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

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<0.05) and of the RRR (39 vs 29, p<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<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.

Introduction The consequences of falling can be fatal to elderly. The mortality, morbidity and the risk ofanxiety and depression increases following a fall. Drug prescription is a preventable fall risk,making the association between antihypertensive medications and risk of falling an importantarea of investigation. Aim Compile the results from studies which have examined the effect of initiating or changing theantihypertensive medication on fall risk in people aged 60 years or older. Methods Data sources: MEDLINE and Cochrane databases. Study selection: Original articles ofcohort-, case control-, case crossover-, cross-sectional- and randomized controlled trial type,published between January 2000 and May 2019 and written in English were included. Dataassessment: 6 studies met the criteria and were included. Study quality was assessed for eachstudy. Results Three studies found significant short-term increase in fall risk, regardless of drug type. Onestudy discovered an 18% increase in fall risk for every 5-day gap in treatment. Two studiesevaluated antihypertensive drug types separately and found contradictive results of thiazidediuretics on short-term fall risk. Calcium channel blockers showed a protective effect andbeta blockers an increased risk during the first 3 weeks after initiating treatment. Conclusions No consistent consensus was seen regarding the short-term fall risk in separateantihypertensive drug types, though most studies agree in a short-term risk increase aftergeneral antihypertensive treatment initiation or change.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 53-59).

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 4 uppsatser.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Sept. 19, 2008). Includes bibliographical references (p. 147-170).

Resumo: 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. / Abstract: 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. / Orientador: Silvana Regina Perez Orrico / Coorientador: Luis Carlos Spolidorio / Banca: José Eduardo Cezar Sampaio / Banca: Maria Angela Naval Machado / Mestre

Orientador: Eros Antonio de Almeida / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-13T21:11:07Z (GMT). No. of bitstreams: 1 Borim_FlaviaSilvaArbex_M.pdf: 1855380 bytes, checksum: 5badad59567e422bfc6ce02c96d55fd1 (MD5) Previous issue date: 2009 / Resumo: A hipertensão arterial sistêmica (HAS) é uma doença multifatorial, de detecção quase sempre tardia devido ao seu curso assintomático e prolongado. Estima-se que no Brasil 30% da população em geral, com mais de 40 anos, possa ter pressão arterial elevada. Um desafio no diagnóstico e controle da HAS é conhecer o impacto da doença e seu tratamento sobre a vida do indivíduo. Tem-se demonstrado que a partir do conhecimento do diagnóstico de HAS os pacientes relatam mudanças sobre sua qualidade de vida. O presente estudo buscou avaliar a qualidade de vida de adultos e idosos hipertensos em tratamento anti-hipertensivo, considerando as comorbidades, a associação de medicamentos, a prática de exercício físico e o controle ou não da pressão arterial. Trata-se de pesquisa descritiva, com amostra de conveniência, de ambos os sexos, em tratamento medicamentoso. Adotaram-se como critérios de exclusão a dificuldade de manter comunicação verbal e agravos decorrentes da hipertensão. Os seguintes instrumentos foram utilizados: Questionário sóciodemográfico e clínico, de Baecke modificado para idosos e