Non-adherence to antihypertensive treatment is frequent, complicates the care of hypertensive patients, represents one of the major causes of treatment failure and is linked with the increased risk of cardiovascular events. Identifying a non-adherent patient is one of the recent daily-practice tasks for which the ideal solution has not yet been found. Presence of certain clinical red flags should prompt the clinician to consider non-adherence. Chemical adherence testing using serum or urine antihypertensive levels is regarded as the best method so far and should be used if available. Alternatively, the check for prescription refills in the patient electronic medical records, or directly observed therapy with subsequent ambulatory blood pressure monitoring may be used. We suggest a simple algorithm to guide the clinicians to detect non-adherence in the practice.
BACKGROUND: Increased glucose uptake and utilization via aerobic glycolysis are among the most prominent hallmarks of tumor cell metabolism. Accumulating evidence suggests that similar metabolic changes are also triggered in many virus-infected cells. Viral propagation, like highly proliferative tumor cells, increases the demand for energy and macromolecular synthesis, leading to high bioenergetic and biosynthetic requirements. Although significant progress has been made in understanding the metabolic changes induced by viruses, the interaction between host cell metabolism and arenavirus infection remains unclear. Our study sheds light on these processes during lymphocytic choriomeningitis virus (LCMV) infection, a model representative of the Arenaviridae family. METHODS: The impact of LCMV on glucose metabolism in MRC-5 cells was studied using reverse transcription-quantitative PCR and biochemical assays. A focus-forming assay and western blot analysis were used to determine the effects of glucose deficiency and glycolysis inhibition on the production of infectious LCMV particles. RESULTS: Despite changes in the expression of glucose transporters and glycolytic enzymes, LCMV infection did not result in increased glucose uptake or lactate excretion. Accordingly, depriving LCMV-infected cells of extracellular glucose or inhibiting lactate production had no impact on viral propagation. However, treatment with the commonly used glycolytic inhibitor 2-deoxy-D-glucose (2-DG) profoundly reduced the production of infectious LCMV particles. This effect of 2-DG was further shown to be the result of suppressed N-linked glycosylation of the viral glycoprotein. CONCLUSIONS: Although our results showed that the LCMV life cycle is not dependent on glucose supply or utilization, they did confirm the importance of N-glycosylation of LCMV GP-C. 2-DG potently reduces LCMV propagation not by disrupting glycolytic flux but by inhibiting N-linked protein glycosylation. These findings highlight the potential for developing new, targeted antiviral therapies that could be relevant to a wider range of arenaviruses.
- Klíčová slova
- Triplixam, poškození cílových orgánů způsobené hypertenzí (HMOD),
- MeSH
- antihypertenziva terapeutické užití MeSH
- echokardiografie MeSH
- hypertenze * farmakoterapie komplikace prevence a kontrola MeSH
- ischemická cévní mozková příhoda diagnóza MeSH
- komorbidita MeSH
- krevní tlak účinky záření MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Sudden cardiac death (SCD) is a major medical, economic and social problem. The estimated annual number of SCDs is approximately 4 million cases worldwide. Approximately 50% of SCDs are unexpected first manifestations of cardiac disease. The survival rate after out-of-hospital cardiac arrest is low even in countries with the most advanced health care systems. It all emphasizes the importance of prevention, in which implantable cardioverter-defibrillators play a dominant role. However, our ability to recognize high-risk patients remains insufficient. Moreover, a declining rate of shockable rhythm as the initial recording has been reported in the last decades. Despite numerous SCD studies and undisputed progress, there are still many unanswered questions.
Těžiště posledních evropských doporučení spočívá v časném zahájení antihypertenzní léčby u rizikových skupin, rychlém dosažení cílového krevního tlaku za pomoci použití fixních kombinací antihypertenziv a maximálním ovlivnění kardiovaskulárního rizika jednotlivce. Časný zásah do rozvoje hypertenzí mediovaného orgánového poškození (hypertenison mediated organ damage = HMOD) má prokazatelně vliv na následné snížení rizika kardiovaskulárních příhod. Okamžik vzniku HMOD koreluje s výší a délkou trvání elevace krevního tlaku, přičemž neexistuje jasně definovatelná hrani- ce, od které se poškození cév začíná rozvíjet. Snížení krevního tlaku farmakoterapií prokazatelně snižuje riziko ischemické choroby srdeční, cévní mozkové příhody a také mortalitu (1). Velké klinické studie shodně prokázaly významné snížení rizika těchto komplikací vlivem antihypertenzní medikace, a to v celém spektru od lehké po těžkou hypertenzi, včetně hypertenze starších osob i izolované systolické hypertenze (2). Na základě nejnovějších poznatků snížení krevního tlaku už o 5 mm Hg působí kardioprotektivně i u normotenzních jedinců, což zcela zásadně mění pohled na diagnózu a definici hypertenze jako onemocnění (3).
