142.07± 2.43 about 1.88% fall baseline and 2.94% increase in BP compared to Phase-I. Almost similar observations were recorded for diastolic blood pressure. Conclusion: The interaction of NSAIDs on the antihypertensive action of the ACE inhibitors is significantly greater than their blunting action on the calcium channel blockers.

Objective: To study the impact of aceclofenac on antihypertensive action of amlodipine and ramiprilin hypertensive patients with osteoarthritis in an open label case control prospective study. Methods: This was an open label case control prospective study. Hypertensive patients on either amlodipine or Ramipril were included in control groups. A total of 120 patients were included in the study and divided into 4 groups: Group A- Hypertensivepatients on Ramipril; Group B – Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Ramipril; Group C– Hypertensive patients on Amlodipine and Group D- Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Amlodipine. Results: At the end of the first month (phase I), the ramipril subgroup in the control group had a mean systolic blood pressure of 136.73±3.80 which was an 8.19% decrease from the baseline and it was found significant (p<0.05). The systolic blood pressure measurements at the end of the second month (phase II) in the control groups revealed further fall in mean systolic blood pressure. The cases of osteoarthritis on aceclofenacand ramiprilshowedan increase in BP. The mean Systolic BP was 159.2 ± 5.816.An increase of 9.74%from the base line and 16.09% was noted at the end of phase-I (P<0.5). Patients on aceclofenac and amlodipine in contrast showed a fall in BP from base line in phase 0 and their mean systolic blood pressure at positive in of second month of phase-II was 142.07± 2.43 about 1.88% fall baseline and 2.94% increase in BP compared to Phase-I. Almost similar observations were recorded for diastolic blood pressure. Conclusion: The interaction of NSAIDs on the antihypertensive action of the ACE inhibitors is significantly greater than their blunting action on the calcium channel blockers.

The African wild olive (Olea europaea subsp. africana) is traditionally used as a hypotensive agent. Herb-drug interactions may result from the concurrent use of herbal medicines and conventional prescription drugs. This aspect was investigated by determining the effect of the extract on the in vitro intestinal epithelial permeation of selected hypotensive drugs using the Caco-2 cell culture model. The phytochemical profiles of leaf extracts of African wild olive from different localities in South Africa were compared, since efficacy is determined by the chemical composition. Extracts were analysed using ultra-performance liquid chromatography. The oleuropein concentration varied considerably from below the detection limit (4.94 µg/mL) to 59.4 mg/g dry weight. Chemometric models constructed from the aligned chromatographic data indicated only quantitative differences between the profiles. The leaf extract was found to increase the permeability of propranolol in the absorptive direction (Papp = 8.93 × 10−6 cm/s) across Caco-2 cell monolayers, but considerably decreased transport in the secretory direction (Papp = 3.68 × 10−6 cm/s). The permeation of diltiazem was enhanced by the extract in both the absorptive (Papp = 7.33 × 10−6 cm/s) as well as in the secretory direction (Papp = 7.16 × 10−6 cm/s), but a decrease in the efflux ratio was observed. The extract therefore caused a net increase in the transport of both drugs in the absorptive direction due to an inhibition effect on their efflux. This suggests a potential increase in the blood levels of these drugs when taken simultaneously with African wild olive leaf extract, indicating potential adverse effects that must be verified in vivo

The African wild olive (Olea europaea subsp. africana) is traditionally used as a hypotensive agent. Herb-drug interactions may result from the concurrent use of herbal medicines and conventional prescription drugs. This aspect was investigated by determining the effect of the extract on the in vitro intestinal epithelial permeation of selected hypotensive drugs using the Caco-2 cell culture model. The phytochemical profiles of leaf extracts of African wild olive from different localities in South Africa were compared, since efficacy is determined by the chemical composition. Extracts were analysed using ultra-performance liquid chromatography. The oleuropein concentration varied considerably from below the detection limit (4.94 µg/mL) to 59.4 mg/g dry weight. Chemometric models constructed from the aligned chromatographic data indicated only quantitative differences between the profiles. The leaf extract was found to increase the permeability of propranolol in the absorptive direction (Papp = 8.93 × 10−6 cm/s) across Caco-2 cell monolayers, but considerably decreased transport in the secretory direction (Papp = 3.68 × 10−6 cm/s). The permeation of diltiazem was enhanced by the extract in both the absorptive (Papp = 7.33 × 10−6 cm/s) as well as in the secretory direction (Papp = 7.16 × 10−6 cm/s), but a decrease in the efflux ratio was observed. The extract therefore caused a net increase in the transport of both drugs in the absorptive direction due to an inhibition effect on their efflux. This suggests a potential increase in the blood levels of these drugs when taken simultaneously with African wild olive leaf extract, indicating potential adverse effects that must be verified in vivo

