Hypertension and Stroke: Update on Treatment

Wajngarten, Maurı́cio; Silva, Gisele Sampaio

doi:10.15420/ecr.2019.11.1

Cited by 209 publications

(166 citation statements)

References 58 publications

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“…2 In the majority of cases, stroke is the result of multiple underlying risk factors including hypertension, obstructive sleep apnea, dyslipidemia, atrial fibrillation, and genetic disorders, for example, sickle cell disease (SCD). [10][11][12][13][14] There are two main types of stroke: acute ischemic or hemorrhagic stroke, with the former bringing ten times more prevalent than the latter, but the latter having worse prognosis. 15 Acute ischemic stroke is further classified into etiologic subtypes such as cardioembolic, atherosclerotic, lacunar, cryptogenic, and unusual cases (eg, vasculitis, dissection, drug abuse, SCD, Alzheimer's disease).…”

Section: Strokementioning

confidence: 99%

“…In the United States alone, almost 800,000 stroke‐related events occur each year 2 . In the majority of cases, stroke is the result of multiple underlying risk factors including hypertension, obstructive sleep apnea, dyslipidemia, atrial fibrillation, and genetic disorders, for example, sickle cell disease (SCD) 10‐14 . There are two main types of stroke: acute ischemic or hemorrhagic stroke, with the former bringing ten times more prevalent than the latter, but the latter having worse prognosis 15 .…”

Section: Introductionmentioning

confidence: 99%

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The impact of thrombo‐inflammation on the cerebral microcirculation

Ansari

Gavins

2021

Microcirculation

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Cerebrovascular diseases include a number of conditions that involve thrombosis and inflammation, including stroke, intracranial stenosis, aneurysms, carotid and vertebral stenosis, and vascular malformations. Ischemic stroke is one of the leading causes of morbidity and mortality worldwide, and the leading cause of adult disability, resulting in a significant socioeconomic burden. 1,2 Rapid recanalization with intravenous thrombolysis or endovascular thrombectomy is the mainstay of current and evolving acute ischemic stroke management. 3 However, there is limited indication of rapid recanalization therapies due to a shorter time window and availability of stroke centers, and a large number of patients with ischemic stroke receive no acute therapy resulting in significant residual neurological damage, a long-term recovery period, and further risk of recurrent events and complications. 4 Therefore, there is a rapidly growing clinical need of additional therapies which may not be time-sensitive and can be given to a wider number of stroke patients and in nonspecialty centers. In recent years, there has been a considerable advancement in the research and development of neuroprotective and anti-inflammatory agents as potential adjunctive therapies in both pre-clinical clinical models. 5,6 In our own work, we have shown that pharmacologically targeting the Annexin A1/formyl peptide receptor (FPR)-2 pathway can significantly attenuate cerebrovascular thrombo-inflammation by modifying neutrophil-platelet phenotype from pro-inflammatory to pro-resolutory. 7,8 The cerebral microcirculation (comprising of neurovasculature within the brain <100 μm in diameter) is the most critical part of neurovascular bed, providing all metabolic needs to the cerebral parenchyma.

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Section: Strokementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of thrombo‐inflammation on the cerebral microcirculation

Ansari

Gavins

2021

Microcirculation

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“…Как продемонстрировано в исследовании INTERSTROKE (Study of the Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World) [31], среди факторов, ассоциированных с инсультом, важнейшим является АГ. Она встречается у 64% пациентов, перенесших инсульт, и повышает риск развития его ишемического варианта приблизительно в 3 раза (отношение рисков [ОР] 2,78; 95%ДИ 2,50-3,10), а геморрагического -более чем в 4 раза (ОР 4,09; 95%ДИ 3,51-4,77) [32][33][34]. В ряде зарубежных рекомендаций по АГ подчеркивается важность использования диуретиков и комбинации диуретик+иАПФ [35,36] у пациентов с инсультом и/или транзиторной ишемической атакой в анамнезе, а рекомендациях Латиноамериканского общества по АГ эксперты указывают на необходимость назначения таким больным индапамида, возможно, в сочетании с иАПФ в качестве терапии первой линии [37].…”

Section: органопротективные свойстваunclassified

Thiazide and Thiazide-like Diuretics in the Treatment of Arterial Hypertension: are there Any Differences?

