摘要:

ObjectiveSmoking is a well recognised cardiovascular risk factor in hypertensive subjects, being associated with an increase in sympathetic activation, impaired endothelial function and, ultimately, an excess of morbidity and mortality. The antihypertensive class of choice in hypertensive smokers has not been clearly established.Design and study participantsAfter a cross-sectional pilot study conducted in more than 3000 hypertensive patients (37.5% of whom were smokers), we conducted a 6-month prospective study in 4219 hypertensive smokers. The aim of the study was to explore the association between antihypertensive treatment (with a focus on β-blockers), blood pressure (BP) control and overall cardiovascular risk reduction in such patients.ResultsChronic treatment with a β-blocker-containing compared with a non-β-blocker-containing antihypertensive regimen was associated with significantly better BP control both at baseline and after a 6-month follow-up period. This resulted in a lower 10-year projected cardiovascular risk, a lower incidence of cardiovascular events and reduced hospitalisation rates compared with patients receiving a non-β-blocker-containing regimen.ConclusionsMore prospective, randomised, controlled studies are needed to further test the hypothesis that β-blockers are the treatment of choice for hypertensive smokers.

ISSN:1120-9879    

出版商:ADIS    

年代:2004

数据来源: ADIS

摘要:

ObjectiveSeveral studies have shown that mental stress may favour the development of hypertension and coronary artery disease, particularly in men. Among the factors causing mental stress, we focused on job-related anxiety (JRA). The aim of this study was to evaluate the association of individual perception of JRA with the prevalence of atherosclerosis.Participants and methodsAmong all the patients referred in 2001 to the outpatient hypertension clinic of our university for a cardiological check-up, 154 patients were found with JRA, whom we frequency matched for age with 155 patients who denied having JRA. JRA was assessed by asking participants whether they would consider their job stressful. Left ventricular (LV) hypertrophy and carotid artery intima-media thickness (IMT) were evaluated with a high-resolution echo-Doppler technique. IMT >1mm and ≤1.3mm was defined as wall thickening, whereas IMT >1.3mm was defined as discrete plaque. Blood pressure was measured at the end of echocardiographic evaluation.ResultsThe prevalence of atherosclerosis was higher in patients with JRA (p < 0.0001). The association between higher values of IMT and JRA remains statistically significant after adjustment for covariates (p = 0.0003). However, LV mass index, relative wall thickness and endocardial shortening were similar in the two groups. Patients with JRA exhibited lower values of systolic, diastolic, pulse pressure, and heart rate.ConclusionThe presence of JRA is associated with high values of IMT independently from the blood pressure values and LV geometry.

ISSN:1120-9879    

出版商:ADIS    

年代:2004

数据来源: ADIS

摘要:

Hypertension is a common disorder of multifactorial origin that constitutes a major risk factor for cardiovascular events such as stroke and myocardial infarction. The subunits of the heterotrimeric G proteins are attractive candidate gene products for both susceptibility to essential hypertension and interindividual variations in blood pressure. A polymorphism (825C/T) in exon 10 of the GNB3 gene, encoding for the Gβ3subunit, has recently been described. The 825T allele is associated with alternative splicing of the gene and formation of a truncated but functionally active β3subunit. Carriers of the 825T allele appear to be at an increased risk of hypertension, obesity, insulin resistance and left ventricular hypertrophy. Moreover, 825T allele carriers respond with a larger decrease in blood pressure to therapy with a thiazide diuretic and with clonidine. The GNB3 825T allele may be regarded as a potential genetic marker for better defining the risk profile of hypertensive patients, but further studies are needed to precisely define the impact of the T allele on the prognosis of hypertensive patients.

ISSN:1120-9879    

出版商:ADIS    

年代:2004

数据来源: ADIS

ISSN:1120-9879    

出版商:ADIS    

年代:2004

数据来源: ADIS

摘要:

The classification of drugs can predict, as in the case of angiotensin II type 1 (AT1) receptor antagonists (sartans), substantially the same chemical structure, pharmacological profile, therapeutic activity and adverse effects for each member of the same drug class. The selective reduction in blood pressure is indeed a class effect that has led to the definition of sartans as antihypertensive drugs. It must be remembered that a therapeutic classification based on a surrogate endpoint relative to a specific pharmacological action (i.e. blood pressure reduction) allows rapid assessment of a specific pharmacological effect, but does not provide information on long-term efficacy and safety. It is now clear that classifying sartans as blood pressure-lowering agents is no longer sufficient to describe their true therapeutic activity. Pharmacological studies first suggested and clinical evidence (e.g. the LIFE [Losartan Intervention For Endpoint reduction in hypertension] study) later showed that antiatherosclerotic properties may contribute to their clinical benefits. In assessing sartans from this point of view, one must question whether or not all the effects of these drugs are class effects and, consequently, whether the clinical benefits of all the sartans are completely superimposable. It is not assumed that individual drugs from the same class, even if they are similar in chemical structure and pharmacodynamic profile, will necessarily have the same long-term efficacy and safety to allow each one to be automatically substituted for another. This article summarises the key pharmacokinetic and pharmacodynamic characteristics of the principal AT1 receptors antagonists.

ISSN:1120-9879    

出版商:ADIS    

年代:2004

数据来源: ADIS

ISSN:1120-9879    

出版商:ADIS    

年代:2004

数据来源: ADIS

ISSN:1120-9879    

出版商:ADIS    

年代:2004

数据来源: ADIS