BACKGROUND: Sudden cardiac arrest (SCA) is a complex multifactorial event and most commonly caused by ventricular tachycardia/ fibrillation (VT/ VF). Some antihypertensive drugs could induce hypokalaemia or hyperkalaemia that may increase susceptibility to VT/VF and SCA.OBJECTIVE: To assess the association between different classes of antihypertensive drugs classified according to their potential impact on serum potassium levels and the occurrence of out-of-hospital cardiac arrest (OHCA) based on VT/VF.METHODS: A case-control study was performed among current users of antihypertensive drugs. Cases were OHCA victims with electrocardiogram documented VT/VF drawn from the AmsteRdam REsuscitation STudies (ARREST) registry, and controls were non-OHCA individuals from the PHARMO database. Antihypertensive drugs were classified into: (1) antihypertensives with neutral effect on serum potassium levels; (2) hypokalaemia-inducing antihypertensives; (3) hyperkalaemia-inducing antihypertensives; (4) combination of antihypertensives with hypo- and hyperkalaemic effects.RESULTS: We included 1,345 cases and 4,145 controls. The risk of OHCA was significantly increased among users of hypokalaemia-inducing antihypertensives (adjusted OR 1.39; 95%CI [1.10-1.76]) and among users of a combination of antihypertensives with hypo- and hyperkalaemic effects (adjusted OR 1.42; 95%CI [1.17-1.72]) versus users of antihypertensives with neutral effect. There was no difference in OHCA risk between users of hyperkalaemia-inducing antihypertensives versus users of antihypertensive drugs with neutral effect (adjusted OR 1.15; 95%CI [0.95-1.40]).CONCLUSION: The risk of OHCA is significantly increased in patients who were current users of hypokalaemia-inducing antihypertensives and patients using a combination of antihypertensives with hypo- and hyperkalaemic effects.

RESEARCH ID M-3378-2014 (María Vallet Regí) ORCID 0000-0002-6104-4889 (María Vallet Regí) RESEARCH ID M-3316-2014 (Antonio Salinas Sánchez) ORCID 0000-0002-8408-3389 (Antonio Salinas Sánchez) ORCID 0000-0001-8380-4781 (Antonio Doadrio Villarejo), Polypill is a medication designed for preventing heart attacks through a combination of drugs. Current formulations contain blood pressure-lowering drugs and others, such statins or acetylsalicylic acid. These drugs exhibit different physical chemical features, and consequently different release kinetics. Therefore, the concentration in plasma of some of them after the release process can be out of the therapeutic range. This paper investigates a new methodology for the control dosage of a polypill recently reported containing hydrochlorothiazide, amlodipine, losartan and simvastatin in a 12.5/2.5/25/40 weight ratio. The procedure is based onmesoporous silica nanoparticles (MSN) with MCM-41 structure (MSN-41) used as carrier, aimed to control release of the four drugs included in the polypill. In vitro release data were obtained by HPLC and the curves adjusted with a kinetic model. To explain the release results, a molecular model was built to determine the drug-matrix interactions, and quantum mechanical calculations were performed to obtain the electrostatic properties of each drug. Amlodipine, losartan and simvastatin were released from the polypill-MSN-41 system in a controlled way. This would be a favourable behavior when used clinically because avoid too quick pressure decrease. However, the diuretic hydrochlorothiazide was quickly released from our system in the first minutes, as is needed in hypertensive urgencies. In addition, an increase in the stability of amlodipine and hydrochlorothiazide occurred in the polypill-MSN-41 system. Therefore, the new way of polypill dosage proposed can result in a safer and effective treatment. (C) 2016 Elsevier B.V. All rights reserved., Ministerio de Ciencia e Innovacion (MICINN), Ministerio de Economía y Competitividad (MINECO), FIS project, Depto. de Química en Ciencias Farmacéuticas, Fac. de Farmacia, FALSE, pub

An important aspect of the family doctor's work is the management of patients with comorbid pathology. Pathogenetic mechanisms of interrelation, as well as the bi-directionality of the association of arterial hypertension and gout are actively studied. By data analysis of literature, in many developed countries of the world there are shortcomings in the management of patients with gout at the primary stage. There is a need to improve the quality of management and prescription of combinations of basic therapy drugs for the treatment of patients with hypertension in combination with gout at the primary stage.

Background: It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts' opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment. Methods: We searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design. Results: Eleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59-0.88) and all-cause mortality (RR 0.86, 95% CI 0.75-0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg. Conclusions: Among older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.

Prevalence of hypertension related disorders is increasing on the total population. This phenomenon seems to be connected to population ageing and has led to an increment of chronic drug treatments. The cost of chronic treatment in this age group will increase, given the demographic changes that are anticipated. Objective: To revise empirical articles concerning to correlation between hypertension and cognitive impairment published in digital databases, responding to the purpose of collect current knowledge and identify possible pathways for future research. Results: The correlation between these two terms is summarized in three theoretical explanations, watching: 1) cognitive impairment as a comorbid disorder with hypertensive diseases, 2) hypertension as a brain damage causal that lead to cognitive impairment, and 3) cognitive impairment as an undesirable effect of antihypertensive medication. Conclusions: Results pretend to provide an overview about the impact of hypertension on cognitive performance at different levels, and to formulate objectives for new investigations that could clarify and improve these theoretical elucidations., A prevalência de patologias relacionadas com a hipertensão está incrementando no total da população. Este fenômeno parece estar relacionado com o envelhecimento populacional, provocando também um incremento nos tratamentos com medicação crônica. O custo dos tratamentos crônicos aumentou neste rango etário provocando uma antecipação dos câmbios demográficos previstos. Objetivo: Revisar artigos empíricos concernentes à correlação entre hipertensão e deterioro cognitivo publicados em base de dados digitais, com o propósito de reunir os conhecimentos atuais e identificar possíveis caminhos para futuras investigações. Resultados: A correlação entre esses dois termos é resumida em três explicações teóricas, observando: 1) deterioro cognitivo como desordem comórbido de transtornos hipertensivos, 2) deterioro cognitivo como consequência do dano cerebral provocado por hipertensão, e 3) deterioro cognitivo como efeito indesejável da medicação anti-hipertensiva. Conclusões: Os resultados pretendem brindar uma visão geral do impacto da hipertensão no desempenho cognitivo em seus diferentes níveis; ao mesmo tempo, formular objetivos para novas investigações tendentes a clarificar e melhorar estas elucidações teóricas., La prevalencia de patologías relacionadas con hipertensión se está incrementando en el total de la población. Este fenómeno parece estar relacionado con el envejecimiento poblacional, provocando también un incremento en los tratamientos con medicación crónica. El costo de los tratamientos crónicos aumentó en este rango etario provocando una anticipación de los cambios demográficos previstos. Objetivo: Revisar artículos empíricos concernientes a la correlación entre hipertensión y deterioro cognitivo publicados en base de datos digitales, con el propósito de reunir los conocimientos actuales e identificar posibles caminos para futuras investigaciones. Resultados: La correlación entre esos dos términos es resumida en tres explicaciones teóricas, observando: 1) deterioro cognitivo como desorden comórbido de trastornos hipertensivos, 2) deterioro cognitivo como consecuencia del daño cerebral provocado por hipertensión, y 3) deterioro cognitivo como efecto indeseable de la medicación antihipertensiva. Conclusiones: Los resultados pretenden brindar una visión general del impacto de la hipertensión en el desempeño cognitivo en sus diferentes niveles; al mismo tiempo, formular objetivos para nuevas investigaciones tendientes a clarificar y mejorar estas elucidaciones teóricas.

