Cardiovascular diseases constitute the main morbidity and mortality cause of death worldwide. The best tool to set priorities in primary cardiovascular prevention is the precise estimation of the ...global cardiovascular risk. This work was aimed at explaining the predictive value for cardiovascular diseases, for which a documentary review of a total of 27 bibliographic sources was done. Among these 26 international impact articles from journals and a thesis, among other sources were reviewed, to which it was accessed through the main information managers. Risk mobility prediction has been an essential element in preventive clinical guidelines for these diseases and has become a useful tool for the family doctor, to set priorities in primary health care, which will allow making progress in studying complex associations that may impact cardiovascular risk.
Calcium antagonists are effective in hypertensive patients of all ethnic groups, irrespective of age, dietary salt intake, salt-sensitivity status or plasma renin activity profile. Some prospective ...studies show that the calcium antagonists, nifedipine GITS and nitrendipine, reduce cardiovascular morbidity and mortality at least to the same extent as the diuretics. Other prospective studies are in progress to evaluate the effect of calcium antagonists on cardiovascular morbidity and mortality, and the progression of atherosclerosis in hypertensive patients. Calcium antagonists, especially the highly lipophilic amlodipine, lacidipine and nisoldipine, are shown to possess antioxidant properties. These drugs reduce the oxidation of LDL and its influx into the arterial wall, and reduce atherosclerotic lesions in animals. Platelet production of malondialdehyde, a marker of oxygen free radical formation, is suppressed by amlodipine, lacidipine or nifedipine in hypertensive patients. New evidence from long-term clinical trials of calcium antagonists indicates that these drugs can reduce the rate of progression of atherosclerosis in hypertensive and coronary heart disease patients. In the Regression Growth Evaluation Statin Study (REGRESS), co-administration of calcium antagonist, amlodipine or nifedipine with pravasatin caused a significant reduction in the appearance of new angiographic lesions. In the Verapamil in Hypertension and Atherosclerosis Study (VHAS), verapamil was more effective than chlorthalidone in promoting regression of thicker carotid lesions in parallel with a reduction in the incidence of cardiovascular events. In the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT), amlodipine slowed the progression of early coronary atherosclerosis in patients with coronary artery disease. In a subprotocol of the Intervention as a Goal in the Hypertension Treatment (INSIGHT) study, nifedipine GITS significantly decreased intima-media thickness as compared to co-amilozide (hydrochlorothiazide + amiloride). Preliminary results of the European Lacidipine Study on Atherosclerosis (ELSA) show that lacidipine reduced the intima-media thickness progression rate as compared to atenolol. Thus, selective calcium antagonists are potential antiatherosclerotic agents.
Nitric oxide and malondialdehyde in human hypertension Armas-Padilla, María Cristina; Armas-Hernández, María José; Sosa-Canache, Beatriz ...
American journal of therapeutics,
2007 Mar-Apr, Letnik:
14, Številka:
2
Journal Article
Recenzirano
Nitric oxide (NO), a multifunctional effector molecule that plays a central role in the maintenance of vascular homeostasis, regulates vascular tone and inhibits platelet and leukocyte adhesion to ...endothelial cells. NO status is related to the endothelial function. Patients with hypertension have lower levels of NO, increased free radical production, higher oxidative stress, augmented platelet aggregation, and a change in the arachidonic acid cascade metabolism, all leading to the acceleration of the atherosclerotic process. The study subjects included a group of 21 normotensive healthy subjects (8 males and 13 females) with a mean age of 39.2 +/- 1.8 years and a body mass index of 27.9 kg/m, and another group of 42 patients (19 males and 23 females) with untreated essential hypertension with a mean age of 47.6 +/- 1.7 years and a body mass index of 28.3 kg/m. Serum levels and urinary excretion of NO determined as combined nitrate/nitrite (NOx) and serum malondialdehyde (MDA) concentrations were measured in the 2 groups of subjects. The serum levels and 24-hour urinary excretion of NOx were significantly higher and the renal clearance of NO was lower in the normotensive group than in the hypertensive patients, indicating decreased NO status in hypertension. There was a negative correlation between serum NO levels and mean arterial pressure, suggesting that a decrease in NO availability is related to increase in blood pressure. Serum concentrations of MDA were higher in the hypertensive patients as compared with the normotensive individuals, suggesting increased oxidative stress in hypertensive patients. These results are in agreement with previous studies showing decreased NO and increased oxidative stress in hypertension. In conclusion, patients with essential hypertension as compared with normotensive individuals have lower NO status, which may contribute to the endothelial dysfunction in hypertension. Increased serum malondialdehyde in hypertensives suggests an association between increased oxidative stress with higher blood pressure.
