European Society of Hypertension 2013 Hypertension guidelines presentation in...JAFAR ALSAID
Summary of the European Society of Hypertension 2013 Hypertension Guidelines presented during the Eighth Hypertension and Cardiovascular highlight session in Bahrain on Sept. 11th 2013.
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
European Society of Hypertension 2013 Hypertension guidelines presentation in...JAFAR ALSAID
Summary of the European Society of Hypertension 2013 Hypertension Guidelines presented during the Eighth Hypertension and Cardiovascular highlight session in Bahrain on Sept. 11th 2013.
Hypertension is a silent, invisible killer that rarely causes symptoms. Increasing public awareness is key, as is access .Raised blood pressure is a warning sign that significant lifestyle changes are urgently needed. People need to know why raised blood pressure is dangerous, and how to take steps to control it.
This is a copy of our first newsletter for Humboldt County Nevada volunteers, potential volunteers, and clients. It includes links to our Facebook page and our twitter page so they can follow, like and share with their friends.
SYSTEMIC HYPERTENSION AND SCOPE OF HOMOEOPATHY
Dr. Smita Brahmachari
Abstract:
Hypertension (HTN) is an enormous health problem and is one of the biggest health challenges in the 21st century. Although the condition is common, readily detectable, and easily treatable, it is usually asymptomatic and often leads to lethal complications if left untreated. The prevalence of HTN is increasing rapidly in India driven by diverse health transitions. Apart from health implications it has huge societal, developmental and economic costs to resource constrained health systems, particularly developing nations like India. Further, hypertension is also a leading cause for hospitalizations and outpatient visits.
Reducing systolic and diastolic BP can decrease cardiovascular risk and this can be achieved by non-pharmacological (lifestyle measures) as well as pharmacological means (medicines). Homoeopathic system of medicine particularly individualized constitutional approach has significant beneficial effects on patients suffering from HTN and thus widely used in length and breadth of our nation as an alternative public health approach in curbing the increasing prevalence of HTN because of its cost effectiveness and minimal side effects.
In current scenario with rising burden of HTN posing a serious health threat to health care system of India, the present article makes a sincere attempt to present before its readers how to timely and effectively address a case of HTN at primary level health care set-up with homoeopathic medicines.
Author : The author has done her post-graduation from National Institute of Homoeopathy, Kolkata in the subject Homoeopathic Repertory. She is presently working as Medical Officer in Dept. of ISM &Homoeopathy under Govt. of NCT Delhi.
E-mail id: smita.brahmachari@rediffmail.com.
Blood Pressure Management in Cardiovascular Protection by DR Nasir Uddin.pptxNasir Sagar
High Blood pressure has multiple adverse reaction on different body system and its proper management causes beneficial effect in multiple co morbid condition.
“La sfida urgente di proteggere la nostra casa comune comprende la preoccupazione di unire tutta la famiglia umana nella ricerca di uno sviluppo sostenibile e integrale, poiché sappiamo che le cose possono cambiare.”
.”Drssa Giorgina Piccoli
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
lessandro Antonelli: CONTROLLO OTTIMALE DELLA PRESSIONE ARTERIOSA dal congresso di Foligno del Gruppo Ipertensione della SIN
1. Dr. A.Antonelli SIN GI
CONTROLLO OTTIMALE DELLA
PRESSIONE ARTERIOSA
Alessandro Antonelli
U.O Nefrologia
Ospedale Campo di Marte - Lucca
2° Corso Interattivo di Aggiornamento
sulla “Ipertensione Arteriosa”
IL DANNO D’ORGANO
Foligno, 23-24 Ottobre 2003
Dr. A.Antonelli SIN GI
Da oltre cento anni, da quando
l’ipertensione fu chiaramente distinta