Estudios recientes han mostrado la presencia de un amplio grupo de principios activos farmacológicos en el medioambiente procedentes principalmente de la descarga de estaciones depuradoras de aguas residuales. Entre ellos, son de especial interés aquellos empleados en el tratamiento de enfermedades crónicas, como los fármacos antihipertensivos, no sólo debido a su consumo continuado, sino además a su potente mecanismo de acción, lo que los hace especialmente peligrosos para el medioambiente. En este trabajo se ha optimizado y validado una metodología analítica, basada en la extracción en fase sólida y determinación mediante cromatografía líquida con detector de espectrometría de masas de triple cuadrupolo, para la determinación de los tres fármacos antihipertensivos más consumidos (irbesartán, telmisartán y valsartán) en aguas superficiales. Las recuperaciones obtenidas se situaron entre el 84 y el 101 %. La precisión, medida en unidades de desviación estándar relativa, fue inferior al 10 % y los límites de detección se situaron entre 0.24 y 2.01 ng/L., Recent studies have reported the presence of a broad spectrum of pharmaceutical compounds in several environmental compartments, where they mainly end up due to discharges of effluent wastewater. Among them, pharmaceuticals designed to treat chronic diseases, including hypertensive pharmaceuticals, are of special interest, not only due to its continued consumption, but also for their potent mechanism of action, which makes them especially dangerous for the environment. In this work, an analytical method, based on solid phase extraction and determination by liquid chromatography with triple quadrupole mass spectrometry detector, has been optimized and validated for the determination of three of the most consumed antihypertensive pharmaceuticals (irbesartan, telmisartan and valsartan) on surface water samples. The recoveries obtained were between 84 and 101%. Precision, expressed as relative standard deviation, was < 10%, and limits of detection were between 0.24 and 2.01 ng/L.

In the conditions of the pharmaceutical market saturated with the similar drugs the consumer choice of drugs is based on the rational and emotional (irrational) components. The emotional state of the user and irrational factors significantly affect the final choice of a particular drug. When determining the consumer’s loyalty to drugs of carvedilol there is a very strong, strong, medium, low and very low level. The level of loyalty will significantly affect further consumption of these drugs on the basis of preference and favor of consumers. By calculating the relative indicators of price premium and income of carvedilol drugs the market reaction and consumer preferences to specific drugs have been objectively substantiated. The leading drugs and brands of carvedilol with a negative index of premium sales have been determined., В условиях фармацевтического рынка, насыщенного аналогичными препаратами, потребительский выбор лекарств основывается на рациональной и эмоциональной (иррациональной) составляющих. Эмоциональное состояние потребителя и иррациональные факторысущественно влияют на конечный выбор конкретного препарата. При анализе лояльности потребителей к препаратам карведилола определены очень сильная, сильная, средняя, низкая и очень низкая степени, что существенно будет влиять на дальнейшее потребление таких лекарств на основе предпочтений и благосклонности потребителей. Путем расчета относительных показателей ценовой премии и дохода препаратов карведилола объективно обоснована реакция рынка и реализация потребительских предпочтений в конкретных препаратах.Определены препараты-лидеры и торговые марки карведилола с негативным показателем премиальных продаж., В умовах фармацевтичного ринку, насиченого аналогічними препаратами, споживацький вибір ліків ґрунтується на раціональній та емоційній (ірраціональній) складових. Емоційний стан споживача та ірраціональні фактори значно впливають на кінцевий вибір конкретного препарату. При аналізі лояльності споживачів до препаратів карведилолу визначено дуже високий, високий, середній, низький та дуже низький ступені, що значно впливатиме на подальше споживання таких ліків на основі уподобань і прихильності споживачів. Шляхом розрахунку відносних показників цінової премії і доходу препаратів карведилолу об’єктивно обґрунтовано реакцію ринку та реалізацію споживацьких уподобань щодо окремих лікарських препаратів. Визначено препарати-лідери споживацької прихильності і торгові марки карведилолу з негативним показником преміальних продажів.

Estudios recientes han mostrado la presencia de un amplio grupo de principios activos farmacológicos en el medioambiente procedentes principalmente de la descarga de estaciones depuradoras de aguas residuales. Entre ellos, son de especial interés aquellos empleados en el tratamiento de enfermedades crónicas, como los fármacos antihipertensivos, no sólo debido a su consumo continuado, sino además a su potente mecanismo de acción, lo que los hace especialmente peligrosos para el medioambiente. En este trabajo se ha optimizado y validado una metodología analítica, basada en la extracción en fase sólida y determinación mediante cromatografía líquida con detector de espectrometría de masas de triple cuadrupolo, para la determinación de los tres fármacos antihipertensivos más consumidos (irbesartán, telmisartán y valsartán) en aguas superficiales. Las recuperaciones obtenidas se situaron entre el 84 y el 101 %. La precisión, medida en unidades de desviación estándar relativa, fue inferior al 10 % y los límites de detección se situaron entre 0.24 y 2.01 ng/L., Recent studies have reported the presence of a broad spectrum of pharmaceutical compounds in several environmental compartments, where they mainly end up due to discharges of effluent wastewater. Among them, pharmaceuticals designed to treat chronic diseases, including hypertensive pharmaceuticals, are of special interest, not only due to its continued consumption, but also for their potent mechanism of action, which makes them especially dangerous for the environment. In this work, an analytical method, based on solid phase extraction and determination by liquid chromatography with triple quadrupole mass spectrometry detector, has been optimized and validated for the determination of three of the most consumed antihypertensive pharmaceuticals (irbesartan, telmisartan and valsartan) on surface water samples. The recoveries obtained were between 84 and 101%. Precision, expressed as relative standard deviation, was < 10%, and limits of detection were between 0.24 and 2.01 ng/L.