Background: several studies show the influence of physical activity as a protective factor of the cardiovascular system. New evidence forcorroborating this are needed to ensure the prevention of ...cardiovascular disease.
Objective: to determine the relationship between cardiovascular hyperactivity, physical activity and some homodynamic and anthropometric variables in normotensive individuals.
Methods: a descriptive correlational cross-sectional study was conducted. The universe of the study consisted of the population between 15 and 74 of the municipality of Cienfuegos in 2010, the sample was 644. The variables were considered: sex, skin colour, age, height, weight, index of body mass, abdominal waist, blood pressures: systolic, diastolic, average and differential (basal and sustained weight test) and physical activity. Pearson Chi- square test was calculated and t was applied for comparison of average independent samples with a significance level of p = 0,05. Prevalence ratios were determined with a confidence interval of 95 %.
Results: the prevalence of cardiovascular hyperactivity was higher in the group of 65-74 years and males. Cardiovascular hyperactives showed values of the average hemodynamic variables studied cardiovascular over normoreactive. There is an association between physical activity and better cardiovascular response in normal weight individuals.
Conclusions: there is an association between increased blood pressure and obesity in cardiovascular hyperactivity. Physical activity is associated with cardiovascular normoreactivity in normal weight.
Background: there are no studies that confirm the association between cardiovascular hyperreactivity and the risk of cardiovascular morbidity.
Objective: to determine the association between ...cardiovascular hyperreactivity and the risk of cardiovascular morbidity in normotensive individuals.
Methods: a cross-sectional, correlational study was conducted. The universe consisted of the population aged 15 to 74 years in Cienfuegos municipality; the sample included 644 people. The variables were: sex, skin color, age, total cholesterol, HDL cholesterol, fasting blood glucose, smoking, baseline systolic blood pressure, cardiovascular reactivity, and risk of cardiovascular morbidity. The risk of cardiovascular morbidity was calculated by applying the Framingham Risk Functions. The Pearson’s Chi-square test and the prevalence ratio were used with a 95 % confidence interval. The direction of the relationship between cardiovascular reactivity, age, and systolic blood pressure was analyzed considering the Eta value.
Results: the prevalence of cardiovascular hyperreactivity was higher among people aged 65 to 74 years and males. A higher risk of cardiovascular morbidity was observed in cardiovascular hyperreactive individuals. There is an association between non-optimal systolic blood pressure, increasing age, and high risk of cardiovascular morbidity in cardiovascular hyperreactive people.
Conclusions: the risk of cardiovascular morbidity is higher in cardiovascular hyperreactive individuals than in normoreactive people. Age and systolic blood pressure showed greater association with high risk of cardiovascular morbidity.
Design a tool for nursing assessment and classification for pediatric patients in primary care emergency.
Comprehensive literature review of systems of evaluation and classification of urgent ...patients, work in groups of experts, creation of the instrument and test its validity, reliability and ease of use in normal operation conditions of service.
Pediatric Emergency Department Dr. Jaime Chaves. Tenerife. Canary Islands.
Nine nurses and nine pediatricians with training and experience in emergency pediatric care. The validity and reliability tests are performed on a sample of 200 pediatric patients who came calling attention to the emergency service alter request informed consent.
Training sessions, motivational and expert group consensus. Nurses apply the classification tool to test at patient entry and level of classification given by the pediatrician at discharge.
Final version of the instrument with the fields of assessment and related documents. Validity tests show a sensitivity of 100% and a specificity of 94% and a concordance between nurse and pediatric of 83% and reliability agreement among nurses of 76% (p < 0.001 in all cases).
The instrument, called VEUPAP (Nurse Pediatric Emergency Valuation in Primary Care), is valid, reliable, simple and useful for application in primary care.
