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[PMID]:28904237
[Au] Autor:Starr JB; Tirschwell DL; Becker KJ
[Ad] Endereço:From the Departments of Anesthesiology and Pain Medicine (J.B.S.) and Neurology (D.L.T., K.J.B.), University of Washington, Seattle. starrj@uw.edu.
[Ti] Título:Labetalol Use Is Associated With Increased In-Hospital Infection Compared With Nicardipine Use in Intracerebral Hemorrhage.
[So] Source:Stroke;48(10):2693-2698, 2017 Oct.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Increased sympathetic tone causes hypertension after intracerebral hemorrhage, and blood pressure reduction has been studied as a way to decrease hemorrhage growth and improve outcomes. It is unknown if the antihypertensive used to achieve blood pressure goals influences either. Because sympatholytic drugs reduce death and infection in animal models, we hypothesized that labetalol would improve outcomes compared with nicardipine. METHODS: Prospective data from a single center were retrospectively reviewed. Patients receiving labetalol, nicardipine, or both during their first 3 days of hospitalization were included. Outcomes included in-hospital death; discharge modified Rankin Score >2; and in-hospital urinary tract infection, pneumonia, or bacteremia. Patients were compared with propensity scoring and analyzed with linear models adjusted for significant confounders. RESULTS: Of 1066 admissions, 525 were treated with labetalol or nicardipine and are included; 229 (43.6%) received labetalol, 107 (20.4%) received nicardipine, and 189 (36.0%) received both. Mortality and infection rates were 40.2% and 15.8%, respectively, 77.2% had a modified Rankin Score >2. After adjustment, compared with nicardipine alone, labetalol alone was associated with infection (odds ratio, 3.12; confidence interval, 1.27-7.64; =0.013) but not when combined with nicardipine (odds ratio, 2.44; confidence interval, 0.98-6.07; =0.055). Labetalol, with or without nicardipine, was not associated with death or discharge modified Rankin Score >2. CONCLUSIONS: Compared with nicardipine, labetalol was associated with increased in-hospital infections, but not mortality or modified Rankin Score >2. These findings do not support our hypothesis that labetalol use improves outcomes relative to nicardipine in intracerebral hemorrhage.
[Mh] Termos MeSH primário: Hemorragia Cerebral/tratamento farmacológico
Hemorragia Cerebral/epidemiologia
Infecção Hospitalar/induzido quimicamente
Infecção Hospitalar/epidemiologia
Labetalol/efeitos adversos
Nicardipino/uso terapêutico
[Mh] Termos MeSH secundário: Antagonistas Adrenérgicos beta/efeitos adversos
Antagonistas Adrenérgicos beta/uso terapêutico
Adulto
Idoso
Anti-Hipertensivos/efeitos adversos
Anti-Hipertensivos/uso terapêutico
Hemorragia Cerebral/diagnóstico
Infecção Hospitalar/diagnóstico
Feminino
Seres Humanos
Hipertensão/tratamento farmacológico
Hipertensão/epidemiologia
Masculino
Meia-Idade
Estudos Prospectivos
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Adrenergic beta-Antagonists); 0 (Antihypertensive Agents); CZ5312222S (Nicardipine); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171009
[Lr] Data última revisão:
171009
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170915
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.017230


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[PMID]:28893900
[Au] Autor:Webster LM; Myers JE; Nelson-Piercy C; Harding K; Cruickshank JK; Watt-Coote I; Khalil A; Wiesender C; Seed PT; Chappell LC
[Ad] Endereço:From the Women's Health Academic Centre, King's College London, United Kingdom (L.M.W., C.N.-P., P.T.S., L.C.C.); Directorate of Women's Health, Guy's and St Thomas' Foundation Trust, London, United Kingdom (L.M.W., C.N.-P., K.H., L.C.C.); Maternaland Fetal Health ResearchCenter, Division of Develop
[Ti] Título:Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy: A Randomized Controlled Trial.
[So] Source:Hypertension;70(5):915-922, 2017 Nov.
