Prohypertensive Effects of Non-Steroidal Anti-Inflammatory Drugs are Mostly Due to Vasoconstriction

Non-steroidal anti-inflammatory drugs (NSAIDs) have prohypertensive effects and blunt the effects of many antihypertensives. The mechanism of this interaction is still not understood enough. The objective of this investigation was to determine the level of prohypertensive effects of two NSAIDs (ibuprofen, piroxicam) and paracetamol, co-prescribed with two antihypertensive drugs (lisinopril + hydrochlorothiazide, amlodipine), and to improve the understanding of this interaction. A prospective clinical trial, conducted in a Croatian family practice, included 110 already treated hypertensive patients, aged 56–85 years; 50 control patients and 60 patients who were also taking NSAIDs for osteoarthritis treatment. The antihypertensive regimens remained the same during this study, while NSAIDs and paracetamol were crossed-over in three monthly periods. Blood pressure, body weight, serum creatinine, potassium, sodium, diuresis and 24 h urinary sodium excretion were followed-up. In the lisinopril/hydrochlorothiazide subgroup, both ibuprofen and piroxicam elevated mean arterial pressure by 8.9–9.5% (p<0.001). Body weight increased significantly in the lisinopril/ hydrochlorothiazide + piroxicam subgroup only, while creatinine, urinary output and electrolyte values did not change appreciably in any of the subgroups. NSAID’s prohypertensive effects seem to be mostly due to vasoconstriction and, to a minor degree, to volume expansion, since no marked changes in body weight, urinary output, serum creatinine or serum/ urinary electrolyte profile were observed

Ethical issues in family medicine

U ovom su prikazu razmotrene određene moralne dvojbe, poput odnosa liječnik-pacijent, liječničke tajne, priziva savjesti, sukoba interesa, suradnje među liječnicima ili nastupanja u medijima, koje se češće susreću u ordinacijama obiteljske medicine.This essay deals with some moral uncertainties concerning doctor-patient relationship, confidentiality, conscientious objection, conflict of interest, cooperation with consultants and appearance in the media, which are often encountered in a family physician\u27s office

Socioeconomic Stress and Drug Consumption: Unemployment as an Adverse Health Factor in Croatia

Aim: To explore to what degree unemployment was related to health problems expressed in terms of consumption of prescription drugs in Croatian citizens. Methods: Based on the Croatian Institute for Health Insurance data for 2003, the number of prescriptions per insured individual (NPI) was calculated for employed and unemployed persons, as well as for different subsets according to the region (Zagreb, Split, Rijeka, Osijek), age, gender, and prescribed drug category. Results: During 2003, a total of 1 003 547 drugs were prescribed to 949 746 health-insured persons aged 18-69 years. NPI was 32% higher for unemployed than for employed citizens; it averaged 0.995 among the employed, and 1.317 among the unemployed. Differences in NPI (∆NPI) between the employed and the unemployed varied within the subsets; the largest difference was observed in the Zagreb region (ΔNPI = 0.522), in the 30-39 age group (ΔNPI = 0.563), in men (ΔNPI = 0.565), and for anxiolytic/antidepressant drugs (ΔNPI = 0.184). Conclusion: Our findings indicate that unemployed Croatian citizens used more drugs, which calls for the implementation of health care measures to reduce or prevent their medical problems, particularly those affecting mental health. Medical problems associated with unemployment present a specific burden for family medicine and the health care system

Socioeconomic Stress and Drug Consumption: Unemployment as an Adverse Health Factor in Croatia

Aim: To explore to what degree unemployment was related to health problems expressed in terms of consumption of prescription drugs in Croatian citizens. Methods: Based on the Croatian Institute for Health Insurance data for 2003, the number of prescriptions per insured individual (NPI) was calculated for employed and unemployed persons, as well as for different subsets according to the region (Zagreb, Split, Rijeka, Osijek), age, gender, and prescribed drug category. Results: During 2003, a total of 1 003 547 drugs were prescribed to 949 746 health-insured persons aged 18-69 years. NPI was 32% higher for unemployed than for employed citizens; it averaged 0.995 among the employed, and 1.317 among the unemployed. Differences in NPI (∆NPI) between the employed and the unemployed varied within the subsets; the largest difference was observed in the Zagreb region (ΔNPI = 0.522), in the 30-39 age group (ΔNPI = 0.563), in men (ΔNPI = 0.565), and for anxiolytic/antidepressant drugs (ΔNPI = 0.184). Conclusion: Our findings indicate that unemployed Croatian citizens used more drugs, which calls for the implementation of health care measures to reduce or prevent their medical problems, particularly those affecting mental health. Medical problems associated with unemployment present a specific burden for family medicine and the health care system

