RESUMO
Introduction: Infantile hemangioma is the most frequent benign vascular tumor in childhood, with an incidence of 3 to 10%. When patients require treatment, oral propranolol, a non-selective lipophilic beta-blocker, is usually considered the therapy of choice. However, its use has been associated with several adverse events related to its ß-2 action and its ability to cross the blood-brain barrier. Because of this, oral atenolol, a hydrophilic ß-1 receptor-selective beta-blocker, may represent a valid treatment alternative. Nonetheless, there is still controversy regarding the efficacy and safety of atenolol when compared with propranolol as monotherapy for this condition. Methods: We searched Epistemonikos, the largest database of systematic reviews in health science, which is maintained by screening multiple sources of information, including MEDLINE/PubMed, EMBASE, and Cochrane, among others. Data were extracted from the identified reviews, data from the primary studies were analyzed, a meta-analysis was performed, and a summary table of the results was prepared using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Results: Nine systematic reviews were identified, including 10 primary studies and three randomized trials. The three randomized trials were included in the analysis of this investigation. Conclusion: The use of oral atenolol compared with oral propranolol as monotherapies may result in little or no difference in terms of likelihood of complete remission, decrease in Hemangioma Activity Score, likelihood of post-treatment relapse, and risk of adverse events and severe adverse events, in infantile hemangioma (low certainty of evidence).
Introducción: El hemangioma infantil corresponde al tumor vascular benigno más frecuente de la infancia, con una incidencia de 3 a 10%. Entre los pacientes que requieren tratamiento el uso oral de propranolol, un betabloqueador no selectivo de tipo lipofílico, es usualmente considerado como la terapia de elección. Sin embargo, su uso se ha asociado a diversos efectos adversos, relacionados con su acción ß-2, y a su capacidad de cruzar la barrera hematoencefálica. Debido a esto, el uso oral de atenolol, un betabloqueador selectivo de receptores ß-1, de tipo hidrofílico, podría representar una alternativa válida de tratamiento. Sin embargo, aún existe controversia en relación con la eficacia y seguridad del tratamiento con atenolol como monoterapia, en comparación con el uso de propranolol como monoterapia para esta condición. Métodos: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el tamizaje de múltiples fuentes de información, incluyendo MEDLINE/PubMed, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas, se analizaron los datos de los estudios primarios, se realizó un metanálisis y se preparó una tabla de resumen de los resultados utilizando el método GRADE. Resultados: Se identificaron nueve revisiones sistemáticas, que en conjunto incluyeron 10 estudios primarios y tres ensayos aleatorizados. Se incluyeron los tres ensayos aleatorizados en el análisis del presente trabajo. Conclusiones: El uso de atenolol oral como monoterapia, comparado con el uso de propranolol oral como monoterapia, podría resultar en poca o nula diferencia en cuanto a la probabilidad de remisión completa, la disminución del , la probabilidad de recaída posterior al tratamiento y el riesgo de presentar efectos adversos y efectos adversos severos, en el hemangioma infantil (certeza de la evidencia baja).