[Is] ISSN:1524-4563
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Data from randomized controlled trials to guide antihypertensive agent choice for chronic hypertension in pregnancy are limited; this study aimed to compare labetalol and nifedipine, additionally assessing the impact of ethnicity on treatment efficacy. Pregnant women with chronic hypertension (12 -27 weeks' gestation) were enrolled at 4 UK centers (August 2014 to October 2015). Open-label first-line antihypertensive treatment was randomly assigned: labetalol- (200-1800 mg/d) or nifedipine-modified release (20-80 mg/d). Analysis included 112 women (98%) who completed the study (labetalol n=55, nifedipine n=57). Maximum blood pressure after randomization was 161/101 mm Hg with labetalol versus 163/105 mm Hg with nifedipine (mean difference systolic: 1.2 mm Hg [-4.9 to 7.2 mm Hg], diastolic: 3.3 mm Hg [-0.6 to 7.3 mm Hg]). Mean blood pressure was 134/84 mm Hg with labetalol and 134/85 mm Hg with nifedipine (mean difference systolic: 0.3 mm Hg [-2.8 to 3.4 mm Hg], and diastolic: -1.9 mm Hg [-4.1 to 0.3 mm Hg]). Nifedipine use was associated with a 7.4-mm Hg reduction (-14.4 to -0.4 mm Hg) in central aortic pressure, measured by pulse wave analysis. No difference in treatment effect was observed in black women (n=63), but a mean 4 mm Hg reduction (-6.6 to -0.8 mm Hg; =0.015) in brachial diastolic blood pressure was observed with labetalol compared with nifedipine in non-black women (n=49). Labetalol and nifedipine control mean blood pressure to target in pregnant women with chronic hypertension. This study provides support for a larger definitive trial scrutinizing the benefits and side effects of first-line antihypertensive treatment. CLINICAL TRIAL REGISTRATION: URL: https://www.isrctn.com. Unique identifier: ISRCTN40973936.
[Mh] Termos MeSH primário: Pressão Arterial/efeitos dos fármacos
Hipertensão
Labetalol
Nifedipino
Complicações Cardiovasculares na Gravidez
[Mh] Termos MeSH secundário: Adulto
Anti-Hipertensivos/administração & dosagem
Anti-Hipertensivos/efeitos adversos
Determinação da Pressão Arterial/métodos
Monitoramento de Medicamentos/métodos
Feminino
Idade Gestacional
Seres Humanos
Hipertensão/diagnóstico
Hipertensão/tratamento farmacológico
Labetalol/administração & dosagem
Labetalol/efeitos adversos
Nifedipino/administração & dosagem
Nifedipino/efeitos adversos
Gravidez
Complicações Cardiovasculares na Gravidez/diagnóstico
Complicações Cardiovasculares na Gravidez/tratamento farmacológico
Análise de Onda de Pulso/métodos
Resultado do Tratamento
Reino Unido
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antihypertensive Agents); I9ZF7L6G2L (Nifedipine); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170913
[St] Status:MEDLINE
[do] DOI:10.1161/HYPERTENSIONAHA.117.09972


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[PMID]:28797767
[Au] Autor:Dong XY; Bai CB; Nao JF
[Ad] Endereço:Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, China.
[Ti] Título:Clinical and radiological features of posterior reversible encephalopathy syndrome in patients with pre-eclampsia and eclampsia.
[So] Source:Clin Radiol;72(10):887-895, 2017 Oct.