qualidade de vida específica para hipertensos. As variáveis foram analisadas pelo teste Qui- Quadrado, pela Regressão Logística e Análise de Cluster. Foram avaliados 156 participantes, sendo que 85 (54,48%) tinham idade igual ou superior a 60 anos e a proporção de mulheres entrevistadas foi 75,64%. Verificou-se que a razão de chance foi significativa para atividade física e quando foram considerados somente os idosos. Assim, os indivíduos com menores escores na atividade física possuíam 11,2 (100 88,8) menos chances de fazer parte do grupo com boa qualidade de vida. Os indivíduos com pressão arterial (PA) controlada possuíam três vezes mais chances de fazer parte do grupo com boa qualidade de vida. Quando separados por critério de idade, observou-se que a razão de chance é significativa apenas nos adultos. Os indivíduos adultos com PA controlada possuíam 7,5 vezes mais chances de fazer parte do grupo com boa qualidade de vida. As variáveis comorbidade e medicamento não apresentaram diferença significativa. Concluiu-se que os adultos e idosos apresentaram diferença significativa nas seguintes variáveis: PA controlada e atividade física, que apresentaram diferença para o impacto na qualidade de vida. Isso mostra a necessidade de diferentes abordagens no tratamento de HAS entre adultos e idosos / Abstract: Systemic arterial hypertension is a multi-factorial disease which is usually detected late, and which presents a prolonged and asymptomatic course. It's esteemed that in Brazil 30% of the population over 40 years old might have high blood pressure. A challenge in the diagnosis and control of the arterial hypertension (AH) is to know the impact of this disease and its treatment on the individual's life. It has been shown that with knowledge of the diagnosis of HAS, people related changes in their quality of life (QoL). The present study evaluated the QoL of adults and elderly with AH submitted to pharmacological treatment, considering the co-morbidities; the association of drugs; the practice of physical exercise; and blood pressure control or not. It's a descriptive research with a convenience sample of both genders in drug treatment. It was used as criteria for exclusion to present difficulty to maintain verbal communication and the disorders resulting from hypertension. The following tools were used: a sociodemographic questionnaire, the modified Baecke questionnaire for elders and a QoL questionnaire for patients with AH. The data were analyzed with the qui-square test, logistic regression and Cluster Analysis. We evaluated 156 patients, of which 85 (54.58%) with 60 years old or more and the proportion of women interviewed was 75.64%. It was found that the odds ratio showed significance for the physical activity and when were considered only the elderly group. Thus, those with lower score in the physical activity showed 11.2 (100 - 88.8) lesser probability of being included in the better QoL group. Those with controlled blood pressure presented 3 times more probability of being included in the better QoL group. When separated by age criteria, it was observed that the odds ratio is significant only in adults. The adults with controlled blood pressure had 7.5 times more probability of being included in the better QoL group. The variables co-morbidities and drug treatment didn't show any significant difference. It was concluded that adult and older presented a significant difference in the following variables: blood pressure controlled and physical exercise, which showed difference to the impact on the quality of life. This shows the need for different approaches in the treatment of hypertension among adults and elderly / Mestrado / Mestre em Gerontologia

