Descripción del proyecto

The Lancet - hipertensión

[Articles] Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials
5/4/2017
ver resumen
Mean achieved SBP less than 120 mm Hg during treatment was associated with increased risk of cardiovascular outcomes except for myocardial infarction and stroke. Similar patterns were observed for DBP less than 70 mm Hg, plus increased risk for myocardial infarction and hospital admission for heart failure. Very low blood pressure achieved on treatment was associated with increased risks of several cardiovascular disease events. These data suggest that the lowest blood pressure possible is not necessarily the optimal target for high-risk patients, although it is not possible to rule out some effect of reverse causality.

[Articles] Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review
9/2/2017
ver resumen
The findings of our small trial in the context of previous randomised evidence suggest that the benefits of quarter-dose therapy could be additive across classes and might confer a clinically important reduction in blood pressure. Further examination of the quadpill concept is needed to investigate effectiveness against usual treatment options and longer term tolerability.

[Articles] Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study
30/8/2016
ver resumen
In patients with hypertension and coronary artery disease from routine clinical practice, systolic blood pressure of less than 120 mm Hg and diastolic blood pressure of less than 70 mm Hg were each associated with adverse cardiovascular outcomes, including mortality, supporting the existence of a J-curve phenomenon. This finding suggests that caution should be taken in the use of blood pressure-lowering treatment in patients with coronary artery disease.

[Articles] Ramipril versus placebo in kidney transplant patients with proteinuria: a multicentre, double-blind, randomised controlled trial
22/10/2015
ver resumen
Treatment with ramipril compared with placebo did not lead to a significant reduction in doubling of serum creatinine, end-stage renal disease, or death in kidney transplant recipients with proteinuria. These results do not support the use of angiotensin-converting enzyme inhibitors with the goal of improving clinical outcomes in this population.

[Articles] Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study
20/10/2015
ver resumen
No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infection-related cancers and cardiovascular disease.

[Comment] Prevention of malaria in pregnancy: a fork in the road?
28/9/2015
ver resumen
In efforts to improve protection against the adverse consequences of malaria in pregnancy, several trials1–3 have investigated alternative drug regimens and strategies to replace sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria in pregnancy. Even before WHO first recommended inclusion of intermittent preventive treatment with sulfadoxine–pyrimethamine in the focused antenatal care package in 2004,4 malaria parasites expressed mutations in the dihydrofolate reductase (Pfdhfr) and dihydropteroate synthetase (Pfdhps) genes,5 compromising the protective effect of the intervention.

[Articles] Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin–piperaquine versus intermittent preventive treatment with sulfadoxine–pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial
28/9/2015
ver resumen
At current levels of rapid diagnostic test sensitivity, intermittent screening and treatment is not a suitable alternative to intermittent preventive treatment with sulfadoxine–pyrimethamine in the context of high sulfadoxine–pyrimethamine resistance and malaria transmission. However, dihydroartemisinin–piperaquine is a promising alternative drug to replace sulfadoxine–pyrimethamine for intermittent preventive treatment. Future studies should investigate the efficacy, safety, operational feasibility, and cost-effectiveness of intermittent preventive treatment with dihydroartemisinin–piperaquine.

[Articles] Cardiovascular safety of albiglutide in the Harmony programme: a meta-analysis
11/8/2015
ver resumen
Cardiovascular events were not significantly more likely to occur with albiglutide than with all comparators. Because the upper bound of the 95% CI for major adverse cardiovascular event plus hospital admission for unstable angina was greater than 1·3, a dedicated study with a cardiovascular endpoint is underway to confirm the safety of albiglutide.

[Review] Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions
13/7/2015
ver resumen
Almost two decades have elapsed since posterior reversible encephalopathy syndrome (PRES) was described in an influential case series. This usually reversible clinical syndrome is becoming increasingly recognised, in large part because of improved and more readily available brain imaging. Although the pathophysiological changes underlying PRES are not fully understood, endothelial dysfunction is a key factor. A diagnosis of PRES should be considered in the setting of acute neurological symptoms in patients with renal failure, blood pressure fluctuations, use of cytotoxic drugs, autoimmune disorders, or eclampsia.

