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Giollo-Junior LT, Cosenso-Martin LN, da Silva Lopes V, Paz Landim M, Barufi Fernandes LA, Aparecido de Oliveira K, Spaziani AO, Santos AP, Silva MA, Yugar-Toledo JC, Vilela-Martin JF. The Effect of Transcutaneous Electrical Nerve Stimulation in Peripheral and Central Hemodynamic Parameters on Resistant Hypertension: A Case Report. Vasc Health Risk Manag 2023; 19:317-323. [PMID: 37215282 PMCID: PMC10199678 DOI: 10.2147/vhrm.s408082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
Resistant hypertension (RH) is characterized by being difficult to control, even with the use of various antihypertensive drugs and is associated with target organ lesions and other comorbidities. Thus, new treatment alternatives such as transcutaneous electrical nerve stimulation (TENS) can offer benefits to resistant hypertensive patients by reducing blood pressure (BP) in a non-invasive way and without the need for the association of more antihypertensive drugs. In this case, a patient with RH was submitted to three weekly applications of TENS on the stellate ganglion lasting 40 min each for 1 month. Peripheral and central hemodynamic assessments were performed by 24-h ambulatory BP monitoring (ABPM) before and after TENS applications. After completion of the TENS applications, significant reductions in office systolic (SBP) and diastolic BP (DBP) were observed. There was also a decrease in peripheral SBP and DBP in the 24-h ABPM and sleep and SBP during wakefulness. Additionally, central parameters including central SBP and pulse wave velocity presented a significant reduction in the 24-h ABPM, during the wakefulness and sleep. TENS is able to attenuate the sympathetic hyperactivity present in RH cases and decrease the peripheral and central hemodynamic parameters of a resistant hypertensive patient.
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Affiliation(s)
- Luiz Tadeu Giollo-Junior
- General Hospital at Brazilian Army, Curitiba, Parana, Brazil
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Luciana Neves Cosenso-Martin
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Valquiria da Silva Lopes
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Manoel Paz Landim
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Leticia Aparecida Barufi Fernandes
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Kleber Aparecido de Oliveira
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Amanda Oliva Spaziani
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Aleandra Polegati Santos
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Marco Antonio Silva
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
| | - Jose Fernando Vilela-Martin
- Hypertension Clinic - Internal Medicine Department, State Medical School in Sao Jose do Rio Preto (FAMERP), Sao Jose do Rio Preto, São Paulo, Brazil
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Cestario EDES, Vilela-Martin JF, Cosenso-Martin LN, Rubio TA, Uyemura JRR, da Silva Lopes V, Fernandes LAB, Bonalume Tacito LH, Moreno Junior H, Yugar-Toledo JC. Effect of Sequential Nephron Blockade versus Dual Renin-Angiotensin System Blockade Plus Bisoprolol in the Treatment of Resistant Hypertension, a Randomized Controlled Trial (Resistant Hypertension on Treatment - ResHypOT). Vasc Health Risk Manag 2022; 18:867-878. [PMID: 36545494 PMCID: PMC9762262 DOI: 10.2147/vhrm.s383007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Hypertension is the most important modifiable risk factor for cardiovascular disease and a leading public health concern. Objectives The primary aim was to compare sequential nephron blockade (SNB) versus dual renin-angiotensin system blockade (DRASB) plus bisoprolol in patients with resistant hypertension to observe reductions in systolic and diastolic blood pressure (SBP and DBP) levels after 20 weeks of treatment. Material and Methods This trial was an open-label, prospective, randomized, parallel-group, clinical study with optional drug up-titration. Participants were evaluated during five visits at 28-day intervals. Results The mean age was 55.5 years in the SNB and 58.4 years in the DRASB + bisoprolol group (p=NS). Significant office BP reductions were observed in both groups. SNB group, SBP decreased from 174.5±21.0 to 127.0±14.74 mmHg (p<0.0001), and DBP decreased from 105.3±15.5 to 78.11±9.28 mmHg (p<0.0001). DRASB group, SBP decreased from 178.4±21.08 to 134.4 ± 23.25 mmHg (p<0.0001) and DBP decreased from 102.7±11.07 to 77.33±13.75 mmHg (p<0.0001). Ambulatory blood pressure monitoring (ABPM) showed also significant SBP and DBP reductions in both groups (p<0.0001). Conclusion In patients with RHTN adherent to treatment, SNB and DRASB plus bisoprolol showed excellent therapeutic efficacy, although SNB was associated with earlier SBP reduction.
