Novas Perspectivas no Tratamento da Hipertensão

Medical Journal of Australia, 1975

Experience in a hypertension clinic attended by 591 patients over a 13-year period has shown marked changes in the pattern of use of hypotensive agents. Thiazides have been used throughout the period in almost all cases. Methyldopa was used for most patients for almost a decade. Since 1967 there has been a steady increase In the use of beta adrenergic blocking agents, and these are now used for over 60% of patients attending the clinic. Combination beta adrenergic blocking agents with peripheral vasilodators such as hydraHazlne and prazosln have provided a very effective means of controlling the blood pressure in moderate and severe hypertension. Prazosin, a new peripheral vasodilator, has been used in the treatment of 295 patients. In most cases It has been used In combination with a thiazide diuretic and beta adrenergic blocking agent. Open studies have demonstrated that this Is an effective hypotensive agent. Side effects are few and are counteracted by combination with a beta adrenergic blocking agent. Prazosin and hydrallazine are being compared in dcuble-bllnd studies. ALTHOUGH there are conflicting views about the levels of systolic and diastolic blood pressure at which treatment should commence, rio-one would doubt that severe hypertension should be treated. In defining "severe" hypertension, it is important to realize that, whereas blood pressure measurements which are obtained in the conventional fashion are the most convenient and most widely applied criteria of severity, they are not necessarily the best. The level of the blood pressure is certainly not the only factor which determines progressive vascular disease and organ damage even in malignant hypertenston." In this era of therapeutic enthusiasm and widespread

1996

Hypertension is one of the most prevalent vascular diseases in the general population and is a major contributor to cardiovascular mortality and morbidity. Recent clinical trials have confirmed the benefits of treatment of hypertension to prevent stroke, congestive heart failure, and left ventricular hypertrophy. Despite the availability of many newer agent, blood pressure continues to be inadequately controlled in the majority of the hypertensive patients. There is still a lot of controversy in some of the issues in the management of hypertension. The present article summarizes some of the recent studies and published guidelines in the management of hypertension and provides some insight to these questions. Although the answers to some of these questions are still unclear, ongoing large scale studies should soon provide additional answers to these questions.

Drugs, 2003

Epidemiological studies have shown that both vascular events, especially among elderly patients systolic and diastolic blood pressure values are di-with isolated systolic hypertension [8,9] or systo-diasrectly and linearly related to the risk of cardio-tolic hypertension. [10] (although in reference 9 and vascular events, and that this relationship is still 10 randomisation was performed according to an detectable for blood pressure values within the nor-alternative scheme). Moreover, a recent overview of mal range. Although blood pressure values are placebo-controlled trials with calcium channel antstrong determinants of the risk of cardiovascular agonists has concluded that, although there is no events, the presence of end-organ damage as well as clear evidence of reductions in coronary artery disthe association with other cardiovascular risk factors ease or heart failure, the estimates of treatment further increases the risk of cardiovascular effects do not exclude the existence of a beneficial events. Therefore, when planning treatment for effect on these major cardiac outcomes and largely patients with hypertension, current guidelines em-preclude the occurrence of adverse effects (includphasise the relevance of risk stratification, based on ing cancer or uncontrolled bleeding). [6,11] However, blood pressure values, the presence of end-organ it is still controversial whether different treatment damage or other cardiovascular risk factors. regimens based on different drug classes can offer additional advantages, beyond a similar degree of Controlled clinical trials have shown the benefit blood pressure control, in the prevention of cardioof blood pressure reduction, which is detectable in vascular morbidity and mortality. young, middle aged and elderly patients, both male and female, with severe, moderate and mild hyper-

2007

This article provides an update on the management of hypertension mostly based on the recent clinical guidelines issued by the National Institute of Clinical Excellence (NICE).1 Key points being highlighted are the importance of assessment of the cardiovascular disease (CVD) risk and the fact that beta-blockers (BBs) are no longer considered as appropriate first-line agents (in the absence of other indications for beta-blockade). The importance of fully involving patients in treatment decisions on an on-going basis is also emphasised. Marise Gauci B Pharm (Hons), MSc

