RESUMEN
A hipertensão arterial resistente (HAR) é uma condição clínica na qual a pressão arterial persiste elevada, acima das metas estabelecidas de controle apesar do uso de três fármacos incluindo um diurético, todos em doses máximas otimizadas ou necessidade de se adicionar quatro ou mais medicamentos para atingir o controle adequado. A terapia com diuréticos, inibidores da enzima de conversão da angiotensina (IECA) ou bloqueadores receptor da angiotensina II (BRA) e bloqueadores de canais de cálcio (BCC) para o controle adequado da pressão arterial já está bem estabelecida pelas diretrizes. A espironolactona firmou-se como quarto fármaco adicional a esse esquema terapêutico, após o estudo Pathway-2. A clonidina passou ser a sexta ou sétima opção, para adição a esta sequência de terapia ficando atrás dos betabloqueadores ou vasodilatadores, dependendo da situação clínica. O estudo brasileiro ReHot, avaliando pacientes com HAR não demonstrou superioridade expressiva deste fármaco em relação a espironolactona, devido aos efeitos adversos, porém não devendo ser substituída pela metildopa pela falta de evidências cientificas em relação a segurança e eficácia do fármaco como terapia adicional para HAR
Resistant arterial hypertension (RAH) is a clinical condition in which blood pressure remains elevated, above the established control goals despite the use of three drugs including a diuretic, all in maximum optimized doses or the need to add four or more medications for achieve adequate control. Therapy with diuretics, ACEI or ARB and CCB for adequate control of blood pressure is already well established by the guidelines. Spironolactone was established as the fourth additional drug to this therapeutic regimen, after the Pathway-2 study. Clonidine became the sixth or seventh option, for addition to this therapy sequence, being behind beta-blockers or vasodilators, depending on the clinical situation. The Brazilian ReHot study, evaluating patients with RAH, did not demonstrate expressive superiority of this drug in relation to spironolactone, due to adverse effects, but should not be replaced by methyldopa due to the lack of scientific evidence regarding the safety and efficacy of the drug as additional therapy for RAH
RESUMEN
A relação maléfica entre hipertensão arterial sistêmica (HAS) e dislipidemia torna-se explícita a partir da análise da progressão dessas comorbidades simultaneamente, agravando diretamente o risco cardiovascular. Se observa o aumento de espécies reativas do oxigênio gerando estresse oxidativo, a diminuição da biodisponibilidade de óxido nítrico promovendo disfunção endotelial, maior concentração de moléculas LDL oxidadas o que resulta na progressão de eventos ateroscleróticos. Somado a isto, se percebe que o tratamento em conjunto das duas doenças é mais eficaz quando comparado ao tratamento de cada uma delas isoladamente, demonstrando o efeito sinérgico do tratamento em conjunto. Concluindo então, que as comorbidades estão intimamente relacionadas e agravam o estado geral do paciente
The harmful relations systemic arterial hypertension (SAH) and dyslipidemia be comes explicit from the analysis of the progression of these comorbidities simultaneously, directly aggravating cardiovascular risk. There is an increase in reactive oxygen species generating oxidative stress, a decrease in the nitric oxide bioavailability promoting endothelial dysfunction, a higher concentration of oxidized LDL molecules which results in the progression of atherosclerotic events. In addition, it is clear that the joint treatment of the two diseases is more effective when compared to the treatment of each separately, demonstrating the synergistic effect of the joint treatment. In conclusion, then, that comorbidities are closely related and aggravate the patient's general condition