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A equivalÃncia farmacÃutica entre dois medicamentos relaciona-se à comprovaÃÃo de que ambos contÃm o mesmo fÃrmaco na mesma dosagem e forma farmacÃutica, o que pode ser avaliado por meio de testes in vitro. No Brasil, os medicamentos alopÃticos sÃo divididos em trÃs categorias quanto ao registro junto à AgÃncia Nacional de VigilÃncia SanitÃria: medicamentos novos, medicamentos similares e medicamentos genÃricos. A legislaÃÃo atual dispÃe que para o registro de novos medicamentos genÃricos e similares à necessÃria a comprovaÃÃo da equivalÃncia farmacÃutica e a bioequivalÃncia em relaÃÃo ao medicamento de referÃncia. Produtos registrados antes de 2003 tÃm um perÃodo de adaptaÃÃo garantido, de modo que os resultados dos testes de equivalÃncia farmacÃutica e perfil de dissoluÃÃo sejam incluÃdos ao seu registro atà 2014. O Programa FarmÃcia Popular do Brasil à uma nova polÃtica de AssistÃncia FarmacÃutica, dentro do Sistema Ãnico de SaÃde que tem como objetivo facilitar o acesso da populaÃÃo aos medicamentos considerados bÃsicos e essenciais, diminuindo assim, o impacto dos preÃos dos medicamentos no orÃamento familiar. O objeivo deste trabalho foi avaliar a EquivalÃncia FarmacÃutica de comprimidos de Captopril 25 mg e Cloridrato de Propranolol 40 mg comercializados no Programa FarmÃcia Popular do Brasil, comparando-o com medicamentos de ReferÃncia e GenÃrico, visando discutir a importÃncia da qualidade dos medicamentos para a saÃde pÃblica. Realizaram-se testes fÃsicos e fÃsico-quÃmicos como: identificaÃÃo, determinaÃÃo de peso, desintegraÃÃo, dureza, friabilidade, teor, uniformidade de conteÃdo, pureza e perfil de dissoluÃÃo, segundo a FarmacopÃia Brasileira, 4a ediÃÃo. Os resultados indicaram uma baixa dureza nos comprimidos de cloridrato de propranolol da FarmÃcia Popular. Os perfis de dissoluÃÃo, analisados por ANOVA e teste de Tukey demonstraram diferenÃas significativas (p<0,001) entre os perfis de dissoluÃÃo da FarmÃcia popular em relaÃÃo ao GenÃrico e ReferÃncia nos tempos avaliados dos dois fÃrmacos em estudo. Compararam-se os perfis de dissoluÃÃo dos comprimidos da FarmÃcia Popular com os medicamentos ReferÃncia e GenÃrico atravÃs da EficiÃncia de DissoluÃÃo (ED%). A extensÃo do fÃrmaco dissolvido do medicamento FarmÃcia Popular foi significativamente menor (P < 0,001) do que o ReferÃncia para Captopril e Propranolol. O Captopril da FarmÃcia Popular, apesar de ter cumprido as exigÃncias da legislaÃÃo, foi reprovado no ensaio de ED%. Portanto, os comprimidos de Cloridrato de Propranolol e Captopril da FarmÃcia Popular nÃo foram considerados equivalentes farmacÃuticos em relaÃÃo aos medicamentos ReferÃncia e GenÃrico. / The pharmaceutical equivalence between two medicines is based on the confirmation that both contain the same active drug on the same dosage and dosage form, wich is assessed by in vitro tests. In Brazil, the National Health Surveillance Agency defines that allopathic medicines can be registered in three categories: innovator, generic and similar drugs. The actual legislation determines that to register new generic and similar medicines it is necessary to prove its pharmaceutical equivalence and bioequivalence with a reference drug. Products registered before 2003 have until 2014 to present these equivalence results. The Popular Pharmacy Program in Brazil is a new strategy of pharmaceutical assistance of the Health Sistem with the purpose to facilitate the populationâs access to medicines considered basic and essential, lowering the price impact of these medicines in the family budgets. The objective of this study was to assess the pharmaceutical equivalence of captopril 25 mg and propranolol hydrochloride 40 mg tablets sold in the Popular Pharmacy Program in Brazil, comparing them to a reference and generic drug, debating the importance of the quality of drugs for the public health. Physical and physicochemical tests such as identification, weight variation, disintegration, hardness, friability, purity, dosage, content uniformity, and dissolution profile, were performed according to the Brazillian Pharmacopeia 4th edition. The results showed a low hardness of propranolol hydrochloride tablets originated from the Popular Pharmacy Program. The dissolution profiles analised by analysis of variance (ANOVA) and Tukey test demonstrated significant differences between the dissolution profiles of both drugs originated from the Popular Pharmacy Program and their respective reference and generic drugs (p<0,001). The dissolution profiles were compared by the Dissolution Efficiency method. The extention of the active drug dissolved from the Popular Pharmacy medicine was significantly lower than the dissolution from the reference and generic drugs (P < 0,001) for both captopril and propranolol hydrochloride. Even though captopril would fulfill the requirements of the National Health Surveillance Agency to be considered equivalent, it was not approved on the dissolution efficiency test. Therefore, the assessed tablets originated from the Popular Pharmacy Program in Brazil were not considered pharmaceutical equivalents when compared to their respective reference and generic drugs.

