Complications Of Arterial Hypertension Research Articles

An Ethno Pharmacological New Strategy for Discovery of Potential Antihypertensive Plants in Cameroon

Objective: Manifold plants are documented in the world, but arterial hypertension still an important public health challenge in both developing and developed countries. Therefore the objective of the study is to identify several herbal medicines used in the treatment of arterial hypertension in Cameroon. Methods: The survey was undertaken between 2003 and 2016 with the aim of establishing a new ethnopharmacological strategy for identifying potential antihypentive plants in Cameroon’s population. Three phytogeographic areas in which live 1131 randomly screened interviewees distributed in 58 socio-cultural groups were involved in this study. In the first phytogeographic area live 293 interviewers distributed in 16 socio-cultural groups. In the second live 277 interviewees distributed in 14 socio-cultural groups and in the third live 561 interviewees distributed in 23 socio-cultural groups. The survey was successfully achieved, using a cluster sampling procedure in each ethnic group. The potential anti arterial hypertensive plants were selected using an extended criterion of identification of suspected anti arterial hypertensive plants and suspected arterial hypertensive patients defined as follow: if a single plant is used to treat three signs, three symptoms and/or three complications of arterial hypertension, we considered it as an anti-arterial hypertensive plants and the person who presented these three signs, three symptoms and/or three complications is a suspected arterial hypertensive patient. Results: The observation of 24.39% of suspected arterial hypertensive patients relieved by traditional healers’ symptomatic treatments and 50% of recorded suspected anti arterial hypertensive plants that were confirmed by previous pharmacological studies, showed promising perspectives for the criterion used. Conclusion: The data provide evidence that potential anti arterial hypertensive plants are common in Cameroon more than usual anti arterial hypertensive species. They should serve as plants documented for the new anti-arterial hypertensive drugs discovery for the prevention and control of this disease worldwide.

Characteristics of lercanidipine – from the pronounced antihypertensive response to the effective neuroprotection

Calcium Antagonists, as one of basic groups for treatment of arterial hypertension, presented by three generations of preparations, each of that has the features. Modern researches are all anymore sent to the study of their influence not only on the reduce blood pressure but also on additional effects, and also on ability to prevent serious cardiovascular catastrophes. To the dihydropyridine the blockers of calcium channels, due to a presence in the structure of dextrorotatory and sinistrorotatory type of isomers and high lipophilicity, declared oneself as effective drugs for the lower of death rate of patients as a result of stroke, heart attack and other complications of arterial hypertension. Lercanidipine (Lercamen®, Berlin-Сhemie AG (Menarini group), Germany) one of the most modern antagonists of calcium of the third generation of dihydro-pyridines, that, except a hypotension effect, does an antiatherogenic, neuro-protective action also, diminishes a hypertrophy of myocardium and his ischemia, improves the diastolic function of heart. For this reason he can be preparation of choice for patients with hypertention with the high risk of origin of complications, and also for patients with concomitant diseases, in particular with the diabetes type ІІ. Good tolerance, a long-term therapeutic action and a minimum of side effects justify popularity of Lercamen among doctors

IMPROVING THE METHODOLOGY OF CONTINUOUS MEDICAL EDUCATION IN THE CONTEXT OF ARTERIAL HYPERTENSION TREATMENT

Aim. To assess the role of the algorithm-based selection of antihypertensive therapy (AHT) and the continuous medical education in the treatment of arterial hypertension (AH).Material and methods. Based on the autopsy data, we analysed the prevalence of AH and the structure of its complications and comorbidities among 3239 patients of a multidisciplinary Moscow City hospital. We also analysed the practices of preceding ambulatory AHT and conducted the survey on the quality of continuous medical education lectures delivered to internal medicine specialists working at polyclinics.Results. Among patients who died from cardiovascular disease, a high prevalence of AH (96,1%) was combined with prevalent target organ damage (TOD), a strong association between blood pressure (BP) levels and the risk of major cardiovascular events, and a wide range of comorbidities and AH complications. There was a lack of universal AHT schemes and regimens for patients of similar age, gender, and nature and severity of comorbidities.Conclusion. Achievement of target BP levels failed to prevent major cardiovascular events which resulted in fatal outcomes. AHT was administered without adequate consideration of organo-protective and pleiotropic effects of antihypertensive medications. The development of an algorithm which considered age, gender, TOD presence, and previous major cardiovascular events in the selection of AHT had improved the doctors’ understanding of the lecture information.

Effects of atorvastatin on the hypertension-induced oxidative stress in the rat brain.

