Antihypertensive medication in metabolic syndrome
Victor A. Voicu
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Antihypertensive agents are – by means of their pharmacodynamics diversity – inevitably targeted at various, complex and interrelated bonds involved in the homeostasis of blood pressure. Realistically speaking, the therapeutic approach of arterial hypertension in the context of metabolic syndrome, whether it is considered a risk factor or a disease, a pathological entity, includes without exception comorbidities, known for being generally present under different practical connotations. This context is a limiting factor for the freedom of choosing among various available antihypertensive drugs. The antihypertensive treatment plan will certainly differ from a patient with essential hypertension and no significant comorbidities to other patients suffering from multiple comorbidities such as chronic limb ischemia, kidney failure, asthma, heart failure, metabolic syndrome, diabetes mellitus, history of cerebrovascular accident, or myocardial infarction, ischemic cardiomyopathy, depressive disorder and so on. What are the pathological issues of metabolic syndrome? What would determine certain restrictions in the antihypertensive treatment options, absolute or relative contraindications, avoidance of pharmacological interactions, and so forth? Restrictions apply to whether direct or indirect consequences regarding pharmacotherapeutic effects, the result of pharmacokinetic processes’ biotransformation (metabolism, excretion) of specifically recommended medications. We emphasize the fact that hypertension is part of the metabolic syndrome conceptual definition.
J Hypertens Res (2020) 6(3):59–66 [download PDF]
Controlling high blood pressure by treating obstructive sleep apnoea in patients with metabolic syndrome
Florin Mihaltan *, Constantin Ancuta, Cosei Valentin, Corina Borcea
Department of Pneumology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Systemic hypertension and obstructive sleep apnoea (OSA) are frequently associated with metabolic syndrome. These comorbidities are important for the evolution, prognosis and therapeutic opportunities. In this review, the authors are aiming to analyze the epidemiological data of this combined syndrome and also to identify the benefits of continuous positive airway pressure (CPAP), weight reduction, and diet on systemic hypertension and metabolic syndrome.
J Hypertens Res (2020) 6(2):67–71 [download PDF]
Medication adherence in patients with hypertension monitored in four GPs’ offices
Mihaela Daniela Balta1, Daciana Toma2 *, Raluca Sfetcu3,4
1 Carol Davila University of Medicine and Pharmacy Bucharest, Romania
2 Private Practice “Dr. Toma Daciana”, Bucharest, Romania
3 National School of Public Health, Management and Professional Development
4 Spiru Haret University, Bucharest, Romania
The prevalence of hypertension is high worldwide, with about one in two people having high blood pressure. Patients’ adherence and persistence to treatment is an issue of particular concern to the family physician, who is in closest contact with the patient and his family. We aimed to evaluate the prevalence of hypertension and adherence to medication in a group of patients from the offices of four family doctors in Bucharest. We analyzed the medication adherence of 1652 patients with hypertension (HTN) by calculating the proportion of days covered (PDC) by prescription of at least one drug, and we have considered the patients adherent at a rate of 80% or above. We have also analyzed how the adherence varied based on the age of the patients and on the duration of the prescription issued by the general practitioner (GP). We have found a general HTN prevalence of 34,95%. Among the patients with HTN, 47.7% have been found to be medication adherent, while 20.3% of patients had 0 days covered by medication. The most frequent type of prescription issued was the longer duration one, valid for 3 months (23.3%), followed closely by the shorter-term ones - the 1-month prescriptions (20.4%). An increase in age was associated with an increase in the adherence rate. Our results indicate that more intensive efforts should be made to increase the adherence of patients HTN and that issuing long-term prescriptions could be one recommended intervention.
J Hypertens Res (2020) 6(2):72–77[download PDF]
The physical rehabilitation for the patients with metabolic syndrome
Carmen Iliana Busneag1,2,3 *
1 Kinetic Therapy and Special Motricity, ”Spiru Haret” University, Bucharest, Romania
2 Individual Medical Office ”Dr. Busneag Carmen”, Bucharest, Romania
3 Medical Department of National Romanian Television, Bucharest, Romania
Metabolic syndrome is a complex chronic disease that requires continuous medical care and in which, beyond glycemic and cardiovascular control, many strategies to reduce multifactorial risks are required. Moderate or intense exercise is recommended by the American Diabetes Guide at all stages of diabetes and metabolic syndrome being able to prevent complications of the disease and optimize the quality of life of patients. Movement therapy works on the pathogenic links of diabetes, hypertension, and ischemic heart disease, improving mobility, strengthening muscles, and improving the coordination and balance of these patients. The present paper specifies the practical aspects of establishing and individualizing kinetic programs in metabolic syndrome, trying to answer the questions: how much, how, and in what way is physical rehabilitation in metabolic syndrome patients performed? The principles of the kinetic programs are presented, but also the basic rules for the application of the rehabilitation program and, of course, the ways of achieving the isotonic or isometric effort in the patient with diabetes/metabolic syndrome. Of course, the contraindications and the precautions related to the physical training of metabolic syndrome patients cannot be missing.
J Hypertens Res (2020) 6(2):78–84 [download PDF]
A comprehensive lifestyle intervention for a patient with morbid obesity and associated metabolic disorders
Anca Hancu *
Nutriscience Clinic, Bucharest, Romania
The new concept of cardiometabolic-based chronic disease is highlighting the key role played by adiposity in further metabolic alterations. In the context of pandemic obesity, morbid obesity treatment represents a challenge. Lifestyle recommendations are the first step in the prevention and delay of metabolic alterations and obesity. This paper presents the case of a patient with morbid obesity, which achieved not only a significant minus 40 kg weight reduction but also a metabolic profile improvement and blood pressure stabilization without prior treatment. How lifestyle medicine principles have been used to achieve this success is outlined below. Also, the importance of the doctor-patient relationship where the doctor acts as a role model will be emphasized in the article.
J Hypertens Res (2020) 6(2):85–91 [download PDF]
Physiopathology of unstable angina in hypertensive patients and clinical risk assessment
Sorin Stefan Popescu1 *, Aura Elena Vijiiac2,3, Maria Dorobantu2,3
1 Carol Davila University of Medicine and Pharmacy Bucharest, Romania
2 Department of Cardiology, “Carol Davila” University of Medicine and Pharmacy, Clinical Emergency Hospital, Bucharest, Romania
3 Department of Cardiology, Clinical Emergency Hospital, Bucharest, Romania
Unstable angina in patients exhibiting acute coronary syndromes without persistent ST-segment elevation is one of the major diagnostic and prognostic challenges that cardiologists worldwide are faced with, due to its multiple definitions and the difficulty related to a standardized evaluation. Long-term arterial hypertension represents a major risk factor for atherosclerotic disease, thus being an important risk factor and prognostic marker in acute coronary syndromes. In this article, we shall describe the physiopathological relationship between acute coronary syndromes and arterial hypertension and review the efficacy of Braunwald’s classification of unstable angina as a reliable prognostic tool in these patients.
J Hypertens Res (2020) 6(2):92–98 [download PDF]