Arterial hypertension is a worldwide serious clinical problem. It affects 30- 40% of the adult population. Resistant hypertension is defined as systolic blood pressure that remains 140mmHg while in the doctors surgery and/ or as average systolic blood pressure during a 24- hour monitoring of an outpatient 130mmHg after a combination of three antihypertensive agents (including a diuretic) has been administered in the maximum tolerated dose amounts. Renal denervation is an invasive method of catheter radio frequency ablation of sympathetic nerves located in the walls of renal arteries. The results of the Symplicity HTN 1 and HTN 2 trials proved that renal denervation can safely decrease blood pressure in patients with resistant hypertension. Further research is necessary in order to verify these data, to clarify the questions which remained unanswered and to evaluate future applications of renal denervation. Current experience and recommendations are included, as well as an overview of existing denervation devices and devices which are in development.
- MeSH
- ambulantní monitorování krevního tlaku MeSH
- arteria renalis inervace patofyziologie MeSH
- denervace MeSH
- dospělí MeSH
- hypertenze patofyziologie chirurgie MeSH
- krevní tlak MeSH
- lidé MeSH
- předpověď MeSH
- sympatektomie přístrojové vybavení metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Cardiorenal (CR) syndrome is defined for the purposes of the following text mainly as primary cardiac dysfunction with a consequent failure of renal haemodynamics. Heart failure leads to a decrease in cardiac output and to the activation of vasoconstrictors; this gradually precipitates a decrease in the level of renal perfusion, the vasoconstriction of renal vessels and a decrease in glomerular filtration with a gradual development of renal failure. The following paper analyses the pathophysiological mechanisms, the characteristics of the patients, the role of medication during CR syndrome, the relationship between proteinuria and anaemia during CR syndrome and the application of bio-markers and pulmonary hypertension in the prognosis of patients with CR syndrome.
- MeSH
- anemie komplikace MeSH
- biologické markery MeSH
- hemodynamika MeSH
- kardiorenální syndrom komplikace farmakoterapie patofyziologie MeSH
- ledviny patofyziologie MeSH
- lidé MeSH
- minutový srdeční výdej fyziologie MeSH
- plicní hypertenze farmakoterapie etiologie patofyziologie MeSH
- prognóza MeSH
- proteinurie komplikace MeSH
- vazokonstrikce fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- biologické markery MeSH
Diuretics belong to the basic group of medicines for the treatment of hypertension and heart failure. In the case of hypertension treatment, their main indication is higher age and isolated systolic hypertension. In the case of heart failure they are used for the treatment of swellings and shortness of breath. The most frequently prescribed group of diuretics is thiazides and similar products. In patients with renal insufficiency, loop diuretics are administered. In the case of hypertension, diuretics are mainly used in the combination treatment. The most frequently used diuretic in combination is again hydrochlorothiazide, which is combined with reninangiotensin system blockers. It is mainly the combination of an ACE inhibitor + indapamide that seems to be modern and promising, and it is, on the basis of large clinical trials, recommended also for diabetics (ADVANCE) or for secondary prevention following a cerebrovascular accident (PROGRESS) or for the elderly (HYVET). Also a combination of two diuretics is popular - mainly hydrochlorothiazide + amiloride. A combination of a betablocker and diuretic is less suitable.
- MeSH
- antihypertenziva aplikace a dávkování MeSH
- diuretika aplikace a dávkování MeSH
- hypertenze farmakoterapie MeSH
- klinické zkoušky jako téma MeSH
- kombinovaná farmakoterapie metody MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antihypertenziva MeSH
- diuretika MeSH
The article gives an overview of the risk factors for hypertension and the appropriate indication for using a fixed combination of telmisartan and hydrochlorothiazide. It cites large, multicentre clinical trials that demonstrate the efficacy and safety of telmisartan in patients with hypertension and also a metaanalysis of treatment with either telmisartan alone (TELMI) or in combination with hydrochlorothiazide (HCTZ) which shows that it is a very well tolerated and safe treatment for patients across a wide age range.