It is well known that the development of brain oxidative stress is one of the most serious complications of arterial hypertension that evokes brain tissue damage. The aim of this study was to examine the effects of atorvastatin treatment (20 mg/kg/day), as an antioxidant, to prevent the brain tissue oxidative stress in the hypertensive (HTN) rats. Experiments were performed in four groups of rats (n = 5 each group): sham, sham-treated, HTN and HTN treated. Rats were made HTN by aortic constriction above the renal arteries. After 30 days, rats were slaughtered under deep anesthesia to remove brain hemispheres. After tissue homogenization, enzyme activities of superoxide dismutase (SOD) and catalase (CAT), as well as glutathione (GSH) content and malondialdehyde (MDA) level were determined by biochemical methods. In HTN rats, arterial blood pressure was increased about 40% and brain enzyme activities of SOD and CAT were significantly decreased compared with sham group. Induction of hypertension significantly decreased GSH content and increased MDA level of brain tissue. Treatment with atorvastatin enhanced the activity of SOD and prevented from GSH decrement during hypertension. Based on the findings of this study, treatment with atorvastatin might have saved the brain tissue of HTN rats from hypertension-induced oxidative stress.

Aortic bypass and bilateral renal autotransplantation for mid-aortic syndrome

Middle aortic syndrome (MAS) is a rare condition characterized by stenosis of the proximal abdominal aorta and the origin of the renal and digestive arteries. When medical therapy and interventional radiology fail to control threatening reno-vascular arterial hypertension (AHT), surgery is required and may need several interventions, which are usually delayed until late childhood. We report on a 3-year-old girl with severe AHT (180/130 mmHg) caused by MAS. There was no evidence of generalized vascular disease or complications of AHT. AHT failed to respond to medical therapy (five drugs), endovascular dilatation, and stenting was considered unfeasible due to the complex multiple strictures. Surgery consisted of: explantation of the two kidneys; aortic bypass between the lower thoracic and lower abdominal aorta using a prosthetic graft; reimplantation of the kidneys onto the normal iliac arteries. The post-operative course was uneventful. Owing to recurrent stenosis of the re-implanted renal arteries, endoluminal dilatations were performed 4 and 5 months after surgery. Two years after surgery, the child is alive and well, off anti-hypertensive therapy, with normal blood pressure. Mild aortic syndrome can be treated with a one-stage surgical repair with aorto-aortic bypass and bilateral auto-transplantation, even in young children.

Physicians’ assessment of the high blood pressure risk and their attitude towards the prevention of arterial hypertension

Aim. To study the physicians’ knowledge of the high blood pressure (BP) risk and to assess their attitude towards the prevention of arterial hypertension (AH). Material and methods. In total, 118 internal disease specialists from three Russian regions participated in an anonymous questionnaire survey on the knowledge of high BP risk and the attitude towards the prevention of AH and its complications. The mean age of participants (13 men and 105 women) was 46,53±11,64 years. The respondents’ answers were compared to the information in the current clinical AH guidelines. Results. More than one-half of the respondents demonstrated inadequate professional knowledge on prediction and prevention of AH complications. These physicians use the “traditional” disease model and do not consider elevated BP as a risk factor; predict the risk of AH complications using subjective complaints of their patients; do not realise the importance of the target organ damage (TOD) prevention; and limit their preventive strategy only to the prevention of hypertensive crises. Conclusion. The demonstrated attitude towards AH management could be a serious barrier for effective AH prevention. This group of physicians needs extensive education and training, in order to modify their attitude and to increase their commitment to preventive strategies.

Coste de la hipertensión arterial en España

Arterial hypertension (AHT) is one of the major cardiovascular risk factors regarding its prevalence and risk of complications. The prevalence of hypertension in our country is approximately 15-20% in the aged 15 or older population, 30% to 36% in the aged 45 years or more population, and 45-48% among those 65 or older.On average, hypertensive patients would cost twice that of a normotensive individual. In 1992, 56.07% of the total costs of AHT corresponded to indirect costs, 61.06% of which were associated to mortality and the rest to disability. Regarding direct costs, in 2006, 69.4% of these corresponded to medication and 20% to the visits. In fact, the percentage corresponding to medication doubled, going from 33.46% of direct costs in 1992 to 69.4% of them in 2006.Cost caused by complications of AHT is very important. Thus, in 2006, a hypertensive subject with high morbidity had a cost which was 3.65 times more than one with mild disease. In addition, the average annual cost per patient was almost triple in those with metabolic syndrome than without it and multiplied by six in hypertensive patients with the five diagnostic criteria for metabolic syndrome.However, costs per patient of the hypertension not only varied according to the diseases associated to it, but also the control obtained in the hypertension treatment. It has been estimated that the lack of control increases the unit cost by 13.05.