[Is] ISSN:1365-229X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To analyse and summarise clinical and radiological features among patients with posterior reversible encephalopathy syndrome (PRES), to assess related factors with eclampsia and pre-eclampsia, and to compare the different factors between cytotoxic and vasogenic oedema among PRES patients. MATERIALS AND METHODS: The clinical and radiological findings of 237 pre-eclamptic or eclamptic patients with neurological symptoms were evaluated retrospectively. Multiple logistic regression analyses were performed to compare the differences among these parameters. RESULTS: Seventy-six patients (32.07%) were diagnosed with PRES. Multiple logistic regression indicated that seizure (odds ratio [OR], 2.760; 95% confidence interval [CI]: 1.087-7.011; p=0.033), visual disturbances (OR=2.062 95%CI, 1.033-4.115; p=0.004), multiple production history (OR=3.637; 95% CI: 1.068-8.228; p=0.002) were independent risk factors for PRES. PRES+ (OR=3.217; 95%CI, 1.346-7.686; p=0.009), Visual disturbances (OR=4.283; 95% CI: 1.843-9.953; p=0.001) had strong association with eclampsia. Visual disturbances (OR=7.200; 95% CI: 2.116-24.496; p=0.002) had strong correlation with eclampsia among PRES+ patients. Visual disturbances (OR=2.947; 95% CI: 1.135-7.648; p=0.026) were independently related to cytotoxic oedema. CONCLUSIONS: Nearly one-third of pre-eclampsia or eclampsia patients with neurological symptoms have PRES. Visual disturbances, seizure, multiple production history are independent risk factors for PRES. Visual disturbances have a strong association with eclampsia whether patients have PRES or not. Visual disturbances are independently related to cytotoxic oedema among PRES+ patients.
[Mh] Termos MeSH primário: Eclampsia/diagnóstico
Imagem por Ressonância Magnética
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem
Pré-Eclâmpsia/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Anticonvulsivantes/uso terapêutico
Anti-Hipertensivos/uso terapêutico
Encéfalo/diagnóstico por imagem
Diazepam/uso terapêutico
Eclampsia/terapia
Feminino
Seres Humanos
Labetalol/uso terapêutico
Sulfato de Magnésio/uso terapêutico
Neuroimagem/métodos
Fenitoína/uso terapêutico
Síndrome da Leucoencefalopatia Posterior/diagnóstico
Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico
Pré-Eclâmpsia/terapia
Gravidez
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticonvulsants); 0 (Antihypertensive Agents); 6158TKW0C5 (Phenytoin); 7487-88-9 (Magnesium Sulfate); Q3JTX2Q7TU (Diazepam); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170812
[St] Status:MEDLINE


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[PMID]:28372658
[Au] Autor:Bordlee JW; Beakley BD; Mody R; McConville AP; Weed JT; McClure BP; Foldes PJ; Ma JG; Kaye AD; Eskander JP
[Ad] Endereço:Department of Anesthesiology, Tulane School of Medicine, New Orleans, LA. Electronic address: jbordlee@tulane.edu.
[Ti] Título:A case of paradoxical presentation of a postural postdural puncture headache after combined spinal-epidural anesthesia.
[So] Source:J Clin Anesth;38:156-157, 2017 May.
[Is] ISSN:1873-4529
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. The patient was discharged from emergency department after an improvement following treatment with labetalol, ondansetron, ketorolac, and fluid resuscitation.
[Mh] Termos MeSH primário: Anestesia Epidural/efeitos adversos
Anestesia Obstétrica/efeitos adversos
Raquianestesia/efeitos adversos
Vazamento de Líquido Cefalorraquidiano/complicações
Cefaleia Pós-Punção Dural/diagnóstico
[Mh] Termos MeSH secundário: Acetaminofen/uso terapêutico
Adulto
Analgésicos Opioides/administração & dosagem
Anestésicos Locais/administração & dosagem
Bupivacaína/administração & dosagem
Parto Obstétrico/efeitos adversos
Combinação de Medicamentos
Feminino
Fentanila/administração & dosagem
Seres Humanos
Hipertensão/tratamento farmacológico
Hipertensão/etiologia
Cetorolaco/uso terapêutico
Labetalol/uso terapêutico
Agulhas
Ondansetron/uso terapêutico
Oxicodona/uso terapêutico
Cefaleia Pós-Punção Dural/tratamento farmacológico
Cefaleia Pós-Punção Dural/etiologia
Gravidez
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid); 0 (Anesthetics, Local); 0 (Drug Combinations); 0 (oxycodone-acetaminophen); 362O9ITL9D (Acetaminophen); 4AF302ESOS (Ondansetron); CD35PMG570 (Oxycodone); R5H8897N95 (Labetalol); UF599785JZ (Fentanyl); Y8335394RO (Bupivacaine); YZI5105V0L (Ketorolac)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE


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[PMID]:28333820
[Au] Autor:Committee on Obstetric Practice
[Ti] Título:Committee Opinion No. 692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.
