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Martín-Enguix D, Aguirre Rodríguez JC, Guisasola Cárdenas M, Generoso Torres MN, Hidalgo Rodríguez A, Sánchez Cambronero M, González Bravo A. [Antihypertensive prescription in type 2 diabetes patients in Andalusia and SEH-LELHA 2022 guidelines: An economic cost evaluation]. HIPERTENSION Y RIESGO VASCULAR 2024:S1889-1837(24)00083-7. [PMID: 38991862 DOI: 10.1016/j.hipert.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE This study aims to analyze the prescription of antihypertensive drugs in patients with type 2 diabetes (T2D) in Andalusia, comparing it with the SEH-LELHA 2022 guidelines, and to assess the direct cost of these treatments. MATERIALS AND METHODS A multicentric, cross-sectional, and descriptive study was conducted with 385 T2D patients. Participants were randomly selected from the patient lists of 120 primary care physicians from Andalusia. Inclusion criteria included a diagnosis of T2D and complete clinical records for the year 2022. Demographic data and drug prescription information were collected, with the average cost per patient being calculated. RESULTS The mean age of the subjects was 70.72 years, with 53.51% being male. A total of 70.9% of the patients were taking antihypertensive drugs, the most common being ACE inhibitors/ARBs (70.9%), diuretics (70.1%), beta-blockers (40.0%), and calcium channel blockers (20.0%). Each patient took an average of 2.46±1.06 antihypertendsive, and fixed association of 2 or more antihypertensive drugs were used by 40.9% of the studied patients. The annual cost per patient was 141.45€/year. CONCLUSIONS The study reveals strong adherence to the SEH-LELHA 2022 guidelines among physicians in Andalusia regarding the of antihypertensives for T2D patients, with a significant preference for Renin-Angiotensin System blockers, diuretics, and beta-blockers. However, a notable deviation in prescription practices was observed with the frequent choice of doxazosin over spironolactone, despite the latter being the recommended option for resistant hypertension. Although the overall expenditure on antihypertensives is moderate, their cost-effectiveness is enhanced by the efficacy of these treatments in preventing cardiovascular complications.
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Affiliation(s)
- D Martín-Enguix
- Centro de Salud Fortuny Veluti de Granada, Granada, España; Distrito Sanitario Granada Metropolitano, Granada, España.
| | - J C Aguirre Rodríguez
- Centro de Salud Fortuny Veluti de Granada, Granada, España; Distrito Sanitario Granada Metropolitano, Granada, España
| | - M Guisasola Cárdenas
- Centro de Salud Fortuny Veluti de Granada, Granada, España; Distrito Sanitario Granada Metropolitano, Granada, España
| | - M N Generoso Torres
- Centro de Salud Fortuny Veluti de Granada, Granada, España; Distrito Sanitario Granada Metropolitano, Granada, España
| | - A Hidalgo Rodríguez
- Consultorio de Cijuela, Cijuela, Granada. Distrito Sanitario Granada Metropolitano, Granada, España
| | - M Sánchez Cambronero
- Centro de Salud Fortuny Veluti de Granada, Granada, España; Distrito Sanitario Granada Metropolitano, Granada, España
| | - A González Bravo
- Centro de Salud Fortuny Veluti de Granada, Granada, España; Distrito Sanitario Granada Metropolitano, Granada, España
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Tan HJ, Ling WC, Chua AL, Lee SK. Oral epigallocatechin gallate reduces intestinal nadolol absorption via modulation of Oatp1a5 and Oct1 transcriptional levels in spontaneously hypertensive rats. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 90:153623. [PMID: 34303263 DOI: 10.1016/j.phymed.2021.153623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/27/2021] [Accepted: 06/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Concurrent use of epigallocatechin-3-gallate (EGCG) and medication may lead to botanical-drug interactions, subsequently therapeutic failure or drug toxicity. It has been reported that EGCG reduces plasma nadolol bioavailability in normotensive models. Nevertheless, evidence on the effects of EGCG on hypertensive model, and the possible underlying mechanism have not been elucidated. OBJECTIVES This study aims (i) to investigate the effects of EGCG on nadolol pharmacokinetics (maximum plasma concentration, time to achieve maximum concentration, area under the time-plasma concentration curve, plasma half-life and total clearance) and subsequently its impact on blood pressure control; and (ii) to identify transcriptional regulatory roles of EGCG on the nadolol intestinal and hepatic drug-transporters in SHR. METHODS Male SHR were pre-treated with a daily dose of EGCG (10 mg/kg body weight, i.g.) for 13 days. On day-14, a single dose of nadolol (10 mg/kg body weight) was given to the rats 30 min after the last dose of EGCG administration. Systolic blood pressure (SBP) was measured at 6-h and 22-h post-nadolol administration. Plasma and urinary nadolol concentrations were quantified using high-performance liquid chromatography, and pharmacokinetic parameters were analyzed by using non-compartmental analysis. Hepatic and ileal Oatp1a5, P-gp, and Oct1 mRNA expressions were determined by real-time PCR. RESULTS SBP of SHR pre-treated with EGCG and received nadolol was significantly higher than those which were not pre-treated with EGCG but received nadolol. Pre-treatment of EGCG resulted in a marked reduction of plasma nadolol maximum concentration (Cmax) and area under the time-plasma concentration curve (AUC) by 53% and 51% compared to its control. The 14-day treatment with oral EGCG led to a significant downregulation of mRNA levels of ileal Oatp1a5, P-gp, and Oct1 genes by 4.03-, 8.01- and 4.03-fold; and hepatic P-gp, and Oct1 genes by 2.61- and 2.66-fold. CONCLUSION These data concluded that exposure to EGCG could lead to reduced nadolol bioavailability and therefore, uncontrolled raised blood pressure and higher risks of cardiovascular events. Our data suggest that the reduced nadolol bioavailability is associated with the downregulation of ileal Oatp1a5 and Oct1 mRNA levels that subsequently lead to poor absorption of nadolol to the systemic circulation.
