Role of triple fixed combination valsartan, amlodipine and hydrochlorothiazide in controlling blood pressure

Hypertension is one of the main risk factors for the development of cardiovascular diseases and the search for new therapeutic strategies aimed at optimizing its control remains an ongoing research and clinical challenge. In recent years, there has been a marked increase in the use of combinations of antihypertensive drugs with complementary mechanisms of action, with the aims of reducing blood pressure levels more rapidly and vigorously than strategies employing monotherapy and improving treatment compliance and adhesion. Therefore, as recommended by the 2009 reappraisal of the European Society of Hypertension/European Society of Cardiology Guidelines, the use of a triple combination that combines a calcium channel blocker, an angiotensin II receptor blocker and a thiazide diuretic seems a reasonable and efficacious combination for the management of hypertensive patients with moderate, high or very high risk. This article reviews the clinical trials carried out with the fixed combination of amlodipine/valsartan/hydrochlorothiazide at the doses recommended for each drug in monotherapy. The data show that this combination achieved greater reductions in mean sitting diastolic and systolic blood pressure than amlodipine, valsartan or hydrochlorothiazide in monotherapy, with favorable pharmacodynamic and pharmacokinetic profiles. The triple combination at high single doses should be used with caution in elderly patients and those with renal or liver failure. Although the tolerability and safety of the triple combination are good, the most-frequently reported adverse effects were peripheral edema, headache and dizziness. Analytical alterations were consistent with the already-known biochemical effects of amlodipine, valsartan or hydrochlorothiazide in monotherapy. In summary, triple-therapy with amlodipine/valsartan/hydrochlorothiazide in a single pill contributes additional advantages to fixed -combinations of two drugs, achieving a greater and more rapid reduction in blood pressure levels in a safe, well-tolerated manner

Hacia una ciberdemocracia con participación social en Bolivia.

Sin resume

Connecting Cerebral White Matter Lesions and Hypertensive Target Organ Damage

Chronic hypertension leads to concomitant remodeling of the cardiac and vascular systems and various organs, especially the brain, kidney, and retina. The brain is an early target of organ damage due to high blood pressure, which is the major modifiable risk factor for stroke and small vessel disease. Stroke is the second leading cause of death and the number one cause of disability worldwide and over 80% of strokes occur in the elderly. Preclinical hypertensive lesions in most target organs are clearly identified: left ventricular hypertrophy for the heart, microalbuminuria for the kidney, fundus abnormalities for the eye, and intima-media thickness and pulse wave velocity for the vessels. However, early hypertensive brain damage is not fully studied due to difficulties in access and the expense of techniques. After age, hypertension is the most-important risk factor for cerebral white matter lesions, which are an important prognostic factor for stroke, cognitive impairment, dementia, and death. Studies have shown an association between white matter lesions and a number of extracranial systems affected by high BP and also suggest that correct antihypertensive treatment could slow white matter lesions progression. There is strong evidence that cerebral white matter lesions in hypertensive patients should be considered a silent early marker of brain damage

Influencia del consumo de sal y de analgésicos efervescentes con sodio en pacientes con hipertensión y riesgo vascular

La ingesta del sodio que contienen los alimentos y algunos medicamentos puede producir una elevación de los valores de presión arterial de los individuos. La Organización Mundial de la Salud recomienda de forma global no superar la ingesta diaria de 2 g de sodio en los adultos sanos (5 g de sal común). Para grupos de riesgo se establecen límites más estrictos (0,5-1,5 g de sodio diarios). En España se estima que cada persona consume al día 11 g de sal por término medio. Diversos estudios, realizados en distintas poblaciones, han podido objetivar una correlación directa entre la ingesta de sodio en la dieta y la prevalencia de hipertensión arterial. Otros estudios corroboran el efecto de la reducción del consumo de sal en la dieta sobre la disminución de los valores de presión arterial y de la morbilidad y mortalidad cardiovascular. Muchos medicamentos contienen una elevada cantidad de sodio por tener excipientes efervescentes (1 g de paracetamol efervescente puede llegar a aportar más de 0,5 g de sodio), de forma que, si su posología es cada 6-8 horas, pueden superar los límites diarios de sodio recomendados, incluso para un adulto sano. En este artículo se revisa la evidencia disponible sobre el efecto beneficioso de una dieta hiposódica para el control de la hipertensión, las consideraciones sobre el uso de analgésicos y AINE en los pacientes con enfermedad cardiovascular y se insiste en la advertencia de evitar, siempre que sea posible, el uso de medicamentos efervescentes, especialmente en los mayores de 50 años

Guidelines for managing high blood pressure

Guidelines for Managing High Blood Pressure To the Editor Someevidence against β-blockers1 has been published in recent years; however, the exclusion of these drugs as initial treatment of uncomplicated hypertension in the report fromthe panelmembersappointed to the Eighth Joint National Committee (JNC 8)2 is surprising..