[So] Source:Obstet Gynecol;129(4):e90-e95, 2017 04.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.
[Mh] Termos MeSH primário: Hipertensão
Labetalol/administração & dosagem
Nifedipino/administração & dosagem
Complicações Cardiovasculares na Gravidez/tratamento farmacológico
Transtornos Puerperais/tratamento farmacológico
[Mh] Termos MeSH secundário: Anti-Hipertensivos/administração & dosagem
Pressão Sanguínea/efeitos dos fármacos
Determinação da Pressão Arterial/métodos
Vias de Administração de Medicamentos
Emergências
Feminino
Seres Humanos
Hipertensão/diagnóstico
Hipertensão/tratamento farmacológico
Hipertensão/fisiopatologia
Conduta do Tratamento Medicamentoso/normas
Gravidez
Complicações Cardiovasculares na Gravidez/diagnóstico
Complicações Cardiovasculares na Gravidez/fisiopatologia
Transtornos Puerperais/diagnóstico
Transtornos Puerperais/fisiopatologia
Melhoria de Qualidade
Encaminhamento e Consulta
Índice de Gravidade de Doença
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Nm] Nome de substância:
0 (Antihypertensive Agents); I9ZF7L6G2L (Nifedipine); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170621
[Lr] Data última revisão:
170621
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170324
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002019


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[PMID]:28333812
[Ti] Título:Committee Opinion No. 692 Summary: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.
[So] Source:Obstet Gynecol;129(4):769-770, 2017 Apr.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive therapy. Introducing standardized, evidence-based clinical guidelines for the management of patients with preeclampsia and eclampsia has been demonstrated to reduce the incidence of adverse maternal outcomes. Individuals and institutions should have mechanisms in place to initiate the prompt administration of medication when a patient presents with a hypertensive emergency. Treatment with first-line agents should be expeditious and occur as soon as possible within 30-60 minutes of confirmed severe hypertension to reduce the risk of maternal stroke. Intravenous labetalol and hydralazine have long been considered first-line medications for the management of acute-onset, severe hypertension in pregnant women and women in the postpartum period. Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available. In the rare circumstance that intravenous bolus labetalol, hydralazine, or immediate release oral nifedipine fails to relieve acute-onset, severe hypertension and is given in successive appropriate doses, emergent consultation with an anesthesiologist, maternal-fetal medicine subspecialist, or critical care subspecialist to discuss second-line intervention is recommended.
[Mh] Termos MeSH primário: Hipertensão
Labetalol/administração & dosagem
Nifedipino/administração & dosagem
Complicações Cardiovasculares na Gravidez/tratamento farmacológico
Transtornos Puerperais/tratamento farmacológico
[Mh] Termos MeSH secundário: Anti-Hipertensivos/administração & dosagem
Pressão Sanguínea/efeitos dos fármacos
Determinação da Pressão Arterial/métodos
Vias de Administração de Medicamentos
Emergências
Feminino
Seres Humanos
Hipertensão/diagnóstico
Hipertensão/tratamento farmacológico
Hipertensão/fisiopatologia
Conduta do Tratamento Medicamentoso/normas
Gravidez
Complicações Cardiovasculares na Gravidez/diagnóstico
Complicações Cardiovasculares na Gravidez/fisiopatologia
Transtornos Puerperais/diagnóstico
Transtornos Puerperais/fisiopatologia
Melhoria de Qualidade
Encaminhamento e Consulta
Índice de Gravidade de Doença
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Nm] Nome de substância:
0 (Antihypertensive Agents); I9ZF7L6G2L (Nifedipine); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170621
[Lr] Data última revisão:
170621
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170324
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002010


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[PMID]:27998008
[Au] Autor:Xu B; Bobek G; Makris A; Hennessy A
[Ad] Endereço:School of Medicine, Western Sydney University, Sydney, NSW, Australia.