Assuntos
Hemangioma Capilar , Hemangioma , Humanos , Propranolol/efeitos adversos , Atenolol/efeitos adversos , Resultado do Tratamento , Recidiva Local de Neoplasia/induzido quimicamente , Revisões Sistemáticas como Assunto , Antagonistas Adrenérgicos beta/efeitos adversos , Hemangioma Capilar/induzido quimicamente , Hemangioma/tratamento farmacológico , Hemangioma/induzido quimicamenteRESUMO
INTRODUCCIÓN: El hemangioma infantil corresponde al tumor vascular benigno más frecuente de la infancia, con una incidencia de 3 a 10%. Entre los pacientes que requieren tratamiento el uso oral de propranolol, un betabloqueador no selectivo de tipo lipofílico, es usualmente considerado como la terapia de elección. Sin embargo, su uso se ha asociado a diversos efectos adversos, relacionados con su acción ß-2, y a su capacidad de cruzar la barrera hematoencefálica. Debido a esto, el uso oral de atenolol, un betabloqueador selectivo de receptores ß-1, de tipo hidrofílico, podría representar una alternativa válida de tratamiento. Sin embargo, aún existe controversia en relación con la eficacia y seguridad del tratamiento con atenolol como monoterapia, en comparación con el uso de propranolol como monoterapia para esta condición. MÉTODOS: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el tamizaje de múltiples fuentes de información, incluyendo MEDLINE/PubMed, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas, se analizaron los datos de los estudios primarios, se realizó un metanálisis y se preparó una tabla de resumen de los resultados utilizando el método , GRADE. RESULTADOS: Se identificaron nueve revisiones sistemáticas, que en conjunto incluyeron 10 estudios primarios y tres ensayos aleatorizados. Se incluyeron los tres ensayos aleatorizados en el análisis del presente trabajo. CONCLUSIONES: El uso de atenolol oral como monoterapia, comparado con el uso de propranolol oral como monoterapia, podría resultar en poca o nula diferencia en cuanto a la probabilidad de remisión completa, la disminución del , la probabilidad de recaída posterior al tratamiento y el riesgo de presentar efectos adversos y efectos adversos severos, en el hemangioma infantil (certeza de la evidencia baja).
INTRODUCTION: Infantile hemangioma is the most frequent benign vascular tumor in childhood, with an incidence of 3 to 10%. When patients require treatment, oral propranolol, a non-selective lipophilic beta-blocker, is usually considered the therapy of choice. However, its use has been associated with several adverse events related to its ß-2 action and its ability to cross the blood-brain barrier. Because of this, oral atenolol, a hydrophilic ß-1 receptor-selective beta-blocker, may represent a valid treatment alternative. Nonetheless, there is still controversy regarding the efficacy and safety of atenolol when compared with propranolol as monotherapy for this condition. METHODS: We searched Epistemonikos, the largest database of systematic reviews in health science, which is maintained by screening multiple sources of information, including MEDLINE/PubMed, EMBASE, and Cochrane, among others. Data were extracted from the identified reviews, data from the primary studies were analyzed, a meta-analysis was performed, and a summary table of the results was prepared using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. RESULTS: Nine systematic reviews were identified, including 10 primary studies and three randomized trials. The three randomized trials were included in the analysis of this investigation. CONCLUSION: The use of oral atenolol compared with oral propranolol as monotherapies may result in little or no difference in terms of likelihood of complete remission, decrease in Hemangioma Activity Score, likelihood of post-treatment relapse, and risk of adverse events and severe adverse events, in infantile hemangioma (low certainty of evidence).
Assuntos
Humanos , Hemangioma Capilar/induzido quimicamente , Hemangioma/induzido quimicamente , Hemangioma/tratamento farmacológico , Propranolol/efeitos adversos , Atenolol/efeitos adversos , Resultado do Tratamento , Antagonistas Adrenérgicos beta/efeitos adversos , Revisões Sistemáticas como Assunto , Recidiva Local de Neoplasia/induzido quimicamenteRESUMO
BACKGROUND: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previous randomized trial assessing fixed-dose combination therapy has included patients early after a MI. We aimed to assess if a multicap containing four secondary prevention drugs increases adherence to treatment at 6 months after MI hospitalization. The study was designed as a randomized, parallel, open-label, controlled trial. METHODS: Patients were randomized within 7 days of a MI to either multicap or control group. The multicap group received a capsule containing aspirin, atenolol, ramipril, and simvastatin. The control group received each drug in separate pills. The primary outcome was adherence at 6 months. We also measured blood pressure, heart rate, serum cholesterol levels, C-reactive protein, and platelet aggregation. RESULTS: The study was stopped prematurely when 100 patients were included for futility. At 6 months, 92 (95.8%) patients were adherent to medical treatment: 98.0% in the multicap group and 93.5% in the control group [relative risk (RR) 1.05; 95% confidence interval (CI) 0.96-1.14; p = 0.347]. There were no differences between groups in systolic blood pressure (p = 0.662), diastolic blood pressure (p = 0.784), heart rate (p = 0.533), total cholesterol (p = 0.760), LDL-c (p = 0.979), C-reactive protein (p = 0.399), or in the proportion of patients with adequate platelet aggregation inhibition (p = 0.600). CONCLUSIONS: The study did not find any improvement in the adherence at 6 months after a MI with a multicap-based strategy (Multicap for Increase Adherence After Acute Myocardial Infarction; [ ClinicalTrials.gov identifier: NCT02271178]).