MATERNAL MORTALITY DUE TO ARTERIAL HYPERTENSION IN SÃO PAULO CITY (1995-1999)

To describe the case profile of maternal death resulting from hypertensive disorders in pregnancy and to propose measures for its reduction. The Committee on Maternal Mortality of São Paulo City has identified 609 cases of obstetric maternal death between 1995 and 1999 with an underreporting rate of 52.2% and a maternal mortality rate of 56.7/100,000 live births. Arterial hypertension was the main cause of maternal death, corresponding to 142 (23.3%) cases. Ninety-five (66.9%) of the deaths occurred during the puerperal period and 34 (23.9%) occurred during pregnancy. The time of death was not reported in 13 (9.2%) cases. Seizures were observed in 41 cases and magnesium sulfate was used in four of them. The causes of death were ruled to be cerebrovascular accident (44.4%), acute pulmonary edema (24.6%), and coagulopathies (14.1%). Cesarean section was performed in 85 (59.9%) cases and vaginal delivery in 15 (16.0%). Complications of arterial hypertension are responsible for the high rates of pregnancy-related maternal death in São Paulo City. Quality prenatal care and appropriate monitoring of the hypertensive pregnant patient during and after delivery are important measures for better control of this condition and are essential to reduce disorders in pregnancy.

Observational Study of Hypertension in Matelica, Italy (Matelica Hypertension Study)

This study summarizes the results of an epidemiological investigation carried out on the occasion of the Second World Hypertension Day (May 13, 2006) in the city of Matelica in the Region of the Marches, Central Italy. In all, 518 subjects (298 males, average age 52.3 years; 220 females, average age 55 years) with either diagnosed hypertension or who were thought to be normotensive had arterial blood pressure measured. Other cardiovascular risk factors and the costs of pharmacological treatment for hypertension were assessed as well. In 72.46% of examined subjects, arterial blood pressure levels averaged ≥140–90 mmHg if non-diabetic and ≥130–80 mmHg if diabetics. A total of 48.14% of individuals assumed in anamnesis to be normotensive had arterial blood pressure levels higher than the above values and were therefore found to have hypertensive values. The cost of anti-hypertensive treatment in the area of Matelica averages €543.7/patient/year. The present data, which are in line with those of other epidemiological studies performed in Italy, confirm the view that arterial hypertension control in Italy is still largely unsatisfactory. This observation should stimulate both health and specific medical measures to counter the risk of complications of arterial hypertension in aged populations, such as those present in the territory examined.

Long-term course and complications of arterial hypertension after heart transplantation

To evaluate the progression of arterial hypertension (AH) and its consequences, in patients submitted to cardiac transplantation (CT) in use of cyclosporine (CY). In 65 patients submitted to orthotopic CT, we evaluated blood pressure, serum creatinine and blood levels of CY before, 15 and 30 days, and 6, 12, 24, 48 and 60 months after CT; in 20 patients we analyzed cardiac index and systemic vascular resistance pre-CT, 15 and 30 days, 6 and 12 months after CT; in 33 patients, we studied anatomic and functional modifications by echocardiography, 24 +/- 13 months after CT. Thirty days after CT, AH was present in 58.5% (50% mild), and after one year, 93% of patients were hypertensives (85% moderate-to-severe), remaining unchanged during the rest of follow-up. The serum creatinine progressively increased, reaching values significantly higher than those pre-CT after one year, persisting with a mild increment until 60 months. Echocardiography showed left ventricle hypertrophy in 54% of patients, all of which had normal function. Two patients died as a direct consequence of hypertensive complications. AH in patients submitted to CT on CY use occurs early, increases in prevalence and severity during the follow-up and is mediated by an increase in vascular resistance. Also, the AH does not correlate to CY blood levels or nefrotoxicity, but it can impair renal function and compromise longevity of transplantation by inducing ventricular hypertrophy.

ОСОБЕННОСТИ КОНТРОЛЯ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ В МОНГОЛИИ (ОБЗОР ЛИТЕРАТУРЫ)

The complications of arterial hypertension cause more than a half of 17 million cases of cardiovascular mortality in the world. According to the official statistics in 2010 Mongolia was the leader among the countries of the Asian Pacific region in mortalityfrom complications connected with arterial hypertension (40.9 people per 100 000 of population). It is proved that lifestyle change with risk factors correction and adequate hypotensive therapy allow to control arterial hypertension in most patients. The real prevalence of the resistant arterial hypertension in the world is less than 10 %. However, in clinical practice even in countries with high income only 50-60 % of persons with arterial hypertension can reach the target blood pressure values less than 140/90 mmHg, in Mongolia, these indicators are worse. Such situation leads to growth of mortality and disability, therefore it is a serious worldwide problem for health care. There are four reasons, which lead to low compliance of patients to be treated: social and administrative problems; medical passivity; irrational therapy and low adherence of patients to recommendations of doctors. But according to different cohort studies, the main reason of poor control of arterial hypertension in Mongolia is insufficient hypotensive therapy, therefore only 23.6 % patients can achieve the target blood pressure values. In such conditions, it is too important to develop a strategy aimed at improving control of arterial hypertension in Mongolia.