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1
Nievelstein, Hubert Nicolas Maria Willem. "Hemodynamic effects of antihypertensive drugs in conscious spontaneously hypertensive rats". Maastricht : Maastricht : Rijksuniversiteit Limburg ; University Library, Maastricht University [Host], 1987. http://arno.unimaas.nl/show.cgi?fid=5367.
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Beaubien, Eliot R. "Non-steroidal anti-inflammatory drugs and the risk of end stage renal disease in hypertensive individuals". Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=81593.
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Objective. To examine the association between non-steroidal anti-inflammatory drug (NSAID) use and end stage renal disease (ESRD) among hypertensive subjects.Study design. We conducted a nested case-control study within a cohort of 77,887 hypertensive adult subjects within the province of Saskatchewan, Canada.
Outcome. The primary outcome was ESRD, defined by chronic dialysis or renal transplantation.
Exposure. NSAID exposure was determined using prescription records, for various time windows up to 10 years preceding the onset of end stage renal disease.
Statistical analysis. Rate ratios (RR) were estimated with 95% confidence intervals using conditional logistic regression, adjusting for potential confounding variables and stratified for effect modifiers.
Results. We identified 397 cases and 7,399 controls. In subjects followed for at least 10 years continuous NSAID use was observed in 20.8% of cases and 17.9% of controls (RR = 1.18, 95% CI 0.68--2.05). Additionally, neither early (RR = 1.10, 95% CI 0.50--2.41) nor late (RR = 0.81, 95% CI 0.32--2.04) NSAID exposure was associated with ESRD during this time period. Evaluation of other time windows (0--2 years, 2--5 years and 5--10 years) and NSAID dosing provided similar results. Results were not modified by loop diuretic and angiotensin converting enzyme inhibitor use.
Conclusion. Up to 10 years of non-steroidal anti-inflammatory drug use does not appear to influence the development of end stage renal disease. These results however may be influenced by unmeasured co-morbidities and confounding by "contra-indication".
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Komulainen, S. (Silja). "Effect of antihypertensive drugs on blood pressure during exposure to cold:experimental study in normotensive and hypertensive subjects". Doctoral thesis, University of Oulu, 2007. http://urn.fi/urn:isbn:9789514286131.
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Abstract The aim of the present study was to describe the effects of different types of cold exposures on blood pressure (BP) and heart rate (HR) and to test how these cold-induced effects are modulated by antihypertensive drugs representing different kind of mechanisms of action. The tested drugs represented the following antihypertensive drug subgroups: metoprolol from beta-blocking agents, carvedilol from alfa- and beta-blocking agents, lisinopril from angiotensin converting enzyme inhibitors, eprosartan from angiotensin II antagonists, amlodipine from calcium channel blockers and hydrochlorothiazide from diuretics. The main outcome measures were the levels and changes in systolic (SBP) and diastolic blood pressure (DBP) and HR before, during and after cold exposure. The normotensive and mildly hypertensive subjects were exposed either to –15°C for 15 minutes (with winter clothing), 5°C for 45 minutes (minimal clothing) or to a cold pressor test (CPT). Before measurements at –15°C, metoprolol, carvedilol, lisinopril, eprosartan, hydrochlorothiazide or placebo were given for a week in a double-blind and crossover manner. In one test procedure (5°C and CPT) the test subjects ingested amlodipine for three days or were without drug ingestion before the tests in a crossover manner. Both SBP and DBP were markedly increased by all types of cold exposure. Cold-induced rises of SBP/DBP were higher during the exposure to 5°C and –15°C (19–35/20–24 mmHg) than during CPT (13/16 mmHg). Metoprolol, carvedilol, lisinopril, eprosartan and amlodipine decreased the level of BP during the exposure to 5°C and –15°C compared to placebo or no drug. The antihypertensive drugs, with dosages used in this study, did not affect the cold-induced rise of BP compared to no drug or placebo. HR increased during CPT, but decreased during exposure to 5°C and –15°C. Metoprolol and carvedilol decreased HR during exposure to –15°C compared to placebo. The present study demonstrates for the first time the effects of antihypertensive drugs on BP in hypertensive subjects exposed to cold similar to normal outdoor exposure in winter. Although the magnitude of the cold-induced rise in BP was not affected by the drugs, the drug-induced decrease in the level of BP kept the peak values in the cold closer to the recommended threshold limit valuesTiivistelmä Tutkimuksen tarkoituksena oli selvittää eri mekanismeilla vaikuttavien verenpainelääkkeiden vaikutusta verenpainevasteisiin ja sydämen lyöntitiheyteen kylmässä sekä verrata erilaisten kylmäaltistusten vaikutusta verenpaineeseen ja sydämen lyöntitiheyteen. Tutkitut lääkkeet edustivat seuraavia verenpainelääkeryhmiä: metoprololi beetasalpaajia, karvediloli yhdistettyjä alfa- ja beetasalpaajia, lisinopriili ACE-estäjiä, eprosartaani angiotensiini II antagonisteja, amlodipiini kalsiumestäjiä ja hydroklooritiatsidi diureetteja. Tärkeimmät mitatut vasteet olivat systolisen ja diastolisen verenpaineen ja sydämen lyöntitiheyden tasot ja muutokset ennen kylmäaltistusta, kylmäaltistuksen aikana ja sen jälkeen. Lisäksi mitattiin lämpötilavasteita ja tuntemuksia. Normo- ja hypertensiiviset koehenkilöt altistettiin joko –15°C:seen 15 minuutin ajaksi (talvivaatetuksessa), 5°C:seen 45 minuutin ajaksi (minimaalisella vaatetuksella) tai tehtiin ns. käden kylmävesitesti (CPT). Testisarjoissa (–15°C) metoprololi, karvediloli, lisinopriili, eprosartaani ja hydroklooritiatsidi tai plasebo annettiin viikon ajan kaksoissokko- ja vaihtovuoromenetelmällä. Yhdessä testisarjassa (5°C ja CPT) koehenkilöt ottivat amlodipiinia 3 päivän ajan tai olivat ilman lääkettä ennen testikertoja vaihtovuoroisessa järjestyksessä. Kaikki kylmäaltistustyypit nostivat merkittävästi sekä systolista että diastolista verenpainetta. Systolisen ja diastolisen verenpaineen nousu oli korkeampi koko kehon kylmäaltistuksissa (5°C tai –15°C) (19–35/20–24 mmHg) kuin ns. kylmävesitestissä (13/16 mmHg). Metoprololi, karvediloli, lisinopriili, eprosartaani ja amlodipiini laskivat verenpaineen tasoja koko kehon kylmäaltistuksessa verrattuna plaseboon. Yksikään verenpainelääkkeistä ei vaikuttanut merkittävästi kylmän aiheuttamaan verenpaineen nousuun verrattuna tutkimuskertaan ilman lääkettä tai plaseboon. Sydämen lyöntitiheys nousi ns. kylmävesitestin aikana, mutta laski koko kehon kylmäaltistuksissa (5°C ja –15°C). Metoprololi ja karvediloli laskivat sydämen lyöntiheyttä kylmäaltistuksessa (–15°C) verrattuna plaseboon. Tämä tutkimus kuvaa ensimmäistä kertaa, kuinka verenpainelääkkeet vaikuttavat verenpainetasoihin ja -vasteisiin kylmäaltistuksessa, joka simuloi tyypillisiä ulko-olosuhteita talvella. Vaikka lääkkeet eivät estäneet kylmän aiheuttamaa verenpaineen nousua, ne laskivat verenpaineen tasoa, jolloin verenpaine pysyi kylmässäkin lähempänä suositusrajoja
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Filho, Gilberto Senechal de Goffredo. "Incapacidade temporária para atividades habituais: relação com a pressão arterial e o uso de terapia farmacológica antihipertensiva no Estudo Pró-Saúde". Universidade do Estado do Rio de Janeiro, 2008. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=5021.
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A hipertensão arterial (HA) desempenha papel determinante na ocorrência de eventos clínicos graves, havendo entretanto controvérsia quanto ao seu impacto no cotidiano do portador. A incapacidade temporária para a realização de atividades habituais, definida como uma restrição temporária na capacidade funcional habitual do indivíduo, é um indicador de
saúde recomendado pela Organização Mundial da Saúde para uso em estudos populacionais. A partir do objetivo geral de investigar a associação entre hipertensão arterial e incapacidade
temporária para atividades habituais, delineamos os seguintes objetivos específicos: A) Investigar se a elevação dos níveis pressóricos determina a freqüência e o período acumulado
de incapacidade temporária para atividades habituais; B) Investigar se o uso de medicações anti-hipertensivas associa-se a alterações na freqüência e no período acumulado de incapacidade temporária para atividades habituais. O estudo seccional com dados de 2953 participantes obtidos através de questionário auto-administrado no Estudo Pró-Saúde, uma
coorte de funcionários técnico-administrativos de universidade localizada no estado do Rio de Janeiro. A exposição foi avaliada a partir do valor aferido da PA e do uso de drogas anti-hipertensivas.