dalla Malattia di Bright, si discute sul
livello di pressione arteriosa da
considerare patologico
• “ Non esiste
una vera demarcazione. Quanto più è elevata la
pressione, tanto peggiore è la prognosi “ Pickering 1972
• “L’ipertensione è il livello al quale i benefici dell’intervento
superano quelli dell’astensione “ Rose 1980
1
2. Dr. A.Antonelli SIN GI
“ L’Ipertensione arteriosa è il
livello di pressione per il quale i
benefici (meno i rischi ed i costi )
dell’azione sono superiori ai rischi e
ai costi
( meno i benefici )
dell’astensione “
Kaplan 1998
Dr. A.Antonelli SIN GI
Prevalenza ipertensione %
Prevalenza di ipertensione arteriosa
in rapporto ad età e razza negli USA
Maschi
80
70
60
50
Neri
Bianchi
Ispanici
40
30
20
10
0
18-29
30-39
40-49
50-59
Età anni
60-69
70-79
> 80
NHANES III, Hypertension 1995
2
3. Dr. A.Antonelli SIN GI
Prevalenza ipertensione %
Prevalenza di ipertensione arteriosa
in rapporto ad età e razza negli USA
Femmine
90
80
70
60
50
40
30
Neri
Bianchi
Ispanici
20
10
0
18-29
30-39
40-49
50-59
60-69
70-79
Età anni
> 80
NHANES III, Hypertension 1995
Dr. A.Antonelli SIN GI
50
Cardiopatia
ischemica
normotesi
N° eventi/2anni/1000 persone
ipertesi
40
30
20
Scompenso
cardiaco
Arteriopatie
periferiche
Ictus
10
0
OR
M
F
22.7-11.8
M
9.1-3.8
F
M
F
4.9-5.3
M
F
10.4-4.2
Kannel WB, JAMA 1996
3
4. Dr. A.Antonelli SIN GI
Multiple Risk Factor Intervention Trial
Causes of death, RR
3,5
3,2
3
2,5
2,5
2
3,0
2,8
2,3
1,5
1
0,5
0
All
deaths
CHD
Stroke
Other
CVDs
All CV
deaths
Stamler J. et al., Diabetes Care, 1993
Dr. A.Antonelli SIN GI
Riduzione percentuale dei tassi di
mortalità corretti per l’età negli USA
%
1972
1975
1980
1985
1990
1995
10
0
-10
Malattie non CV
-20
-30
-40
-50
Ictus
Cardiopatia
Ischemica
-60
-70
National Center for Health Statistics, 1997
4
5. Dr. A.Antonelli SIN GI
Trials exploring the
optimal drug
Trials comparing more
intensive and less
intensive blood
pressure lowering
strategies
Dr. A.Antonelli SIN GI
Prospectively designed overviews of randomised trials
Trials comparing more intensive and less intensive blood
pressure lowering strategies
ABCD-hypert
HOT
UKPDS-HDS
SBP
-6
-3
-10
DBP
-8
-3
-5
follow-up
5
4
8
Blood Pressure Lowering Treatment Trialist’ Collaboration, The Lancet, 356, 2000
5
6. Dr. A.Antonelli SIN GI
Prospectively designed overviews of randomised trials
Trials comparing more intensive and less intensive blood
pressure lowering strategies
Stroke
0.80 (0.65-0.98)
CHD
0.81 (0.67-0.98)
HF
0.78 (0.53-1.15)
Major CV events
0.85 (0.76-0.96)
CV deaths
0.90 (0.75-1.09)
Total mortality
0.97 (0.85-1.11)
0.5
1
Favours more
intensive
Relative risk
2
Favours less
intensive
Blood Pressure Lowering Treatment Trialist’ Collaboration, The Lancet, 356, 2000
Dr. A.Antonelli SIN GI
HOT Study: Significant Benefit from
Intensive Treatment in the Diabetic Subgroup
25
20
Major
cardiovascular 15
events/1,000
patient-years
10
p = 0.005 for trend
5
0
≤ 90
≤ 85
≤ 80
mmHg
Target Diastolic Blood Pressure
Hansson L et al. Lancet 1998;351:1755-1762.
6
7. Dr. A.Antonelli SIN GI
Trials exploring the
optimal drug
Trials comparing
active treatment and
placebo
Dr. A.Antonelli SIN GI
Prospectively designed overviews of randomised trials
ACE-inhibitor-based therapy vs placebo
HOPE
PART2
QUIET
SCAT
SBP
-3
-6
---4
DBP
-1
-4
---3
follow-up
5
4
2
5
Blood Pressure Lowering Treatment Trialist’ Collaboration, The Lancet, 356, 2000
7
8. Dr. A.Antonelli SIN GI
Prospectively designed overviews of randomised trials
ACE-inhibitor-based therapy vs placebo
Stroke
0.70 (0.57-0.85)
CHD
0.80 (0.72-0.89)
HF
0.84 (0.68-1.04)
Major CV events
0.79 (0.73-0.86)
CV deaths
0.74 (0.64-0.85)
Total mortality
0.84 (0.76-0.94)
0.5
1
Favours ACEs
Relative risk
2
Favours placebo
Blood Pressure Lowering Treatment Trialist’ Collaboration, The Lancet, 356, 2000
Dr. A.Antonelli SIN GI
Effects of ramipril on cardiovascular and microvascular
outcomes in people with diabetes mellitus: results of the
HOPE study and MICRO-HOPE substudy.
