Assuntos
Humanos , Sistema Renina-Angiotensina , Sódio/efeitos adversos , Sistema Nervoso Simpático , Sistema Calicreína-Cinina , Rim/fisiologia , Hipertensão/genética , Hipertensão/complicações , Hipertensão/fisiopatologia , Estresse Psicológico/complicações , Espironolactona/uso terapêutico , Fatores de RiscoRESUMO
Oral vasodilators have proved to be valuable drugs in the management of systolic or diastolic heart failure. They produce a clinical and hemodynamic relief of preload, afterload or both during the resting state or exercise. Although left ventricular hypertrophy is an adaptative response to myocardial stress, in the long run it becomes an independent risk factor leading to diastolic dysfunction. At present, pharmacological regression of ventricular hypertrophy has a prognostic importance. Of the large number of available vasodilators, angiotensin converting enzyme inhibitors have proved to be the most succesful drugs. They behave as afterload relievers, counteracting both the renin-angiotensin and adrenergic systems, but also are powerful inhibitors of cardiomyocite enlargement and interstitial connective tissue proliferation. This last structural change may revert the compromised diastolic function of the heart
Assuntos
Humanos , Vasodilatadores/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Vasodilatadores/classificação , HemodinâmicaRESUMO
Nowadays treatments of risk factors seem to be successful than treating illness itself or its complications. The importance of prospective international surveys in reducing complications has been underlined. From an epidemiological point of view, therapeutic strategies have proved to be more eficacious when applied to the whole hypertensive population than to selective high risk groups. Historically, tendency was aimed to lower diastolic blood pressure, classically a marker of essential hypertension. At present, trends seem to indicatate that prognosis is more influenced by systolic hypertension, mainly in the aged. As aging progresses, diastolic pressure tends to decrease, arteries become rigid, cardiac output diminishes and pulse wave velocity increases enhancing quick blood return to the heart at the end of systole. All these changes heighten blood pressure, overload the heart and dimished coronary flow. It has been recently reported that lowering diastolic blood pressure under 85-80 mmHg leads to coronary insufficiency or death. HOT study is under way in order to achieve the right criteria on this point. In our view, a key figure is not going to be answer for everyone
Assuntos
Humanos , Hipertensão/terapia , Doenças Cardiovasculares/prevenção & controle , Fatores de Risco , Hipertensão/fisiopatologia , Prevenção Primária/métodosRESUMO
Comparison of the frequence of electrocardiographical alterations in groups of apparently helathy persons with positive serology for Chagas disease, for toxoplasmosis or for both parasitoses