Conduzimos a análise separando os participantes em 4 grupos, combinando as informações quanto à PA aferida (< ou 140/90 mmHg), e o relato de uso ou não de medicação anti-hipertensiva. O desfecho foi avaliado com a utilização de uma variável composta com informação referente à ocorrência e ao período de incapacidade. Realizamos análise multivariada através de regressão logística multinomial. Temos como resultado 690 (23,4 %) participantes foram classificados como hipertensos, e 704 (23,8 %) relataram incapacidade temporária. O relato do uso de medicação anti-hipertensiva mostrou, entre os indivíduos com PA < 140/90 mmHg, associação direta com a prevalência de incapacidade temporária de longa duração, com OR=2,25 (IC 95 %: 1,31 3,87). A presença de PA 140/90 mmHg mostrou relação inversa com a chance de incapacidade temporária de curta duração entre os indivíduos que não usavam medicação anti-hipertensiva, a qual porém não foi estatisticamente significativa (OR=0,64; IC 95 %: 0,40 1,03). Encontramos uma associação direta entre o uso de drogas anti-hipertensivas e incapacidade temporária de longa
duração, a qual pode relacionar-se a efeitos adversos da medicação; os resultados sugerem também uma relação inversa entre os valores da PA e a prevalência de incapacidade de curta
duração, a qual não alcançou significância estatística, e que pode estar relacionada a um fenômeno conhecido como hipoalgesia associada à HA.Arterial hypertension (AH) plays a determinant role in the occurrence of severe clinical events; however, there are controversies about its impact on daily life. The temporary disability for daily activities, which is defined as a temporary restriction in an individuals usual level of functioning, is a health indicator proposed by the World Health Organization for utilization in population studies. To investigate the association between arterial hypertension and temporary disability for daily activities, we proposed the following specific objectives: A) To investigate whether elevated blood pressure (BP) determine the frequency or accumulated period of temporary disability for daily activities; 2) To investigate whether the use of anti-hypertensive drugs are associated with changes in the frequency or accumulated period of temporary disability for daily activities. We have a cross-sectional study with data obtained from 2953 participants who answered a self administered questionnaire in the Pro-Saude Study, a cohort of university employees in Rio de Janeiro state. The exposure was evaluated using the measured value of BP and the report of the use of anti-hypertensive drugs. We conducted the analysis classifying the participants in 4 groups, combining the information about measured BP (< or 140/90 mmHg) and the report of the use of anti-hypertensive drugs or not. The outcome was evaluated with a composite variable with information about the report and period of disability. Multivariate analyses were conducted using multinomial logistic regression. The results are 690 (23.4 %) were classified as hypertensives, and 704 (23.8 %) reported temporary disability. The use of antihypertensive drugs, among the participants with BP < 140/90 mmHg, was directly associated with the prevalence of temporary disability for daily activities for a longer period (OR=2.25, CI 95 %: 1.31 - 3.87). The presence of BP 140/90 mmHg showed an inverse relationship with the chance of temporary disability for a short period among the participants that did not use ntihypertensive drugs, not reaching statistical significance (OR=0.64; CI 95 %: 0.40 - 1.03). We found a direct association between the use of anti-hypertensive drugs and temporary disability for daily activities for a long period, which may be related to adverse effects of the drugs; the results also suggest an inverse relationship between BP values and the prevalence of temporary disability for a short period, which did not reach statistical significance, and can be related to a phenomenon known as AH-asociated hypalgesia.
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Forino, Andrew Stephen. "Determining Effects of the PAF-R and Anti-Hypertensive Drugs Mediated Microvesicle Particle Release in Modulating Anti-Tumor Response of Lung Cancer". Wright State University / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=wright1590691151424173.
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Merlo, Juan. "Pharmacoepidemiologic studies on cardiovascular drugs with special reference to the effectiveness and safety of blood pressure lowering drugs /". Lund : Dept. of Community Medicine, Lund University, and the NEPI Foundation, 1998. http://books.google.com/books?id=c_BsAAAAMAAJ.
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Moore, Suzanne P. "Adherence to randomised drug regimens of patients enrolled in the Second Australian National Blood Pressure Study : a description of the patterns of adherence and of factors influencing non-adherence /". [St. Lucia, Qld.], 2001. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe16251.pdf.
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Yates, John. "Haemodynamic effects of vasoactive drugs in experimental portal hypertension". Thesis, Liverpool John Moores University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.337787.
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Yu, Zhen. "Altered drug responses in diabetic and hypertensive-diabetic cardiomyopathy". Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/29406.
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Diabetes mellitus has been associated with both clinical and experimental cardiac dysfunction. Diabetic cardiomyopathy which is characterized by depressed cardiac contractility is accompanied by a variety of biochemical changes in Ca⁺⁺ metabolism. This cardiomyopathy may occur in the presence of normal coronary arteries and normal blood pressure. However, some studies have shown that hypertension is more prevalent among diabetics and can aggravate the cardiovascular abnormalities associated with diabetes. To understand the mechanisms of diabetic cardiomyopathy and consequences of combined hypertension and diabetes, experiments were designed to measure cardiac tissue responses to various inotropic agents in experimental diabetes.
Six weeks following streptozotocin (STZ) administration, Wistar, spontaneously hypertensive (SHR) and Wistar Kyoto (WKY) rats exhibited the 'classical signs' of diabetes which included: hyperglycemia, hypoinsulinemia, hyperlipidemia (except in WKY), and hypothyroidism. Decreased basal atrial rate and increased basal developed force (BDF) suggest a depressed SA node function and an alteration of Ca⁺⁺ utilization by diabetic ventricles. Decreased post quiescent potentiation (PQP) values (except in WKY) in ventricular tissues suggest a diminished amount of releasable Ca⁺⁺ from sarcoplasmic reticulum (SR). Decreased post stimulation potentiation (PSP) values in SHR papillary muscles (PM) are probably suggestive of a depressed sarcolemmal Na⁺-Ca⁺⁺ exchange function in this tissue. Diabetic rats show subsensitivity to β-adrenergic stimulation in ventricular tissues, supersensitivity and hyperresponsiveness to Ca⁺⁺ and α-adrenergic stimulation (except in WKY) in
ventricular tissues and left atria (LA) and supersensitivity to BAY K 8644 in SHR LA and hyperresponsiveness to verapamil in ventricular strips. These alterations may be attributed to a change in receptor number and/or a post receptor alteration.
Ryanodine decreased the PQP of Wistar and SHR PM and SHR LA in both controls and diabetics. It especially abolished PQP in SHR diabetic tissues, but had no effect on WKY tissues, which may suggest a difference in the SR function in these tissues. SR with impaired Ca⁺⁺ uptake may contribute to these phenomena in diabetic rats. Ryanodine also diminished (PQP + BDF) of SHR LA and (PQP/BDF) of Wistar and SHR PM, ˙but had no effects on control and other diabetic tissues. It appears that ryanodine has some influence on the Na⁺-Ca⁺⁺ exchange generated by sarcolemma (SL) of certain diabetic tissues. Further experiments are required to clarify this.
SHR diabetic rats had greater changes in most of the measurements such as hyperlipidemia, depressed PQP and PSP values, and altered drug responses. This model exhibited very high mortality as compared to Wistar and WKY diabetic rats. As has been shown previously, the combination of hypertension and diabetes exerts a synergistic effect on the cardiac dysfunction in this model, and that altered lipid metabolism, SL and SR function are all involved in the development of cardiomyopathy. WKY diabetic rats, on the other hand, exhibited no significant changes in blood lipids, or in response to phenylephrine or to Ca⁺⁺ (LA) stimulation. Lack of change in these factors may explain the relatively normal cardiac function of this model as measured previously.Pharmaceutical Sciences, Faculty of
Graduate
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Greer, I. A. "The effect of anti-hypertensive agents on platelets, prostacylin and thromboxane and observations on prostacyclin and thromboxane in normal and hypertensive pregnancy". Thesis, University of Glasgow, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380334.
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Rasmussen, Kelly. "The Impact of JNC-7 and New Clinical Studies on Antihypertensive Drug Prescribing". The University of Arizona, 2005. http://hdl.handle.net/10150/624769.
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Class of 2005 AbstractObjectives: The objectives of this study were to assess the number of antihypertensive prescriptions by therapeutic class including beta-blockers, calcium channel blockers (CCBs), diuretics, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs), dispensed in the fiscal years 2002 through 2004. Methods: The project was a retrospective analysis of pharmacy data for medications used to treat hypertension from October 2002 through December 2004 (FY02 through the first quarter of FY05). Drug classes used to treat hypertension were obtained from the VA Integrated Service Network 18 (VISN 18). Within the drug classes, only drugs within the class having at least 100 prescriptions were included for the class. Rates of prescriptions dispensed by quarter over the three-year period of interest were obtained. Descriptive statistics were used to compare the before and after ALLHAT and JNC-7 time periods. Results: After the publication of The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), The Australian National Blood Pressure Study 2 (ANBP2), and Joint National Committee (JNC-7) guidelines, dihydropyridine CCB use declined to from 1.80% to 1.65% and non-dihydropyridine CCB use declined from 0.99% to 0.83% of all prescriptions from the first quarter 2002 to the first quarter 2004. In addition, after the publication of ALLHAT, hydrochlorothiazide use increased from 1.42% to 1.83% and ACE-inhibitor use increased from 4.26% to 4.79% of all prescriptions. Implications: The findings have several implications for encouraging our prescribing patterns to follow national guidelines and clinical studies more closely. Health care providers need to accept some responsibility through continuous education to be able to maintain appropriate therapy.