American Heart Journal, 1976

2011

The Journal of Clinical Hypertension, 2008

Journal of Nursing Ufpe Online, 2015

Objective: to analyze pharmacotherapy treatment with hypertensive group. Method: study of action research, carried out from March 2012 to November 2013 in a Family Health Center in Sobral-CE, with a group of hypertensive patients. For data collection, an interview, the Moriski-Green test and educational activities, and the data analyzed by thematic categorization were conducted. The research project was approved by the Ethics Committee in Research, CAAE 11156213.6.0000.5053. Results: the results show that hypertensive patients have low degree of adherence to medication treatment, and the forgetfulness and carelessness of the time are the main factors associated with inadequate adherence to medicine therapy. Conclusion: the results showed the need to develop health promotion actions for hypertensive become aware of the importance of properly adhere to treatment regimens. Descriptors: Hypertension; Pharmacotherapy; Health Promotion; Patient Cooperation. RESUMO Objetivo: analisar a adesão ao tratamento farmacoterápico mediante ação com grupo de hipertensos. Método: estudo de pesquisa-ação, desenvolvido no período de março de 2012 a novembro de 2013 em um Centro de Saúde da Família de Sobral-CE, com um grupo de hipertensos. Para coleta de dados, foi realizada entrevista, o teste de Moriski-Green e de ações educativas, sendo os dados analisados por de categorização temática. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, CAAE nº 11156213.6.0000.5053. Resultados: os resultados demonstram que os hipertensos apresentam baixo grau de adesão ao tratamento medicamentoso, sendo o esquecimento e o descuido quanto ao horário os principais fatores associados a não adesão adequada ao tratamento medicamentoso. Conclusão: os resultados mostraram a necessidade de desenvolver ações de promoção em saúde para que os hipertensos se conscientizem da importância de aderir adequadamente aos regimes terapêuticos. Descritores: Hipertensão; Farmacoterapia; Promoção em Saúde; Cooperação do Paciente. RESUMEN Objetivo: analizar la adhesión al tratamiento farmacológico mediante acción con grupo de hipertensos. Método: estudio de investigación-acción, desarrollado en el período de marzo de 2012 a noviembre de 2012 en un Centro de Salud de la Familia de Sobral-CE, con un grupo de hipertensos. Para recolección de datos, fue realizada entrevista, el test de Moriski-Green y de acciones educativas, siendo los datos analizados por de categorización temática. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAAE nº 11156213.6.0000.5053. Resultados: los resultados demuestran que los hipertensos presentan bajo grado de adhesión al tratamiento medicamentoso, siendo el olvido y el descuido del horario son los principales factores asociados a no adhesión adecuada al tratamiento medicamentoso. Conclusión: los resultados mostraron la necesidad de desarrollar acciones de promoción en salud para que los hipertensos tomen conciencia de la importancia de adherir adecuadamente a los regímenes terapéuticos. Descriptores: Hipertensión; Fármaco-terapia; Promoción en Salud; Cooperación del Paciente.

Pharmacotherapy, 2004

Hypertension is a key risk factor for cardiovascular disease. Current management of hypertension, both pharmacologic and nonpharmacologic, is based on an extensive amount of published literature. We present a list of publications, clinical trials, meta-analyses, and clinical practice guidelines that we believe are essential in defining the current practice standards in the management of hypertension.

Journal of Hypertension, 2004

f on behalf of the investigators of the STRATHE trial Objective To compare the efficacy and the tolerability of three different strategies in the treatment of hypertension (low-dose combination, sequential monotherapy and stepped-care). Design Hypertensive patients were randomized to a 9month treatment with the aim to lower blood pressure below 140/90 mmHg. Treatment adjustments were allowed at months 3 and 6. The study was discontinued for patients with normal blood pressure at month 6. In the 'low-dose combination' group, perindopril (2 mg) and indapamide (0.625 mg) were first administered with the possibility to increase the doses in two steps up to respectively, 4 and 1.25 mg. In the 'sequential monotherapy' group, the treatment was initiated with atenolol (50 mg), replaced if necessary by losartan (50 mg), and then by amlodipine (5 mg). In the 'steppedcare' group, valsartan, was given first at a 40 mg dose, then at a 80 mg dose, to be co-administered finally if needed with hydrochlorothiazide, 12.5 mg. All study tablets were encapsulated to conceal their identity and had to be taken once a day. Patients Patients with uncomplicated essential hypertension were recruited (n 180 in the 'low-dose combination' group, n 176 in the 'sequential monotherapy' group and n 177 in the 'stepped-care' group). Results The percentage of patients having achieved the target blood pressure was significantly greater in the 'lowdose combination' group (62%) than in the 'sequential monotherapy' (49%, P 0.02) and the 'stepped-care' group (47%, P 0.005). The percentage of patients having normalized their blood pressure without experiencing drug-related adverse events was also significantly higher in the 'low-dose combination' group (56%) than in the 'sequential monotherapy' (42%, P 0.002) and the 'stepped-care' group (42%, P 0.004). Conclusions A first line management of hypertension based on a low-dose combination of perindopril and indapamide allows the normalization of blood pressure in significantly more patients than a 'sequential monotherapy' strategy involving atenolol, losartan and amlodipine, and a 'stepped-care' strategy involving valsartan and hydrochlorothiazide. These better blood pressure results were not obtained at the expense of a worsening of tolerability.