Estudios recientes han mostrado la presencia de un amplio grupo de principios activos farmacológicos en el medioambiente procedentes principalmente de la descarga de estaciones depuradoras de aguas residuales. Entre ellos, son de especial interés aquellos empleados en el tratamiento de enfermedades crónicas, como los fármacos antihipertensivos, no sólo debido a su consumo continuado, sino además a su potente mecanismo de acción, lo que los hace especialmente peligrosos para el medioambiente. En este trabajo se ha optimizado y validado una metodología analítica, basada en la extracción en fase sólida y determinación mediante cromatografía líquida con detector de espectrometría de masas de triple cuadrupolo, para la determinación de los tres fármacos antihipertensivos más consumidos (irbesartán, telmisartán y valsartán) en aguas superficiales. Las recuperaciones obtenidas se situaron entre el 84 y el 101 %. La precisión, medida en unidades de desviación estándar relativa, fue inferior al 10 % y los límites de detección se situaron entre 0.24 y 2.01 ng/L., Recent studies have reported the presence of a broad spectrum of pharmaceutical compounds in several environmental compartments, where they mainly end up due to discharges of effluent wastewater. Among them, pharmaceuticals designed to treat chronic diseases, including hypertensive pharmaceuticals, are of special interest, not only due to its continued consumption, but also for their potent mechanism of action, which makes them especially dangerous for the environment. In this work, an analytical method, based on solid phase extraction and determination by liquid chromatography with triple quadrupole mass spectrometry detector, has been optimized and validated for the determination of three of the most consumed antihypertensive pharmaceuticals (irbesartan, telmisartan and valsartan) on surface water samples. The recoveries obtained were between 84 and 101%. Precision, expressed as relative standard deviation, was < 10%, and limits of detection were between 0.24 and 2.01 ng/L.

Estudios recientes han mostrado la presencia de un amplio grupo de principios activos farmacológicos en el medioambiente procedentes principalmente de la descarga de estaciones depuradoras de aguas residuales. Entre ellos, son de especial interés aquellos empleados en el tratamiento de enfermedades crónicas, como los fármacos antihipertensivos, no sólo debido a su consumo continuado, sino además a su potente mecanismo de acción, lo que los hace especialmente peligrosos para el medioambiente. En este trabajo se ha optimizado y validado una metodología analítica, basada en la extracción en fase sólida y determinación mediante cromatografía líquida con detector de espectrometría de masas de triple cuadrupolo, para la determinación de los tres fármacos antihipertensivos más consumidos (irbesartán, telmisartán y valsartán) en aguas superficiales. Las recuperaciones obtenidas se situaron entre el 84 y el 101 %. La precisión, medida en unidades de desviación estándar relativa, fue inferior al 10 % y los límites de detección se situaron entre 0.24 y 2.01 ng/L., Recent studies have reported the presence of a broad spectrum of pharmaceutical compounds in several environmental compartments, where they mainly end up due to discharges of effluent wastewater. Among them, pharmaceuticals designed to treat chronic diseases, including hypertensive pharmaceuticals, are of special interest, not only due to its continued consumption, but also for their potent mechanism of action, which makes them especially dangerous for the environment. In this work, an analytical method, based on solid phase extraction and determination by liquid chromatography with triple quadrupole mass spectrometry detector, has been optimized and validated for the determination of three of the most consumed antihypertensive pharmaceuticals (irbesartan, telmisartan and valsartan) on surface water samples. The recoveries obtained were between 84 and 101%. Precision, expressed as relative standard deviation, was < 10%, and limits of detection were between 0.24 and 2.01 ng/L.