- MeSH
- antihypertenziva aplikace a dávkování MeSH
- benzimidazoly aplikace a dávkování MeSH
- benzoáty aplikace a dávkování MeSH
- diuretika aplikace a dávkování MeSH
- hydrochlorthiazid aplikace a dávkování MeSH
- hypertenze farmakoterapie MeSH
- inhibitory ACE aplikace a dávkování MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- telmisartan MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antihypertenziva MeSH
- benzimidazoly MeSH
- benzoáty MeSH
- diuretika MeSH
- hydrochlorthiazid MeSH
- inhibitory ACE MeSH
- telmisartan MeSH
All antagonists (sartans) are considered to be a group of pharmaceuticals with comparable indications and comparable effects as ACE inhibitors, while almost lacking the side effect ofa dry cough. Large clinical trials showed that All antagonists had a comparable (statistically insignificantly smaller) effect on so called "hard targets", i.e. mortality and morbidity, in patients with ischemic heart diseases and/or heart failure. The study of their effect in the treatment of hypertension was first limited to diabetics and patients with microalbuminuria and showed that they had a significant renoprotective effect in said cases. Large clinical trials followed, focusing on hypertension in primary as well as secondary prevention of cardiovascular diseases. Five large clinical trials focusing on All antagonists addressed cerebrovascular accidents and cognitive functions: LIFE, SCOPE, OSCAR, MOSES and POWER. The LIFE study (Losartan Intervention For Endpoint) confirmed that in 9,193 patients with proven left ventricular hypertrophy, losartan led to a lower incidence of cerebrovascular accidents or new development of diabetes mellitus than atenolol, which in turn led to statistically significant lower primary endpoint (fatality, myocardial infarction and cerebrovascular accident) (p = 0.021), while blood pressure dropped at the same rate. The SCOPE study (Study on COgnition and Prognosis in Elderly hypertensives) compared candesartan with another antihypertensive treatment in 4,937 hypertonic patients older than 70. The primary endpoint was a decrease in massive cardiovascular accidents (fatality, MI, CVA). The decrease rate reached 10.9%, which was not considered statistically significant (p = 0.19). However, statistically significant was the decrease in cerebrovascular accidents (p = 0.04). The MOSES study (Morbidity and mortality after stroke) compared eprosartan and nitrendipine in secondary prevention of cerebrovascular diseases in 1,405 patients. Blood pressure was reduced to a comparable extent without showing significant differences between the two groups. During the study period, a total of 461 primary accidents occurred: 206 in patients with eprosartan and 255 in patients with nitrendipine (p = 0.014). Cardiovascular accidents were: 77 with eprosartan and 101 with nitrendipine (p = 0.06); cerebrovascular accidents were: 102 with eprosartan and 134 with nitrendipine (p = 0.03). OSCAR study was an open study with the objective to assess the impact of eprosartan treatment on cognitive functions. Use of eprosartan was associated with a significant reduction in blood pressure from 161.9/93.1 mm Hg to 136.1/80.8 mm Hg after 6 months (p < 0.0001). The total average score of the MMSE test after the completion of the follow-up period was 27.9 - 2.9 compared to 27.1 + 3.4 at the beginning (p < 0.0001). The results of the OSCAR study support the statement that antihypertensive treatment based on drugs that target the reninangiotensin system is associated with the preservation of cognitive functions. The POWER study proved in a large unselected population the suitability and practical aspect ofa reduction in the total cardiovascular risk by means of systematic treatment of high blood pressure.
- MeSH
- antihypertenziva terapeutické užití MeSH
- blokátory receptoru 1 pro angiotenzin II terapeutické užití MeSH
- hypertenze komplikace farmakoterapie MeSH
- kardiovaskulární nemoci prevence a kontrola MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antihypertenziva MeSH
- blokátory receptoru 1 pro angiotenzin II MeSH
The SHIFT study showed a positive effect of ivabradine in patients with chronic heart failure, sinus rhythm and heart rate at rest above 70 beats per minute. The aim of the first sub-study was to ascertain the effect of ivabradine on changes to the left ventricle function using echocardiography; ivabradine significantly increased ejection fraction of the left ventricle and reduced terminal left ventricular end-systolic and end-diastolic volumes. The second sub-study explored changes to the quality of life in patients treated with ivabradine or placebo. This study also showed statistically significantly improved quality of life after treatment with ivabradine. Both sub-studies confirmed the positive effect of ivabradine on patients with optimal treatment of heart failure, including maximum tolerated dose of beta-blockers and sinus heart rate above 70/min.
