State Higher Vocational School in Kalisz

Kalisz Pomorski, Poland

State Higher Vocational School in Kalisz

Kalisz Pomorski, Poland
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Gluszek J.,State Higher Vocational School in Kalisz | Kosicka T.,Poznan University of Medical Sciences
Arterial Hypertension (Poland) | Year: 2017

In recent years a new very promising drug was introduced for the treatment of chronic heart failure. This drug, sacubitril/valsartan, prevents the clinical progression of surviving patients with heart failure more effectively than enalapril and it reduces the need for hospitalization by more than 20%. At the same time it has been shown that it reduces blood pressure particularly in patients with essential hypertension. This drug is an inhibitor of neprilysin, an enzyme that degrades natriuretic factors. Natriuretic factors (ANP, BNP, CNP) increase diuresis and natriuresis, reduce the activity of the sympathetic system, relax the blood vessels and inhibit fibrosis. Several studies have shown that sacubitril/valsartan therapy more significantly reduces blood pressure in patients with salt-sensitive or refractory to treatment hypertension than is observed with valsartan or amlodipine. Furthermore, beneficial effects of this drug on central blood pressure and renal function have been demonstrated in patients with chronic renal failure. More rarely than enalapril it leads to hyperkalaemia in patients treated simultaneously with mineralocorticoid receptor inhibitors. Sacubitril/valsartan is the first representative of a new class of drugs that inhibit neprilysin, which probably in the future will be frequently used in hypertension. © 2017 Via Medica.


Gluszek J.,State Higher Vocational School in Kalisz | Kosicka T.,Poznan University of Medical Sciences
Nadcisnienie Tetnicze | Year: 2016

In healthy people and patients with hypertension, blood pressure varies between clinic visits every several days, a week, or a month apart. Although long thought to be an artifact, recent data suggest that visit-to-visit variability of blood pressure is reproducible and has independent association with cardiovascular outcomes and mortality. There currently is no consensus on how to define blood pressure variability best. The most common metric used is standard deviation of mean blood pressure, variation independent of the mean and average real variability. Blood pressure variability is higher in female, older age and patients with hypertension, with cardiovascular diseases, with diabetes mellitus and chronic kidney disease. Therefore, we are not sure if higher blood pressure variability is the only marker of arterial stiffness and consequence of end organ damage or prognostic indicator of cardiovascular events. We also do not know whether reducing blood pressure variability would reduce the risk of cardiovascular outcomes. However, the number of studies on blood pressure variability is growing exponentially and perhaps in the near future, high blood pressure variability will also be the goal of hypertension therapy. © 2016 Via Medica.

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