Assuntos
Síndrome Coronariana Aguda/terapia , Antagonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Aspirina/administração & dosagem , Atenolol/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Adesão à Medicação , Infarto do Miocárdio/tratamento farmacológico , Inibidores da Agregação Plaquetária/administração & dosagem , Ramipril/administração & dosagem , Sinvastatina/administração & dosagem , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Administração Oral , Antagonistas de Receptores Adrenérgicos beta 1/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Argentina , Aspirina/efeitos adversos , Atenolol/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/fisiopatologia , Inibidores da Agregação Plaquetária/efeitos adversos , Ramipril/efeitos adversos , Prevenção Secundária , Sinvastatina/efeitos adversos , Comprimidos , Fatores de Tempo , Resultado do TratamentoRESUMO
Hypertension, a chronic non-transmissible multifactorial condition, it is highly frequent in Brazil, affecting about 32.5% of the population over 25 years of age. It is characterized by the sustained increase in systolic and diastolic blood pressure levels above 140 mmHg and 90 mmHg, respectively. It is the major aggravating factor in cardiovascular complications and the appearance of other comorbidities. Aiming to promote greater adherence to treatment and improve the population's access to basic medicament, in 2004 the Federal Government created the Programa Farmácia Popular do Brasil (PFPB); partnership with private institutions that provides the population with medicament to control hypertension, free of charge or subsidized at up to 90% of the value. The PFPB distributes the anti-hypertensives atenolol, captopril, enalapril, hydrochlorothiazide, losartan and propranolol. In this way, this work aims to evaluate the genotoxic potential of antihypertensives in human lymphocytes and macrophages, since they are widely used drugs and with few studies about their genotoxicological safety. The tests were developed from cell cultures treated with five different antihypertensive concentrations, all based on plasma peaks, evaluating cell viability, DNA damage index and DNA double strand breakdown. The results show that, as the concentration of captopril and enalapril maleate increased, cell viability decreased. In addition, a DNA damage was observed with the use Captopril and Enalapril in the higher concentrations. Hydrochlorothiazide also caused DNA damage in the five doses tested. Regarding the breaking of double strands of DNA, all the compounds showed increased ruptures. This decrease in dsDNA is dose dependent for all compounds tested. The set of results shows that the use although frequent still requires care and greater knowledge. In general, the antihypertensive drugs that proved to be safer in relation to the genetic damage tested were Losartan and Propranolol.