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Affiliation(s)
| | - Jose Fernando Vilela-Martin
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil,Correspondence: Jose Fernando Vilela-Martin, Ave Brig Faria Lima 5416, Sao Jose do Rio Preto, São Paulo, SP, 15090-000, Brazil, Tel +55 17 32015727, Email
| | - Luciana Neves Cosenso-Martin
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | - Tatiane Azevedo Rubio
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Valquiria da Silva Lopes
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
| | | | - Lucia Helena Bonalume Tacito
- Endocrinology Division, Internal Medicine Department, Medical School in São José Rio Preto (FAMERP), São Paulo, Brazil
| | - Heitor Moreno Junior
- Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Hypertension Clinic, Internal Medicine Department, Medical School in São José Do Rio Preto (FAMERP), São Paulo, Brazil
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Zanatta JMDM, Cosenso-Martin LN, da Silva Lopes V, Roma Uyemura JR, Polegati Santos AM, Paz Landim MI, Yugar-Toledo JC, Vilela-Martin JF. Evidence of Nonadherence in Cases of Pseudoresistant Hypertension. Integr Blood Press Control 2021; 14:9-17. [PMID: 33603455 PMCID: PMC7887157 DOI: 10.2147/ibpc.s264057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/26/2020] [Indexed: 11/23/2022] Open
Abstract
Resistant hypertension (RH) is characterized by the use of three or more antihypertensive drugs without reaching the goal of controlling blood pressure (BP). For a definitive diagnosis of RH, it is necessary to exclude causes of pseudoresistance, including the white-coat effect, errors in BP measurement, secondary hypertension, therapeutic inertia, and poor adherence to lifestyle changes and pharmacological treatment. Herein, we report the history of a patient with long-standing uncontrolled BP, even when using seven antihypertensive drugs. Causes of secondary hypertension that justified the high BP levels were investigated, in addition to the other causes of pseudo-RH. In view of the difficult-to-control BP situation, it was decided to hospitalize the patient for better investigation. After 5 days, he had BP control with practically the same medications previously used. Finally, all factors related to the presence of pseudo-RH are discussed, especially poor adherence to treatment. Poor adherence to antihypertensive treatment is common in daily medical practice, and its investigation is of fundamental importance for better management of BP.
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Affiliation(s)
- João Marcos de Menezes Zanatta
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Luciana Neves Cosenso-Martin
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Valquíria da Silva Lopes
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Jéssica Rodrigues Roma Uyemura
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Aleandra Marton Polegati Santos
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Manoel Ildefonso Paz Landim
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - Juan Carlos Yugar-Toledo
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
| | - José Fernando Vilela-Martin
- Internal Medicine Department, State Medical School at Sao Jose Do Rio Preto (FAMERP), Sao Jose Do Rio Preto, Sao Paulo, Brazil
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Feitosa ADM, Mota-Gomes M, Passarelli Júnior O, Barroso WKS, Miranda RD, Barbosa ECD, Brandão AA, Nadruz W. Pharmacological Treatment of Hypertension: From the Golden Trio to the Octet. Arq Bras Cardiol 2020; 115:270-272. [PMID: 32876195 PMCID: PMC8384273 DOI: 10.36660/abc.20190780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/09/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Andrea A Brandão
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | - Wilson Nadruz
- Universidade Estadual de Campinas, Campinas, SP - Brasil
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Dantas RCDO, Roncalli AG. Reprodutibilidade do protocolo para usuários com hipertensão arterial assistidos na Atenção Básica à Saúde. CIENCIA & SAUDE COLETIVA 2020; 25:3037-3046. [DOI: 10.1590/1413-81232020258.17762018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 09/11/2018] [Indexed: 11/21/2022] Open
Abstract
Resumo Os protocolos têm sido adotados como estratégia para melhorar os índices de acompanhamento e controle da Hipertensão Arterial (HA). Objetivou-se verificar a reprodutibilidade de um protocolo para a consulta e o acompanhamento do usuário com HA atendido na Atenção Básica à Saúde (ABS). Tratou-se de estudo metodológico, realizado de janeiro a agosto de 2016, com 160 usuários com HA. A reprodutibilidade se deu nas dimensões indicadoras de saúde, psicossociais, sinais de alterações das cifras pressóricas, ocorrência de complicações e realizações de exames. O protocolo foi aplicado por enfermeiros em dois momentos distintos, com intervalo de acordo com o retorno do participante. A concordância foi avaliada pelos coeficientes Kappa (κ) e de Correlação Intraclasse (CCI), conforme o tipo de variável. O κ intraexaminadores variou de 0,673 a 0,984 e interexaminadores de 0,515 a 0,985. O CCI intraexaminadores pontuou de 0,785 a 0,998 e interexaminadores de 0,845 a 0,999. A média das medidas antropométricas e a das pressões apresentou diferença < 1 entre os examinadores nos tempos 1 e 2. O protocolo apresentou boa reprodutibilidade e alta confiabilidade, podendo ser replicado e utilizado na consulta de acompanhamento do usuário com HA assistido na ABS.
