Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Made available in DSpace on 2014-06-11T19:28:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2004-02-16Bitstream added on 2014-06-13T19:15:55Z : No. of bitstreams: 1 correa_fob_me_arafo.pdf: 2398179 bytes, checksum: 762e3a720233fd398699c82e570416b6 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O diltiazem é um bloqueador dos canais de cálcio indicado para o tratamento da hipertensão e diversos tipos de angina. Esse medicamento pode provocar aumento gengival, embora apresente baixa prevalência. O objetivo deste trabalho foi avaliar a influência da dosagem e do período de administração do diltiazem na indução ou não de aumento gengival em ratos. Quarenta ratos machos jovens foram distribuídos aleatoriamente em oito grupos de acordo com a dosagem e o período de aplicação. Os animais receberam 0 (controle), 5, 20 e 50 mg/kg de peso corporal/dia do diltiazem e foram sacrificados após 20 e 40 dias. Posteriormente, foram realizadas análises macroscópica, histológica e histométrica do tecido gengival. Macro e microscopicamente o tecido gengival de todos os animais dos grupos controle e experimentais apresentou características de normalidade. A análise histométrica da gengiva livre vestibular do primeiro molar inferior demonstrou que não houve influência da dosagem para cada período de aplicação, sendo que somente o grupo de 20 mg/kg mantido 40 dias apresentou uma redução significativa de área de tecido epitelial (teste de Kruskall-Wallis, p=0,010) em relação ao grupo controle/40 dias. Ao analisar a influência do período, por meio do teste de Mann-Whitney, foi verificado que somente o grupo de 20mg/kg apresentou redução significativa tanto de área de tecido conjuntivo (p=0,0367) quanto de tecido epitelial (p=0,0122) comparando-se o período de 20 e 40 dias. Os autores concluíram que o diltiazem não induziu aumento gengival em ratos. Estudos posteriores são necessários para avaliar a influência da dosagem de 20 mg/kg e de dosagens superiores às empregadas neste estudo. / Diltiazem is a calcium channel blocker for treatment of hypertension and various types of angina. It may also, however, provoke gingival overgrowth although this is not frequent. This study evaluated the influence of dosage and duration of diltiazem administration on inducing gingival overgrowth in rats. Forty young male rats were separated into eight groups according to the dosage and duration of administration. The animals received 0 (control), 5, 20 or 50 mg of diltiazem daily per kilogram of bodyweight. They were sacrificed after 20 or 40 day periods for macroscopic, histologic and histometric analysis of the gingiva. Macro and microscopic characteristics of the gingival tissue of all animals studied were found to be normal. Histometric analyses of the free buccal gingiva of the first lower molars showed that regarding the dosage for each period only the group of 20 mg/kg administered for 40 days presented a significant reduction in the area of the epithelial tissue in relation to the control group (p=0,010). Analyses of the time periods indicated that only the 20mg/kg group presented a significant reduction in both the connective (p=0.0367) and epithelial tissues (p=0.0122) when the 20 and 40 day durations were compared. The authors concluded that diltiazem did not induce gingival overgrowth in rats or influence their weight gain. Studies are now necessary to evaluate the influence of the 20 mg/kg and of the larger dosages administered in this study.

No description available.

Many older patients are not being aggressively managed for hypertension. Healthcare providers are often hesitant to start or even aggressively titrate antihypertensive medication, especially in the aged. Multiple studies have demonstrated that morbidity and mortality can be significantly reduced by appropriate intervention in all age groups. There are some clinical situations, however, where the provider must approach cautiously, such as in patients with a wide pulse pressure or those with a propensity toward adverse reactions. The data are clear that in the United States, undertreatment, rather than overtreatment, appears to be the issue. This article reviews studies that support the aggressive treatment of hypertension. The nuances of aging, which often influence the healthcare provider's treatment decisions, are also discussed. Suggestions for reasonable approaches to these difficult cases will be considered.