The current recommendations by the American Heart Association for health promotion are that all persons should partake in regular physical activity in order to reduce the risk of cardiovascular disease. Regular physical exercise reduces blood pressure and is an important component of the management of hypertension. It is therefore important that patients with hypertension participate in habitual physical exercise. Many hypertensive patients who exercise will require anti-hypertensive medication. However, some antihypertensive agents cause fatigue during exercise. In order for patients to gain the full benefits of an active lifestyle, it is important that the prescribed antihypertensive agent does not prevent them performing and enjoying sustained exercise. It has been well documented that β-blockers cause premature fatigue during physical exercise. The effects on exercise performance of other first line antihypertensive medications, such as calcium channel antagonists have not been extensively investigated. In particular, the effects of these agents on prolonged submaximal exercise endurance have not been well studied. The object of this thesis was to compare the effects of isradipine, a dihydropyridine calcium channel antagonist, to those of atenolol, a β₁-selective antagonist, on maximal and submaximal exercise performance and on short duration high-intensity exercise in physically active hypertensive patients. The study design was a crossover trial where drug treatments were double blinded and randomised. Physically active volunteers with mild to moderate hypertension were recruited. 11 subjects performed i) progressive exercise to exhaustion for determination of maximal oxygen consumption (VO₂max), maximal work load and cardiorespiratory responses to maximal exercise, ii) prolonged submaximal exercise for determination of exercise endurance, cardiorespiratory responses and ratings of perceived exertion (APE), and iii) short duration, high intensity exercise consisting of a 30 second maximal exercise test (Wingate test) to determine skeletal muscle power output, following 4 weeks ingestion of isradipine (2.5mg bd), atenolol (50mg bd) or placebo. Diastolic blood pressure at rest was reduced by both atenolol and isradipine, but was lowered to a greater extent by atenolol (83.3 vs 89.0 vs 96.1 mmHg, atenolol vs isradipine vs placebo, p<.0005). Systolic blood pressure at rest tended to be similarly reduced by both agents, but was significantly reduced during maximal and submaximal exercise by atenolol only (p<.001, atenolol vs isradipine, placebo). Heart rate at rest and during maximal and submaximal exercise was decreased by atenolol only (p<.0005, atenolol vs isradipine, placebo). Maximal exercise performance was reduced after atenolol ingestion compared to placebo but not after isradipine ingestion. Peak workload achieved during the maximal exercise test was decreased after atenolol but unchanged after isradipine ingestion (214 vs 243 W, atenolol vs placebo, p<.01). Similarly, VO₂max was reduced after atenolol compared to placebo but was unchanged after isradipine ingestion (33.6 vs 36.4, 33.6 vs 36.1 mlO₂/kg/min, atenolol vs placebo, atenolol vs isradipine, p<.05). Both atenolol and isradipine ingestion reduced submaximal endurance time compared to placebo (27.8 vs 46.4, 34.4 vs 46.4 min, atenolol vs placebo, isradipine vs placebo, p<.005), and increased rating of perceived exertion (APE) after 30 min of submaximal exercise (p<.05). Submaximal oxygen consumption (VO₂), ventilation, respiratory exchange ratio (REA) and blood lactate, glucose and free fatty acid concentrations were not altered after the ingestion of either agent. Neither agent influenced peak skeletal muscle power, total work done, or rate of fatigue during the Wingate test compared to placebo. The results of these studies indicate that impaired performance and increased RPE during submaximal exercise after ingestion of either atenolol or isradipine is not due to alterations of ventilation, VO₂, RER, or blood lactate, glucose and free fatty acid concentrations during prolonged submaximal exercise. Similarly, reduced submaximal exercise performance after atenolol or isradipine ingestion is not due to factors which would also limit the ability of skeletal muscle to perform short duration, high intensity exercise before a bout of prolonged exercise. This study demonstrates that prolonged submaximal exercise testing can reveal an impairment in exercise performance after ingestion of antihypertensive medication which is not evident during maximal exercise testing. This finding is important as prolonged submaximal exercise is the form of exercise which most hypertensive patients actually perform. Further research is required on the effects of anti-hypertensive medications on submaximal exercise performance before firm recommendations can be made regarding medications most suitable for the physically active hypertensive patient. The results of these and other studies indicate that it is not yet possible to make claims that the calcium channel antagonist agents are without effect on physical exercise performance in physically active hypertensive patients.