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Macedo C, Aras R, de Macedo IS. Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants. Arq Bras Cardiol 2020; 115:31-39. [PMID: 32236323 PMCID: PMC8384326 DOI: 10.36660/abc.20190218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/17/2019] [Accepted: 07/17/2019] [Indexed: 01/13/2023] Open
Abstract
Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol.2020; 115(1):31-39).
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Affiliation(s)
- Cristiano Macedo
- Hospital Universitário Professor Edgard SantosSalvadorBABrasilHospital Universitário Professor Edgard Santos – Cardiologia,Salvador- BA - Brasil
| | - Roque Aras
- Hospital Universitário Professor Edgard SantosSalvadorBABrasilHospital Universitário Professor Edgard Santos – Cardiologia,Salvador- BA - Brasil
| | - Isabella Sales de Macedo
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo - Faculdade de Medicina,São Paulo, SP – Brasil
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Yugar-Toledo JC, Moreno Júnior H, Gus M, Rosito GBA, Scala LCN, Muxfeldt ES, Alessi A, Brandão AA, Moreira Filho O, Feitosa ADDM, Passarelli Júnior O, Souza DDSMD, Amodeo C, Barroso WKS, Gomes MAM, Paiva AMGD, Barbosa ECD, Miranda RD, Vilela-Martin JF, Nadruz Júnior W, Rodrigues CIS, Drager LF, Bortolotto LA, Consolim-Colombo FM, Sousa MGD, Borelli FADO, Kaiser SE, Salles GF, Azevedo MDFD, Magalhães LBNC, Póvoa RMDS, Malachias MVB, Nogueira ADR, Jardim PCBV, Jardim TDSV. Brazilian Position Statement on Resistant Hypertension - 2020. Arq Bras Cardiol 2020; 114:576-596. [PMID: 32267335 PMCID: PMC7792719 DOI: 10.36660/abc.20200198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Heitor Moreno Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Miguel Gus
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | | | - Elizabeth Silaid Muxfeldt
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Celso Amodeo
- Instituto Dante Pazzanese de Cardiologia,São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Wilson Nadruz Júnior
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, SP - Brasil
| | - Cibele Isaac Saad Rodrigues
- Faculdade de Ciências Médicas e da Saúde Pontifícia Universidade Católica de são Paulo, São Paulo, SP - Brasil
| | - Luciano Ferreira Drager
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | - Luiz Aparecido Bortolotto
- Instituto do Coração do Hospital das Clínicas da Faculdade Medicina Universidade de São Paulo,São Paulo, SP - Brasil
| | | | | | | | | | - Gil Fernando Salles
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
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Dantas RCDO, Roncalli AG. Protocol for hypertensive individuals assisted in Basic Health Care. CIENCIA & SAUDE COLETIVA 2019; 24:295-306. [PMID: 30698262 DOI: 10.1590/1413-81232018241.35362016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/01/2017] [Indexed: 11/22/2022] Open
Abstract
Hypertension has low control rate in Brazil and around the World, resulting in social and medical costs; thus there is the need to apply control strategies. This study aimed to create and validate a protocol for consultation and monitoring of hypertensive patients attended in primary health care. It is constituted a methodological research which uses the Delphi method for content validation. The analysis of the protocol by experts was performed in three cycles, using a scale that was not important to extremely important, with a graduation from 1 to 5. The analysis was performed by the Likert scale, percentage of agreement, content validation index, Pearson correlation. The percentage of agreement was 96%. The CVI of 0.98. The Likert scale scored items, at least, as very important. The Pearson correlation was positive for all items ranging from moderate to strong. The protocol is composed of 53 items, divided into seven dimensions. It was concluded that the protocol enables more expressive and systematics monitoring of hypertensive patients and it identifies social and individual conditions that contribute to high blood pressure, so it may be used to guide the consultation, encouraging dialogue between the professional and patient and effective recording of care.