Assuntos
Anti-Hipertensivos/efeitos adversos , Hipertensão/tratamento farmacológico , Linfócitos/efeitos dos fármacos , Macrófagos/efeitos dos fármacos , Anti-Hipertensivos/farmacologia , Atenolol/efeitos adversos , Atenolol/farmacologia , Brasil , Captopril/efeitos adversos , Captopril/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Dano ao DNA , Relação Dose-Resposta a Droga , Enalapril/efeitos adversos , Enalapril/farmacologia , Programas Governamentais , Humanos , Hidroclorotiazida/efeitos adversos , Hidroclorotiazida/farmacologia , Losartan/efeitos adversos , Losartan/farmacologia , Linfócitos/citologia , Macrófagos/citologia , Masculino , Testes de Mutagenicidade , Avaliação de Programas e Projetos de Saúde , Propranolol/efeitos adversos , Propranolol/farmacologiaRESUMO
Se realizó un estudio cuantitativo, retrospectivo y descriptivo para determinar el la incorrecta prescripción del atenolol en el área sur de Morón, se distribuyeron los pacientes según sexo, edad, criterio de prescripción, se precisó la dosis indicada, se determinó el tiempo de duración de la terapia y se describieron las interacciones y reacciones medicamentosas encontradas. Se determinó que el sexo más afectado fue el masculino con un 50,87 por ciento, el grupo de edad más afectado fue el de 25 a 59 con un 54, 31%, el criterio que prevaleció fue la epilepsia con un total de 70 pacientes y un 60,74 por ciento, la dosis que con mayor frecuencia se usó fue la de 3 tabletas diarias, la interacción medicamentosa más frecuente fue con el fenobarbital en un 70,69 por ciento y la reacción medicamentosa más común fue el ras cutáneo para un 14, 65 por ciento.
Assuntos
Humanos , Masculino , Feminino , Atenolol/administração & dosagem , Atenolol , Atenolol/efeitos adversos , Epidemiologia Descritiva , Estudos de Avaliação como Assunto , Estudos RetrospectivosRESUMO
OBJECTIVE: Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS: Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS: When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS: We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.
Assuntos
Anlodipino/economia , Anti-Hipertensivos/economia , Atenolol/economia , Hidroclorotiazida/economia , Hipertensão/tratamento farmacológico , Losartan/economia , Anlodipino/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Atenolol/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Custos de Medicamentos , Quimioterapia Combinada/economia , Enalapril/administração & dosagem , Enalapril/economia , Feminino , Humanos , Hidroclorotiazida/efeitos adversos , Hipertensão/classificação , Losartan/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS: Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS: When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS: We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anlodipino/economia , Anti-Hipertensivos/economia , Atenolol/economia , Hidroclorotiazida/economia , Hipertensão/tratamento farmacológico , Losartan/economia , Anlodipino/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Atenolol/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Custos de Medicamentos , Quimioterapia Combinada/economia , Enalapril/administração & dosagem , Enalapril/economia , Hidroclorotiazida/efeitos adversos , Hipertensão/classificação , Losartan/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
O tratamento atual da doença coronariana crônica - angina estável, envolve o uso de medicamentos com ação hemodinâmica, como os nitratos, os betabloqueadores (BB) e os bloqueadores dos canais de cálcio (BCC). O presente artigo apresenta Ivabradina, um novo medicamento para a abordagem da angina estável, revisa o seu modo de ação e os resultados da literatura médica recente.
Assuntos
Humanos , Masculino , Feminino , Angina Instável/complicações , Angina Instável/diagnóstico , Atenolol/administração & dosagem , Atenolol/efeitos adversos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnósticoRESUMO
Background: Atenolol is one of the most widely used beta blockers clinically, and has often been used as a reference drug in randomized controlled trials of hypertension. However, questions have been raised about atenolol as the best reference drug for comparisons with other antihypertensives. Thus, our aim was to systematically review the effect of atenolol on cardiovascular morbidity and mortality in hypertensive patients. Methods: Reports were identified through searches of The Cochrane Library, MEDLINE, relevant textbooks, and by personal communication with established researchers in hypertension. Randomized controlled trials that assessed the effect of atenolol on cardiovascular morbidity or mortality in patients with primary hypertension were included. Findings: We identified four studies that compared atenolol with placebo or no treatment, and five that compared atenolol with other antihypertensive drugs. Despite major differences in blood pressure lowering, there were no outcome differences between atenolol and placebo in the four studies, comprising 6,825 patients, who were followed up for a mean of 4.6 years on all-cause mortality (relative risk 1.01 [95% CI 0.89-1.15]), cardiovascular mortality (0.99[0.83-1.18]), or myocardial infarction (0.99 [0.83-1.19]). The risk of stroke, however, tended to be lower in the atenolol than in the placebo group (0.85 [0.72-1.01]). When atenolol was compared with other antihypertensives, there were no major differences in blood pressure lowering between the treatment arms. Our meta-analysis showed a significantly higher mortality (1.13[1.02-1.25]) with atenolol treatment than with other active treatment, in the five studies comprising 17,671 patients who were followed up for a mean of 4.6 years. Moreover, cardiovascular mortality also tended to be higher with atenolol treatment than with other antihypertensive treatment. Stroke was also more frequent with atenolol treatment. Interpretation: Our results cast doubts ...
Assuntos
Humanos , Antagonistas Adrenérgicos beta/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , Medicina Baseada em Evidências , Hipertensão/tratamento farmacológico , Antagonistas Adrenérgicos beta/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Atenolol/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto/normasRESUMO
Níveis plasmáticos e farmacocinética de beta-bloqueadores podem ser alterados por hipotermia e circulação extracorpórea (H-CEC). Avaliou-se, em pacientes submetidos a revascularização miocárdica (RM) com H-CEC, a farmacocinética do propranolol (n=11) e do atenolol (n=8) nos períodos pré e pós-operatório. Observou-se aumento da meia vida biológica e volume de distribuição apenas para o propranolol. O clearance total permaneceu inalterado para os dois fármacos e ocorreu aumento da concentração plasmática de propranolol do início até o final da H-CEC. Os resultados mostram que a RM com H-CEC induz alterações farmacocinéticas diferentes para o propranolol e o atenolol / Plasma levels and pharmacokinetics of betablockers may be altered by hypothermic cardiopulmonary bypass (H-CPB). We evaluated the pharmacokinetics of propranolol (n=11) and atenolol (n=8) pre and postoperatively in patients submitted to coronary artery bypass grafting surgery (CABG) employing H-CPB. Increase of biological half-life and volume of distribution was observed only for propranolol. The total clearance remained unchanged for both drugs and an increase in plasma propranolol was observed from the beginning to the end of H-CPB. Data obtained show that CABG employing H-CPB influences the propranolol and atenolol pharmacokinetics in distinct ways.
Assuntos
Humanos , Adulto , Atenolol/efeitos adversos , Atenolol/farmacocinética , Atenolol/uso terapêutico , Circulação Extracorpórea/métodos , Propranolol/efeitos adversos , Propranolol/farmacocinética , Propranolol/uso terapêutico , Revascularização Miocárdica/métodosAssuntos
Humanos , Feminino , Idoso , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/tratamento farmacológico , Lúpus Eritematoso Cutâneo/patologia , Fatores Desencadeantes , Atenolol/efeitos adversos , Piroxicam/efeitos adversos , Penicilamina/efeitos adversos , Procainamida/efeitos adversos , Griseofulvina/efeitos adversos , Espironolactona/efeitos adversosRESUMO
The authors describe a 62 year-old white male who was diagnosed as autoimmune hyperthyroidism and treated with methimazole and atenolol. Ten days later he showed itching, jaundice and choluria. All drugs were discontinued. The patient was given radioactive iodine. Two months later direct serum bilirubin levels reached 35 mg%. Endoscopic retrograde cholangiogram evidenced normal extrahepatic biliary ducts. The percutaneous liver biopsy showed marked cholestasis specially in the centrolobular zone with a slight infiltrate of mononuclear cells in the portal areas. Together with the liver disease the patient presented an anemic syndrome. Bone marrow aspiration showed rich cellularity, Perls staining showed 70% sideroblasts, with 10% ringed sideroblasts and increased extracorpuscular iron. The patient's evolution was satisfactory. Twenty months after the beginning of the disease clinical and biochemical tests were normal. A new bone marrow aspiration rendered normal. Hepatic cholestasis suffered by our patient was probably due to an adverse reaction of methimazole. Physiopathology of reversible sideroblastic anemia is discussed.