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Yoon, Jean. "Adherence to prescription drugs and adverse health events for patients with hypertension". Diss., Restricted to subscribing institutions, 2008. http://proquest.umi.com/pqdweb?did=1679722851&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.
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Sanders, Gillian. "Therapeutic interventions in the management of hypertension : clinical studies in individuals and the community". Thesis, University of Newcastle Upon Tyne, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.329166.
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Capewell, Simon. "Studies of the calcium antagonist felodipine in the treatment of hypertension and heart failure". Thesis, University of Newcastle Upon Tyne, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.330281.
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Nordmann, Alain Joel. "Cost-effectiveness of routine echocardiography in hypertensive patients starting antihypertensive drug therapy". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/MQ58821.pdf.
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Persson, Mats. "Bring hypertension guidelines into play : guideline-based decision support system for drug treatment of hypertension and epidemiological aspects of hypertension guidelines". Doctoral thesis, Umeå universitet, Allmänmedicin, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-94105.
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Lu, Changwu [Verfasser]. "Antifibrotic drugs: new candidates for the treatment of pulmonary arterial hypertension? / Changwu Lu". Gießen : Universitätsbibliothek, 2018. http://d-nb.info/1163533688/34.
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Chellingsworth, Miriam Claire. "Could a calcium antagonist be the ideal drug treatment of elderly hypertensives?" Thesis, University of Southampton, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316397.
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Cowan, Simone. "Anti-hypertensive drug use and the risk of serious hypoglycemia in patients with diabetes". Thesis, McGill University, 1999. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=30840.
Pełny tekst źródłaStreszczenie:
Recently, there have been conflicting reports on whether anti-hypertensive medications cause serious hypoglycemia in patients with diabetes. We assessed this association using a population-based approach.Utilizing the Saskatchewan Health databases, we conducted a case-control study nested within a cohort of 3639 patients with diabetes, newly prescribed angiotensin converting enzyme inhibitors (ACE-I) or dispensed other anti-hypertensive drugs during 1982 to 1987. There were 162 cases of hypoglycemia identified. All potential controls, matched to the case on entry date and at different eligible at-risk times, were selected (n = 8329).
After adjustment for confounders, current users of ACE-I and non-selective beta-blockers had a clinically important increased risk of hypoglycemia, RR 1.61 (95% CI: 0.99--2.60) and RR 1.81 (0.97--3.40), respectively. Current users of ACE-I for a duration of 120 days or greater had a 2-fold increased hypoglycemic risk, RR 2.06 (1.12--3.82).
The use of ACE-I and non-selective beta-blockers may be associated with serious hypoglycemia.
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Griffith, D. N. W. "The cerebral circulation in diabetes mellitus and hypertension and its responses to beta adrenergic receptor-blocking drugs". Thesis, University of Cambridge, 1985. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.599714.
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Wathen, Christopher George. "Studies of the cardiovascular effects of inotropic agents and vasodilators on the pulmonary and systemic circulation in man". Thesis, University of Edinburgh, 1988. http://hdl.handle.net/1842/27032.
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Lees, K. R. "Studies of the clinical pharmacology of perindopril : A new inhibitor of angiotensin converting enzyme". Thesis, University of Glasgow, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.383183.
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Mchowat, Jane. "Cardiovascular control by central beta-adrenoceptors in the rat". Thesis, University of Bath, 1987. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.380621.
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Kung, Kin-hang. "An audit on anti-hypertensive drug management amongst general out-patient clinics in New Territories West region". Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31971878.
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Kung, Kin-hang, i 龔健恆. "An audit on anti-hypertensive drug management amongst general out-patient clinics in New Territories West region". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2004. http://hub.hku.hk/bib/B31971878.
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Chetty, Prakash. "Development and assessment of propranolol sustained release dosage forms separately and in combination with hydrochlorothiazide". Thesis, Rhodes University, 2006. http://eprints.ru.ac.za/1342/.
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Chu, Wai-on. "The prevalence of cognitive impairment and dementia among hypertensive elderly as a whole and among different classes of anti-hypertensive drug users in a regional geriatric clinic in Hong Kong /". View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38348202.
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Kondowe, Greeves Burton Chianira. "An investigation of some of the mechanisms of action of angiotensin converting enzyme inhibitors". Thesis, Queen's University Belfast, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.254326.
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Waller, Patrick Charles. "Pharmacokinetics and antihypertensive effect of the serotonin antagonist ketanserin". Thesis, University of Sheffield, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.335054.
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Hatton, R. "The role of angiotensin in the control of blood pressure : a functional interaction with the autonomic nervous system". Thesis, Open University, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.378202.
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An interaction of the renin-angiotensin system and the autonomic nervous system was demonstrated in vivo during activation of the former by sodium depletion in the dog and the latter during application of lower body negative pressure (LBNP) in the cat. In the dog, inhibitors of angiotensin converting enzyme (ACE), teprotide and captopril, together with an angiotensin II (AII) antagonist, saralasin, and a peptide inhibitor of renin, H77, given intravenously lowered blood pressure (BP) by reducing peripheral resistance in relation to the prevailing level of plasma renin activity (PRA). They did so without changing cardiac output or heart rate as PRA rose above the resting level. The lack of tachycardia was due to a resetting of the baroreflex without a change in sensitivity as teprotide unmasked an action of AII at a peripheral site since when administered into a lateral cerebral ventricle it was ineffective. In the cat, teprotide and saralasin enhanced the fall in BP induced by LBNP and impaired its recovery. When these inhibitors were given during LBNP, a greater and more sustained fall in BP was seen than with either inhibitor alone. This occurred before activation of plasma renin and was not associated with a reduction in sympathetic efferent nerve activity. Further studies revealed that teprotide, captopril and enalapril interfered with neurogenic vasoconstriction involving AII in pithed rats and moreover, captopril was active in lowering BP in two strains of rat shown to be particularly sensitive to the adrenergic potentiating effect of AII. These findings have provided physiological evidence in vivo supporting a peripheral interaction between the autonomic nervous system and AII even at low levels of activation which potentiate adrenergic mechanisms and maintain homeostatic reflexes. They suggest that a significant part of the hypotensive activity of ACE inhibitors is due to interference with facilitatory actions of AII on the autonomic nervous system.
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Girvan, B. G. "The influence of drug dosing interval on patient compliance with antihypertensive agents and the effect of non-compliance on blood pressure control". Thesis, Queen's University Belfast, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268921.
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HAMAJIMA, NOBUYUKI, YOSHITOKU YOSHIDA, AMONOV MALIK, SALIM DAVLATOV i ERKIN TOIROV. "HYPERTENSION-RELATED KNOWLEDGE, PRACTICE AND DRUG ADHERENCE AMONG INPATIENTS OF A HOSPITAL IN SAMARKAND, UZBEKISTAN". Nagoya University School of Medicine, 2014. http://hdl.handle.net/2237/20544.
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Kim, Eunju. "Sequential drug decision problems in long-term medical conditions : a case study of primary hypertension". Thesis, University of Sheffield, 2015. http://etheses.whiterose.ac.uk/10004/.
