Hipertension y Riesgo Vascular最新文献

Approximately 10% of cases of arterial hypertension are due to a secondary cause, being among the most frequent primary hyperaldosteronism, characterized by hypertension, metabolic alkalosis and hypokalemia. However, on rare occasions it can present in an atypical way, in the form of muscle weakness and myalgia secondary to rhabdomyolysis due to severe hypokalemia, as in the case described.

Primary aldosteronism (PA) is the most common cause of secondary arterial hypertension. For unilateral cases, surgery offers the possibility of cure, with unilateral adrenalectomy being the treatment of choice, whereas bilateral forms of PA are treated mainly with mineralocorticoid receptor antagonists (MRA). The goals of treatment for PA due to either unilateral or bilateral adrenal disease include reversal of the adverse cardiovascular effects of hyperaldosteronism, normalization of serum potassium in patients with hypokalemia, and normalization of blood pressure. The Primary Aldosteronism Surgery Outcome group (PASO) published a study defining clinical and biochemical outcomes based on blood pressure and correction of hypokalemia and aldosterone to renin ratio (ARR) levels for patients undergoing total unilateral adrenalectomy for unilateral PA. In this review, we provide several practical recommendations for the medical and surgical management and follow-up of patients with PA.

Introduction

The relationship between obesity and hypertension is clearly known and cardiac rehabilitation (CR) is shown as an effective treatment method in both obese and hypertensive patients. The aim of this study is to reveal the effect of CR on obese hypertensive patients by comparing them with non-obese hypertensive patients.

Methods

Eighty eligible, volunteer participants with hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg) were enrolled in this study. The patients were divided into 2 groups according to their BMI values: obese (BMI ≥30 kg/m²) hypertensive patients and non-obese (BMI <30 kg/m²) hypertensive patients. The CR program, in which aerobic exercise training was the main part, was performed on the patients. At the end of the 10-week CR program, the resting SBP and DBP values were measured.

Results

A total of 74 patients (37 obese and 37 non-obese) completed the study. After CR significant improvements were achieved in all evaluated parameters compared to pre-CR values. When the amounts of changes before and after CR were compared, the decrease in SBP was found to be significantly higher in obese patients compared to non-obese patients (p = .003). Higher BMI was associated with more reduction in SBP (r = 0.287, p = 0.013).

Conclusions

Exercise-based CR effectively reduced SBP in obese and non-obese hypertensive patients. However, it was more effective in obese patients compared to non-obese patients.

Renal artery stenting (RAS) and its effectiveness in the treatment of atherosclerotic renal artery disease are controversial.¹ Catheter-based renal denervation (RDN) has been shown to reduce blood pressure in the treatment of multidrug-resistant hypertension.² In this case, we presented the successful regulation of multidrug resistant hypertension after renal denervation in a patient with renal artery stent.

Introduction

Antihypertensive medication non-adherence is an important cause of poor control in hypertension. The role of motivational interventions to increase antihypertensive medication adherence remains unclear.

Objective

To systematically review RCTs of motivational interventions for improving medication adherence in hypertension.

Methods

EMBASE and Pubmed were searched from inception to February 2019 for RCTs of motivational interventions for improving medication adherence in hypertension vs. usual care. Inclusion criteria: RCTs with motivational intervention to improve medication adherence in adults with hypertension. A blinded review was conducted by 2 reviewers. Disagreements were resolved by consensus/a third reviewer.

Data extraction and quality appraisal was performed using the risk of bias tool from cochrane collaboration. The meta-analyses of blood pressure control used random-effects models to report mean difference and 95% CIs. Primary outcome was medication adherence and second outcome was blood pressure control.

Results

The search methodology yielded 10 studies comprising 1171 participants. Medication adherence improved significantly in 5 studies. We could not perform pool analysis for this outcome due to different measurements of medication adherence. Seven trials reported significant results regarding blood pressure control.

On pooled analysis, motivational interventions were not significantly associated with a systolic blood pressure (mean difference, −0.06; 95% CI, −0.05 to 0.18; p = 0.63; I² = 0.0%) or diastolic blood pressure (mean difference, −0.11; 95% CI, −0.10 to 0.31; p = 0.28; I² = 23.8%) decrease or blood pressure control.

Conclusions

Motivational interventions seem to significantly improve medication adherence but not significantly blood pressure control in hypertension, although evidence is still being based on few studies, with unclear risk of bias.