Assuntos
Anemia Sideroblástica/etiologia , Colestase Intra-Hepática/etiologia , Hipertireoidismo/complicações , Anemia Sideroblástica/patologia , Atenolol/efeitos adversos , Atenolol/uso terapêutico , Colestase Intra-Hepática/patologia , Humanos , Hipertireoidismo/tratamento farmacológico , Testes de Função Hepática , Masculino , Metimazol/efeitos adversos , Metimazol/uso terapêutico , Pessoa de Meia-Idade , Testes de Função TireóideaRESUMO
Se describe un paciente de 62 años quien padeció de hipertiroidismo autoinmune, siendo tratado con metimazol y atenolol. Diez días después del inicio del tratamiento comenzó con prurito, icterícia y coluria. Se suspendieron ambos y se le administro iodo radioactivo. Dos meses después Ia bilirrubina directa aicanzó 35 mg por ciento. La colangiografía endoscópica retrógrada evidenció vías biliares extrahepáticas normales. Una biopsia del hígado mostró marcada colestasis, especialmente en la zona centrolobulillar, con un discreto infiltrado de células mononucleares en los espacios portales. Junto con el comienzo de la enfermedad presentó anemia. La aspiración de la médula ósea mostró rica celularidad, sideroblastos con un 10 por ciento de formas anilladas e incremento de hierro extracorpuscular. La evolución del paciente fue satisfactoria. A dieciocho meses del comienzo de la enfermedad se hallaba asintomático, no presentando ningún signo físico o humorai patológico. Una nueva punción de la médula ósea resulto normal. La severa colestasis intrahepática sufrida por el paciente, estaría relacionada con una reacción adversa ai metimazoi. Se discute la etio-fisiopatogenia de la anemia siderobiástica reversible.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anemia Sideroblástica/etiologia , Colestase Intra-Hepática/etiologia , Hipertireoidismo/complicações , Anemia Sideroblástica/patologia , Atenolol/efeitos adversos , Atenolol/uso terapêutico , Colestase Intra-Hepática/patologia , Hipertireoidismo/tratamento farmacológico , Testes de Função Hepática , Metimazol/efeitos adversos , Metimazol/uso terapêutico , Testes de Função TireóideaRESUMO
Se describe un paciente de 62 años quien padeció de hipertiroidismo autoinmune, siendo tratado con metimazol y atenolol. Diez días después del inicio del tratamiento comenzó con prurito, icterícia y coluria. Se suspendieron ambos y se le administro iodo radioactivo. Dos meses después Ia bilirrubina directa aicanzó 35 mg por ciento. La colangiografía endoscópica retrógrada evidenció vías biliares extrahepáticas normales. Una biopsia del hígado mostró marcada colestasis, especialmente en la zona centrolobulillar, con un discreto infiltrado de células mononucleares en los espacios portales. Junto con el comienzo de la enfermedad presentó anemia. La aspiración de la médula ósea mostró rica celularidad, sideroblastos con un 10 por ciento de formas anilladas e incremento de hierro extracorpuscular. La evolución del paciente fue satisfactoria. A dieciocho meses del comienzo de la enfermedad se hallaba asintomático, no presentando ningún signo físico o humorai patológico. Una nueva punción de la médula ósea resulto normal. La severa colestasis intrahepática sufrida por el paciente, estaría relacionada con una reacción adversa ai metimazoi. Se discute la etio-fisiopatogenia de la anemia siderobiástica reversible.(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anemia Sideroblástica/etiologia , Colestase Intra-Hepática/etiologia , Hipertireoidismo/complicações , Anemia Sideroblástica/patologia , Colestase Intra-Hepática/patologia , Hipertireoidismo/tratamento farmacológico , Metimazol/efeitos adversos , Metimazol/uso terapêutico , Atenolol/efeitos adversos , Atenolol/uso terapêutico , Testes de Função Hepática , Testes de Função TireóideaRESUMO
A randomized, double-blind, parallel-group study was conducted to compare the safety and efficacy of the angiotensin-converting enzyme inhibitor quinapril with that of the beta-blocker atenolol. Fifty-six outpatients with mild to moderate hypertension were enrolled in the trial. After a 4-week washout period, 27 patients were treated with quinapril 20 mg once daily and 29 patients were treated with atenolol 50 mg once daily for 4 weeks. During a third 4-week period, the daily doses were adjusted on an individual basis. At the end of the 8-week treatment period, the systolic and diastolic blood pressures were significantly reduced in both groups of patients. Heart rate was significantly reduced only in the atenolol group. Adverse effects were inconsequential and comparable in both groups. Quinapril was shown to be a safe and effective treatment for patients with mild to moderate hypertension.