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Affiliation(s)
- Hong-Jie Tan
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000 Kajang, Bandar Sungai Long, Selangor, Malaysia
| | - Wei-Chih Ling
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000 Kajang, Bandar Sungai Long, Selangor, Malaysia
| | - Ang-Lim Chua
- Faculty of Medicine, Universiti Teknologi Malaysia, Sungai Buloh, Selangor, Malaysia
| | - Siew-Keah Lee
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, 43000 Kajang, Bandar Sungai Long, Selangor, Malaysia.
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Cordero A, Rodríguez-Mañero M, Bertomeu-González V, García-Acuña JM, Baluja A, Agra-Bermejo R, Álvarez-Álvarez B, Cid B, Zuazola P, González-Juanatey JR. Insuficiencia cardiaca de novo tras un síndrome coronario agudo en pacientes sin insuficiencia cardiaca ni disfunción ventricular izquierda. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Cordero A, Rodríguez-Mañero M, Bertomeu-González V, García-Acuña JM, Baluja A, Agra-Bermejo R, Álvarez-Álvarez B, Cid B, Zuazola P, González-Juanatey JR. New-onset heart failure after acute coronary syndrome in patients without heart failure or left ventricular dysfunction. ACTA ACUST UNITED AC 2020; 74:494-501. [PMID: 32448726 DOI: 10.1016/j.rec.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronary heart disease is the leading cause of heart failure (HF). The aim of this study was to assess the risk of readmission for HF in patients with acute coronary syndrome without previous HF or left ventricular dysfunction. METHODS Prospective study of consecutive patients admitted for acute coronary syndrome in 2 institutions. Risk factors for HF were analyzed by competing risk regression, taking all-cause mortality as a competing event. RESULTS We included 5962 patients and 567 (9.5%) experienced at least 1 hospital readmission for acute HF. Median follow-up was 63 months and median time to HF readmission was 27.1 months. The cumulative incidence of HF was higher than mortality in the first 7 years after hospital discharge. A higher risk of HF readmission was associated with age, diabetes, previous coronary heart disease, GRACE score> 140, peripheral arterial disease, renal dysfunction, hypertension and atrial fibrillation; a lower risk was associated with optimal medical treatment. The incidence of HF in the first year of follow-up was 2.73% and no protective variables were found. A simple HF risk score predicted HF readmissions risk. CONCLUSIONS One out of 10 patients discharged after an acute coronary syndrome without previous HF or left ventricular dysfunction had new-onset HF and the risk was higher than the risk of mortality. A simple clinical score can estimate individual risk of HF readmission even in patients without previous HF or left ventricular dysfunction.