combined
primary
0
-5
myocardial stroke
cardio-
infarction
vascular mortality
outcome
25%
total
revascularization
death
22%
33%
37%
overt
nephro-
heart
failure
pathy
24%
17%
24%
20%
-10
-15
p=0.031
-20
-25
-30
-35
-40
%
p=0.019
p=0.01
p=0.004
p=0.000
4
p=0.0074
p=0.027
p=0.0001
HOPE Study Investigators, The Lancet, 2000
8
9. Dr. A.Antonelli SIN GI
Prospectively designed overviews of randomised trials
Calcium-antagonist-based therapy vs placebo
PREVENT
SYST-EUR
SBP
-5
-10
DBP
-4
-5
follow-up
3
2
Blood Pressure Lowering Treatment Trialist’ Collaboration, The Lancet, 356, 2000
Dr. A.Antonelli SIN GI
Prospectively designed overviews of randomised trials
Calcium-antagonist-based therapy vs placebo
Stroke
0.61 (0.44-0.85)
CHD
0.79 (0.50-1.06)
HF
0.72 (0.48-1.07)
Major CV events
0.72 (0.59-0.87)
CV death
0.72 (0.52-0.98)
Total mortality
0.87 (0.70-1.09)
0.5
Favours CCBs
1
Relative risk
2
Favours placebo
Blood Pressure Lowering Treatment Trialist’ Collaboration, The Lancet, 356, 2000
9
10. Dr. A.Antonelli SIN GI
Prospectively designed overviews of randomised trials
ACE-inhibitors vs
Calcium antagonists:
a comparison “at
distance”
Stroke
CHD
HF
Major CV events
CV death
Total mortality
0.5
Favours ACEc/CCBs
1
Relative risk
2
Favours placebo
Blood Pressure Lowering Treatment Trialist’ Collaboration, The Lancet, 356, 2000
Dr. A.Antonelli SIN GI
Cause principali di nuovi casi di ESRD negli
USA (1997)
Glomerulonefriti
9%
Altre cause
Altre cause 10%
urologiche
2%
Cisti
2%
Diabete
43%
Cause non
note
9%
Ipertensione
25%
USRDS 1999
Renal Data Report
10
11. Dr. A.Antonelli SIN GI
Ruolo dell’ipertensione arteriosa nel
determinare il danno renale
Ipertensione arteriosa
(stadio III)
Ipertensione arteriosa
(stadio I- II)
Fino a 10 anni fa
prevaleva l’idea che
fosse una situazione
innocua per il rene
Ben documentato
Dr. A.Antonelli SIN GI
<100
80
100-110
60
%
>110
40
0
2
4
Time, years
6
8
MAP, mmHg
Probability of survival
100
10
Renal survival probability in 423 patients with non diabetic renal
disease and chronic renal failure
Oldrizzi L, Am J Kidney Dis 1993
11
12. Dr. A.Antonelli SIN GI
% Ipertesi in Trattamento
% Ipertesi Controllati
Controllati
24%
47%
53%
29%
Non controllati
Non trattati
Trattati
Burt et al; Hypertension 95
Dr. A.Antonelli SIN GI
Qual’ è la prevalenza del controllo
ottimale dell’ipertensione arteriosa in
Italia ?
1 - 50%
2 - 32%
3 - 24%
12
13. USA
Canada
27 %
Italia
24 %
Germania
Dr. A.Antonelli SIN GI
Australia
16 %
Inghilterra
India
9 %
Finlandia
22.5 %
19 %
9 %
Spagna
20.5 %
20 %
Marques Am J Hypertens 2000
Dr. A.Antonelli SIN GI
Stratification of Risk to Quantify Prognosis
1999 WHO-ISH Guidelines for the Managenent of Hypertension
Other Risk Factors &
Disease History
Grade 1
(mild)
Grade 2
(moderate)
Grade 3
(severe)
SBP 140-159 or
DBP 90-99
SBP 160-179 or
DBP 100-109
SBP >180 or
DBP >110
I.
no other risk factors
LOW RISK
MED RISK
HIGH RISK
II.