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Background: Sequential drug decision problems (SDDP) occur when assigning drugs sequentially in long-term medical conditions. SDDPs are important for both clinical decision-making and resource allocation. They can be large and complex because of the considerable number of drug sequences and disease pathways and the interdependence between them over time. Where classic mathematical programming has a limited capacity for dealing with the complexities of a sequential decision problem, approximate optimisation methods have been widely used to solve the problem more efficiently using simulation. Objective: This thesis aims to set down the definitions of SDDPs mathematically to understand the nature of SDDPs, to examine the potential methods to identify optimal or near-optimal sequential treatment strategies in a long-term SDDP; and to discuss the performance of the proposed methods using a case study of primary hypertension. Methods: A mathematical description of SDDPs was developed to gain an understanding of the nature of SDDPs. A systematic review was conducted to examine potential optimisation methods for solving large and complex SDDPs. A hypothetical simple SDDP was used to test the feasibility of incorporating the promising methods into an economic evaluation model. A de novo hypertension cost-effectiveness model estimating blood pressure lowering effects of sequential use of antihypertensive drugs was developed. Enumeration, simulated annealing (SA), genetic algorithm (GA) and reinforcement learning (RL) were used to solve the SDDP in primary hypertension. Their performance was tested in terms of computational time and the quality of solution, which is defined by the closeness of the final objective function values and the real global optimum are obtained from enumeration. Results: The computational complexity of SDDPs comes from a range of factors, which are: 1) the number of relevant health states, 2) the number of potential drug treatment options, 3) the number of times that a treatment change may occur, 4) whether the transition probability between health states depends on historic health states and drug uses and 5) relevant clinical-based rules that need to be incorporated. Various trade-offs, such as the trade-off between the computational complexity and model validity, the trade-off between the research effort and time required to develop the optimisation model and the underlying evaluation model, and the trade-off between the amount of search time and the quality of the solution, are fundamental features of SDDP modelling. These trade-offs are all interrelated with each other rather than existing separately. In the case study of primary hypertension, the optimal solution identified by enumeration was to start with an angiotensin converting enzyme inhibitor or an angiotensin II receptor blocker (ACEI/ARB), followed by the combination of thiazide-type diuretic (D) and ACEI/ARB, the combination of D, ACEI/ARB and calcium channel blocker (CCB) and the combination of D, ACEI/ARB and beta-blocker (BB) as second, third and fourth-line treatments. The total expected net benefit for this optimal sequential treatment policy was £330,080 (95% CI £330,013-£330,147). SA and GA found the same (or statistically indifferent) solution(s) identified by enumeration with shorter search time and smaller iteration number. The computational time was 4.1-4.6 hours in SA or GA whereas enumeration took 12.20 hours. The performance depended on some key parameters of the methods: cooling rate and the maximum number of iterations within the same temperature for SA and the number of generation, population size, crossover rate and mutation rate for GA. The performance of RL was relatively less favourable. This may be because of the structure of the hypertension SDDP model, whose total net benefit is mostly affected by the add-on Markov model after the drug switching period than the short-term drug switching model. Conclusion: SA and GA can be used to solve a large and complex SDDP as demonstrated in the primary hypertension case study. They can find the optimal or near optimal solutions efficiently where the key parameters are properly set. The optimal parameter setting is problem specific and requires a tuning procedure considering various scenarios with different sets of parameters. RL needs further investigation to improve the performance possibly by using more complicated RL methods or in a different structure of the underlying evaluation model. This study can be extended to construct the underlying evaluation model using a DES and to technically improve the optimisation methods. Producing the data relevant to SDDPs will also help to make better informed decisions for SDDPs in health technology appraisal.
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Nikam, Vandana S. "Identification of circulating fibrocytes as a new and specific pharmacological target in a murine model of pulmonary hypertension". Giessen VVB Laufersweiler, 2008. http://d-nb.info/1000204677/04.
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Pietras, Kristian. "Inhibition of PDGF receptor signaling in tumor stroma : Effects on interstitial hypertension, drug uptake and therapeutic response". Doctoral thesis, Uppsala University, Ludwig Institute for Cancer Research, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-2633.
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The role of platelet-derived growth factor (PDGF) in malignancies involves both autocrine and paracrine stimulation of cells within the tumor. The interstitial fluid pressure (IFP) is one of the forces that govern the transvascular flow of fluids. In both experimental and clinical cancers, the IFP is elevated and is thought to act as a barrier for delivery of drugs. Increasing evidence points to PDGF as a positive regulator of the interstitial fluid pressure in loose connective tissue. In this thesis, the effect of PDGF receptor inhibition on the tumor IFP, transvascular transport and efficacy of anti-cancer drugs is investigated.
All studies were performed using tumor models that display extensive tumor stroma and PDGF receptor expression restricted to stroma cells. Blocking of PDGF receptor signaling significantly reduced the tumor IFP in various tumor models. In parallel, pre-treatment with PDGF antagonists increased the tumor content of cytotoxic agents without affecting the uptake in other organs. Moreover, combination treatment with PDGF receptor inhibitors and chemotherapeutic agents dramatically enhanced the anti-tumor effects of the cytotoxic drugs, whereas treatment with only PDGF receptor inhibitors did not affect the growth of the tumors. Beneficial effects on the tumor reponse to radioimmunotherapy were also produced after concomitant administration of PDGF antagonists. Importantly, anti-angiogenic effects, changes in cell composition and increased tumor cell sensitivity to cytotoxic agents were ruled out as the cause for the synergistic effects.
Studies with different temporal scheduling of PDGF receptor inhibitors demonstrated a perfect correlation between a reduced IFP, an increased transvascular transport and an enhanced therapeutic effect of cytotoxic drugs, strongly suggesting that the phenomena are causally linked.
The studies presented herein illustrate for the first time the potential of cells in the stroma compartment as a target for efforts to treat cancer. In conclusion, a novel, possibly general, strategy to enhance the effects of conventional anti-cancer drugs has been identified.
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Zarnke, Kelly B. "Hypertension management using home blood pressure monitors and patient-initiated drug dosage adjustments, a randomized equivalence trial". Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0033/MQ30705.pdf.
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Sobko, D. I. "Blood pressure changes as a result of taking nonsteroidal anti-inflammatory drugs among the patients who suffer from osteoarthritis with concomitant hypertension". Thesis, БДМУ, 2020. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18060.
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Selvey, Christine Enid. "Comparative effects of calcium channel antagonism and beta-1 selective blockade on exercise performance in physically active hypertensive patients". Master's thesis, University of Cape Town, 1997. http://hdl.handle.net/11427/26736.
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The current recommendations by the American Heart Association for health promotion are that all persons should partake in regular physical activity in order to reduce the risk of cardiovascular disease. Regular physical exercise reduces blood pressure and is an important component of the management of hypertension. It is therefore important that patients with hypertension participate in habitual physical exercise. Many hypertensive patients who exercise will require anti-hypertensive medication. However, some antihypertensive agents cause fatigue during exercise. In order for patients to gain the full benefits of an active lifestyle, it is important that the prescribed antihypertensive agent does not prevent them performing and enjoying sustained exercise. It has been well documented that β-blockers cause premature fatigue during physical exercise. The effects on exercise performance of other first line antihypertensive medications, such as calcium channel antagonists have not been extensively investigated. In particular, the effects of these agents on prolonged submaximal exercise endurance have not been well studied. The object of this thesis was to compare the effects of isradipine, a dihydropyridine calcium channel antagonist, to those of atenolol, a β₁-selective antagonist, on maximal and submaximal exercise performance and on short duration high-intensity exercise in physically active hypertensive patients. The study design was a crossover trial where drug treatments were double blinded and randomised. Physically active volunteers with mild to moderate hypertension were recruited. 11 subjects performed i) progressive exercise to exhaustion for determination of maximal oxygen consumption (VO₂max), maximal work load and cardiorespiratory responses to maximal exercise, ii) prolonged submaximal exercise for determination of exercise endurance, cardiorespiratory responses and ratings of perceived exertion (APE), and iii) short duration, high intensity exercise consisting of a 30 second maximal exercise test (Wingate test) to determine skeletal muscle power output, following 4 weeks ingestion of isradipine (2.5mg bd), atenolol (50mg bd) or placebo. Diastolic blood pressure at rest was reduced by both atenolol and isradipine, but was lowered to a greater extent by atenolol (83.3 vs 89.0 vs 96.1 mmHg, atenolol vs isradipine vs placebo, p<.0005). Systolic blood pressure at rest tended to be similarly reduced by both agents, but was significantly reduced during maximal and submaximal exercise by atenolol only (p<.001, atenolol vs isradipine, placebo). Heart rate at rest and during maximal and submaximal exercise was decreased by atenolol only (p<.0005, atenolol vs isradipine, placebo). Maximal exercise performance was reduced after atenolol ingestion compared to placebo but not after isradipine ingestion. Peak workload achieved during the maximal exercise test was decreased after atenolol but unchanged after isradipine ingestion (214 vs 243 W, atenolol vs placebo, p<.01). Similarly, VO₂max was reduced after atenolol compared to placebo but was unchanged after isradipine ingestion (33.6 vs 36.4, 33.6 vs 36.1 mlO₂/kg/min, atenolol vs placebo, atenolol vs isradipine, p<.05). Both atenolol and isradipine ingestion reduced submaximal endurance time compared to placebo (27.8 vs 46.4, 34.4 vs 46.4 min, atenolol vs placebo, isradipine vs placebo, p<.005), and increased rating of perceived exertion (APE) after 30 min of submaximal exercise (p<.05). Submaximal oxygen consumption (VO₂), ventilation, respiratory exchange ratio (REA) and blood lactate, glucose and free fatty acid concentrations were not altered after the ingestion of either agent. Neither agent influenced peak skeletal muscle power, total work done, or rate of fatigue during the Wingate test compared to placebo. The results of these studies indicate that impaired performance and increased RPE during submaximal exercise after ingestion of either atenolol or isradipine is not due to alterations of ventilation, VO₂, RER, or blood lactate, glucose and free fatty acid concentrations during prolonged submaximal exercise. Similarly, reduced submaximal exercise performance after atenolol or isradipine ingestion is not due to factors which would also limit the ability of skeletal muscle to perform short duration, high intensity exercise before a bout of prolonged exercise. This study demonstrates that prolonged submaximal exercise testing can reveal an impairment in exercise performance after ingestion of antihypertensive medication which is not evident during maximal exercise testing. This finding is important as prolonged submaximal exercise is the form of exercise which most hypertensive patients actually perform. Further research is required on the effects of anti-hypertensive medications on submaximal exercise performance before firm recommendations can be made regarding medications most suitable for the physically active hypertensive patient. The results of these and other studies indicate that it is not yet possible to make claims that the calcium channel antagonist agents are without effect on physical exercise performance in physically active hypertensive patients.