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Affiliation(s)
- Rosimery Cruz de Oliveira Dantas
- Unidade de Ciências da Vida, Centro de Formação de Professores, Universidade Federal de Campina Grande. R. Aprígio Veloso 882, Universitário. 58429-900 Campina Grande PB Brasil.
| | - Angelo Giuseppe Roncalli
- Departamento de Odontologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Natal RN Brasil
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Rodrigues CIS. Biomarker-based Inflammatory Score in Obese Patients with Resistant Hypertension. Arq Bras Cardiol 2019; 112:390-391. [PMID: 30994716 PMCID: PMC6459433 DOI: 10.5935/abc.20190051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Muxfeldt ES, Chedier B, Rodrigues CIS. Resistant and refractory hypertension: two sides of the same disease? ACTA ACUST UNITED AC 2018; 41:266-274. [PMID: 30525180 PMCID: PMC6699444 DOI: 10.1590/2175-8239-jbn-2018-0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/05/2018] [Indexed: 01/16/2023]
Abstract
Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension
(RH), being considered an uncontrolled blood pressure besides the use of 5 or
more antihypertensive medications, including a long-acting thiazide diuretic and
a mineralocorticoid antagonist. RH is common, with 10-20% of the general
hypertensives, and its associated with renin angiotensin aldosterone system
hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems
to be influenced by increased sympathetic activity. RH patients are older and
more obese than general hypertensives. It is strongly associated with diabetes,
obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in
women, younger patients and Afro-americans compared to RFs. Both are associated
with increased albuminuria, left ventricular hypertrophy, chronic kidney
diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat
effect seems to be higher among RH patients. Intensification of diuretic therapy
is indicated in RH, while in RfH, therapy failure imposes new treatment
alternatives such as the use of sympatholytic therapies. In conclusion, both RH
and RfH constitute challenges in clinical practice and should be addressed as
distinct clinical entities by trained professionals who are capable to identify
comorbidities and provide specific, diversified, and individualized
treatment.