1-2 risk factors
MED RISK
MED RISK
V HIGH RISK
HIGH RISK
HIGH RISK
V HIGH RISK
V HIGH RISK
V HIGH RISK
V HIGH RISK
III. 3 or more risk factors
or TOD or diabetes
IV.
ACC
TOD - Target Organ Damage
ACC - Associated Clinical Conditions, including clinical CVD or renal disease
13
14. Dr. A.Antonelli SIN GI
Stratification of Risk to Quantify Prognosis
1999 WHO-ISH Guidelines for the Managenent of Hypertension
Other Risk Factors &
Disease History
Grade 1
(mild)
Grade 2
(moderate)
SBP 140-159 or SBP 160-179 or
DBP 90-99
DBP 100-109
Grade 3
(severe)
SBP >180 or
DBP >110
I.
no other risk factors
Lifestyle 12
Drug therapy
Drug therapy
II.
1-2 risk factors
Lifestyle 6
Drug therapy
Drug therapy
III. 3 or more risk factors
or TOD or diabetes
Drug therapy
Drug therapy
Drug therapy
IV.
Drug therapy
Drug therapy
Drug therapy
ACC
TOD - Target Organ Damage
ACC - Associated Clinical Conditions, including clinical CVD or renal disease
Dr. A.Antonelli SIN GI
Stratification of Risk to Quantify Prognosis
1999 WHO-ISH Guidelines for the Managenent of Hypertension
Other Risk Factors &
Disease History
HighNormal
Grade 1
(mild)
Grade 2
(moderate)
Grade 3
(severe)
Drug therapy
SBP 130-139 SBP 140-159 or SBP 160-179 or SBP >180 or
DBP 85-89
DBP 90-99
DBP 100-109
DBP >110
I.
no other risk factors
Lifestyle
Lifestyle 12
Drug therapy
II.
1-2 risk factors
Lifestyle
Lifestyle 6
Drug therapy Drug therapy
III. 3 or more risk factors
or TOD or diabetes
Drug therapy
Drug therapy
Drug therapy Drug therapy
IV.
Drug therapy
Drug therapy
Drug therapy Drug therapy
ACC
TOD - Target Organ Damage
ACC - Associated Clinical Conditions, including clinical CVD or renal disease
14
15. Dr. A.Antonelli SIN GI
Stratification of Risk to Quantify Prognosis
European Society of Hypertension Guidelines 2003
Altri fattori di rischio
e anamnesi
I.no other risk factors
Normale
Normale alta
Grado 1
Grado 2
PAS 120-129 PAS 130-139 PAS 140-159 PAS 160-179
o PAD 80-84
RANGE RISK
o PAD 85-89
RANGE RISK
LOW RISK
MED RISK
LOW RISK
MED RISK
MED RISK
II.1-2 risk factors
LOW RISK
III.3 or more risk factors
or TOD or diabetes
MED RISK
HIGH RISK
IV ACC
HIGH RISK
V HIGH RISK
Grado 3
PAS >180
o PAD 90-99 o PAD 100-109 DBP >110
HIGH RISK
V HIGH RISK
HIGH RISK
V HIGH RISK
HIGH RISK
V HIGH RISK
V HIGH RISK
V HIGH RISK
TOD - Target Organ Damage
ACC - Associated Clinical Conditions, including clinical CVD or renal disease
Dr. A.Antonelli SIN GI
Soglia di
intervento
Obiettivi del
trattamento
PAS
PAD
PAS
PAD
National Joint Committee VI
1997
In presenza di proteinuria>1g/24h
130
85
<130
<125
<85
<75
Italian Hypertension Guidelines
140
90
<130
<85
140
90
140
90
<130
<130
<125
<135
<125
<85
<80
<75
<85
<75
140
90
<130
<80
1999
World Health Organization &
International Society of Hypertens 1999
In presenza di proteinuria<1g/24h
In presenza di proteinuria>1g/24h
German Hypertension Guidelines
In presenza di proteinuria>1g/24h 2002
American Diabetes Association
2002
15
16. Dr. A.Antonelli SIN GI
Quali sono i valori ottimali della
pressione arteriosa secondo i
criteri del JNC VII ?