[Ti] Título:Antihypertensive methyldopa, labetalol, hydralazine, and clonidine reversed tumour necrosis factor-α inhibited endothelial nitric oxide synthase expression in endothelial-trophoblast cellular networks.
[So] Source:Clin Exp Pharmacol Physiol;44(3):421-427, 2017 Mar.
[Is] ISSN:1440-1681
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:Medications used to control hypertension in pregnancy also improve trophoblast and endothelial cellular interaction in vitro. Tumour necrosis factor-α (TNF-α) inhibits trophoblast and endothelial cellular interactions and simultaneously decreases endothelial nitric oxide synthase (eNOS) expression. This study investigated whether antihypertensive medications improved these cellular interactions by modulating eNOS and inducible nitric oxide synthase (iNOS) expression. Human uterine myometrial microvascular endothelial cells (UtMVECs) were pre-incubated with (or without) low dose TNF-α (0.5 ng/mL) or TNF-α plus soluble fms-like tyrosine kinase-1 (sFlt-1) (100 ng/mL). The endothelial cells were cultured on Matrigel. After endothelial cellular networks appeared, trophoblast derived HTR-8/SVneo cells were co-cultured in the presence of clinically relevant doses of methyldopa, labetalol, hydralazine or clonidine for 24 hours. Cells were retrieved from the Matrigel to extract mRNA and eNOS and iNOS expression were examined by quantitative PCR. Methyldopa, labetalol, hydralazine and clonidine reversed the inhibitory effect of TNF-α on eNOS mRNA expression. After pre-incubating endothelial cells with TNF-α and sFlt-1, all the medications except methyldopa lost their effect on eNOS mRNA expression. In the absence of TNF-α, antihypertensive medications did not change eNOS expression. The mRNA expression of iNOS was not affected by TNF-α or any medications. This study shows that selected antihypertensive medications used in the treatment of hypertension in pregnancy increase eNOS expression in vitro when induced by the inflammatory TNF-α. The anti-angiogenic molecule sFlt-1 may antagonise the potential benefit of these medications by interfering with the NOS pathway.
[Mh] Termos MeSH primário: Anti-Hipertensivos/farmacologia
Células Endoteliais/efeitos dos fármacos
Óxido Nítrico Sintase Tipo III/antagonistas & inibidores
Trofoblastos/efeitos dos fármacos
Fator de Necrose Tumoral alfa/farmacologia
[Mh] Termos MeSH secundário: Células Cultivadas
Clonidina/farmacologia
Técnicas de Cocultura
Meios de Cultivo Condicionados
Células Endoteliais/citologia
Endotélio Vascular/citologia
Endotélio Vascular/efeitos dos fármacos
Feminino
Seres Humanos
Hidralazina/farmacologia
Proteína 1 Semelhante a Receptor de Interleucina-1/fisiologia
Labetalol/farmacologia
Metildopa/farmacologia
Óxido Nítrico Sintase Tipo III/genética
Trofoblastos/citologia
Útero/citologia
Útero/efeitos dos fármacos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antihypertensive Agents); 0 (Culture Media, Conditioned); 0 (IL1RL1 protein, human); 0 (Interleukin-1 Receptor-Like 1 Protein); 0 (Tumor Necrosis Factor-alpha); 26NAK24LS8 (Hydralazine); 56LH93261Y (Methyldopa); EC 1.14.13.39 (NOS3 protein, human); EC 1.14.13.39 (Nitric Oxide Synthase Type III); MN3L5RMN02 (Clonidine); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161221
[St] Status:MEDLINE
[do] DOI:10.1111/1440-1681.12712


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[PMID]:27786578
[Au] Autor:Sharma KJ; Greene N; Kilpatrick SJ
[Ad] Endereço:a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Cedars-Sinai Medical Center , Los Angeles , California , USA.
[Ti] Título:Oral labetalol compared to oral nifedipine for postpartum hypertension: A randomized controlled trial.
[So] Source:Hypertens Pregnancy;36(1):44-47, 2017 Feb.
