Mostrando las entradas con la etiqueta hypertension. Mostrar todas las entradas
Mostrando las entradas con la etiqueta hypertension. Mostrar todas las entradas
03 junio, 2013
Waste and Harm in the treatment of mild Hypertension
31 mayo, 2013
Diabetic Patients with Uncontrolled Blood Pressure
Context
- Why do clinicians fail to intensify antihypertensive therapy when a patient's blood pressure is elevated?
Contribution
- This study involved 1169 diabetic patients seen by 92 primary care providers at 9 Veterans Affairs facilities. All had elevated triage blood pressures, but only half received antihypertensive treatment intensification by providers. Patient reports of home blood pressures or repeated blood pressures by providers within normal limits and discussion of medication issues decreased the likelihood of antihypertensive intensification at clinic visits.
Implication
- Uncertainty about true blood pressure values may underlie many reasons why physicians do not intensify antihypertensive therapy.
—The Editors
Despite
some recent improvements in blood pressure control, the number of
patients with inadequate control remains high and contributes to excess
morbidity and mortality, especially among patients at high risk from
complications of hypertension (1 - 8).
Several studies have suggested that “clinical inertia”—the failure by
providers to initiate or intensify therapy (medication intensification)
in the face of apparent need to do so—is a main contributor to poor
control of hypertension (9 - 12).
Although
the failure to intensify treatment medications for patients with
elevated blood pressures at visits has been well documented ((5 - 6), (12 - 18)),
factors underlying what seems to be clinical inertia have been studied
less systematically. When providers are queried after clinic visits
about the lack of medication intensification for elevated blood
pressure, they variously report that the patient's “true” blood pressure
was lower than the clinic blood pressure reading, that other patient
concerns precluded attention on blood pressure management, and that
patient adherence should be improved before medication intensification
((6), (17)). Some studies have examined the role of various clinical and patient factors in intensification decisions ((6), (8), (17), (19 - 20)),
but no study has used a detailed conceptual model to comprehensively
examine the relative contribution of a broad array of potential patient,
provider, organizational, and visit-specific contributors to a
medication intensification decision. In addition, although a frequently
cited reason for deferring medication changes is that the clinic blood
pressure does not reflect the patient's “true” blood pressure (21 - 22), this clinical uncertainty and its effects have not been explored.
To
better understand factors underlying apparent clinical inertia for
hypertension, we designed the ABATe (Addressing Barriers to Treatment
for Hypertension) study to examine treatment change decisions for
diabetic primary care patients with elevated triage blood pressures
before a primary care visit. We defined elevated blood pressure for this
population to be 140/90 mm Hg, a value well above guideline targets for
diabetic patients and one clearly requiring some type of action (4).
Our goals were to assess how often patients presenting with an elevated
triage blood pressure received medication intensification or were
scheduled for close follow-up and the role that clinical uncertainty
about blood pressure, competing demands and prioritization,
medication-related factors, and care organization play in treatment
change decisions.
27 mayo, 2013
Derroche y daño en el tratamiento de la hipertensión leve / Iona Heath
Fuente: Estan cambiando los tiempos
Autor: Miguel Pizzanelli
Quien es Iona Heath?
She worked as a GP in London since 1975 and retired 2010. She has held several roles in the Royal College of General Practitioners (RCGP) including chair of the Ethics Committee, the International Committee, and the Health Inequalities Standing Group. She was vice chair of the college and in 2009 was elected college president. She chaired the BMJ Ethics Committee 2004 to 2009 and writes a regular column for the BMJ.
Sacarse el sombrero con esta señora y luego ponerse a leer y pensar en los excesos que podemos cometer.
Compartiremos con ella el taller sobre Prevención Cuaternaria que coordina Marc Jamoulle en la Conferencia Mundial de WONCA en Praga:
"Quaternary prevention, addressing the limits of medical practice"
authors: M. Jamoulle, G. Tsoi, I. Heath, D. Mangin, M. Z. Pezeshki, M. Pizzanelli Báez, A.L. Silva, J. Bernstein. Presenting author: M. Jamoulle, G. Tsoi, I. Heath, D. Mangin, M.Z. Pezeshki, M. Pizzanelli Báez
Agendado:
Día: 26 de Junio, de 10.30 a 12.00
Para ver artículo: http://archinte.jamanetwork.com/article.aspx?articleid=1687525
14 mayo, 2013
Effects of a new hormone therapy, drospirenone and 17-beta-estradiol, in postmenopausal women with hypertension.
 |
| English: Blood pressure measurement. (Photo credit: Wikipedia) |
Hypertension. 2006 Aug;48(2):246-53. Epub 2006 Jun 26.
Effects of a new hormone therapy, drospirenone and 17-beta-estradiol, in postmenopausal women with hypertension.
Source
Division of Hypertension and Clinical Pharmacology, The Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030-3940, USA. wwhite@nso1.uchc.eduAbstract
Drospirenone
(DRSP), a progestin with antialdosterone activity, has been developed
for hormone therapy in combination with 17-beta-estradiol (E2) in
postmenopausal women. We evaluated the antihypertensive efficacy and
safety of various doses of DRSP and E2 and estradiol alone in
postmenopausal women with hypertension using ambulatory and clinic blood
pressure (BP) monitoring. This was a randomized, double-blind clinical
trial of 3 doses of DRSP combined with estradiol, estradiol alone, and
placebo in 750 postmenopausal women with stage 1 to 2 hypertension
between 45 to 75 years. Ambulatory and clinic BPs, potassium,
aldosterone, and lipid measurements and adverse events were evaluated in
postmenopausal women with stages 1 to 2 hypertension during 8 weeks of
double-blind therapy. DRSP and E2 induced dose-related reductions in the
ambulatory and clinic systolic BP with physiological increases in serum
aldosterone. Significant decreases in 24-hour systolic pressure were
observed at doses of 2 and 3 mg of DRSP combined with estradiol but not
by estradiol alone or 1 mg of DRSP with estradiol. There were no
significant changes from baseline in potassium in any treatment group.
Small, significant reductions in total and low-density lipoprotein
cholesterol occurred on all of the active treatments, and serum
triglycerides did not change. Adverse event rates were low and similar
across treatment groups. In conclusion, these data show that DRSP
combined with E2 significantly reduces BP in postmenopausal women with
hypertension and did not induce significant increases in serum
potassium. These characteristics may lead to a new benefit for this
novel hormone therapy in postmenopausal women with hypertension.
Comment in
- Antihypertensive effects of drospirenone and 17beta-estradiol in hypertensive postmenopausal women. [Curr Hypertens Rep. 2007]
- Drospirenone: an antihypertensive in waiting. [Hypertension. 2006]
- A new hormone therapy with drospirenone and NO production in postmenopausal women. [Hypertension. 2006]
28 abril, 2013
Hipertensión Arterial
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