1 - < 129/84 mmHg
2 - < 120/80 mmHg
3 - < 140/90 mmHg
Dr. A.Antonelli SIN GI
The Seventh report of the Joint National Committee
on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure
Classification and Management of Blood Pressure
Normal
With
compelling
indications
Stage 1
Hypertension
Stage 2
hypertension
SBP <120
DBP <80
Lifestyle
modification
Prehypertension
SBP 120-139
DBP 80-89
SBP 140-159
DBP 90-99
SBP >159
DBP >99
Encourage
Yes
Yes
Yes
Drug(s) for the
compelling
indications
Drug(s) for the
compelling
indications
Drug(s) for the
compelling
indications
The JNC 7 Report, JAMA 289: 2560-2572, 2003
16
17. Dr. A.Antonelli SIN GI
The Seventh report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure
Compelling Indications for Individual Drug Classes
High-Risk
Conditions with
compelling
indications
Diuretic
ß-Blocker
ACE
inhibitor
ARB
CCB
Aldosterone
antagonist
Heart failure
Post-myocardial
infarction
High coronary
disease risk
DIABETES
Chronic kidney
disease
Recurrent
stroke
prevention
The JNC 7 Report, JAMA 289: 2560-2572, 2003
Dr. A.Antonelli SIN GI
Quali dei seguenti sono fattori
utilizzati per la stratificazione del
rischio cardiovascolare ?
1
2
3
4
5
6
- Dislipidemia
- Abitudine al fumo
- Microalbuminuria
- Obesità addominale
- Nefropatia Diabetica
- Proteina C Reattiva
17
18. Dr. A.Antonelli SIN GI
Factors influencing prognosis
Risk factors for cardiovascular disease used for
stratification
• Levels of systolic and diastolic BP
• Men >55 years
• Women > 65 years
• Smoking
• Dyslipidaemia
(total cholesterol >6.5 mmol/l, >250 mg/dl,
or LDL-cholesterol > 4.0 mmol/l, >155 mg/dl,
or HDL-cholesterol M < 1.0,W < 1.2 mmol/l,
M < 40,W < 45 mg/dl)
• Family history of premature cardiovascular disease
(at age < 55 years M, < 65 years W)
• Abdominal obesity
(abdominal circumference M > 102 cm, W> 88 cm)
• C-reactive protein >1 mg/dl
TARGET ORGAN DAMAGE
Dr. A.Antonelli SIN GI
• Left ventricular hypertrophy
(electrocardiogram:
Sokolow–Lyons .38 mm; Cornell .2440 mm_ms;
echocardiogram:
LVMI M > 125, W> 110 g/m2)
• Ultrasound evidence of arterial wall thickening
(carotid IMT > 0.9 mm) or atherosclerotic
plaque
• Slight increase in serum creatinine
(M 115–133,W 107– 124 _mol/l;
M 1.3–1.5,W1.2–1.4 mg/dl)
• Microalbuminuria
(30–300 mg/24 h; albumin–creatinine
ratio M > 22,W >31 mg/g;
M > 2.5,W > 3.5 mg/mmol)
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19. Clinical Conditions Associated
Dr. A.Antonelli SIN GI
• Cerebrovascular disease:
ischaemic stroke;
cerebral haemorrhage;
transient ischaemic attack
• Heart disease:
myocardial infarction;
angina;
coronary revascularization;
congestive heart failure
• Renal disease:
diabetic nephropathy;
renal impairment
(serum creatinine M >133, W>124 umol/l;M
>1.5,W>1.4 mg/dl)
proteinuria (>300 mg/24 h)
• Peripheral vascular disease
• Advanced retinopathy:
haemorrhages or exudates,
papilloedema
CONCLUSIONI
Hypertension:
Dr. A.Antonelli SIN GI
“test of vascular health”
“important target in the prevention of
cardiovascular disease”
T.D. Giles New York ASH 15/5/2003
• Le nostre conoscenze sull’ipertensione arteriosa sono
notevolmente aumentate negli anni ed è il momento di
valorizzarle trasformandole in comportamenti di buona
pratica clinica.
• Le linee guida diagnostiche terapeutiche delle diverse
comunità scientifiche rappresentano una ulteriore risorsa
per raggiungere il controllo ottimale della pressione
arteriosa.
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