Srovnani trough/peak pomeru kardioselektivnich betablokatoru u pacientu s cerstve zjistenou hypertenzi.

Hypertension is an important risk factor for cardiovascular disease. One of the major characteristic features of the new antihypertensive drugs is their 24-hour effectiveness. If the drug reaches the mean trough/peak ratio over 50%, it can be dosed once a day. Beta-blockers are one of initial drug choice in young patients with hypertension. The objectives of the study were to compare T/P ratios of slow-release betaxolole and metaprolol using 24-hour blood pressure monitoring in patients with newly diagnosed hypertension, to evaluate its 24-hour and office efficacy in blood pressure lowering and to review diurnal rhythm changes after the treatment (dippers contra nondippers).Available from STL Prague, CZ / NTK - National Technical LibrarySIGLECZCzech Republi

Wartości uzyskane w całodobowym automatycznym pomiarze ciśnienia tętniczego odpowiadające wartości ciśnienia tętniczego zmierzonej w gabinecie lekarskim wynoszącej 130/80 mm Hg

Background: 24 hour ambulatory blood pressure monitoring (ABPM) values for patients who have office BP of 130/80 mm Hghave not been clearly reported.Aim: The determination of ABPM values in treated hypertensive subjects corresponding to a mean office BP of 130/80 mm Hg.Methods: BP measurement in subjects 40–70 years old, by ABPM and mercury sphygmomanometer. The inclusion criteria were:mean office BP systolic (SBP) 128–132 mm Hg and diastolic (DBP) 78–82 mm Hg. Seventy six subjects met all study inclusion criteria.Results: Mean office BP: SBP 129.5 ± 1.1 mm Hg, DBP 79.9 ± 1.3 mm Hg. Mean 24 hour BP: SBP 121.9 ± 2.0 mm Hg,DBP 73.1 ± 1.9 mm Hg. Mean awake BP: SBP 124.9 ± 2.4 mm Hg, DBP 75.5 ± 2.2 mm Hg. Mean asleep BP: SBP109.1 ± 3.9 mm Hg, DBP 63.3 ± 4.0 mm Hg.Conclusions: The target values of ABPM identified in this study can be used in clinical practice and will contribute to riskstratification and treatment of hypertension.Wstęp: Dotychczas nie przedstawiono danych dotyczących wartości uzyskanych w całodobowym automatycznym pomiarzeciśnienia tętniczego (ABPM) u chorych, u których ciśnienie tętnicze zmierzone w gabinecie lekarskim wynosiło 130/80 mm Hg.Cel: Celem badania było ustalenie, jakie wartości ciśnienia tętniczego w ABPM u chorych z nadciśnieniem tętniczym stosującychleki przeciwnadciśnieniowe odpowiadają wynikowi pomiaru gabinetowego wynoszącego 130/80 mm Hg.Metody: Przeprowadzono pomiary ciśnienia tętniczego u osób w wieku 40–70 lat, stosując ABPM i gabinetowy pomiarsfigmomanometrem rtęciowym. Kryterium włączenia do badania było uzyskanie w pomiarze gabinetowym średniej wartościciśnienia skurczowego (SBP) 128–132 mm Hg i rozkurczowego (DBP) 78–82 mm Hg. Kryteria włączenia spełniło 76 osób.Wyniki: Średnie wartości w gabinetowych pomiarach ciśnienia tętniczego wynosiły: SBP 129,5 ± 1,1 mm Hg, DBP79,9 ± 1,3 mm Hg. W pomiarach za pomocą ABPM uzyskano następujące wartości: SBP 121,9 ± 2,0 mm Hg, DBP73,1 ± 1,9 mm Hg. Średnie ciśnienie tętnicze w porze aktywności dziennej wynosiło: SBP 124,9 ± 2,4 mm Hg, DBP75,5 ± 2,2 mm Hg, a w porze nocnej — SBP 109,1 ± 3,9 mm Hg, DBP 63,3 ± 4,0 mm Hg.Wnioski: Uzyskane w niniejszym badaniu wartości ciśnienia tętniczego zmierzone w ABPM mogą być użyteczne w praktyceklinicznej i przyczynią się do poprawy stratyfikacji ryzyka oraz leczenia nadciśnienia tętniczego

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk