Comparison of different therapeutic strategies in hypertension: a low-dose combination of perindopril/indapamide versus a sequential monotherapy or a stepped-care approach.

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 9-month 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 'stepped-care' 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 'low-dose 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

IMPLICAÇÕES SIMBÓLICAS NA ORGANIZAÇÃO DE UM HOME CARE: INTERPRETAÇÕES ENTRE A EQUIPE DE SAÚDE E OS CUIDADORES FAMILIARES

RESUMO O objetivo deste artigo é compreender as implicações simbólicas na organização de um home care em torno das práticas dos cuidadores familiares e da equipe de saúde. Utiliza-se uma perspectiva simbólica para desvendar símbolos resultantes de interações sociais presentes no dia-a-dia do grupo estudado, de forma a possibilitar a compreensão de seus significados. A pesquisa empírica realizada foi de cunho qualitativo e descritivo. Os dados foram coletados por meio de sete entrevistas semiestruturadas com os cuidadores familiares dos pacientes e três grupos focais com 27 profissionais do home care de uma empresa de saúde privada. Após a transcrição das entrevistas e dos grupos focais, os dados obtidos foram agrupados e categorizados por meio da análise de conteúdo de modelo misto. Os resultados indicam que interpretações de aspectos simbólicos interferem na avaliação e operação do atendimento domiciliar em oposição ao hospitalar. Elas levam à reconstrução social dos simbolismos dos familiares, porque se inserem em um novo contexto adverso (a doença), a despeito de permanecerem em um contexto conhecido (o lar). Nessa reconstrução, as práticas dos atores organizacionais envolvidos se legitimam ou são rejeitadas; portanto, cabe reconhecer tal dinâmica na preparação das equipes de profissionais para atuarem no serviço de home care