[Articles] Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data
28/5/2015
ver resumen
Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when these measures are already assessed for clinical purpose or if cardiovascular mortality and heart failure are outcomes of interest. ACR could have particularly broad implications for cardiovascular prediction. In populations with chronic kidney disease, the simultaneous assessment of eGFR and ACR could facilitate improved classification of cardiovascular risk, supporting current guidelines for chronic kidney disease.

[Articles] Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration)
18/5/2015
ver resumen
Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjustment for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age could be associated with disturbed offspring glucose metabolism.

[Articles] Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)
6/3/2015
ver resumen
Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. A randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.

[Articles] Effects of statin therapy on coronary artery plaque volume and high-risk plaque morphology in HIV-infected patients with subclinical atherosclerosis: a randomised, double-blind, placebo-controlled trial
9/1/2015
ver resumen
No significant effects of statin therapy on arterial inflammation of the aorta were seen as measured by FDG-PET. However, statin therapy reduced non-calcified plaque volume and high-risk coronary plaque features in HIV-infected patients. Further studies should assess whether reduction in high-risk coronary artery disease translates into effective prevention of cardiovascular events in this at-risk population.

[Comment] Optimum antihypertensive therapy: does adiposity matter?
4/11/2014
ver resumen
Given that at least 75% of patients with hypertension are obese, it is no coincidence that the continuing obesity epidemic is driving the increasing incidence of hypertension.1 Physicians have questioned whether the benefits of blood pressure lowering for cardiovascular disease might depend, in part, on choice of antihypertensive drugs (as shown in ACCOMPLISH2) and that the choice of drugs should vary with the state of adiposity.3

[Articles] Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials
4/11/2014
ver resumen
We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean.

[Articles] Effects of long-term blood pressure lowering and dual antiplatelet treatment on cognitive function in patients with recent lacunar stroke: a secondary analysis from the SPS3 randomised trial
24/10/2014
ver resumen
Cognitive function is not affected by short-term dual antiplatelet treatment or blood pressure reduction in fairly young patients with recent lacunar stroke. Future studies of cognitive function after stroke should be of longer duration or focus on patients with higher rates of cognitive decline.

[Comment] Blood pressure control after stroke: too little, too late, or too soon to tell?
24/10/2014
ver resumen
Cognitive decline is among the most feared and common changes in late life, and prevention of cognitive decline in any population is a worthy goal. In The Lancet Neurology, Lesly Pearce and colleagues1 report results of a prespecified secondary outcome analysis of cognitive function from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, which compared aspirin plus clopidogrel with aspirin plus placebo, and high goal (130–149 mm Hg) with low goal (<130 mm Hg) blood pressure targets, in a factorial design.

[Comment] Low vitamin D and hypertension: a causal association?
25/6/2014
ver resumen
In The Lancet Diabetes & Endocrinology, Karani Vimaleswaran and colleagues1 report the results of a mendelian randomisation study with data from up to 146 581 individuals, which suggest that low vitamin D concentrations might be causally associated with an increased risk of hypertension. The investigators used variants of genes that affect 25-hydroxyvitamin D (25[OH]D) synthesis or substrate availability (CYP2R1 and DHCR7) and report that each 10% increase in genetically instrumented plasma 25(OH)D concentration was associated with a decrease in diastolic blood pressure (−0·29 mm Hg, 95%CI −0·52 to −0·07; p=0·01) and systolic blood pressure (−0·37 mm Hg, −0·73 to 0·003; p=0·052), and an 8·1% reduced odds of hypertension (odds ratio [OR] 0·92, 95% CI 0·87–0·97; p=0·002).

[Articles] Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study
25/6/2014
ver resumen
Increased plasma concentrations of 25(OH)D might reduce the risk of hypertension. This finding warrants further investigation in an independent, similarly powered study.

[Personal View] Adrenal vein sampling in primary aldosteronism: towards a standardised protocol
12/5/2014
ver resumen
Primary aldosteronism comprises subtypes that need different therapeutic strategies. Adrenal vein sampling is recognised by Endocrine Society guidelines as the only reliable way to correctly diagnose the subtype of primary aldosteronism. Unfortunately, despite being the gold-standard procedure, no standardised procedure exists either in terms of performance or interpretation criteria. In this Personal View, we address several questions that clinicians are presented with when considering adrenal vein sampling.







Feed aggregation powered by Syndicate Press.
Processed request in 0.01161 seconds.