BEER IS FOOD, ISN’T IT? THE EFFECT OF BEER ADVERTISING ON DRINKING AMONG YOUTH

Cilj rada bio je ispitati utjecaj reklama za pivo na stavove i ponašanja glede potrošnje piva u adolescentskoj populaciji. Istraživanje je pomoću anonimnog upitnika provedeno na uzorku (n=934) učenika završnih razreda srednjih škola u Splitu. Rezultati su pokazali da je pijenje piva povezano s muškim spolom, s lošijim školskim uspjehom, s pohađanjem četverogodišnje strukovne škole, s popularnosti reklama za pivo te s rizičnim ponašanjima. Iako su reklame za pivo omiljene većini ispitanika, promocija piva nije povezana s učestalošću i količinom potrošnje piva. Pozitivan stav prema određenoj reklami ne jamći privrženost i potrošnju promoviranog proizvoda. S obzirom na učestalost izlaganja oglašavanju piva i popularnost tih reklama među mladima, potrebno je razviti približno jednako zanimljive antialkoholne reklame, usmjerene na mlađu populaciju te educirati mlade o utjecaju medija.The aim of this study was to analyse the influence of beer advertising on attitudes and drinking behavior among adolescents. A total of 934 high school students in Split were interviewed using a confidential questionnaire. The results showed that the extent of beer consumption corrrelated to male gender, lower academic performance, type of school, owning of promotional items, likability of beer ads, and risky behavior. Although beer ads are popular among most of the participants, beer promotion (advertising, promotional items, sales promotion) was not related to drinking frequency or quantity, and there was no clear link between the ad preference and the consumption of the respective brand. Regarding the frequency of advertising exposure and its acceptance among adolescents,it is necessary to dilute this influence with equally attractive counter-advertising targeting youth and educate them about the media impact

Predictive Impact of Coronary Risk Factors in Southern Croatia: A Case Control Study

The aim of study was to compare the impact of coronary risk factors on the incidence of acute myocardial infarction (MI) between Croatia, Central and Eastern Europe, and the rest of the world. As a part of the large international INTERHEART case-control study of acute MI in 52 countries (15,152 cases and 14,820 controls) we have investigated the relationship between several known risk factors (smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins, and psychosocial factors) and MI among patients without previously known coronary heart disease in Southern Croatia. The main identified MI risk factors in Southern Croatia were heavy smoking (>20 cig/day; OR 3.86; 95% CI 2.31–6.46), diabetes mellitus (OR 2.83; 95% CI 1.58–5.23), abnormal ratio of B-100 and A-1 apolipoproteins (OR 2.23; 95% CI 1.28–3.89), elevated waist to hip ratio (OR 1.96; 95% CI 1.21–3.18), and arterial hypertension (OR 1.68; 95% CI 1.15–2.45). Protective was moderate alcohol consumption (OR 0.63; 95% CI 0.40–0.99). The prevalence of major MI risk factors in Croatia is similar to that in the surrounding countries and in the world, accounting for over 90% of the population attributable risk. However, physical activity, dietary and psychosocial factors are seemingly less important in this country, while moderate alcohol consumption is more protective than regionally or globally

Quality of Life after Stroke in Croatian Patients

In order to evaluate the microsocial factors affecting quality of life in stroke victims, 100 survivors of ischemic stroke and the same number of their relevant family members (key persons, controls) were interviewed using Stroke Specific Quality of Life Scale (SS-QOL)1 questionnaire. Total SS-QOL score did not differ significantly between post-stroke patients and key persons (z=0.64, P=0.524). Relevant family members ranked the patients’ family (P=0.022) and social role (P=0.08), and their mobility (P=0.09) slightly higher than the patients themselves. However, male patients rated their »family role« (z=–2.82, P=0.005), »mobility« (z=–2.28, P=0.023) and »social role« (z=–1.86, P=0.063) higher than their female peers. Recent ( 33 months) and remote (>33 months after the ischemic accident) stroke patients did not differ substantially in total SS-QOL score, social role and hand function assessment but in mobility (z=–1.90, P= 0.057) and family role estimation (z=–2.47, P=0.014) the difference was in favor of recent stroke patients. The domain scores and total SS-QOL score did not differ by gender between recent stroke patients and their controls either. It is concluded that assessment of general functioning and global quality of life among post-stroke patients provided by relevant patients’ family members could be accepted with confidence. Male patients slightly overestimate their mobility and social role. No significant impact of post-stroke time span on quality of life estimation was observed