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Affiliation(s)
- Elizabeth Silaid Muxfeldt
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil.,Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Bernardo Chedier
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brasil.,Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Departamento de Medicina, Sorocaba, SP, Brasil
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Resistant Hypertension On Treatment (ResHypOT): sequential nephron blockade compared to dual blockade of the renin-angiotensin-aldosterone system plus bisoprolol in the treatment of resistant arterial hypertension - study protocol for a randomized controlled trial. Trials 2018; 19:101. [PMID: 29433578 PMCID: PMC5810004 DOI: 10.1186/s13063-017-2343-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/21/2017] [Indexed: 01/19/2023] Open
Abstract
Background Resistant hypertension is characterized when the blood pressure (BP) remains above the recommended goal after taking three antihypertensive drugs with synergistic actions at their maximum recommended tolerated doses, preferably including a diuretic. Identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether acting on the control of intravascular volume or sodium balance, or acting on the effects of the renin-angiotensin-aldosterone system (RAAS) on the kidney. Methods/design This is a randomized, open-label, clinical trial is designed to compare sequential nephron blockade and its contribution to the intravascular volume component with dual blockade of the RAAS plus bisoprolol and the importance of serum renin in maintaining BP levels. The trial has two arms: sequential nephron blockade versus dual blockade of the RAAS (with an angiotensin converting enzyme (ACE) inhibitor plus a beta-blocker) both added-on to a thiazide diuretic, a calcium-channel blocker and an angiotensin receptor-1 blocker (ARB). Sequential nephron blockade consists in a progressive increase in sodium depletion using a thiazide diuretic, an aldosterone-receptor blocker, furosemide and, finally, amiloride. On the other hand, the dual blockade of the RAAS consists of the progressive addition of an ACE inhibitor until the maximum dose and then the administration of a beta-blocker until the maximum dose. The primary outcomes will be reductions in the systolic BP, diastolic BP, mean BP and pulse pressure (PP) after 20 weeks of treatment. The secondary outcomes will evaluate treatment safety and tolerability, biochemical changes, evaluation of renal function and recognition of hypotension (ambulatory BP monitoring (ABPM)). The sample size was calculated assuming an alpha error of 5% to reject the null hypothesis with a statistical power of 80% giving a total of 40 individuals per group. Discussion In recent years, the cost of resistant hypertension (RH) treatment has increased. Thus, identifying the contribution of intravascular volume and serum renin in maintaining BP levels could help tailor more effective hypertension treatment, whether by acting on the control of intravascular volume or sodium balance, or by acting on the effects of the RAAS on the kidney. Trial registration Sequential Nephron Blockade vs. Dual Blockade Renin-angiotensin System + Bisoprolol in Resistant Arterial Hypertension (ResHypOT). ClinicalTrials.gov, ID: NCT02832973. Registered on 14 July 2016. First received: 12 June 2016. Last updated: 18 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2343-3) contains supplementary material, which is available to authorized users.
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Jesus NSD, Nogueira ADR, Pachu CO, Luiz RR, Oliveira GMMD. Blood Pressure Treatment Adherence and Control after Participation in the ReHOT. Arq Bras Cardiol 2017; 107:437-445. [PMID: 27982269 PMCID: PMC5137388 DOI: 10.5935/abc.20160165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 06/02/2016] [Indexed: 01/13/2023] Open
Abstract
Background Lack of adherence to pharmacological treatment is one of the main causes of
low control rates in hypertension. Objective To verify treatment adherence and associated factors, as well as blood
pressure (BP) control in participants of the Resistant Hypertension Optimal
Treatment (ReHOT) clinical trial. Method Cross-sectional study including all 109 patients who had completed the ReHOT
for at least 6 months. We excluded those participants who failed to respond
to the new recruitment after three phone contact attempts. We evaluated the
BP control by ambulatory BP monitoring (ABPM; controlled levels: 24-hour
systolic and diastolic BP < 130 x 80 mmHg) and analyzed the patients'
treatment adherence using the Morisky Medication Adherence Scale (MMAS)
questionnaire validated by Bloch, Melo, and Nogueira (2008). The statistical
analysis was performed with the software IBM SPSS statistics 21.0. We tested
the normality of the data distribution with kurtosis and skewness. The
variables tested in the study are presented with descriptive statistics.
Comparisons between treatment adherence and other variables were performed
with Student's t test for independent variables and Pearson's chi-square or
Fisher's exact test. To conduct analyses among patients considering
adherence to treatment and BP control, we created four groups: G0, G1, G2,
and G3. We considered a 5% significance level in all tests. Results During the ReHOT, 80% of the patients had good BP control and treatment
adherence. Of 96 patients reevaluated in the present study, only 52.1% had
controlled hypertension when assessed by ABPM, while 31.3% were considered
adherent by the MMAS. Regarding other ABPM measures, we observed an absence
of a nocturnal dip in 64.6% of the patients and a white-coat effect and
false BP control in 23% and 12.5%, respectively. Patients' education level
showed a trend towards being a determinant factor associated with lack of
adherence (p = 0.05). Resistant hypertension and number of medications were
significantly associated with BP control assessed by ABPM (p = 0.009 and p =
0.001, respectively). Resistant hypertension was also significantly
associated with group G0 (patients with no control or adherence, p =
0.012). Conclusion There was a decrease in BP control and adherence measured by the MMAS after
participation of at least 6 months in the ReHOT clinical trial.