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Lévi, Natacha. "Impact et réversibilité du syndrome métabolique et de ses composantes sur le vieillissement cognitif et le risque de démence". Thesis, Paris Est, 2012. http://www.theses.fr/2012PEST0080.
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L’hypertension artérielle (HTA) est considérée comme un facteur de risque modifiable de démence. Dans ce contexte, nous nous sommes intéressés à différents aspects du traitement de l’HTA indépendamment de la réduction de pression artérielle : d’une part aux effets des différentes classes d’antihypertenseurs sur le déclin cognitif et l’incidence de démence, en réalisant une méta-analyse en réseau ; et, d’autre part, sur la variabilité depression artérielle (PA), qui pourrait être impliquée dans la relation délétère entre l’HTA et la cognition, à partir d’une cohorte de sujets hypertendus traités. Nous avons également étudié le rôle de l’HTA dans la relation entre le syndrome métabolique et les troubles cognitifs, à partir d’une cohorte de patients avec facteurs de risque vasculaires. Nos résultats confirment la prévention de démence avec les antihypertenseurs et soutiennent l’hypothèse de bénéfices cognitifs supérieurs avec les antagonistes des récepteurs de l’angiotensine II par rapport aux autres classes d’antihypertenseurs, mais, ils suggèrent que la variabilité de pression artérielle ne constitue pas un mécanisme principal à l’origine de ces différences, puisque les inhibiteurs calciques offrent la meilleure réduction de variabilité de PA. Nos résultats ne supportent pas le rôle du syndrome métabolique en tant que tel dans le déclin cognitif, mais de celui de l’HTA et du diabète. L’ensemble de ces résultats démontrent qu’une approche multifactorielle doit être considérée dans le traitement de l’HTA, et offrent des perspectives dans le choix du traitement antihypertenseur pour prévenir le fardeau de la démenceHypertension is considered a modifiable risk factor of dementia. In this context, we studied different aspects of the treatment of hypertension independantly from the blood pressure reduction. We compared the effects of the different antihypertensive drug classes, on cognitive decline and incidence of dementia in a network meta-analysis on the one hand, and on short-term blood pressure variability, which is suspected to be related to cognitive decline,in a cohort of treated hypertensive patients, on the other hand. We also studied the contribution of hypertension in the relationship between metabolic syndrome and cognitive impairment, in a cohort of patients with vascular risk factors. Our results confirmed the benefits of antihypertensive treatment in the prevention of incident dementia, and support the hypothesis of superior benefits with angiotensin receptor blockers compared to the other drug classes. Our finding of calcium channel blockers being the class providing the lowest blood pressure variability does not support blood pressure variability being a primary mechanism involved in the differential effects of antihypertensive drug classes on cognition. We demonstrated that hypertension and diabetes, rather thanmetabolic syndrome in itself, were related to cognitive impairment. Overall, our results highlight the need to consider a multifactorial approach in hypertensiontreatment, and provide perspectives regarding the choice of antihypertensive treatment to prevent the burden of dementia
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Fitton, Catherine Alexandra. "Identifying adverse outcomes in neonates and children following in utero exposure to medication". Thesis, University of Aberdeen, 2019. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=240861.
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Introduction: Many medications have an unproven safety profile for use during pregnancy, leading to issues when chronic diseases, such as hypertension and depression, present during pregnancy. The focus of this research programme is to determine whether in utero exposure to antihypertensive and antidepressant medication is associated with increased risk of adverse events at birth, and up to 27 months of age in the child. Methods: Two systematic reviews were performed to identify current published literature and knowledge gaps. Following this, using Scottish healthcare data, a cohort of 268,711 children born 2010-2014 were identified. Following cleaning of the data, multiple imputation was used to account for missing values. Poisson, linear and multinomial regressions were performed to identify the relationship between in utero medication exposure and child outcomes. Results: In utero antihypertensive exposure was associated with preterm birth, low birth weight, small for gestational age, but not developmental issues. However, untreated hypertension was associated with low birth weight, preterm birth, and small for gestational age. In utero antidepressant exposure was associated with preterm birth, low birth weight, small for gestational age, preeclampsia, having a special needs indicator at 10 days and 6-8 weeks post-birth, developmental issues at 27 months Conclusions: This research programme identified several adverse outcomes following in utero exposure to antihypertensive and antidepressant medication.
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Sutton, Sandra Cecile. "The development of a method to evaluate the use and medical and socioeconomic implications of antihypertensive drug treatment in the Mamre community". Thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/25756.
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Graden, Suzanne. "National Estimate of Cost of Illness for Hypertension and Non-Persistence with Drug Therapy Using the Medical Expenditure Panel Survey". The Ohio State University, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=osu1046972930.
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Ericson, Karin, i Mimmi Moser. "Faktorer som påverkar patienters följsamhet till behandling vid hypertoni". Thesis, Högskolan i Halmstad, Sektionen för hälsa och samhälle (HOS), 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-16899.
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Hypertoni är en folksjukdom och en riskfaktor för hjärt-kärlsjukdom. Effektiva behandlingsmetoder finns men brist på följsamhet till behandlingsregimer vid hypertoni är ett stort problem, som utgör en risk för patienters hälsa. Bättre kunskap om vad som kan påverka patienternas följsamhet till hypertonibehandling är därmed av stor betydelse för sjuksköterskans hälsofrämjande arbete. Syftet med studien var att undersöka faktorer som påverkar patienters följsamhet till behandling vid hypertoni. Studien genomfördes som en litteraturstudie. Data bestod av 16 vetenskapliga artiklar som valdes ut, granskades och analyserades för att finna påverkande faktorer. De faktorer som framkom delades in i fem kategorier. Dessa var inställning till hypertoni och behandling, upplevelser av biverkningar, hälso- och sjukvårdens påverkan, omgivningens påverkan samt personliga faktorer. Misstro till diagnosen, behandling och hälso- och sjukvården samt rädsla för biverkningar utgjorde faktorer av vikt för följsamheten. Familjens engagemang var av betydelse för att hålla fast vid ordinationer och rekommendationer. En annan faktor av vikt var att patienter glömde ta sina läkemedel. Resurser i hälso- och sjukvården bör läggas på att utarbeta strategier för att effektivt kunna arbeta med hälsofrämjande arbete samt att optimera patientens delaktighet i beslut gällande den egna vården, detta för att öka följsamhet till behandling vid hypertoni.Hypertension is a widespread disease and a risk factor for cardiovascular disease. Effective treatments are available but lack of compliance to treatment regimens in hypertension is considered a major problem that presents a risk to patient health. Better knowledge of what affect patients´ compliance to hypertension treatment is therefore of great importance to the nurse´s health promotion. The purpose of this study was to investigate factors that influence patients´ compliance to the treatment of hypertension. The study was conducted as a literature study. Data consisted of 16 scientific articles that were selected, reviewed and analyzed to find the influencing factors. The factors that emerged were divided into five categories. These were attitudes to hypertension and treatment, experiences of side effects, health care impact, impact of the surroundings and personal factors. Distrust of the diagnosis, treatment, health care and fear of side effects were factors of importance to compliance. The family´s involvement was important to adhere to prescriptions and recommendations. Another factor of importance was that the patients forgot to take their medicines. Resources in health care should be given to developing strategies to effectively work with health care promotion and to optimize the patient´s participation in decisions regarding their own care, this in order to increase compliance to hypertension treatment.
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Siew, Keith. "Gitelman & Gordon : mirror image syndromes reveal the roles of WNKs in blood pressure homeostasis and novel anti-hypertensive targets". Thesis, University of Cambridge, 2019. https://www.repository.cam.ac.uk/handle/1810/289398.