[Is] ISSN:1525-6065
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether oral labetalol is associated with a shorter time to blood pressure control compared to oral extended release nifedipine for management of persistent postpartum hypertension. STUDY DESIGN: This randomized controlled trial conducted between June 2014 and June 2015 included women who delivered at ≥32 weeks' gestation with persistent postpartum hypertension (sustained blood pressure ≥150/100 mmHg) requiring an oral antihypertensive agent. We included women with gestational hypertension, preeclampsia, or chronic hypertension not previously on medication. Women were randomized to labetalol or nifedipine, and the allocated study drug was incrementally increased to achieve blood pressure control. The primary outcome was time to sustained blood pressure control defined as the absence of severe hypertension for at least 12 hours. Secondary outcomes included postpartum length of stay, need for increased dosing, need for additional oral antihypertensive agents, and patient reported side effects. Twenty women were needed in each group as determined by the sample size calculation. RESULTS: We randomized 25 women to oral labetalol and 25 women to oral extended release nifedipine. The time to achieve BP control was similar between labetalol and nifedipine groups (37.6 hours versus 38.2 hours, p = 0.51). Secondary outcomes including postpartum length of stay, need for increased dosing, and need for additional oral antihypertensive agents were similar between groups. For women discharged on a single agent, significantly more subjects in the labetalol group (16/21) compared to the nifedipine group (10/22) achieved BP control with the initial starting dose (76% versus 46%, p = 0.04). No major side effects were observed. Minor side effects were significantly more common in women taking nifedipine compared to labetalol (48% versus 20%, p = 0.04). CONCLUSIONS: Both labetalol and nifedipine were effective for control of persistent postpartum hypertension. However, labetalol achieved control significantly more often with the starting dose and had fewer side effects. CLINICAL TRIAL REGISTRATION: Oral nifedipine versus oral labetalol, NCT02168309. https://clinicaltrials.gov/ct2/show/NCT02168309?term=labetalol+versus+nifedipine&rank=2.
[Mh] Termos MeSH primário: Anti-Hipertensivos/uso terapêutico
Hipertensão/tratamento farmacológico
Labetalol/uso terapêutico
Nifedipino/uso terapêutico
Transtornos Puerperais/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Anti-Hipertensivos/farmacologia
Pressão Sanguínea/efeitos dos fármacos
Feminino
Seres Humanos
Labetalol/farmacologia
Nifedipino/farmacologia
Período Pós-Parto
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antihypertensive Agents); I9ZF7L6G2L (Nifedipine); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161028
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1080/10641955.2016.1231317


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[PMID]:27769852
[Au] Autor:Furuhashi T; Sakamoto K
[Ad] Endereço:Graduate School of Life and Environmental Sciences, University of Tsukuba, Japan.
[Ti] Título:Regulation of AKT activity prevents autonomic nervous system imbalance.
[So] Source:Physiol Behav;168:20-23, 2017 Jan 01.
[Is] ISSN:1873-507X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Autonomic nervous system (ANS) imbalances are involved in the etiology of cancer, allergy, and collagen diseases. Previously, we hypothesized that FoxO and HSF-1 limit autonomic stress responses via negative feedback on the ANS. Here, we evaluated the role of AKT, a negative regulator of FoxO, during activation of the ANS by loneliness stress in mice. Spontaneous motility was increased during loneliness stress and decreased after release from stress. The AKT activator SC79 attenuated stress-induced spontaneous motility, whereas the AKT inhibitor API-2 prevented decreases in motility after stress release. Our results show that AKT activity regulates ANS responses to loneliness stress.