Asunto(s)
Humanos , Dislipidemias/complicaciones , Factores de Riesgo de Enfermedad Cardiaca , Hipertensión/diagnósticoAsunto(s)
Diabetes Mellitus Tipo 2/mortalidad , Electrocardiografía , Hipertrofia Ventricular Izquierda/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Salud Global , Humanos , Hipertrofia Ventricular Izquierda/mortalidad , Hipertrofia Ventricular Izquierda/fisiopatología , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
OBJECTIVE: To compare the lipid profiles and coronary heart disease risks of 2 Brazilian Amazonian populations as follows: a riverside population (village of Vigia) and an urban population (city of Belém in the state of Pará). METHODS: Fifty individuals controlled for age and sex were assessed in each region, and the major risk factors for coronary heart disease were analyzed. RESULTS: According to the National Cholesterol Education Program (NCEP III) and using the Framingham score, both populations had the same absolute risk of events (Vigia = 5.4 ± 1 vs Belém = 5.7 ± 1), although the population of Vigia had a lower consumption of saturated fat (P<0.0001), a greater consumption of mono- and polyunsaturated fat (P<0.03), in addition to lower values for body mass index (25.4± 0.6 vs 27.6 ± 0.7 kg/m², P<0.02), of biceps skin fold (18.6 ± 1.1 vs 27.5 ± 1.3 mm, P<0.0001), of triceps skin fold (28.7 ± 1.2 vs 37.3 ± 1.7 mm, P<0.002), and of total cholesterol (205 ± 5 vs 223 ± 6 mg/dL, P< 0.03) and triglycerides (119 ± 9 vs 177 ± 18 mg/dL, P<0.005). Both populations did not differ in regard to HDL-C (46 ± 1 vs 46 ± 1 mg/dL), LDL-C (135 ± 4 vs 144 ± 5 mg/dL) and blood pressure (SBP 124 ± 3 vs 128 ± 3 mmHg; DBP 80 ± 2 vs 82 ± 2 mmHg). CONCLUSION: The riverside and urban populations of Amazonia had similar cardiovascular risks. However, the marked difference in the variables studied suggests that different strategies of prevention should be applied
Asunto(s)
Humanos , Animales , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades Cardiovasculares , Grasas de la Dieta , Lípidos , Antropometría , Brasil , Enfermedades Cardiovasculares , Distribución de Chi-Cuadrado , Colesterol , Dieta , Ácidos Grasos Monoinsaturados , Ácidos Grasos Insaturados , Peces , Factores de Riesgo , Población Rural , Fumar , Triglicéridos , Población UrbanaRESUMEN
OBJECTIVE: To compare the lipid profiles and coronary heart disease risks of 2 Brazilian Amazonian populations as follows: a riverside population (village of Vigia) and an urban population (city of Bel m in the state of Par ). METHODS: Fifty individuals controlled for age and sex were assessed in each region, and the major risk factors for coronary heart disease were analyzed. RESULTS: According to the National Cholesterol Education Program (NCEP III) and using the Framingham score, both populations had the same absolute risk of events (Vigia = 5.4 +/- 1 vs Bel m = 5.7 +/- 1), although the population of Vigia had a lower consumption of saturated fat (P<0.0001), a greater consumption of mono- and polyunsaturated fat (P<0.03), in addition to lower values for body mass index (25.4 +/- 0.6 vs 27.6 +/- 0.7 kg/m , P<0.02), of biceps skin fold (18.6 1.1 vs 27.5 +/- 1.3 mm, P<0.0001), of triceps skin fold (28.7 +/- 1.2 vs 37.3 +/- 1.7 mm, P<0.002), and of total cholesterol (205 +/- 5 vs 223 +/- 6 mg/dL, P< 0.03) and triglycerides (119 +/- 9 vs 177 +/- 18 mg/dL, P<0.005). Both populations did not differ in regard to HDL-C (46 +/- 1 vs 46 +/- 1 mg/dL), LDL-C (135 +/- 4 vs 144 +/- 5 mg/dL) and blood pressure (SBP 124 +/- 3 vs 128 +/- 3 mmHg; DBP 80 +/- 2 vs 82 +/- 2 mmHg). CONCLUSION: The riverside and urban populations of Amazonia had similar cardiovascular risks. However, the marked difference in the variables studied suggests that different strategies of prevention should be applied.