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6This 8-week, randomized, double-blind, controlled study compared efficacy and tolerability of telmisartan ⁄ amlodipine (T ⁄ A) single-pill combination (SPC) vs the respective monotherapies in 858 patients with severe hypertension (systolic ⁄ diastolic blood pressure [SBP ⁄ DBP] !180 ⁄ 95 mm Hg). At 8 weeks, T ⁄ A provided significantly greater reductions from baseline in seated trough cuff SBP ⁄ DBP ()47.5 mm Hg ⁄ )18.7 mm Hg) vs T (P<.0001) or A (P=.0002) monotherapy; superior reductions were also evident at 1, 2, 4, and 6 weeks. Blood pressure (BP) goal and response rates were consistently higher with T ⁄ A vs T or A. T ⁄ A was well tolerated, with less frequent treatmentrelated adverse events vs A (12.6% vs 16.4%) and a numerically lower incidence of peripheral edema and treatment discontinuation. In conclusion, treatment of patients with substantially elevated BP with T ⁄ A SPCs resulted in high and significantly greater BP reductions and higher BP goal and response rates than the respective monotherapies. T ⁄ A SPCs were well tolerated. J Clin Hypertens (Greenwich). 2012;14:206-215. Ó2012 Wiley Periodicals, Inc.Based on evidence from a number of large antihypertensive trials, 1-9 most guidelines acknowledge that combination therapy is needed to reduce blood pressure (BP) successfully to goal in the majority of patients; only a minority of patients achieve their BP goal with a single agent.10-14 Also, the Avoiding Cardiovascular Events Through Combination Therapy in Patients Living With Systolic Hypertension (ACCOMPLISH) study showed a significant reduction of cardiovascular (CV) events and death in hypertensive patients at high CV risk treated with a combination of an angiotensin-converting enzyme (ACE) inhibitor and a calcium channel blocker (CCB).15 Nevertheless, despite rigorous and comprehensive guidelines, and a trend towards an increase in the use of combination therapy in treatment practice, 16 several studies have demonstrated the persistence of poor BP goal rates in treated patients. [17][18][19] The impact of poor BP control is compounded by the often high prevalence of other CV risk factors in hypertensive patients (eg, hypercholesterolemia, obesity, type 2 diabetes mellitus [T2DM], and smoking).13 Therefore, an urgent need still remains to improve the management of hypertension. One logical approach would be to use 2 drugs from different classes and complementary mechanisms of action in combination. Such combinations may result in additional BP decreases and improved goal rates, compared with either agent used alone. 20-23Furthermore, single-pill combinations (SPCs) are known to increase treatment adherence and reduce health care costs. [24][25][26][27] A combination of a CCB and an angiotensin II receptor blocker (ARB) is a rational approach for managing hypertension and there is increasing evidence that this combination is effective. 11,13,28,29 The aim of the current study was to compare the efficacy and tolerability of the SPC of telmisartan 80 mg ⁄ amlodipine 10 mg (T80 ⁄ A10) with that of...

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From March 1991 to September 1993, 26 patients (aged 4–78 years) with brain tumors (4 glioblastoma multiforme, 10 nonglioblastoma multiforme, 1 mixed oligoastrocytoma, 2 carniopharyngiomas, 2 meningiomas and 7 metastases) were treated with stereotactic techniques at the Centro Internacional de Restauracion Neurológica, La Habana, Cuba. A total of 28 stereotactic surgical procedures were performed with no operative mortality; they included biopsies in all cases, 1 stereotactic microsurgical resection and 12 permanent implants of ¹⁹²Ir, followed by external beam fractionated radiation therapy (40–60 Gy). The present paper shows that the combined use of a stereotactic approach, a comprehensive and reliable stereotactic dosimetric planning system, stereotactic brachytherapy with ¹⁹²Ir and complementary percutaneous radiation treatment constitutes a promising strategy for brain tumor management.

Introdução: A hipertensão arterial sistêmica afeta mais de 1,2 milhão de pessoas no mundo. Apenas 35% dos pacientes hipertensos têm valores de pressão arterial controlados. Recentemente a denervação simpática renal (DSR) tem demonstrado diminuir significativamente os valores de pressão arterial nos pacientes com hipertensão arterial sistêmica resistente. Métodos: Estudo prospectivo, de braço único, observacional, multicêntrico, incluindo pacientes consecutivos submetidos a DSR. O objetivo primário foi avaliar os níveis da pressão arterial sistólica aos 30 dias de seguimento. O objetivo secundário foi determinar a ocorrência de qualquer evento adverso relacionado com o procedimento. Resultados: Foram incluídos os primeiros 20 pacientes submetidos a DSR. A média de pressão arterial antes do procedimento foi de 171,6/93,2 ± 15,5/11,3 mmHg, com média de uso de 4,1 ± 1,5 fármacos anti-hipertensivos por paciente. A taxa de sucesso foi de 95%, tendo sido aplicadas 11,1 ± 1,9 ablações por paciente. Foi observada diminuição média de 29 ± 21 mmHg (P = 0,009) na pressão arterial sistólica 30 dias após o procedimento. Não houve complicação associada ao procedimento. Conclusões: A DSR por cateter em pacientes da prática clínica diária diminuiu significativamente os valores de pressão arterial. Em nossa experiência, a DSR demonstrou ser factível e segura.

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