Brain gene therapy consists of introducing nucleic acids into nerve tissue whose expression may prove to be therapeutically useful. This genetic material is indirectly introduced by means of non ...invasive gene therapy into the blood thereby avoiding its direct injection into the brain and the damage to the blood brain barrier.
The different non invasive vectors and means of gene transfer to the central nervous system will be discussed.
There has been a remarkable breakthrough in recent years in non invasive gene transfer strategies into the central nervous system. The development of new serotypes of adenoassociated vectors, such as AAV9, and of functionalized nanoparticles, such as pegylated immunoliposomes, polymeric nanoparticles, pegylated nanoparticles, dendrimers, fullerens, as well as specific transporters specific to the low density lipoprotein receptor family, means that it is now possible to introduce and express gene material in nerve tissue following peripherical administration of the above mentioned vectors.
Non invasive gene therapy entails exciting new perspectives for the treatment of the numerous neurological diseases for which there are no effective pharmacological treatments. Studies already performed on animals have proved to be highly promising and it is likely that, in the next few years, they will give rise to non invasive gene therapy procedures which will be useful and safe for treating patients.
The aim of the present study was to assess the effects on blood pressure, platelet aggregation, and insulin sensitivity of lacidipine and nifedipine gastrointestinal therapeutic system (GITS) given ...once daily in a parallel-group, double-blind, randomized study of patients with mild to moderate hypertension.
Twenty patients (12 men, 8 women) with mild to moderate hypertension aged 45 to 56 years (average age, 50 ± 2.3 years) were included. They received placebo for 4 weeks and were then randomly divided into 2 groups of 10 patients each. Nifedipine GITS 30 mg and lacidipine 4 mg were given for 16 weeks. Blood pressure and heart rate were measured at the clinic in the supine, sitting, and standing positions 24 ± 1 hours after the last dose. At the end of the placebo and active phases the following procedures were performed: a platelet aggregation test; determination of platelet malondialdehyde production; and determination of tolerance to 100 g of glucose by measuring plasma insulin.
Both drugs significantly reduced systolic and diastolic blood pressures to the same level; however, observable differences in the rate of reduction were noted. In week 1, systolic blood pressure decreased 15.15% in the nifedipine GITS group and 6.54% in the lacidipine group. Heart rate was increased slightly but significantly in the standing position in the nifedipine GITS group only. Neither of the drugs reduced platelet aggregation ex vivo, however, both modified malondialdehyde production, indicating an effect at the arachidonic acid metabolic pathway.
The effects of the drugs on the metabolism of carbohydrates were inconclusive. However, a tendency for lacidipine to improve insulin sensitivity and for nifedipine GITS to have the opposite effect was observed.
The aim of the study was to evaluate the effect of losartan therapy on endothelial function by measuring serum nitric oxide (NO) levels and urinary excretion of NO in patients with essential ...hypertension. A group of 30 untreated stage 2 hypertensive patients (15 males and 15 females; age, 51.3 +/- 1.5 years) were included in the study. Office systolic and diastolic blood pressure (BP) was measured by using a mercury sphygmomanometer according to phase I and V of Korotkoff sounds. NO levels in serum and 24-hour urine were determined at baseline and after 6 weeks of daily dosing with losartan (50-100 mg). Losartan therapy resulted in a significant fall in systolic/diastolic BP (from 169.7 +/- 4.1/105 +/- 1.8 mm Hg at baseline to 146 +/- 2.7/91 +/- 1.9 mm Hg at the end of losartan treatment; P < 0.001). The therapy also caused significant increases in both serum NO level (32.74 +/- 3.01 microM/L at baseline versus 79.04 +/- 5.17 microM/L; P < 0.001 after therapy) and urinary NO excretion (58.21 +/- 3.72 microM/L at baseline versus 113.21 +/- 8.63 microM/L; P < 0.001 after therapy). Losartan therapy also reduced serum malondialdehyde (MDA), which is a measure of oxidative stress, by 0.201 nM (15.3%; P = 0.009). Losartan at a dose of 50 to 100 mg per day was effective in reducing elevated BP. The increase in serum NO levels and urinary NO excretion and a decrease in serum MDA levels by losartan treatment indicate a reduction in oxidative stress and enhances NO availability, both of which improve endothelial function. Thus, losartan therapy improves endothelial function in hypertensive patients with essential hypertension.