MERITS OF PARACETAMOL IN OSTEOARTHRITIC HYPERTENSIVE PATIENTS

Cilj ispitivanja bio je odrediti mjesto paracetamola u liječenju hipertoničara s artrozom, i utvrditi najpovoljniju kombinaciju antihipertenziva i antireumatika za te pacijente. U prospektivno ispitivanje provedeno u ordinaciji obiteljske medicine uključeno je 110 liječenih hipertoničara starijih od 55 godina; 50 u kontrolnu i 60 u interventnu skupinu (uzimali su i nesteroidne antireumatike zbog osteoartritisa). U tromjesečnom su razdoblju uspoređivana dva antihipertenziva, lizinopril/hidroklorotiazid i amlodipin s dva nesteroidna anrireumatika (NSAR): ibuprofenom i piroksikamom, te s paracetamolom. Nakon svakog jednomjesečnog razdoblja mjeren je arterijski tlak, učinak ispitivanih lijekova na intenzitet boli i kvalitetu života ispitanika. Ibuprofen i piroksikam pokazali su značajno prohipertenzivno djelovanje, a u razdoblju uzimanja paracetamola ono je bilo neznatno i klinički zanemarivo. U podskupini amlodipin ± ibuprofen, prosječni rezultat na ljestvici boli statistički se značajno smanjivao tijekom pokusa. U podskupini lizinopril/hidroklorotiazid ± piroksikam prosječna procijenjena kvaliteta života značajno se mijenjala. Paracetamol je pokazao podjednaku analgetsku učinkovitost kao ibuprofen, a tek nešto slabiju od piroksikama. Kvaliteta života je u NSAR fazama bila lošija nego tijekom uzimanja paracetamola. Samo paracetamol nije utjecao na antihipertenzivno djelovanje lizinopril/ hidroklorotiazid kombinacije. U hipertoničara s artrozom paracetamol je analgetik prvog izbora, dok je antihipertenziv izbora jedan antagonist kalcija, navlastito amlodipin.Background: Nonsteroidal anti-inflammatory drug (NSAID) side effects can impair quality of life in patients with osteoarthritis. Due to its particular mechanism of action, paracetamol might bypass these negative effects. Objectives: To determine both the role of paracetamol in the treatment of osteoarthritis patients and optimal combination of antihypertensives and antirheumatics for these patients. Methods: A prospective clinical trial in a family practice included 110 treated hypertensives aged over 55 years: 50 controls and 60 also taking NSAIDs for osteoarthritis. This 3-month study compared two antihypertensives, lisinopril/hydrochlorothiazide fixed combination and amlodipine, with two NSAIDs, ibuprofen and piroxicam, and with paracetamol. Following clinical work-up and NSAID discontinuation for at least 3 days (run-in period of only 3-7 days), osteoarthritis subjects were randomized to 1-month periods of ibuprofen (400-600 mg t.i.d.) or piroxicam (10-20 mg o.d.) with one month of paracetamol (1000 mg t.i.d.) in the middle as a “wash-out” interval, continuing the prescribed amlodipine (5-10 mg o.d.) or lisinopril/hydrochlorothiazide fixed drug combination (10/6.25-20/12.5 mg o.d.), while control subjects (hypertensives with no osteoarthritis) were just keeping their antihypertensive therapy. Blood pressure was measured with standard mercury sphygmomanometer and with an automatic device, in standing, sitting and supine position. The intensity of arthritic pain (on a visual analogue scale from 1 to 10, where 0 means “no pain” and 10 “the worst pain you may imagine”) and the patient’s quality of life estimate (on a visual analogue scale from 1 to 10, where 0 means “general condition excellent” and 10 “the worst possible”) were recorded. Results: Blood pressure control was unchanged in the amlodipine group across the study periods and impaired in the lisinopril/ hydrochlorothiazide group during either ibuprofen or piroxicam, but not during paracetamol. In the amlodipine ± ibuprofen subgroup, the reduction of the average pain intensity score throughout the study was significant (2=8.250; df 3; P=0.037). In the lisinopril/hydrochlorothiazide ± piroxicam subgroup, the assessed quality of life differed significantly (2=9.716; df 3; P=0.018), while in the amlodipine ± ibuprofen and amlodipine ± piroxicam subgroups the changes were marginal (2=6.936; df 3; P=0.072 and 2=7.146; df 3; P=0.065, respectively). Discussion: In our trial, paracetamol had analgesic efficacy similar to ibuprofen and only marginally inferior to piroxicam. The analgesic effect of ibuprofen, piroxicam and paracetamol was more pronounced in amlodipine than in the lisinopril/hydrochlorothiazide subgroups. The quality of life was reported to be worse with NSAIDs than with paracetamol, presumably due to dyspeptic problems. Although during the paracetamol phases, the quality of life was slightly improved, the difference was statistically nonsignificant because of the small samples and insufficiently sensitive scale. Conclusion: Analgesic efficiency of paracetamol is comparable to that of ibuprofen and is marginally inferior to piroxicam. Only paracetamol did not interfere with the antihypertensive effects of lisinopril/ hydrochlorothiazide combination. Piroxicam and ibuprofen markedly blunt the effects of antihypertensive drugs while paracetamol is almost inert in this sense. Lisinopril/hydrochlorothiazide combination is much more affected by this interaction than amlodipine. Because of less side effects and better tolerability, paracetamol is the analgesic of choice for hypertensive patients with osteoarthritis, needed prolonged pain relief. The second choice drugs are narcotic analgesics (e.g., tramadol). Small doses of NSAIDs can eventually be added with concomitant prescription of gastroprotective agents

OBITELJSKA MEDICINA 2. PREUREĐENO I PROŠIRENO IZDANJE

OBITELJSKA MEDICINA 2. PREUREĐENO I PROŠIRENO IZDANJ

OBITELJSKA MEDICINA 2. PREUREĐENO I PROŠIRENO IZDANJE

OBITELJSKA MEDICINA 2. PREUREĐENO I PROŠIRENO IZDANJ