[Mh] Termos MeSH primário: Doenças do Sistema Nervoso Autônomo/etiologia
Doenças do Sistema Nervoso Autônomo/prevenção & controle
Solidão/psicologia
Proteína Oncogênica v-akt/metabolismo
Estresse Psicológico/complicações
[Mh] Termos MeSH secundário: Acetatos/uso terapêutico
Antagonistas Adrenérgicos beta/farmacologia
Animais
Benzopiranos/uso terapêutico
Modelos Animais de Doenças
Comportamento Exploratório/efeitos dos fármacos
Labetalol/farmacologia
Masculino
Camundongos
Camundongos Endogâmicos C57BL
Ribonucleosídeos/farmacologia
Isolamento Social
Estresse Psicológico/etiologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (2-amino-6-chloro-alpha-cyano-3-(ethoxycarbonyl)-4H-1-benzopyran-4-acetic acid ethyl ester); 0 (Acetates); 0 (Adrenergic beta-Antagonists); 0 (Benzopyrans); 0 (Ribonucleosides); 2421HMY9N6 (triciribine); EC 2.7.11.1 (Oncogene Protein v-akt); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170626
[Lr] Data última revisão:
170626
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161107
[St] Status:MEDLINE


  10 / 1756 MEDLINE  
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[PMID]:27762457
[Au] Autor:Stott D; Bolten M; Paraschiv D; Papastefanou I; Chambers JB; Kametas NA
[Ad] Endereço:Antenatal Hypertension Clinic, Division of Women's Health, King's College Hospital, London, UK.
[Ti] Título:Longitudinal hemodynamics in acute phase of treatment with labetalol in hypertensive pregnant women to predict need for vasodilatory therapy.
[So] Source:Ultrasound Obstet Gynecol;49(1):85-94, 2017 Jan.
[Is] ISSN:1469-0705
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Hypertensive pregnant women who do not respond to treatment with labetalol to control blood pressure (BP), but require vasodilatory therapy, progress rapidly to severe hypertension. This could be delayed by early recognition and individualized treatment. In this study, we sought to create prediction models from data at presentation and at 1 h and 24 h after commencement of treatment to identify patients who will not have a sustained response to labetalol and therefore need vasodilatory therapy. METHODS: The study population comprised 134 women presenting with hypertension at a UK hospital. Treatment with oral labetalol was administered when BP was > 150/100 mmHg or > 140/90 mmHg with systemic disease. BP and hemodynamic parameters were recorded at presentation and at 1 h and 24 h after commencement of treatment. Labetalol doses were titrated to maintain BP around 135/85 mmHg. Women with unresponsive BP, despite labetalol dose maximization (2400 mg/day), received additional vasodilatory therapy with nifedipine. Binary logistic and longitudinal (mixed-model) data analyses were performed to create prediction models anticipating the likelihood of hypertensive women needing vasodilatory therapy. The prediction models were created from data at presentation and at 1 h and 24 h after treatment, to assess the value of central hemodynamics relative to the predictive power of BP, heart rate and demographic variables at these intervals. RESULTS: Twenty-two percent of our cohort required additional vasodilatory therapy antenatally. These women had higher rates of severe hypertension and delivered smaller babies at earlier gestational ages. The unresponsive women were more likely to be of black ethnicity, had higher BP and peripheral vascular resistance (PVR), and lower heart rate and cardiac output (CO) at presentation. Those who needed vasodilatory therapy showed an initial decrease in BP and PVR, which rebounded at 24 h, whereas BP and PVR in those who responded to labetalol showed a sustained decrease at 1 h and 24 h. Stroke volume and CO did not decrease during the acute phase of treatment in either group. The best model for prediction of the need for vasodilators was provided at 24 h by combining ethnicity and longitudinal BP and heart rate changes. The model achieved a detection rate of 100% for a false-positive rate of 20% and an area under the receiver-operating characteristics curve of 0.97. CONCLUSION: Maternal demographics and hemodynamic changes in the acute phase of labetalol monotherapy provide a powerful tool to identify hypertensive pregnant patients who are unlikely to have their BP controlled by this therapy