Кочетков

2020

Racionalʹnaâ farmakoterapiâ v kardiologii

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In the current clinical guidelines for arterial hypertension, diuretics are considered one of the first line antihypertensive drugs, which are equivalent in their effectiveness to other main pharmacological classes used in the treatment of this disease. To date, much attention is paid to both the antihypertensive potential of diuretics and their safety profile and ability to influence prognosis. In this regard, a rational approach to the consideration of the clinical and pharmacological properties of these drugs is the isolation of thiazide and thiazide-like drugs among them, which is reflected in international clinical guidelines. Among thiazide-like diuretics, indapamide occupies a special place, favorably distinguished by its antihypertensive properties, metabolic neutrality, as well as the ability to improve the prognosis and favorably influence hard endpoints in the form of mortality rates in patients with hypertension. A unique feature of indapamide is also the presence, in addition to the direct diuretic effect, pleiotropic properties, including, in particular, some antagonism towards calcium and beneficial effects on arteries. This drug has been studied in a large number of studies, including such "difficult" categories of patients as the elderly and patients with diabetes mellitus, where indapamide has proven its powerful target-organ protective potential and metabolic neutrality, distinguishing it among both thiazide-like and thiazide diuretics. Indapamide provides a comprehensive target-organ protection at the level of the heart, blood vessels, kidneys and brain. Based on this, it can be expected that the widespread use of this drug as part of a first-line combination antihypertensive therapy will not only achieve target blood pressure levet in most patients with hypertension, but also provide an improved prognosis and improve the quality and duration of their life.

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“…Sedentary time is an independent risk factor to health such that moderate to vigorous physical activity (MVPA) does not mitigate high levels of sedentary time, and adverse health effects tend to persist despite engaging in MVPA. These health risks include increased incidence of cardiovascular disease, stroke, hypertension, type 2 diabetes, chronic respiratory diseases, dementia, certain cancers, and premature mortality [ 1 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

Can Physical Activity While Sedentary Produce Health Benefits? A Single-Arm Randomized Trial

Sackner

López

Banderas³

et al. 2020

Sports Med - Open

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Background Sedentary time poses a risk to health. Substituting physical activity for inactivity is obvious but this requires a behavior change. Interventions advocated to decrease uninterrupted physical inactivity (defined as Metabolic Equivalent of Task (METS) less than 1.5) are important. One such intervention is accomplished with the Gentle Jogger (GJ), a low risk motorized wellness device which produces effortless, rapid motion of the lower extremities simulating locomotion or fidgeting. GJ produces health benefits in type 2 diabetes, heart disease, and high blood pressure. The purpose of this trial was to ascertain whether GJ increases METS above 1.5 to explain its effectiveness despite sedentary behavior or whether tapping is responsible. Methods A randomized single-arm trial was conducted. Subjects were randomized to begin the study in either the supine or seated postures and on the same day crossed over with the starting posture reversed. Oxygen consumption was measured at rest and during GJ. Results Twenty-six subjects were studied (15 women and 11 men) with a mean age of 44 ± 15 years and BMI 27.9 ± 5.0, 19 were overweight or obese, and 7 had normal BMI. GJ increased oxygen consumption and METS 15% in the seated posture and 13% in the supine posture. No individual receiving GJ achieved METS exceeding 1.5. Conclusions In a moderately obese population, GJ in seated or supine posture did not exceed 1.5 METS. The values are comparable to those reported for sit-stand interventions and cannot explain the health benefits of GJ. Trial registration ClinicalTrials.gov, NCT03602365. Registered on July 26, 2018

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Hypertension and Stroke: Update on Treatment

Cited by 209 publications

References 58 publications

The impact of thrombo‐inflammation on the cerebral microcirculation

The impact of thrombo‐inflammation on the cerebral microcirculation

Thiazide and Thiazide-like Diuretics in the Treatment of Arterial Hypertension: are there Any Differences?

Can Physical Activity While Sedentary Produce Health Benefits? A Single-Arm Randomized Trial

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