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Study of Gordon (PHAII) and Gitelman (GS) syndromes revealed the importance of the WNK pathway and thiazide-sensitive Na-Cl Cotransporter (NCC) in the renal control of blood pressure. PHAII mutations lead to WNK accumulation resulting in the hyperphosphorylation of the downstream effector, SPAK, which overactivates NCC causing salt retention and hypertension. Mutations causing deletion of exon-9 in Cullin-3, which normally ubiquitylates WNKs for degradation, were recently discovered to cause the severest subtype of PHAII (PHA2E) with early onset salt-sensitive hypertension and hyperkalaemia. The reasons for this severity have remained elusive, however clues came from SPAK knock-out mice which recapitulate GS, the phenotypic mirror image of PHAII, typically caused by activation-inhibiting NCC phosphorylation site mutations resulting in salt-wasting and hypotension. As these mice were also discovered to have reduced vascular tone, it suggests the WNK pathway may have extra-renal roles in vascular smooth muscle function and highlights inhibition of SPAK function as a promising anti-hypertensive strategy with multiple sites of action. To address these possibilities the work aimed to phenotype: (1) heterozygous CUL3$^{WT/\Delta403-459}$ mice to investigate a possible vascular contribution to PHAII pathophysiology, (2) homozygous knock-out mice of MO25, a master regulator known to increase SPAK activity up to 100-fold independent of WNKs, and (3) homozygous SPAK$^{L502A/L502A}$ knock-ins, predicted to have disrupted SPAK binding to WNK/NCC, in order to validate SPAK signalling inhibition as a viable anti-hypertensive strategy. In mice, the CUL3$^{\Delta403-459}$ proteins are hyperflexible, hypermodified and ultimately have reduced WNK ubiquitylation. This lead to hypertension, hyperkalaemia, hyperchloraemia with compensated metabolic acidosis and growth retardation, which closely recapitulates human PHA2E. The discovery of increased vascular tone suggests an explanation for the severity of CUL3$^{\Delta}$$^{ex9}$PHAII. In mice, homozygous MO25$\alpha$ knock-out proved embryonically lethal, while homozygous MO25$\beta$ knock-out did not meaningfully alter blood pressure or electrolyte homeostasis. However, the SPAK$^{L502A}$ protein had a decreased ability to bind WNKs and cation-chloride cotransporters NCC and NKCC1/2, serving to reduce their activation. SPAK$^{L502A/L502A}$ mice showed typical features of GS with mild hypokalaemia, hypomagnesaemia, hypocalciuria and salt-wasting hypotension. The mice also presented with decreased markers of vascular tone potentially due to effects on cardiovascular and neuronal NKCC1. These results show that SPAK binding is crucial for blood pressure control and pharmacological inhibition of this binding is an attractive anti-hypertensive strategy.
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Vieira, Suenimeire. "Estudo das adaptações morfológicas e funcionais cardíacas promovidas pela abordagem farmacológica em associação ao treinamento físico aeróbio em ratos hipertensos". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17152/tde-26042018-120135/.
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O tratamento da hipertensão arterial sistêmica (HAS) mais usual envolve uma abordagem farmacológica baseada, principalmente, na inibição do sistema renina-angiotensinaaldosterona (SRAA). Contudo, outras abordagens têm sido utilizadas com excelentes resultados, como a prescrição de exercícios físicos regulares, principalmente o aeróbio, muitas vezes como terapia coadjuvante ao tratamento farmacológico. No entanto, embora a literatura mostre que a associação dos tratamentos promova maiores reduções da pressão arterial (PA), pouco sabemos sobre os efeitos teciduais e funcionais cardíacos. Portanto, o principal objetivo do estudo foi investigar os efeitos dos tratamentos isolados e associados da inibição do SRAA e do treinamento físico aeróbio sobre a hemodinâmica, morfologia e funcionalidade cardíaca em ratos espontaneamente hipertensos (SHR), bem como sobre a reatividade do leito coronariano e contratilidade do ventrículo esquerdo. Para tanto, a tese foi dividida em dois estudos; o primeiro abordou os efeitos da hipertensão sobre os parâmetros supracitados, e as adaptações promovidas pelo treinamento físico aeróbio; enquanto que no segundo estudo comparamos os efeitos do treinamento físico aeróbio e da inibição do SRAA prescritos de forma isolada ou associada. Foram utilizados ratos Wistar (N=12) e SHR, machos, com 18 semanas de vida (N=24). Os animais foram distribuídos em três grupos: grupo de ratos Wistar normotensos (N=12), grupo de SHR (N=12) tratados com veículo (água) e grupo de SHR (N=12) tratados com maleato de Enalapril (10mg/kg/dia-1) por 10 semanas. A metade de cada grupo foi submetida ao treinamento físico aeróbio por meio da natação durante 10 semanas. Todos os grupos foram submetidos a dois protocolos experimentais; a avaliação morfofuncional do ventrículo esquerdo por meio da ecocardiografia bidimensional convencional, realizada nos animais vivos; e o estudo da reatividade do leito coronariano e da contratilidade do ventrículo esquerdo em corações isolados por meio da técnica de Langendorff. Nossos resultados mostraram que a associação do treinamento físico com o maleato de Enalapril promoveu as reduções mais expressivas da PA. Os resultados da avaliação ecocardiográfica nos animais vivos evidenciaram que os SHR apresentavam importantes alterações morfológicas quando comparados com os normotensos. O treinamento físico teve pouco efeito sobre essas alterações, ao contrário do maleato de Enalapril que modificou diversos parâmetros avaliados. Por sua vez, os resultados da técnica de Langendorff em corações isolados mostraram que os SHR apresentavam maior reatividade ao fluxo coronariano e menor pressão sistólica intraventricular. O treinamento físico e o maleato de Enalapril aumentaram a pressão sistólica intraventricular, e quando comparados, o treinamento físico apresentou maiores valores. A associação dos tratamentos não potencializou os resultados. Em conclusão, no exame ecocardiográfico o tratamento com maleato de Enalapril apresentou resultados mais proeminentes, enquanto que os efeitos do treinamento físico sobre o coração foram melhores evidenciados pela técnica de Langendorff. A associação dos dois tratamentos não apresentou efeitos adicionais sobre os parâmetros avaliados.The most common systemic arterial hypertension (HBP) treatment involves a pharmacological approach based mainly on the inhibition of the renin-angiotensin-aldosterone system (RAAS). However, other approaches have been used with excellent results, such as the prescription of regular physical exercises, mainly aerobic, often as adjunctive therapy to pharmacological treatment. However, although the literature shows that the combination of treatments promotes greater blood pressure reductions (PA), we know little about the tissue and functional effects of the heart. Therefore, the main objective of the study was to investigate the effects of isolated and associated treatments of RAAS inhibition and aerobic physical training on hemodynamics, morphology and cardiac function in spontaneously hypertensive rats (SHR), as well as on the reactivity of the coronary bed and contractility of the left ventricle. For that, the thesis was divided in two studies; The first addressed the effects of hypertension on the aforementioned parameters, and the adaptations promoted by aerobic physical training; While in the second study we compared the effects of aerobic physical training and inhibition of prescribed RAAS alone or in combination. Male Wistar rats (N = 12) and SHR, 18 weeks of age (N = 24) were used. The animals were divided into three groups: group of normotensive Wistar rats (N = 12), SHR (N = 12) group treated with vehicle (water) and SHR group (N = 12) treated with Enalapril maleate (10 mg / Kg / day-1) for 10 weeks. Half of each group underwent aerobic physical training by swimming for 10 weeks. All groups were submitted to two experimental protocols; The morphofunctional evaluation of the left ventricle using conventional two-dimensional echocardiography performed on live animals; And the study of coronary bed reactivity and left ventricular contractility in isolated hearts by the Langendorff technique. Our results showed that the association of physical training with Enalapril maleate promoted the most significant reductions in BP. The results of the echocardiographic evaluation in the live animals showed that the SHR had important morphological alterations when compared with the normotensive ones. Physical training had little effect on these alterations, unlike Enalapril maleate that modified several parameters evaluated. In turn, results from the Langendorff technique in isolated hearts showed that SHR presented higher reactivity to coronary flow and lower intraventricular systolic pressure. Physical training and Enalapril maleate increased intraventricular systolic pressure, and when compared, physical training presented higher values. The combination of the treatments did not potentiate the results. In conclusion, in the echocardiographic examination the treatment with Enalapril maleate presented more prominent results, whereas the effects of the physical training on the heart were better evidenced by the technique of Langendorff. The combination of the two treatments had no additional effects on the parameters evaluated.
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Hascoët, Sébastien. "Thérapies avancée de l'hypertension artérielle pulmonaire associée aux cardiopathies congénitales Pumpless Lung Assist as a Bridge to Medical Therapy in a Teenager With Pulmonary Arterial Hypertension and Partial Anomalous Pulmonary Venous Return Transplantation for Pulmonary Arterial Hypertension with Congenital Heart Disease: Impact of Current Therapeutic Approach Including a High-Priority Allocation Programme on Outcomes Outcome of adults with Eisenmenger syndrome treated with drugs specific to pulmonary arterial hypertension: A French multicentre study Long-term outcomesofpulmonaryarterial hypertension underspecific drugtherapyin Eisenmenger syndrome". Thesis, université Paris-Saclay, 2020. http://www.theses.fr/2020UPASQ010.
