Hypertension/therapy – ABC CARDIOL

IJCS

Editorial

Factors Associated With Quality of Life in Patients with Systemic Arterial Hypertension

In 1966, Avedis Donabedian published a seminal article showing the importance of measuring health care quality. Donabedian also defined that it should be done in the dimensions of structure, process or results. The author showed that the “results” dimension is not necessarily related to the other two. While the measurement of some results, such as mortality, is easy to be carried out, other results are difficult to be measured, such as quality of life and patients’ satisfaction.

In the early 80’s, I became interested in the subject of health care quality. My thesis to obtain the master’s degree in Internal Medicine from the Federal University of Rio de Janeiro Medical School was entitled “Hypertension: health care quality at the HU-UFRJ”.

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Brief Communication

Diuretics are Similar to Losartan on Echocardiographic Target-Organ Damage in Stage I Hypertension. PREVER-Treatment Study

Carolina Bertoluci et al. Murilo Foppa Angela Barreto Santiago Santos Sandra C. Fuchs Flávio Danni Fuchs

Abstract

Blood pressure (BP)-lowering therapy improves left ventricular (LV) parameters of hypertensive target-organ damage in stage II hypertension, but whether there is a drug-class difference in echocardiographic parameters in stage I hypertension patients is less often studied. In the PREVER treatment study, where individuals with stage I hypertension were randomized for treatment with diuretics (chlorthalidone/amiloride) or losartan, 110 participants accepted to participate in a sub-study, where two-dimensional echocardiograms were performed at baseline and after 18 months of antihypertensive treatment. As in the general study, systolic BP reduction was similar with diuretics or with losartan. Echocardiographic parameters showed small but significant changes in both treatment groups, with a favorable LV remodeling with antihypertensive treatment for 18 months when target blood pressure was achieved either with chlorthalidone/amiloride or with losartan as the initial treatment strategy. In conclusion, even in stage I hypertension, blood pressure reduction is associated with improvement in echocardiographic parameters, either with diuretics or losartan as first-drug regimens.

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Special Article

I Brazilian Position Paper on Prehypertension, White Coat Hypertension and Masked Hypertension: Diagnosis and Management

Alexandre Alessi et al. Andréa Araujo Brandão Annelise Machado Gomes de Paiva Armando da Rocha Nogueira … Audes Feitosa Carolina de Campos Gonzaga Celso Amodeo Decio Mion Dilma do Socorro Moraes de Souza Eduardo Barbosa Emilton Lima Junior Fernando Nobre Flavio Dani Fuchs Hilton Chaves Junior Jamil Cherem Schneider João Gemelli José Fernando Villela-Martin Luiz Cesar Nazario Scala Marco Antonio Mota Gomes Marcus Vinicus Bolivar Malachias Nelson Siqueira de Morais Osni Moreira Filho Oswaldo Passarelli Junior Paulo Cesar Brandão Veiga Jardim Roberto Dischinger Miranda Rui Póvoa Sandra Cristina Fuchs Sergio Baiocchi Thiago Veiga Jardim Weimar Kunz Sebba Barroso

Introduction

Arterial blood pressure (BP) is a very useful variable in clinical practice. Its measurement is simple, inexpensive and easy; it is worth noting that BP should be accurately obtained, following the recommendations of the VI Brazilian Guidelines on Hypertension (DBH VI).

Office BP measurement is the central parameter for the diagnosis, treatment and follow-up of systemic arterial hypertension (SAH), being directly, continuously and independently related to the risk of fatal and non-fatal cardiovascular (CV) events ^– .

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Artigo Especial

I Brazilian Position Paper on Antihypertensive Drug Combination

Rui Póvoa et al. Weimar Sebba Barroso Andrea A Brandão Paulo Cesar Veiga Jardim … Oswaldo Barroso Oswaldo Passarelli Jr. João Roberto Gemelli Audes Feitosa Thiago Veiga Jardim Sergio Baiocchi Carneiro Celso Amodeo Osni Moreira Filho Armando da Rocha Nogueira Nelson Siqueira de Morais Luiz Cesar Nazário Scala Carolina Gonzaga Dilma do Socorro Moraes de Souza Annelise Machado Gomes de Paiva Marcus Vinicius Bolivar Malachias Décio Mion Jr. Marco Antônio Mota-Gomes Eduardo Costa Duarte Barbosa Marcio Gonçalves de Sousa Henrique Tria Bianco Francisco Antonio Helfenstein Fonseca Marcio Kalil Roberto Dischinger Miranda Carlos André Uehara Antônio Felipe Sanjuliani

Evidence of clinical trials

Data available have suggested that most of the hypertensive population requires combined therapy to achieve BP control goals. A meta-analysis of 354 double-blind randomized clinical trials has found mean BP reductions with monotherapy of only 9.1 mm Hg and 5.5 mm Hg for systolic BP (SBP) and diastolic BP (DBP), respectively. There were only few differences in the responses to the following drugs assessed: diuretics; beta-blockers (BBs); angiotensin-converting-enzyme inhibitors (ACEIs); type 1 angiotensin-receptor blockers (ARBs); and calcium channel antagonists (CCAs). In the ALLHAT, only 26% of the patients achieved the BP control goal with monotherapy, even considering the goal for diabetic patients (36% of the patients) of < 140/90 mm Hg, rather than 130/80 mm Hg as recommended by several guidelines at the time. In the HOT Study, only 33% of the patients met the DBP goal with monotherapy; 45% required two drugs and 22% needed three drugs to meet that goal. The mean SBP at the end of the HOT Study was 141 mm Hg, indicating that an even higher percentage of patients would have needed combined therapy to meet the goal of < 140 mmHg. In the LIFE Study, treatment to meet the recommended goal (<140/90 mmHg) was aggressively pursued in elderly patients with left ventricular hypertrophy (LVH). Considering an initial mean BP of 175/98 mm Hg, more than 90% need to use at least two antihypertensive drugs. The Strategies in Treatment of Hypertension (STRATHE) Study, in which treatment was initiated with a combination of low doses and compared to monotherapy, has found a greater percentage of individuals in the low-dose combination group who met the BP control goal (BP < 140/90 mm Hg) as compared to those receiving sequential monotherapy (62% vs. 49%, p = 0.02).

Based on the criteria of efficacy, tolerability, likelihood of higher adherence, evidence of CV and kidney protections, and safety, the associations of antihypertensive drugs can be divided as follows: preferential; acceptable; less usual; and unusual (). summarizes the current recommendations for drug association in AH treatment. It is worth noting that non-pharmacological measures of lifestyle change should be always emphasized to improve AH control and prevention of its complications.

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Revisão

Mechanisms and treatment of resistant hypertension

Eduardo Pimenta et al. David A. Calhoun Suzanne Oparil

REVIEW ARTICLE

Mechanisms and treatment of resistant hypertension

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Factors Associated With Quality of Life in Patients with Systemic Arterial Hypertension

Diuretics are Similar to Losartan on Echocardiographic Target-Organ Damage in Stage I Hypertension. PREVER-Treatment Study

Abstract

I Brazilian Position Paper on Prehypertension, White Coat Hypertension and Masked Hypertension: Diagnosis and Management

Introduction

I Brazilian Position Paper on Antihypertensive Drug Combination

Evidence of clinical trials

Mechanisms and treatment of resistant hypertension

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