Estudios recientes han mostrado la presencia de un amplio grupo de principios activos farmacológicos en el medioambiente procedentes principalmente de la descarga de estaciones depuradoras de aguas residuales. Entre ellos, son de especial interés aquellos empleados en el tratamiento de enfermedades crónicas, como los fármacos antihipertensivos, no sólo debido a su consumo continuado, sino además a su potente mecanismo de acción, lo que los hace especialmente peligrosos para el medioambiente. En este trabajo se ha optimizado y validado una metodología analítica, basada en la extracción en fase sólida y determinación mediante cromatografía líquida con detector de espectrometría de masas de triple cuadrupolo, para la determinación de los tres fármacos antihipertensivos más consumidos (irbesartán, telmisartán y valsartán) en aguas superficiales. Las recuperaciones obtenidas se situaron entre el 84 y el 101 %. La precisión, medida en unidades de desviación estándar relativa, fue inferior al 10 % y los límites de detección se situaron entre 0.24 y 2.01 ng/L., Recent studies have reported the presence of a broad spectrum of pharmaceutical compounds in several environmental compartments, where they mainly end up due to discharges of effluent wastewater. Among them, pharmaceuticals designed to treat chronic diseases, including hypertensive pharmaceuticals, are of special interest, not only due to its continued consumption, but also for their potent mechanism of action, which makes them especially dangerous for the environment. In this work, an analytical method, based on solid phase extraction and determination by liquid chromatography with triple quadrupole mass spectrometry detector, has been optimized and validated for the determination of three of the most consumed antihypertensive pharmaceuticals (irbesartan, telmisartan and valsartan) on surface water samples. The recoveries obtained were between 84 and 101%. Precision, expressed as relative standard deviation, was < 10%, and limits of detection were between 0.24 and 2.01 ng/L.

Background: Management guidelines for drug-drug interactions between non-steroidal anti-inflammatory drugs (NSAIDs) and antihypertensives recommend blood pressure monitoring in hypertensive patients. We measured the short-term effect of initiating NSAIDs on systolic blood pressure (SBP) in users of antihypertensives, aiming to investigate which outpatients are at risk for an increase in SBP in daily clinical practice. Design: A cohort study with a nested case-control design in Dutch community pharmacies. Methods: Patients with a drug-drug interaction alert for a newly initiated NSAID and antihypertensive were interviewed and their SBP was measured at T0, after one week (T1) and after two weeks (T2). We evaluated risk factors for exceeding a predefined limit of change (PLoC) in SBP (≥10mmHg to ≥140 mmHg) at T1 and T2 versus T0. Results: For 112 patients the SBP at T0 was measured. Two patients were excluded (T0 SBP ≥180 mmHg). PLoC was exceeded in 10 patients (10.4%) at T1 and in seven patients (8.0%) at T2. Patients using etoricoxib (odds ratio (OR), 21.0; 95% confidence interval (CI), 3.7-120.6) and patients using >1 defined daily dose of an NSAID (OR, 3.3; 95% CI, 1.1-10.0) were at increased risk of a rise in SBP. Conclusions: A newly initiated NSAID has an immediate clinically relevant effect on SBP in some users of antihypertensives. Management guidelines for NSAID-antihypertensive drug-drug interactions should advise SBP monitoring before and after initiation of an NSAID or intensification of NSAID therapy. Monitoring is especially relevant in patients prescribed high dosages of NSAIDs. Etoricoxib should not be used in hypertensive patients.

A new, simple and sensitive UV spectrophotometric method has been developed for simultaneous quantitative determination of propranolol hydrochloride and rosuvastatin calcium in bulk and pharmaceutical dosage form. This is achieved by simultaneous equation (Vierodts method) and absorbance ratio (Q- point) method. Propranolol hydrochloride and rosuvastatin calcium exhibits maximum absorbance at 289 nm and 243 nm respectively in methanol as solvent. Beers law was found to be obeyed in the concentration range 2-40 g/ml for propranolol hydrochloride and 2-42 g/ml or rosuvastatin calcium. Method were validated for linearity, accuracy, precision, LOD, LOQ as per ICH guidelines.