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Affiliation(s)
- Nathália Silva de Jesus
- Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio de Janeiro, RJ - Brazil
| | | | - Cacilda Oliveira Pachu
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, RJ - Brazil
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13
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Prognostic Importance of Ambulatory Blood Pressure Monitoring in Resistant Hypertension: Is It All that Matters? Curr Hypertens Rep 2016; 18:85. [DOI: 10.1007/s11906-016-0693-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Malachias MVB, Rodrigues CIS, Muxfeldt E, Salles GF, Moreno H, Gus M. 7th Brazilian Guideline of Arterial Hypertension: Chapter 13 - Resistant Arterial Hypertension. Arq Bras Cardiol 2016; 107:75-78. [PMID: 27819392 PMCID: PMC5319459 DOI: 10.5935/abc.20160163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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15
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Vilela-Martin JF, Giollo-Junior LT, Chiappa GR, Cipriano-Junior G, Vieira PJC, dos Santos Ricardi F, Paz-Landim MI, de Andrade DO, Cestário EDES, Cosenso-Martin LN, Yugar-Toledo JC, Cipullo JP. Effects of transcutaneous electrical nerve stimulation (TENS) on arterial stiffness and blood pressure in resistant hypertensive individuals: study protocol for a randomized controlled trial. Trials 2016; 17:168. [PMID: 27026087 PMCID: PMC4812656 DOI: 10.1186/s13063-016-1302-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 03/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resistant hypertension (RH) treatment requires an adequate and intense therapeutic approach. However, the results are not always satisfactory despite intensive treatment. Of the different pathophysiological mechanisms involved in the pathogenesis of RH, sympathetic overstimulation and therapies that block the sympathetic system have been widely studied. These approaches, however, are invasive and expensive. Another possible approach is by transcutaneous electrical nerve stimulation (TENS), a noninvasive method that modulates activity by using low-frequency transcutaneous electrical stimulation to inhibit primary afferent pathways. Thus, the current study will evaluate the effect of applying TENS in the cervicothoracic region of subjects with RH and will seek to develop a new low-cost and readily available therapy to treat this group of hypertensive individuals. METHODS/DESIGN This is a randomized, single blind (subject), parallel-assignment study controlled with a sham group and including participants aged 40 to 70 years with resistant hypertension. The trial has two arms: the treatment and control (sham group). The treatment group will be submitted to the stimulation procedure (TENS). The sham group will not be submitted to stimulation. The primary outcomes will be a reduction in the peripheral blood pressure and adverse events. The secondary outcomes will be a reduction the central blood pressure. The study will last 30 days. The sample size was calculated assuming an alpha error of 5 % to reject the null hypothesis with a statistical power of 80 %, thereby resulting in 28 participants per group (intervention versus sham). DISCUSSION In recent decades, RH has become very common and costly. Adequate control requires several drugs, and in many cases, treatment is not successful. Sympathetic nervous system inhibition by renal denervation and central inhibition have significant effects in reducing BP; however, these treatments are costly and invasive. Another type of sympathetic nervous system inhibition can also be noninvasively achieved by electric current. Therefore, the application of TENS may be a new therapeutic option for treating resistant hypertensive individuals. TRIAL REGISTRATION Clinical Trials NCT02365974.