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Résumé : Les cardiopathies congénitales sont les anomalies congénitales les plus fréquentes. Grâce aux progrès dans la prise en charge chirurgicale, environ 90% des enfants ayant une cardiopathie congénitale vivent désormais jusqu’à l’âge adulte. Néanmoins, l’évolution clinique de ces patients peut être marquée par des complications, dont l’hypertension artérielle pulmonaire. Celle-ci peut se développer secondairement à l’absence ou au retard de prise en charge dans l’enfance ou à des lésions résiduelles. L’hypertension artérielle pulmonaire est associée à un pronostic altéré, essentiellement par défaillance ventriculaire. L’hypertension artérielle pulmonaire chez ces patients se caractérise par la variabilité des aspects hémodynamiques selon les lésions anatomiques sous-jacentes. Sa prise en charge demeure variable, complexe et controversée. La correction de la cardiopathie congénitale sous-jacente est recommandée ou contre-indiquée selon la sévérité de l’hypertension artérielle pulmonaire. Les traitements spécifiques médicamenteux vasodilatateurs pulmonaires pourraient être bénéfiques dans les atteintes les plus évoluées. Les patients avec atteinte terminale pourraient bénéficier de la transplantation cardio-pulmonaire. L’objectif principal de cette thèse a été d’étudier l’impact hémodynamique et sur le pronostic des différentes approches thérapeutiques avancées actuellement disponibles pour la prise en charge de l’hypertension artérielle pulmonaire associée aux cardiopathies congénitales. Ont été étudiés en particulier les traitements médicamenteux spécifiques, la correction du shunt par voie percutanée, l’assistance circulatoire et la transplantation cardio-pulmonaire. Cette thèse a permis de montrer qu’une prise en charge pro-active de l’hypertension artérielle pulmonaire chez les patients ayant une cardiopathie congénitale est associée à une amélioration des paramètres hémodynamiques, des paramètres cliniques et par une amélioration du pronostic. Les résultats de cette thèse invitent à poursuivre le recours aux thérapies avancées et leur évaluation afin d’affiner les algorithmes de prise en charge cliniqueAbstract: Congenital heart disease is the most common birth defect. Thanks to advances in surgical management, about 90% of children with congenital heart disease now live to adulthood. Nevertheless, the clinical course of these patients may be marked by complications, including pulmonary arterial hypertension. It may develop secondary to the absence or delay of treatment in childhood or to residual lesions. It is associated with an altered prognosis, primarily due to ventricular failure. Pulmonary arterial hypertension in these patients is characterized by variability in hemodynamic aspects depending on the underlying anatomical lesions. Its management remains variable, complex and controversial. Correction of underlying predisposing congenital heart disease is recommended or contraindicated depending on the degree of severity of pulmonary arterial hypertension. Specific pulmonary vasodilator drug therapies may be beneficial in more advanced disease. Patients with end stage disease may benefit from cardiopulmonary transplantation. The main objective of this thesis was to study the hemodynamic and prognostic impact of the different advanced therapeutic approaches currently available for the management of pulmonary arterial hypertension associated with congenital heart disease. Specific drug therapies, percutaneous shunt correction, circulatory support and cardiopulmonary transplant were studied. This thesis has shown that proactive management of pulmonary arterial hypertension in patients with congenital heart disease is associated with improved hemodynamic parameters, clinical parameters and improved prognosis. The results of this thesis call for further use and evaluation of advanced therapies to refine clinical management algorithms
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Prestipino, Louise. "Developmental Programming of Cardiovascular Control: How Maternal Factors Influence the Health of the Adult Offspring". Thesis, University of Sydney, 2020. https://hdl.handle.net/2123/23005.
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There is accumulating evidence that hypertension is a symptom of underlying autonomic dysfunction, including aberrant stress responses. Before autonomic activity is examined in models of hypertension, the underlying connectivity that drives stress responses under physiological conditions must be further elucidated. In Chapter 3, we examined the afferent connectivity of the dorsomedial hypothalamus (DMH) by combining retrograde tracing and Fos immunohistochemistry following air jet stress. Stress-activated, DMH-projecting neurons were located predominantly in forebrain nuclei. Total numbers of these cells were modest, suggesting that their role may involve contextual modulation of the DMH output. In chapter 4, we demonstrated that gestational dofetilide programs hypertensive offspring with impaired stress habituation. Spectral analysis provided evidence of increased sympathetic vasomotor tone. Dofetilide shares its mechanism of action with several other drugs, thus, the results emphasise the need for further research into gestational drug use and potential programming effects. In chapter 5, we present the first evidence in rodents that advanced maternal age (AMA) programs offspring with lower blood pressure. Despite the proclivity for metabolic dysfunction, AMA offspring display reduced indices of sympathetic vasomotor tone and improved baroreflex. We hypothesise that the positive influence of maternal attentiveness programs improved blood pressure regulation. In chapter 6, we present preliminary data that show the DMH is influenced by reactive oxygen species. DMH microinjection of the O2 scavenger Tempol appeared to attenuate the sympathoexcitatory effects of a GABA(A) antagonist. Data from models of programmed hypertension indicate that the hypertensive phenotype is preceded by elevated oxidative stress. If ROS stimulates excitation of the DMH, this may explain why antioxidant intervention has proven to be an effective treatment in programmed hypertension.
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Penha, Lilliam Rocha. "Mieloperoxidase em síndromes hipertensivas da gestação". Botucatu, 2017. http://hdl.handle.net/11449/149735.
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Orientador: Valéria Cristina SandrimResumo: A enzima mieloperoxidase (MPO) é caracterizada por produzir substâncias altamente reativas e é reconhecida por desencadear estresse oxidativo e disfunção endotelial mediada, em parte, pela interferência com o vasodilatador óxido nítrico. Neste estudo, nós investigamos a relação entre o óxido nítrico e a MPO in vitro incubando o plasma de gestantes saudáveis, hipertensas e com pré-eclâmpsia com células endoteliais (HUVEC). Foram observados maiores níveis de MPO no sobrenadante de células incubadas com o plasma de pacientes com pré-eclâmpsia comparado ao de células incubadas com plasma de gestantes saudáveis, e que a inibição da atividade enzimática aumentou a disponibilidade de óxido nítrico. Posteriormente, nós avaliamos a concentração e atividade da MPO no plasma de 219 gestantes saudáveis, 130 hipertensas gestacionais (com e sem terapia anti-hipertensiva) e 143 gestantes com pré-eclâmpsia (com e sem terapia anti-hipertensiva). Nós observamos que pacientes com síndromes hipertensivas e sob tratamento anti-hipertensivo apresentaram menores níveis e atividade desta enzima e, curiosamente, pacientes que tiveram o plasma coletado antes do tratamento anti-hipertensivo apresentaram níveis elevados de MPO. Nossos resultados indicam um elevado risco cardiovascular em gestantes com síndromes hipertensivas e que a MPO ativa pode ter um papel na disfunção endotelial nestas síndromes pelo comprometimento da disponibilidade do óxido nítrico. Além disso, o uso de drogas anti-hipertensivas... (Resumo completo, clicar acesso eletrônico abaixo)
Mestre
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Vieira, Liliana Batista. "Avaliação da adesão à terapêutica medicamentosa de pacientes idosos hipertensos antes e após o desenvolvimento e uso de um Sistema Eletrônico de Uso Personalizado e Controlado de Medicamentos (SUPERMED)". Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-17012014-110238/.