A new, simple and sensitive UV spectrophotometric method has been developed for simultaneous quantitative determination of propranolol hydrochloride and rosuvastatin calcium in bulk and pharmaceutical dosage form. This is achieved by simultaneous equation (Vierodts method) and absorbance ratio (Q- point) method. Propranolol hydrochloride and rosuvastatin calcium exhibits maximum absorbance at 289 nm and 243 nm respectively in methanol as solvent. Beers law was found to be obeyed in the concentration range 2-40 g/ml for propranolol hydrochloride and 2-42 g/ml or rosuvastatin calcium. Method were validated for linearity, accuracy, precision, LOD, LOQ as per ICH guidelines.

A new, simple and sensitive UV spectrophotometric method has been developed for simultaneous quantitative determination of propranolol hydrochloride and rosuvastatin calcium in bulk and pharmaceutical dosage form. This is achieved by simultaneous equation (Vierodts method) and absorbance ratio (Q- point) method. Propranolol hydrochloride and rosuvastatin calcium exhibits maximum absorbance at 289 nm and 243 nm respectively in methanol as solvent. Beers law was found to be obeyed in the concentration range 2-40 g/ml for propranolol hydrochloride and 2-42 g/ml or rosuvastatin calcium. Method were validated for linearity, accuracy, precision, LOD, LOQ as per ICH guidelines.

Background: Hypertension remains a public health challenge worldwide. In the Democratic Republic of Congo, its prevalence has increased in the past three decades. Higher prevalence of poor blood pressure control and an increasing number of reported cases of complications due to hypertension have also been observed. It is well established that non-adherence to antihypertensive medication contributes to poor control of blood pressure. The aim of this study is to measure non-adherence to antihypertensive medication and to identify its predictors. Methods: A cross-sectional study was conducted at Kinshasa Primary Health-care network facilities from October to November 2013. A total of 395 hypertensive patients were included in the study. A structured interview was used to collect data. Adherence to medication was assessed using the Morisky Medication Scale. Covariates were defined according to the framework of the World Health Organization. Logistic regression was used to identify predictors of non-adherence. Results: A total of 395 patients participated in this study. The prevalence of non-adherence to antihypertensive medication and blood pressure control was 54.2 % (95 % CI 47.3-61.8) and 15.6 % (95 % CI 12.1-20.0), respectively. Poor knowledge of complications of hypertension (OR = 2.4; 95 % CI 1.4-4.4), unavailability of antihypertensive drugs in the healthcare facilities (OR = 2.8; 95 % CI 1.4-5.5), lack of hypertensive patients education in the healthcare facilities (OR = 1.7; 95 % CI 1.1-2.7), prior experience of medication side effects (OR = 2.2; 95 % CI 1.4-3.3), uncontrolled blood pressure (OR = 2.0; 95 % CI 1.1-3.9), and taking non-prescribed medications (OR = 2.2; 95 % CI 1.2-3.8) were associated with non-adherence to antihypertensive medication. Conclusion: This study identified predictors of non-adherence to antihypertensive medication. All predictors identified were modifiable. Interventional studies targeting these predictors for improving adherence are, SCOPUS: ar.j, info:eu-repo/semantics/published

The high cost of fertilizer production and environmental pollution caused by the use of these fertilizers makes necessary to use other sources especially biofertilizers. The biomass of the bacterium Azotobacter can be used as a biofertilizer due to its ability to fix nitrogen from the atmosphere. The purpose of this research was to study the survival of bacteria Azotobacter on different carrier such as vermicast and charcoal. The physical and chemical parameters of the carriers were analyzed to determine the effect of carrier in the survival of bacteria. Bacterial population inoculated in carriers were measured at times 0, 15, 30, 45, and 60 days by colony forming unit. The results of bacterial count after 15 days incubation showed that bacterial population in vermicast was increased and decreased in the charcoal. Considering these results, the use of vermicast as carrier could increase the survival of bacteria.

The high cost of fertilizer production and environmental pollution caused by the use of these fertilizers makes necessary to use other sources especially biofertilizers. The biomass of the bacterium Azotobacter can be used as a biofertilizer due to its ability to fix nitrogen from the atmosphere. The purpose of this research was to study the survival of bacteria Azotobacter on different carrier such as vermicast and charcoal. The physical and chemical parameters of the carriers were analyzed to determine the effect of carrier in the survival of bacteria. Bacterial population inoculated in carriers were measured at times 0, 15, 30, 45, and 60 days by colony forming unit. The results of bacterial count after 15 days incubation showed that bacterial population in vermicast was increased and decreased in the charcoal. Considering these results, the use of vermicast as carrier could increase the survival of bacteria.