V článku je podán přehled poznatků o užití ARB v léčbě chronického srdečního selhání a stavů po infarktu myokardu. Jsou srovnány účinky ARB s ACE-I u nemocných s postiženou funkcí levé komory a doporučena stratetige podávání ARB u nemocných s chronickým srdečním selháním.
A review of current knowledge and use of ARB in heart failure and post myocardial infarction management is presented. The efficacy of ARB is compared with ACE-I in patients with left ventricle dysfunction and strategy how to use ARB in patients with chronic heart failure is being proposed.
Studie SCOPE sledovala účinek kandesartanu v léčbě hypertenze u starších nemocných s cílem určit změnu kognitivních funkcí.
SCOPE study follows and action of candesartan in the treatment of hypertension in older patients and a goal is to assess any change in cognitive functions.
- MeSH
- angiotensiny antagonisté a inhibitory MeSH
- antihypertenziva farmakologie škodlivé účinky terapeutické užití MeSH
- dospělí MeSH
- hypertenze farmakoterapie MeSH
- kognitivní poruchy MeSH
- lidé MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinické zkoušky MeSH
Studie SCOPE sledovala účinek kandesartanu v léčbě hypertenze u starších nemocných s cílem určit změnu kognitivních funkcí.
- Klíčová slova
- ARB, kognitivní funkce,
- MeSH
- angiotensiny antagonisté a inhibitory MeSH
- antihypertenziva * farmakologie škodlivé účinky terapeutické užití MeSH
- dospělí MeSH
- hypertenze farmakoterapie MeSH
- kognitivní poruchy MeSH
- lidé MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinické zkoušky MeSH
Diastolic dysfunction might represent an important pathophysiological intermediate between hypertension and heart failure. Our aim was to determine whether inhibitors of the renin-angiotensin-aldosterone system, which can reduce ventricular hypertrophy and myocardial fibrosis, can improve diastolic function to a greater extent than can other antihypertensive agents. METHODS: Patients with hypertension and evidence of diastolic dysfunction were randomly assigned to receive either the angiotensin receptor blocker valsartan (titrated to 320 mg once daily) or matched placebo. Patients in both groups also received concomitant antihypertensive agents that did not inhibit the renin-angiotensin system to reach targets of under 135 mm Hg systolic blood pressure and under 80 mm Hg diastolic blood pressure. The primary endpoint was change in diastolic relaxation velocity between baseline and 38 weeks as determined by tissue doppler imaging. Analyses were done by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00170924. FINDINGS: 186 patients were randomly assigned to receive valsartan; 198 were randomly assigned to receive placebo. 43 patients were lost to follow-up or discontinued the assigned intervention. Over 38 weeks, there was a 12.8 (SD 17.2)/7.1 (9.9) mm Hg reduction in blood pressure in the valsartan group and a 9.7 (17.0)/5.5 (10.2) mm Hg reduction in the placebo group. The difference in blood pressure reduction between the two groups was not significant. Diastolic relaxation velocity increased by 0.60 (SD 1.4) cm/s from baseline in the valsartan group (p<0.0001) and 0.44 (1.4) cm/s from baseline in the placebo group (p<0.0001) by week 38. However, there was no significant difference in the change in diastolic relaxation velocity between the groups (p=0.29). INTERPRETATION: Lowering blood pressure improves diastolic function irrespective of the type of antihypertensive agent used.
- MeSH
- antihypertenziva farmakologie škodlivé účinky terapeutické užití MeSH
- blokátory receptorů AT1 pro angiotensin II farmakologie škodlivé účinky terapeutické užití MeSH
- dvojitá slepá metoda MeSH
- echokardiografie MeSH
- hypertenze farmakoterapie komplikace MeSH
- hypertrofie levé komory srdeční etiologie prevence a kontrola MeSH
- krevní tlak účinky záření MeSH
- lidé středního věku MeSH
- lidé MeSH
- renin-angiotensin systém účinky léků MeSH
- senioři MeSH
- srdeční frekvence účinky léků MeSH
- tepový objem účinky léků MeSH
- tetrazoly farmakologie škodlivé účinky terapeutické užití MeSH
- valin analogy a deriváty farmakologie terapeutické užití účinky léků MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
INTRODUCTION: Hypertension is an important factor driving mortality among dialysis patients. Angiotensin-II receptor blocker (ARB) has been effective similarly to angiotensin-converting enzymes (ACEs) but with a low incidence of side effects. METHODOLOGY: The meta-analysis included all published studies that investigated the effect of ARB on the hypertension in adult dialysis patients (≥18 years). Data extraction was guided by a predetermined checklist. Data sources of the retrieved studies were PubMed, MEDLINE, ScienceDirect, SCOPUS, Cochrane, Web of knowledge, and Google Scholar were systematically searched until February 2023. Using the RevMan 5 software, the mean difference for systolic and diastolic BP (SBP and DBP) and the risk ratio (RR) of the adverse events (AEs) were pooled from the selected studies. The random-effects model was used to compare the difference in the pre-and post-dialysis of the SBP and DBP. Data analyses were performed from December 2022 to February 2023. The primary outcome was the reduction in SBP and DBP in dialysis hypertensive patients who were on anti-hypertensive agents, and the secondary outcome was assessment of AE associated with the drug after dialysis (PROSPERO Registration: CRD42022355369). RESULTS: The initial search yielded 1,679 records, of which 84 studies underwent full-text evaluation, which identified 13 studies and 1,462 patients. The pooled standard MD for losartan with other anti-hypertensive agents, where the pre-dialysis SBP was 0.17 (95% confidence interval [CI]: -0.21-0.55) and the post-dialysis was 0.35 (95% CI: -0.17-1.02); yet, both are statistically non-significant, implies that there was no difference between Losartan and ARB drugs regarding the effect on the SBP. Diastolic BP for predialysis was -0.01 (95% CI: -0.65-0.63) and post-dialysis was 0.03 (95% CI: -0.24-0.30) and statistically non-significant. AEs by the ARB agents were lower compared to other anti-antihypertensive agents (relative risk [RR]: 1.01; 95% CI: 0.59-1.75) and statistically non-significant. CONCLUSION: This systematic review and meta-analysis of RCT demonstrated that ARB and other anti-hypertensive medications had similar impacts on the treatment of hypertension.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