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Considerando que a hipertensão arterial sistêmica tem alta prevalência, baixas taxas de controle e que o risco de desenvolver a doença aumenta com a idade, este estudo teve como propósito avaliar a adesão à terapêutica medicamentosa de um grupo de pacientes idosos, hipertensos e atendidos em uma Unidade Básica de Saúde do interior do estado de São Paulo, antes e após o desenvolvimento e a utilização de um Sistema Eletrônico de Uso Personalizado e Controlado de Medicamentos (SUPERMED). Com metodologia do tipo de estudo quase experimental, prospectivo e comparativo, foram acompanhados 32 idosos hipertensos, que utilizavam pelo menos quatro medicamentos diferentes continuamente, em períodos diferentes: \"antes da implantação do SUPERMED\", no \"dia da implantação\" e \"após a implantação do SUPERMED\". Para o acompanhamento dos idosos, foram utilizados os seguintes recursos do SUPERMED: as caixas organizadoras de medicamentos, identificadas com o horário correto de utilização, os sachês de doses unitárias e um relógio com alarme. A adesão foi avaliada através do Teste de Morisky e Green, aplicado antes e após o uso do SUPERMED. Durante todo o acompanhamento dos idosos, realizou-se o controle da pressão arterial, da glicemia pós-prandial, do índice de massa corporal e da circunferência abdominal. O projeto foi provado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo e foi solicitado aos participantes da pesquisa o seu consentimento, mediante a assinatura do Termo de Consentimento Livre e Esclarecido. Todas as análises foram conduzidas com software estatístico e com o programa Microsoft Excel ®. A média da idade dos participantes do estudo foi de 71,4 anos (DP 5,6); o predomínio foi do sexo feminino (65,6%); 18,8% eram analfabetos; a média do diagnóstico de hipertensão foi de 19,4 (DP 10,1) anos e a média de medicamentos utilizados foi de 8,0 por idoso. Além da hipertensão, 75% dos idosos apresentavam diabetes melito, 75% dislipidemia e 59,4% obesidade. Após o uso do SUPERMED, a média dos valores da pressão arterial sistólica diminuiu em 21,6 mmHg (p<0,0001) e da pressão arterial diastólica em 4,7 mmHg (p<0,0001). Os resultados do Teste de Morisky e Green mostraram uma baixa adesão dos idosos antes da implantação do SUPERMED, onde 81,2% foram considerados como \"menos aderentes\". Após a implantação do SUPERMED, 96,9% foram considerados como \"mais aderentes\" (p<0,01). O uso do SUPERMED melhorou a adesão medicamentosa e diminuiu os valores da pressão arterial, proporcionando ao idoso uma segurança e uma satisfação no que diz respeito à organização e à utilização correta de seus medicamentosConsidering that the arterial systemic hypertension has a high prevalence, low control taxes and that the risk to develop the disease increases with the aging, the objective of this study was to evaluate the adherence to the drug therapy in a group of elderly patients who have hypertension and are taken care of in a Basic Health Care Unit, in the country of São Paulo state, before and after the development and the utilization of an Electronic System of Personal and Controlled Use of Medication (SUPERMED). The study was almost experimental, prospective and comparative. 32 hypertensive elders were monitored, who used continually at least four different medications, in different periods: \"before the use of SUPERMED\", at \"the day that they started using it\" and \"after the use of SUPERMED\". To monitor the elderlies, the following SUPERMED resources were used: organizing medications boxes, identified with the suitable use time, the single dose pill packs and an alarm clock. The adherence was evaluated by the Morisky and Green Test, applied before and after the use of SUPERMED. During all the monitoring, the arterial pressure and the postprandial glycemia were controlled from the body mass index and the waist circumference. The project was approved by the Ethics Committee in Research from the College of Nursing from the University of São Paulo at Ribeirão Preto and approval from the research participants was asked, followed by the signing of the Statement of Consent. All the analysis was conducted with a statistics software application and the Microsoft Excel program. The elders´ average age in the study was 71.4 years old (DP 5.6); the female gender had the prevalence (65.6%); 18.8% were illiterate; the diagnosis average of hypertension was 19.4% (DP 10.1) years and the average of drugs used per elder was 8. Besides the hypertension, 75% of the elders showed diabetes mellitus, dyslipidemia rate was 75% and 59.4% were obese. After the use of SUPERMED, the systolic arterial pressure values\' average decreased in 21.6 mmHg (p<0.0001) and the diastolic arterial pressure in 4.7 mmHg (p<0.0001). The Morisky and Green Test results showed a low adherence before SUPERMED was implanted, where 81.2% of the elders were considered \"less adherent\". After it was implanted, 96.9% were considered \"more adherent\" (p<0.01). The use of SUPERMED improved the medication adherence and decreased the arterial pressure values, providing the elders with safety and satisfaction about the organization and the proper use of their medications
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"Haemodynamic effects of different anti-hypertensive drugs". Chinese University of Hong Kong, 1995. http://library.cuhk.edu.hk/record=b5888527.
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Lau Siu Wai Maggie.Thesis (M.Phil.)--Chinese University of Hong Kong, 1995.
Includes bibliographical references (leaves 236-245).
List of Figures --- p.i
List of Tables --- p.viii
List of Abbreviations --- p.x
Abstract --- p.xii
Chapter Chapter 1 --- Introduction --- p.1
Chapter 1.1 --- Postulated Pathophysiology of Essential Hypertension --- p.1
Chapter 1.2 --- Measurement of Cardiac Output (CO) by Transthoracic Electrical Bioimpedance (TEB) and Other Methodologies --- p.6
Chapter 1.3 --- Measurement of Blood Pressure --- p.10
Chapter 1.4 --- Use of Antihypertensive Agents in Essential Hypertension --- p.12
Chapter Chapter 2. --- The Method of Transthoracic Electrical Bioimpedance --- p.15
Chapter 2.1 --- Introduction --- p.15
Chapter 2.2 --- Development of Theory --- p.18
Chapter 2.3 --- Measurements of Haemodynamic Parameters --- p.24
Chapter 2.4 --- Literature Review - Validity of the Technique --- p.30
Chapter Chapter 3 --- A Study on Reproducibility of Thoracic Electrical Bioimpedance in Healthy Subjects --- p.39
Chapter 3.1 --- Objectives --- p.39
Chapter 3.2 --- Methodology --- p.39
Chapter 3.2.1 --- Subjects --- p.39
Chapter 3.2.2 --- Study design --- p.41
Chapter 3.2.3 --- Non-invasive haemodynamic monitoring --- p.41
Chapter 3.2.4 --- Blood Pressure Measurement --- p.43
Chapter 3.2.5 --- Isometric Exercise --- p.43
Chapter 3.2.6 --- Data analysis --- p.44
Chapter 3.2.7 --- Statistical analysis --- p.46
Chapter 3.3 --- Results --- p.50
Chapter 3.3.1 --- Systolic blood pressure --- p.50
Chapter 3.3.2 --- Diastolic blood pressure --- p.52
Chapter 3.3.3 --- Mean arterial pressure --- p.54
Chapter 3.3.4 --- Heart rate --- p.55
Chapter 3.3.5 --- Thoracic fluid index --- p.58
Chapter 3.3.6 --- Stroke index --- p.60
Chapter 3.3.7 --- Cardiac index --- p.62
Chapter 3.3.8 --- Systemic vascular resistance index --- p.65
Chapter 3.4 --- Discussion --- p.70
Chapter Chapter 4 --- Literature Review --- p.73
Chapter 4.1 --- Atenolol: Beta-adrenoceptor antagonists with β1-selectivity --- p.73
Chapter 4.2 --- Pindolol: Beta-adrenoceptor antagonists with ISA --- p.78
Chapter 4.3 --- Alpha1-adrenoceptor antagonists --- p.81
Chapter 4.4 --- Angiotensin Converting Enzyme Inhibitors --- p.84
Chapter 4.5 --- Calcium Channel Blockers --- p.87
Chapter 4.6 --- Central Alpha Agonist --- p.91
Chapter 4.7 --- Thiazide Diuretics --- p.94
Chapter Chapter 5 --- The Integrated Hypertension Study --- p.97
Chapter 5.1 --- Objectives --- p.97
Chapter 5.2 --- Methodology --- p.97
Chapter 5.2.1 --- Subjects --- p.97
Chapter 5.2.2 --- Study design --- p.109
Chapter 5.2.3 --- Non-invasive haemodynamic monitoring --- p.110
Chapter 5.2 4 --- Blood Pressure Measurement --- p.111
Chapter 5.2.5 --- Isometric Exercise --- p.111
Chapter 5.2.6 --- Data analysis --- p.111
Chapter 5.2.7 --- Statistical analysis --- p.112
Chapter 5.2.8 --- Limitations of the study --- p.113
Chapter 5.3 --- Results --- p.117
Chapter 5.3.1 --- Atenolol --- p.117
Chapter 5.3.2 --- Pindolol --- p.125
Chapter 5.3.3 --- Doxazosin --- p.132
Chapter 5.3.4 --- Enalapril --- p.138
Chapter 5.3.5 --- Nifedipine Retard --- p.145
Chapter 5.3.6 --- Methyldopa --- p.152
Chapter 5.3.7 --- Cyclopenthiazide --- p.160
Chapter 5.4 --- Comparisons of the anti-hypertensive drugs studied --- p.167
Chapter 5.4.1 --- Baseline values --- p.167
Chapter 5.4.2 --- Percentage changes after active treatment --- p.170
Chapter 5.5 --- Discussion --- p.196
Chapter 5.5.1 --- Atenolol --- p.196
Chapter 5.5.2 --- Pindolol --- p.199
Chapter 5.5.3 --- Doxazosin --- p.200
Chapter 5.5.4 --- Enalapril --- p.202
Chapter 5.5.5 --- Nifedipine Retard --- p.203
Chapter 5.5.6 --- Methyldopa --- p.204
Chapter 5.5.7 --- Cyclopenthiazide --- p.205
Chapter 5.5.8 --- Comparison of the anti-hypertensive drugs studied --- p.206
Chapter Chapter 6 --- Acute haemodynamic effects of Atenolol and Pindolol --- p.208
Chapter 6.1 --- Objectives --- p.208
Chapter 6.2 --- Methodology --- p.208
Chapter 6.2.1 --- Subjects --- p.208
Chapter 6.2.2 --- Study Design --- p.209
Chapter 6.2.3 --- Statistical analysis --- p.209
Chapter 6.3 --- Results --- p.211
Chapter 6.3.1 --- Acute haemodynamic changes of atenolol --- p.211
Chapter 6.3.2 --- Acute and short-term haemodynamic changes of atenolol --- p.219
Chapter 6.3.3 --- Acute haemodymmic changes of pindolol --- p.221
Chapter 6.3.4 --- Acute and short-term haemodymmic changes of pindolol --- p.222
Chapter 6.3.5 --- Comparison of the acute haemodymmic effects of atenolol and pindolol --- p.226
Chapter 6.4 --- Discussion --- p.230
Chapter Chapter 7 --- Conclusion --- p.232
References --- p.236
Acknowledgements