- MeSH
- benzazepiny terapeutické užití MeSH
- ivabradin MeSH
- kvalita života * MeSH
- lidé MeSH
- remodelace komor účinky léků MeSH
- srdeční frekvence účinky léků MeSH
- srdeční selhání diagnostické zobrazování farmakoterapie patofyziologie MeSH
- ultrasonografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- benzazepiny MeSH
- ivabradin MeSH
Heart transplantation is now used for the treatment of severe heart failure. In a long-term patient follow-up, hypertension has been identified as a complication. Incidence of hypertension in patients treated with cyclosporine and prednisone is between 70-90%. Besides the traditional mechanisms (renin-angiotensin system, fluid volume and peripheral resistance), aetiology of hypertension includes negative effect of cardiac denervation, cyclosporine immunosuppression, administration of corticosteroids and nephropathy. There is no night drop in the blood pressure and heart rate. Treatment aims to maintain cyclosporine level as low as possible and, if feasible, to discontinue steroids during the first year. Hypertension is usually treated with a combination therapy. Our own observations suggest that the majority of post-transplantation patients have a dual therapy. Calcium channel blockers should be the treatment of choice as they also have an effect on graft vasculopathy. Angiotenzin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB), beta-blockers and diuretics are also recommended. Long-acting products should be preferred.
- MeSH
- hypertenze farmakoterapie etiologie MeSH
- kombinovaná farmakoterapie MeSH
- lidé MeSH
- transplantace srdce škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
We present an overview of current opinions on combination therapy and the role of fixed combinations in the treatment of hypertension as per the ESH/ESC and CSH guidelines of 2007 and the revised European guidelines of 2009. A renin-angiotensin system blocker (ACE-I or sartan) combined with a calcium channel blocker is the most frequently recommended combination, followed by renin-angiotensin system blocker and a diuretic and a calcium channel blocker and a diuretic. A fixed combination of a calcium channel blocker and a beta-blocker has now been also recommended. Higher patient compliance and thus better control of hypertension is the main advantage of fixed combinations. We present an overview of fixed combinations registered in the Czech Republic until May 2012.
- MeSH
- antihypertenziva aplikace a dávkování MeSH
- fixní kombinace léků MeSH
- hypertenze farmakoterapie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antihypertenziva MeSH
- fixní kombinace léků MeSH
- MeSH
- hypertenze diagnóza farmakoterapie MeSH
- lidé MeSH
- měření krevního tlaku metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
Treatment of hypertension with angiotensin II receptor antagonists (AIIA) was first limited to diabetics and patients with microalbuminuria. So far, results of several large clinical trials with AIIAs were published, confirming significant renoprotective effect of these agents compared to placebo (RENAAL and IRMA), amlodipin (MARVAL and IDNT) and a combination of ACEI and AIIA (CALM). In 2002, results of 2 large comparator studies in hypertension were published: LIFE - Losartan Intervention For Endpoints and SCOPE - the Study on COgnition and Prognosis in Elderly hypertensives. In 2003, a series of the CHARM studies involving patients with heart failure were published and, from than, AIIA have been used as an alternative to ACEI or in a combination with ACEI. MOSES study - Morbidity and mortality after stroke, eprosartan compared with nitrendipine for secondary prevention - results were published in 2005 and ONTARGET study, focusing on secondary prevention of ischemic heart disease, was published in 2008. The CORD study - Comparison of recommended doses - and the ACTIVE I study (AF Clopidogrel Trial with Irbesartan for prevention of Vascular Events) were published in 2009. Candesartan was used in the CALM, SCOPE, RESOLVED and CHARM studies, irbesartan in the IRMA, IDNT and ACTIVE I.
- MeSH
- antagonisté receptorů pro angiotenzin terapeutické užití MeSH
- antihypertenziva terapeutické užití MeSH
- benzimidazoly terapeutické užití MeSH
- bifenylové sloučeniny terapeutické užití MeSH
- irbesartan MeSH
- kardiovaskulární nemoci farmakoterapie MeSH
- lidé MeSH
- tetrazoly terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antagonisté receptorů pro angiotenzin MeSH
- antihypertenziva MeSH
- benzimidazoly MeSH
- bifenylové sloučeniny MeSH
- candesartan MeSH Prohlížeč
- irbesartan MeSH
- tetrazoly MeSH