Background: An adequate supply of medicines in health establishments will increase the possibility of adequate control of hypertension and diabetes. Objective: To determine the shortage of antidiabetic and antihypertensive drugs at the national level in the context of the initial stage of the COVID-19 pandemic in Peru. Material y methods: Analysis of the "Sistema Integrado de Suministro de Medicamentos e Insumos Médicos Quirúrgicos" (SISMED) Database, between June 13th and July 15th, 2020, according to the "National list for medicines of essential medicines" (PNUME) of Ministry of health. Results: And between 4 and 96% of the departments have a total shortage of at least one antidiabetic, and 4% and 96% of at least one antihypertensive. The most depleted antidiabetic was Metformin 500 mg, and the most depleted antihypertensive drugs were Labetalol 5 mg / ml iny, Atenolol 50 mg tab and Carvedilol 6.25 mg tab. The percentage of distribution was higher in hospitals and specialized institutes in comparison with primary health facilities. Conclusions: There is a shortage of antihypertensive and antidiabetic drugs in health centers in Peru. © 2021 Medical Body of the Almanzor Aguinaga Asenjo National Hospital. / Revisión por pares

Introdução: A prática de atividade física tem sido crescentemente indicada como tratamento não medicamentoso para a hipertensão arterial sistêmica (HAS), doença de alta prevalência e um dos principais fatores de risco para as maiores causas de mortalidade mundiais atualmente, as doenças do sistema cardiovascular. O crescente uso de medicamentos na população idosa deve motivar a busca por formas alternativas de tratamento dos elevados valores pressóricos na população, objetivando um envelhecimento com menos agravos e maior qualidade de vida. Objetivo: Avaliar a relação entre a prática de atividade física e o uso de medicamentos anti-hipertensivos em população de 65 anos ou mais no Município de São Paulo. Metodologia: Este trabalho decorre da pesquisa de Saúde, Bem Estar e Envelhecimento, SABE. O estudo em questão utilizou um corte transversal para os dados de 2010, coletados por entrevista domiciliar. Investigou-se o uso de medicamentos anti-hipertensivos e a prática de atividade física por meio do IPAQ versão curta. A análise de dados utilizou modelos multivariados de regressão de Poisson. Resultados: A amostra total do estudo foi de 978 indivíduos com idade de 65 anos ou mais. Observou-se nessa população prevalência de autorrelato de HAS em 71,2 por cento dos idosos, sendo que 69,4 por cento fazem uso de medicamentos anti-hipertensivos. A população apresentou baixa prática de atividade física, 62,9 por cento dos idosos foram considerados insuficientemente ativos. O uso de anti-hipertensivos teve associação com maior faixa etária, viver sem companheiro atualmente, relato de cor de pele preta e histórico de tabagismo no passado. Não foi encontrada associação significativa entre uso de medicamentos e atividade física na população. Conclusões: Observou-se diferentes associações entre o uso de medicamentos anti-hipertensivos e as características demográficas, socioeconômicas e comportamentais da população, mas não se encontrou relação estatística entre uso de anti-hipertensivo e atividade física. Ressalta-se a importância de novas contribuições na temática do tratamento não medicamentoso relacionado ao controle da hipertensão arterial na população idosa. As reflexões sobre os desdobramentos do tema, como as consequências do uso de fármacos em grande quantidade na saúde do idoso e a baixa prática de atividade física na população, servem como fomento para a discussão sobre as formas de tratamento não medicamentoso, controle de doenças crônicas de alta prevalência, além de contribuir na discussão a respeito de programas de manutenção, tratamento e promoção de saúde / Introduction: Physical activity has been progressively indicated as a non-pharmacological treatment to high blood pressure (HBP), a highly prevalent condition, and one of the main risk factors for cardiovascular diseases, the major causes of death worldwide. The growing use of medicines by the elderly population should motivate the search for alternative ways of dealing with high blood pressure, aiming a healthful aging and improved life quality. Objective: To assess the relation between physical activity and the use of antihypertensive drugs among individuals aged 65 years or older in São Paulo. Methods: We assessed the database of the SABE (Health, Wellbeing and Aging) study. We used cross-sectional information gathered by household survey in 2010. We investigated the use of antihypertensive medicines and physical activity by the short version of IPAQ. Data analysis used multivariate Poisson regression models. Results: The study sample comprised 978 individuals aged 65 or older. 71.2 per cent of the elderly reported hypertension; 69.4 per cent of the study sample reported the use of antihypertensive medication. Practice of physical activity was low in this population, 62.9 per cent of the elderly were considered insufficiently active. The use of antihypertensive drugs was associated with older age groups in the study sample, living without a partner, the self-report of having black skin color and previous experience of smoking. The use of antihypertensive medicines was not significantly associated with physical activity in this population. Conclusions: Different associations were observed between the use of antihypertensive medications and demographic, socioeconomic and behavioral characteristics of the population. However, this study observed an absent statistical relation between the use of antihypertensive medicines and physical activity. This study highlights the importance of new contributions on non-pharmacological treatments for high blood pressure among the elderly. These findings, in addition to the observation of a high prevalence of use of antihypertensive medicines by the elderly, should foster the proposition of alternative methods for controlling chronic diseases, and should be considered in the discussion of programs aimed at treatment and health promotion.