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Affiliation(s)
- José Fernando Vilela-Martin
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - Luiz Tadeu Giollo-Junior
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - Gaspar Rogério Chiappa
- />Cardiology Division, Federal University of Rio Grande do Sul (UFRS), Porto Alegre, Brazil
| | | | | | - Fábio dos Santos Ricardi
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - Manoel Ildefonso Paz-Landim
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - Days Oliveira de Andrade
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - Elizabeth do Espírito Santo Cestário
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - Luciana Neves Cosenso-Martin
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - Juan Carlos Yugar-Toledo
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
| | - José Paulo Cipullo
- />Internal Medicine Department and Hospital de Base, Hypertension Clinic, Medical School in São José do Rio Preto (FAMERP), Av Anísio Haddad 7700 casa 129, Jd das Palmeiras, 15093-000 São José do Rio Preto, SP Brazil
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16
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Jardim PCBV. Regarding hypertension treatment are we following worldwide tendencies? Arq Bras Cardiol 2014; 103:1-3. [PMID: 25120080 PMCID: PMC4126754 DOI: 10.5935/abc.20140111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paulo César B. Veiga Jardim
- Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da
Universidade Federal de Goiás, Goiania, Goiás - Brazil
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17
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Póvoa R, Barroso WS, Brandão AA, Jardim PCV, Barroso O, Passarelli O, Gemelli JR, Feitosa A, Jardim TV, Carneiro SB, Amodeo C, Moreira O, Nogueira ADR, de Morais NS, Scala LCN, Gonzaga C, de Souza DDSM, de Paiva AMG, Malachias MVB, Mion D, Mota-Gomes MA, Barbosa ECD, de Sousa MG, Bianco HT, Fonseca FAH, Kalil M, Miranda RD, Uehara CA, Sanjuliani AF. I brazilian position paper on antihypertensive drug combination. Arq Bras Cardiol 2014; 102:203-10. [PMID: 24714792 PMCID: PMC3987325 DOI: 10.5935/abc.20140023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 01/13/2023] Open
Affiliation(s)
- Rui Póvoa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - Oswaldo Barroso
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | - Audes Feitosa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | - Celso Amodeo
- Brazilian Society of Cardiology Arterial Hypertension Department
| | - Osni Moreira
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - Carolina Gonzaga
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - Décio Mion
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | | | | | - Marcio Kalil
- Brazilian Society of Cardiology Arterial Hypertension Department
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18
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Santos RC, de Faria APC, Barbaro NR, Modolo R, Ferreira-Melo SE, Matos-Souza JR, Coelho OR, Yugar-Toledo JC, Fontana V, Calhoun D, Moreno H. Tadalafil-induced improvement in left ventricular diastolic function in resistant hypertension. Eur J Clin Pharmacol 2013; 70:147-54. [PMID: 24271647 DOI: 10.1007/s00228-013-1611-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/05/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Left ventricular hypertrophy and diastolic dysfunction (LVDD) remain highly frequent markers of cardiac damage and risk of progression to symptomatic heart failure, especially in resistant hypertension (RHTN). We have previously demonstrated that administration of sildenafil in hypertensive rats improves LVDD, restoring phosphodiesterase type 5 (PDE-5) inhibition in cardiac myocytes. METHODS We hypothesized that the long-acting PDE-5 inhibitor tadalafil may be clinically useful in improving LVDD in RHTN independently of blood pressure (BP) reduction. A single blinded, placebo-controlled, crossover study enrolled 19 patients with both RHTN and LVDD. Firstly, subjects received tadalafil (20 mg) for 14 days and after a 2-week washout period, they received placebo orally for 14 days. Patients were evaluated by office BP and ambulatory BP monitoring (ABPM), endothelial function (FMD), echocardiography, plasma brain natriuretic peptide (BNP-32), cyclic guanosine monophosphate (cGMP) and nitrite levels. RESULTS No significant differences were detected in BP measurements. Remarkably, at least four echocardiographic parameters related with diastolic function improved accompanied by decrease in BNP-32 in tadalafil use. Although increasing cGMP, tadalafil did not change endothelial function or nitrites. There were no changes in those parameters after placebo. CONCLUSION The current findings suggest that tadalafil improves LV relaxation through direct effects PDE-5-mediated in the cardiomyocytes with potential benefit as an adjunct to treat symptomatic subjects with LVDD such as RHTN patients.
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Affiliation(s)
- Rodrigo C Santos
- Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Bortolotto LA, Midlej-Brito T, Pisani C, Costa-Hong V, Scanavacca M. Renal denervation by ablation with innovative technique in resistant hypertension. Arq Bras Cardiol 2013; 101:e77-9. [PMID: 24217435 PMCID: PMC4062378 DOI: 10.5935/abc.20130194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Thiago Midlej-Brito
- Mailing Address: Thiago Midlej-Brito, Rua Dr. Enéas de Carvalho
Aguiar, 44, Cerqueira César. Postal Code 05403-000, São Paulo - SP - Brazil.
E-mail: ,
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