Ace inhibition and cardiovascular mortality and morbidity in essential hypertension: The end of the search or a need for further investigations?

Scientific evidence currently available supports the concept that renin-angiotensin blockade with angiotensin converting enzyme inhibitors as a first-line treatment exhibits in arterial hypertension beneficial effects in the prevention of mortality and morbidity comparable to those achieved with diuretics and β-blockers. In addition, the renin-angiotensin blockade has also proved to be beneficial in the secondary prevention of several complications of hypertensive disease such as after myocardial infarction and congestive heart failure, as well as in the prevention of the incidence of type 2 diabetes, and the progression of diabetic and nondiabetic nephropathy. In this later regard, recent evidence with angiotensin II receptor antagonists in reducing the progression of nephropathy in type 2 diabetes strongly confirms that antagonism of the renin-angiotensin system is an effective approach to cardiovascular and renal disease. Finally, the renin-angiotensin blockade in high-risk patients may reduce cardiovascular mortality independently of the effect on blood pressure (BP). The effect of other antihypertensive drugs on cardiovascular risk in patients with high-normal BP should be investigated to establish whether they exhibit a comparable effect or whether there is a class-related benefit of drugs blocking the renin-angiotensin system. Such a strategy could also be encouraged to design future interventional studies with the newer classes of compounds (angiotensin II AT1-receptor antagonists, vasopeptidase inhibitors, endothelin antagonists), which would have the additional potential advantage of providing information more easily transferable to large-scale clinical practice. Am J Hypertens 2002;15:367-371 © 2002 American Journal of Hypertension, Lt

Proceso de experiencia multimedia interactiva desde el punto de vista comunicativo visual: conceptos de presencia y nuevas tecnologías

Proceso de experiencia multimedia interactiva desde el punto de vista comunicativo visual: conceptos de presencia y nuevas tecnología

Polypill in cardiovascular disease prevention: recent advances.

Triple therapy with lipid‑lowering, antihypertensive, and antiplatelet agents reduces the risk of recurrent cardiovascular fatal and nonfatal events, cardiovascular mortality, and total mortality in secondary prevention. In real life, however, effective implementation of these optimal treatments both in primary and secondary prevention is low, and thus their contribution to cardiovascular prevention is much lower than it could be, based on research data. One of the main barriers to the adequate implementation of these strategies is low adherence to the elevated number of pills, as adherence is adversely affected by the complexity of the prescribed treatment regimen, and can be considerably improved by treatment simplification. This review updates the findings provided by recent epidemiological and clinical studies favoring a polypill‑based approach to cardiovascular prevention. The increased prevalence of patients with multiple cardiovascular risk factors and comorbidities provides the rationale for a therapeutic strategy based on a combination of drugs against different risk factors in a single pill. Pharmacologic studies have demonstrated that different cardiovascular drugs can be combined in a single pill with no loss of their individual efficacy, and this favors adherence to and persistence of treatment, as well as multiple risk factor control. Recently, a randomized clinical trial SECURE (Secondary Prevention of Cardiovascular Disease in the Elderly) has shown a significant, 30% reduction in cardiovascular events, and a 33% reduction in cardiovascular death in patients after myocardial infarction treated with a polypill, as compared with usual care, thus supporting the polypill use as an integral part of any cardiovascular prevention strategy.S

Gestión educativa y perfil de egreso de estudiantes de las instituciones educativas públicas, UGEL 08. Lima, 2022

El presente trabajo de investigación tuvo como objetivo general determinar la forma en que se relaciona la gestión educativa y el perfil de egreso de estudiantes de las instituciones educativas públicas, UGEL 08. Lima, 2022. La investigación que se realizó fue de tipo básica, diseño descriptivo, no experimental, correlacional, cuyo enfoque fue cuantitativo. La muestra estuvo compuesta por 80 participantes de diversas instituciones educativas públicas. Para la recolección de datos se emplearon 2 cuestionarios de elaboración propia para cada una de las variables de estudio según la escala de Likert. Para realizar el análisis descriptivo e inferencial de los datos recogidos se empleó el programa Microsoft Excel y el software estadístico SPSS 25. Además, para determinar la correlación entre las variables se aplicó el coeficiente de Rho Spearman. Los resultados mostraron que existe una correlación de -,229 y el valor (sig.) equivalente a 0,41 entre las variables de estudio, lo que refleja un nivel de correlación negativa débil entre las variables por lo que se concluye que, si existe una relación entre la gestión educativa y el perfil de egreso de estudiantes de las instituciones educativas públicas, UGEL 08. Lima, 2022