The focus of recent European guidelines has been early initiation of antihypertensive therapy in risk groups, rapid achievement of target blood pressure with fixed combinations of antihypertensive drugs, and the best possible management of an individual's cardiovascular risk. Early intervention in the development of hypertension-mediated organ damage (HMOD) has been shown to have an effect on the subsequent reduction in the risk of cardiovascular events. The point of HMOD origination correlates with the magnitude and duration of blood pressure elevation, and there is no clearly defined boundary from which vascular damage begins to develop. A reduction in blood pressure with pharmacotherapy demonstrably decreases the risk of ischaemic heart disease, stroke, as well as the mortality rate (1). Large clinical trials have consistently shown a significant reduction in the risk of these complications with antihypertensive medications across the entire spectrum from mild to severe hypertension, including hypertension in the elderly as well as isolated systolic hypertension (2). Based on the latest knowledge, a reduction in blood pressure by a mere 5 mm Hg has a cardioprotective effect even in normotensive individuals, which fundamentally changes the view on the diagnosis and definition of hypertension as a disease (3).
- Klíčová slova
- orgánové poškození,
- MeSH
- albuminurie MeSH
- hypertenze * komplikace terapie MeSH
- hypertrofie levé komory srdeční MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
První fixní kombinace AT1 blokátoru a diuretika podobného thiazidu nabízí 80 mg telmisartanu a 2,5 mg indapamidu v jedné tabletě. Lék je ve shodě s intenzifikačním algoritmem doporučeným českou, evropskou i mezinárodní společností pro hypertenzi. Silnými stránkami kombinace jsou výborná snášenlivost, 24hodinová účinnost včetně posledních šesti hodin dávkovacího schématu, ochrana před kardiovaskulárními komplikacemi, příznivý metabolický profil a renoprotektivita.
The first fixed combination of an AT1 blocker and a thiazide-like diuretic offers 80 mg of telmisartan and 2.5 mg of indapamide in one pill. The medicine is in agreement with the intensification algorithm recommended by the Czech, European and International Society for Hypertension. The strong points of this combination are excellent tolerance, 24-hour efficacy including the last 6 hours of the dosing schema, protection against cardiovascular complications, beneficial metabolic profile and renoprotectivity.
- MeSH
- analýza dat MeSH
- hypertenze * diagnóza prevence a kontrola terapie MeSH
- lidé MeSH
- měření krevního tlaku metody MeSH
- samotestování MeSH
- telemedicína * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: To evaluate laboratory and clinical results after unilateral adrenalectomy in patients with primary aldosteronism (PHA). METHODS: A cross-sectional analysis was performed using data from patients who underwent transperitoneal laparoscopic adrenalectomy for PHA, between January 2008 and December 2019. Surgical indications were based on adrenal venous sampling without ACTH stimulation. Analyses included patient demographics; preoperative clinical, pharmacological, laboratory, and radiological data; and postoperative results assessed after a median of 4 months. Antihypertensive drug use was quantified by estimating the daily defined dose (DDD) of antihypertensive medication, thus enabling standardized comparison of dosage between the drug classes. Statistical assessments included univariable and multivariable logistic regression analysis. RESULTS: This study enrolled 87 patients. The patients were taking 5.4 DDD of antihypertensive medication before surgery, and 3.0 DDD after surgery. Complete biochemical success of surgery was reached 67 patients (77%), 19 patients (22%) had partial biochemical success. Complete clinical success with normalization of blood pressure and withdrawal of all antihypertensive drugs was achieved in 19 patients (22%). 57 patients (65%) exhibited a reduction of DDD after surgery and/or improvement of blood pressure-partial clinical success. Thus, in 76 (87%) of all enrolled patients, surgery had an overall positive effect on hypertension control. Multivariable logistic regression showed that complete clinical success was independently associated with female gender and baseline sum of antihypertensive drugs DDD < 4. CONCLUSION: A majority of patients undergoing unilateral adrenalectomy for PHA achieved markedly improved hypertension control, despite almost halving their antihypertensive medication. Almost a quarter of patients were cured and able to cease using all antihypertensive drugs.
- MeSH
- adrenalektomie MeSH
- antihypertenziva terapeutické užití MeSH
- hyperaldosteronismus * komplikace farmakoterapie chirurgie MeSH
- hypertenze * farmakoterapie etiologie chirurgie MeSH
- lidé MeSH
- průřezové studie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