and will consequently need additional vasodilatory therapy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. RESUMEN OBJETIVO: Las embarazadas hipertensas que no responden al tratamiento con labetalol para el control de la presión arterial (PA), pero que requieren terapia vasodilatadora, evolucionan rápidamente hacia una hipertensión severa. Ésta se puede retrasar mediante un diagnóstico precoz y un tratamiento individual. En este estudio se ha tratado de crear modelos de predicción a partir de datos al inicio del tratamiento y al cabo de 1 hora y de 24 horas después del mismo, para identificar a las pacientes que no mostrarán una respuesta constante al labetalol y que por lo tanto necesitarán terapia vasodilatadora. MÉTODOS: La población de estudio incluyó 134 mujeres con hipertensión en un hospital del Reino Unido. El tratamiento con labetalol por vía oral se administró cuando la PA fue >150/100 mm de Hg o >140/90 mm de Hg con enfermedad multisistémica. Se registró la PA y los parámetros hemodinámicos tanto al inicio como al cabo de 1 h y de 24 h después del inicio del tratamiento. Las dosis de Labetalol se ajustaron para mantener la PA en torno a los 135/85 mm de Hg. Las mujeres cuya PA no produjo respuesta, a pesar de haberles administrado la dosis máxima de labetalol (2400 mg/día), recibieron terapia vasodilatadora adicional con nifedipino. Se realizaron análisis de datos mediante logística binaria y longitudinal (modelo mixto), para crear modelos de predicción con los que pronosticar la probabilidad de la necesidad de terapia vasodilatadora en mujeres hipertensas. Los modelos de predicción se crearon a partir de datos al inicio y al cabo de 1 hora y 24 horas del tratamiento, para evaluar el valor de los parámetros hemodinámicos principales con respecto a la capacidad predictiva de la PA, la frecuencia cardíaca y las variables demográficas en estos intervalos. RESULTADOS: El 22 % de la cohorte necesitó terapia vasodilatadora adicional antes del parto. Estas mujeres tuvieron tasas más altas de hipertensión grave y neonatos más pequeños en edades gestacionales más tempranas. Las mujeres que no respondieron al tratamiento fueron con más frecuencia de raza negra, tuvieron la PA y la resistencia vascular periférica (RVP) más alta, y la frecuencia cardíaca y el gasto cardíaco (GC) más bajos al inicio del tratamiento. Aquellas que necesitaron terapia vasodilatadora mostraron un descenso inicial de la PA y la RVP, que se recuperó al cabo de 24 h, mientras que la PA y la RVP en las que respondieron al labetalol mostraron una disminución constante al cabo de 1 h y de 24 h. El volumen sistólico y el GC no disminuyeron durante la fase aguda del tratamiento en ninguno de los grupos. El mejor modelo para la predicción de la necesidad de vasodilatadores se obtuvo a las 24 h mediante la combinación de la etnia con los cambios longitudinales de la PA y la frecuencia cardíaca. El modelo alcanzó una tasa de detección del 100% para una tasa de falsos positivos del 20% y un área bajo la curva de características operativas del receptor de 0,97. CONCLUSIÓN: Los datos demográficos maternos y los cambios hemodinámicos en la fase aguda de la monoterapia con labetalol constituyen una herramienta poderosa para identificar a las pacientes embarazadas hipertensas con pocas probabilidades de que se les pueda controlar su PA mediante esta terapia y que por lo tanto necesitarán terapia vasodilatadora adicional. : 、(blood pressure,BP),。。,1 h24 h,。 : 134。BP>150/100 mmHgBP>140/90 mmHg。1 h24 hBP。,BP135/85 mmHg。BP,()。logistic(),。1 h24 h,,BP、。 : 22%。。,BP(peripheral vascular resistance,PVR),(cardiac output,CO)。BPPVR,24 h,1 h24 hBPPVR。CO。24hBP。100%,20%,0.97。 : ,BP。.
[Mh] Termos MeSH primário: Hipertensão/tratamento farmacológico
Labetalol/uso terapêutico
Vasodilatadores/uso terapêutico
[Mh] Termos MeSH secundário: Quimioterapia Combinada
Feminino
Hemodinâmica
Seres Humanos
Recém-Nascido de Baixo Peso
Recém-Nascido
Estudos Longitudinais
Medicina de Precisão
Gravidez
Resistência Vascular
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Vasodilator Agents); R5H8897N95 (Labetalol)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161021
[St] Status:MEDLINE
[do] DOI:10.1002/uog.17335



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