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Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Vicente Bertomeu-González
- Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José M García-Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Aurora Baluja
- Departamento de Anestesiología, Cuidados Intensivos y Tratamiento del Dolor, Complejo Hospitalario de la Universidad de Santiago, Santiago de Compostela, A Coruña, Spain; Grupo de Investigación del Paciente Crítico, Fundación Instituto de Investigación Sanitaria de Santiago de Compostela, Universidad de Santiago de Compostela, A Coruña, Spain
| | - Rosa Agra-Bermejo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Belén Álvarez-Álvarez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Belén Cid
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Pilar Zuazola
- Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
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Ávila-Valencia JC, Hurtado-Gutiérrez H, Benavides-Córdoba V, Betancourt-Peña J. Ejercicio aeróbico en pacientes con falla cardiaca con y sin disfunción ventricular en un programa de rehabilitación cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Carrillo X, Vilalta V, Cediel G, Fernandez-Nofrerias E, Rodriguez-Leor O, Mauri J, Abdul Jawad-Altisent O, Garcia-Garcia C, Serra J, Bayes-Genis A. Trends in prevalence and outcomes of acute coronary syndrome associated with cocaine consumption: The RUTI-cocaine study. Int J Cardiol 2019; 283:23-27. [DOI: 10.1016/j.ijcard.2018.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/08/2018] [Accepted: 12/06/2018] [Indexed: 11/15/2022]
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González-Juanatey JR. Hipertensión arterial y enfermedad arterial periférica. Una asociación peligrosa. Med Clin (Barc) 2012; 139:67-9. [DOI: 10.1016/j.medcli.2012.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/23/2012] [Indexed: 11/29/2022]
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Cordero A, Bertomeu-González V, Mazón P, Moreno-Arribas J, Fácila L, Bueno H, González-Juanatey JR, Bertomeu-Martínez V. Differential effect of β-blockers for heart rate control in coronary artery disease. Clin Cardiol 2011; 34:748-54. [PMID: 22083944 DOI: 10.1002/clc.20981] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 08/26/2011] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Resting heart rate is an independent risk factor for cardiovascular disease and is mainly controlled by β-blockers (BBs). BBs are part of the optimal medical treatment for coronary artery disease (CAD), and their benefit correlates with resting heart rate (RHR) reduction. HYPOTHESIS RHR is poorly controlled in daily practice among patients with stable cardiovascular disease, and control is only achieved by some BBs. METHODS Observational, cross-sectional, and multicenter study of CAD patients recruited nationwide from 20 institutions. Antecedents, risk factors, and treatments were collected. Controlled RHR was considered at <70 bpm. RESULTS The mean age of the 2897 patients included was 67.4 years (11.4%), and 75.9% were males. Patients treated with a BB (56.5%) had a lower mean age and comorbidities. The mean RHR was 69.6 bpm (12.6). A significantly lower RHR was observed in patients treated with a BB compared to the rest (67.2 vs 73.0 bpm; P<0.01), and no difference was observed in patients treated with a calciumchannel blocker (CCB). The analysis by individual agents identified that only patients treated with atenolol, bisoprolol, and metoprolol had significantly lower RHR than those not receiving a BB. No differences were observed in mean doses of each agent according to RHR control, except for verapamil. BB treatment was independently associated with RHR control (odds ratio [OR]: 2.42, 95% CI: 2.05-2.87; P<0.01), and no association was found for nondihydropyridine CCBs (OR: 0.99, 95% CI: 0.96-1.02; P = 0.38). Bisoprolol (OR: 1.56, 95% CI: 1.38-1.78; P<0.01), atenolol (OR: 2.01, 95% CI: 1.57-3.49; P<0.01), and metoprolol (OR: 1.29, 95% CI: 1.04-1618; P = 0.04) were independently associated with RHR control. CONCLUSIONS RHR is poorly controlled in CAD patients, and although BBs are the most efficient therapy, in daily clinical practice RHR <70 bpm is only independently associated with atenolol, bisoprolol, or metoprolol.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain.
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Carrillo X, Curos A, Muga R, Serra J, Sanvisens A, Bayes-Genis A. Acute coronary syndrome and cocaine use: 8-year prevalence and inhospital outcomes. Eur Heart J 2011; 32:1244-50. [DOI: 10.1093/eurheartj/ehq504] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Control of risk factors in and treatment of patients with coronary heart disease: the TRECE study. Rev Esp Cardiol 2009; 62:807-11. [PMID: 19709516 DOI: 10.1016/s1885-5857(09)72361-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The aim of the TRECE study was to describe treatment in patients with coronary heart disease (CHD). It was an observational, cross-sectional multicenter study of patients who were treated in either an internal medicine (n=50) or cardiology (n=50) department or in primary care (n=100) during 2006. The patients' history, risk factors and treatment were recorded, and noncardiac disease was evaluated using the Charlson index. Optimal medical treatment (OMT) was regarded as comprising combined administration of antiplatelet agents, statins, beta-blockers, and renin-angiotensin-aldosterone system blockers. In total, data on 2897 patients were analyzed; their mean age was 67.4 years and 71.5% were male. Overall, 25.9% (95% confidence interval, 25.6-26.2%) received OMT. Multivariate analysis showed that prescription of OMT was independently associated with hypertension, diabetes, current smoking, myocardial infarction and angina. In contrast, nonprescription of OMT was associated with atrial fibrillation, chronic obstructive pulmonary disease and a Charlson index>/=4. The main findings were that few CHD patients were prescribed OMT and that its prescription was determined by the presence of symptoms and comorbid conditions.
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Bertomeu V, Cordero A, Quiles J, Mazón P, Aznar J, Bueno H. Control de los factores de riesgo y tratamiento de los pacientes con cardiopatía isquémica: registro TRECE. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)71694-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Burillo-Putze G, Nogué-Xarau S, Suárez-Peláez J, Dueñas-Laita A. Documento de consenso sobre bloqueadores de los receptores betaadrenérgicos y consumo de cocaína. Rev Esp Cardiol 2007; 60:1334; author reply 1335. [DOI: 10.1157/13113943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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