The aim of this thesis was to investigate the effect of antihypertensive therapy on vascular function and placental markers in hypertensive disorders in pregnancy (HTD). We prospectively studied 208 women at the Homerton and University College London Hospitals. Vascular and serum markers were measured in 80 with HTD [51 pre-eclampsia (PE), 29 gestational hypertension (GH)] and 80 normotensive controls. The same markers were measured in placental samples from another 48 women (14 PE, 10 GH, 24 controls). Pulse wave analysis indices [augmentation pressure (AP) and augmentation index at heart rate 75/minute (Aix-75)], serum and placental concentrations of soluble fms-like tyrosine-kinase-1 (sFlt-1), soluble endoglin (sEng), placental growth factor (PIGF), vascular endothelial growth factor (VEGF), inhibin A, activin A, and uterine artery Doppler were measured before, and 24-48 hours after, initiating antihypertensive therapy. The three study groups were compared using ANOVA multiple comparisons with Bonferroni post hoc testing. Marker levels before and after antihypertensives were compared using paired t-test. In both pre-eclampsia (P < 0.0001) and gestational hypertension (P < 0.05), serum sFlt-1 was increased and PIGF reduced (P < 0.001) compared to controls. Serum sEng levels were also increased in pre-eclampsia. Placental sFlt-1 and sEng were significantly higher (P < 0.0001), and PIGF lower (P = 0.008), in pre-eclampsia compared to controls and gestational hypertension. Antihypertensive therapy was associated with a significant fall in serum and placental sFlt-1 and sEng in pre-eclampsia only (P < 0.05). In pre-eclampsia, but not gestational hypertension, treatment was associated with significantly (P < 0.05) lower serum and placental inhibin A and activin A. In women with pre-eclampsia or gestational hypertension, both AP (P < 0.0001 and P < 0.05) and Aix-75 (P < 0.0001 and P < 0.001) were significantly higher than controls. Antihypertensive therapy resulted in a significant fall in both AP and Aix-75 in pre-eclampsia only (P < 0.0001). Anti hypertensive drugs may have an effect on the pathophysiology of pre-eclampsia other than their known anti hypertensive action.

Conclusions. Regardless the method the information on benefit was provided, the maximum amount of money which people are willing to pay for antihypertensive varied substantially. Using relative risk to present the benefit would distort the viewpoint of the public regarding the importance of drug treatment. Residents were much more conservative in antihypertensive drugs than physicians. Most hypertensive patients in China would probably not accept drugs treatment for primary prevention if they are adequately informed. Rural residents were on average, less willing to take antihypertensive drugs than urban residents. Residents had a poor perception of their cardiovascular risk due to hypertension and the benefit of drug treatment. Most physicians in our study did not have good knowledge on overall risk approach and Chinese national guidelines. They had also very poor knowledge and skills related to evidence based medicine. (Abstract shortened by UMI.) / Objective. To assess the maximum amount of money residents are willing to pay for antihypertensive drugs given the actual benefit of treatment. To decide the minimum benefit (expressed in NNT) above which people are willing to pay for antihypertensive drugs at the current cost. To determine the minimum risk of cardiovascular disease (CVD) above which people would be willing to pay for antihypertensive at the current cost. To assess whether reporting of study results by using relative risk reduction and NNT affects people's willingness to pay for and physicians' willingness to prescribe antihypertensive drugs. To evaluate patients' and physicians' perception of perceived CVD risk due to hypertension and benefit of treatment. To assess knowledge, attitude and perception of the public and physicians regarding antihypertensive drugs and physicians' knowledge and skills on evidence based medicine. / Results. The response rate for residents was 91%. 95% of respondents reported that they would be willing to take antihypertensive drugs if they found to have high blood pressure. The majority of residents did not know the ultimate goal of blood pressure lowering was to reduce the risk of CVD. 91% said that they had not enough knowledge and information to make drug-taking decisions. The perceived 5-year baseline risk in the absence of treatment, absolute risk reduction and relative risk reduction was 70%, 40% and 60% respectively. Rural residents tended to over-rate their risk and benefit more than urban residents. Overall, 2%, 3% and 47% of residents were not willing to pay anything for antihypertensive drugs when information on benefit of treatment was described in general, with RRR and with NNT respectively. The median cost the residents were willing to pay was $500, $700 and $100 respectively for responding three ways of describing the benefit. / The response rate for physicians was 95%. The perceived 5-year baseline risk, absolute risk reduction and relative risk reduction was 40%, 20% and 39% respectively. Internists tended to give a slightly higher estimate of the 5-year risk (40% vs 30%, p&lt;0.05) and of the RRR (39 vs 29, p&lt;0.05). Overall, physicians were more likely to prescribe antihypertensive drugs when the benefit information was expressed in RRR than when it was expressed in NNT (p&lt;0.001). The median minimum NNT and the 5-year CVD risk above which physicians are willing to prescribe was 200 and 1.5% respectively. / Wang Weizhong. / "November 2006." / Adviser: Jinling Tang. / Source: Dissertation Abstracts International, Volume: 68-08, Section: B, page: 5119. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 105-114) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest dissertations and theses, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Introdução: A prática de atividade física tem sido crescentemente indicada como tratamento não medicamentoso para a hipertensão arterial sistêmica (HAS), doença de alta prevalência e um dos principais fatores de risco para as maiores causas de mortalidade mundiais atualmente, as doenças do sistema cardiovascular. O crescente uso de medicamentos na população idosa deve motivar a busca por formas alternativas de tratamento dos elevados valores pressóricos na população, objetivando um envelhecimento com menos agravos e maior qualidade de vida. Objetivo: Avaliar a relação entre a prática de atividade física e o uso de medicamentos anti-hipertensivos em população de 65 anos ou mais no Município de São Paulo. Metodologia: Este trabalho decorre da pesquisa de Saúde, Bem Estar e Envelhecimento, SABE. O estudo em questão utilizou um corte transversal para os dados de 2010, coletados por entrevista domiciliar. Investigou-se o uso de medicamentos anti-hipertensivos e a prática de atividade física por meio do IPAQ versão curta. A análise de dados utilizou modelos multivariados de regressão de Poisson. Resultados: A amostra total do estudo foi de 978 indivíduos com idade de 65 anos ou mais. Observou-se nessa população prevalência de autorrelato de HAS em 71,2 por cento dos idosos, sendo que 69,4 por cento fazem uso de medicamentos anti-hipertensivos. A população apresentou baixa prática de atividade física, 62,9 por cento dos idosos foram considerados insuficientemente ativos. O uso de anti-hipertensivos teve associação com maior faixa etária, viver sem companheiro atualmente, relato de cor de pele preta e histórico de tabagismo no passado. Não foi encontrada associação significativa entre uso de medicamentos e atividade física na população. Conclusões: Observou-se diferentes associações entre o uso de medicamentos anti-hipertensivos e as características demográficas, socioeconômicas e comportamentais da população, mas não se encontrou relação estatística entre uso de anti-hipertensivo e atividade física. Ressalta-se a importância de novas contribuições na temática do tratamento não medicamentoso relacionado ao controle da hipertensão arterial na população idosa. As reflexões sobre os desdobramentos do tema, como as consequências do uso de fármacos em grande quantidade na saúde do idoso e a baixa prática de atividade física na população, servem como fomento para a discussão sobre as formas de tratamento não medicamentoso, controle de doenças crônicas de alta prevalência, além de contribuir na discussão a respeito de programas de manutenção, tratamento e promoção de saúde / Introduction: Physical activity has been progressively indicated as a non-pharmacological treatment to high blood pressure (HBP), a highly prevalent condition, and one of the main risk factors for cardiovascular diseases, the major causes of death worldwide. The growing use of medicines by the elderly population should motivate the search for alternative ways of dealing with high blood pressure, aiming a healthful aging and improved life quality. Objective: To assess the relation between physical activity and the use of antihypertensive drugs among individuals aged 65 years or older in São Paulo. Methods: We assessed the database of the SABE (Health, Wellbeing and Aging) study. We used cross-sectional information gathered by household survey in 2010. We investigated the use of antihypertensive medicines and physical activity by the short version of IPAQ. Data analysis used multivariate Poisson regression models. Results: The study sample comprised 978 individuals aged 65 or older. 71.2 per cent of the elderly reported hypertension; 69.4 per cent of the study sample reported the use of antihypertensive medication. Practice of physical activity was low in this population, 62.9 per cent of the elderly were considered insufficiently active. The use of antihypertensive drugs was associated with older age groups in the study sample, living without a partner, the self-report of having black skin color and previous experience of smoking. The use of antihypertensive medicines was not significantly associated with physical activity in this population. Conclusions: Different associations were observed between the use of antihypertensive medications and demographic, socioeconomic and behavioral characteristics of the population. However, this study observed an absent statistical relation between the use of antihypertensive medicines and physical activity. This study highlights the importance of new contributions on non-pharmacological treatments for high blood pressure among the elderly. These findings, in addition to the observation of a high prevalence of use of antihypertensive medicines by the elderly, should foster the proposition of alternative methods for controlling chronic diseases, and should be considered in the discussion of programs aimed at treatment and health promotion.