Assuntos
Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Atenolol/uso terapêutico , Hipertensão/tratamento farmacológico , Isoquinolinas/uso terapêutico , Tetra-Hidroisoquinolinas , Adulto , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Atenolol/administração & dosagem , Atenolol/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Isoquinolinas/administração & dosagem , Isoquinolinas/efeitos adversos , Masculino , Pessoa de Meia-Idade , QuinaprilRESUMO
This study was designed to compare the antihypertensive efficacy of nitrendipine and atenolol in young and middle-aged patients with mild or moderate essential hypertension and to assess treatment effects on plasma lipids and potential changes in left ventricular mass (LVM). After 2 weeks off medication and a 4-week placebo phase, patients who met the inclusion criteria [sitting diastolic blood pressure (DBP) 95 to 114 mm Hg, age below 50 years] entered a 12-week dose-adjustment and maintenance period with nitrendipine or atenolol. Serum lipids were determined before and after therapy. At the same time, LVM was evaluated echocardiographically (M mode). Twenty-two patients completed the double-blind, randomized study. After 12 weeks on nitrendipine, the systolic blood pressure (SBP) and DBP were reduced (p less than 0.005 and p less than 0.001, respectively). No significant changes in heart rate were observed. There were no changes in the lipid profile, and LVM was reduced from 93.7 to 23.4 to 82.4 +/- 22.6 g/m2 of body surface (p less than 0.05). On atenolol the SBP and DBP were reduced (p less than 0.001 and p less than 0.001, respectively). The expected reduction in heart rate was significant (p less than 0.05). Total cholesterol and LDL cholesterol increased by 11% (p less than 0.05) and 12.3% (p less than 0.01), respectively. HDL cholesterol showed a small reduction. Tryglycerides increased by 22% (n.s.). LVM did not change. In conclusion, nitrendipine and atenolol showed comparable antihypertensive efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Atenolol/uso terapêutico , Ventrículos do Coração/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Lipídeos/sangue , Nitrendipino/uso terapêutico , Adulto , Atenolol/efeitos adversos , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nitrendipino/efeitos adversosRESUMO
The purpose of this multicenter investigation was to determine the efficacy and safety of the alpha/beta-blocker labetalol versus the beta 1-selective beta-blocker atenolol in white and black patients with essential hypertension. Equal numbers of black and white patients were enlisted to form four treatment groups (white patients taking either labetalol or atenolol and black patients taking either labetalol or atenolol). Two hundred ninety-two patients (152 white and 140 black patients) with essential hypertension characterized by a standing diastolic blood pressure of 105 to 119 mm Hg (inclusive) were recruited for this trial. Patients were randomized to either labetalol (dosage titrated from 200 to 1600 mg/day) or atenolol (dosage titrated from 50 to 100 mg/day). The therapeutic goal was achievement of a standing diastolic blood pressure of 90 mm Hg or less or a fall of 15 mm Hg in diastolic pressure from baseline value at the end of the placebo run in period. At the end of the study there were no significant differences in blood pressure or heart rate changes in the supine position between the labetalol and atenolol groups. In contrast, labetalol produced greater reduction in both the standing systolic and diastolic blood pressure (-12/-13 mm Hg, respectively) compared with atenolol (-7/-9 mm Hg; p less than 0.05; p less than 0.005, respectively). The greatest decrease in blood pressure was observed in white patients receiving labetalol. In black patients the decrease in blood pressure was greater in those treated with labetalol compared with atenolol, particularly with respect to the systolic blood pressure. We conclude that the alpha 1-blocking property of labetalol provides an additional lowering of the blood pressure over that seen with beta 1-blockade alone, especially in the standing position, and this enhanced efficacy is not confined to one radical group.
Assuntos
Atenolol/uso terapêutico , Hipertensão/tratamento farmacológico , Labetalol/uso terapêutico , Atenolol/efeitos adversos , População Negra , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipertensão/fisiopatologia , Labetalol/efeitos adversos , Estudos Prospectivos , População BrancaRESUMO
The myocardial effects of a daily oral dose of atenolol were studied by radionuclide multitriggered ventriculogram in 10 patients (7 men and 3 women) with mild to moderate essential hypertension, aged 29 to 53 years (mean 43) at rest and during exercise. Before and after two months of treatment with 100 mg/day orally of atenolol, the following variables were recordedÑ systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), ejection fraction (EF), peak filling rate (PFR) and peak ejection rate (PER). Beta-blockade treatment caused a significant drop in SBP and DBP, both at rest and during exerciseñ HR slowed down at rest and during exercise. PFR diminished at rest and during exercise. PER was reduced at rest and during exercise (p < 0.001). No significant changes in EF were observed after treatment with atenolol. In conclusion,k atenolol impaired left ventricular relaxation in spite of the drop in blood pressure
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Atenolol/uso terapêutico , Hipertensão/tratamento farmacológico , Função Ventricular Esquerda , Atenolol/efeitos adversos , Teste de Esforço , Ventriculografia com Radionuclídeos , DescansoRESUMO
The myocardial effects of a daily oral dose of atenolol were studied by radionuclide multitriggered ventriculogram in 10 patients (7 men and 3 women) with mild to moderate essential hypertension, aged 29 to 53 years (mean 43) at rest and during exercise. Before and after two months of treatment with 100 mg/day orally of atenolol, the following variables were recordedÑ systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), ejection fraction (EF), peak filling rate (PFR) and peak ejection rate (PER). Beta-blockade treatment caused a significant drop in SBP and DBP, both at rest and during exerciseñ HR slowed down at rest and during exercise. PFR diminished at rest and during exercise. PER was reduced at rest and during exercise (p < 0.001). No significant changes in EF were observed after treatment with atenolol. In conclusion,k atenolol impaired left ventricular relaxation in spite of the drop in blood pressure (AU)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Masculino , Feminino , Estudo Comparativo , Hipertensão/tratamento farmacológico , Atenolol/uso terapêutico , Função Ventricular Esquerda , Ventriculografia com Radionuclídeos , Descanso , Teste de Esforço , Atenolol/efeitos adversosRESUMO
The myocardial effects of a daily oral dose of atenolol were studied by radionuclide multi-triggered ventriculogram in 10 patients (7 men and 3 women) with mild to moderate essential hypertension, aged 29 to 53 years (mean 43) at rest and during exercise. Before and after two months of treatment with 100 mg/day orally of atenolol, the following variables were recorded: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), ejection fraction (EF), peak filling rate (PFR) and peak ejection rate (PER). Beta-blockade treatment caused a significant drop in SBP and DBP, both at rest and during exercise; HR slowed down at rest and during exercise. PFR diminished at rest and during exercise. PER was reduced at rest and during exercise (p less than 0.001). No significant changes in EF were observed after treatment with atenolol. In conclusion, atenolol impaired left ventricular relaxation in spite of the drop in blood pressure.