Terapêutica anti-hipertensiva em doentes diabéticos RESUMO Diabetes Mellitus e Hipertensão Arterial são entidades clínicas que se associam frequentemente num mesmo doente; juntas exercem um efeito sinérgico provocando, entre outras, deterioração acelerada da função renal e um aumento do risco cardiovascular.A tensão arterial no doente diabético deve ser rigorosamente controlada de modo a atingir valores inferiores a 130/80 mmHg. Objectivos: Análise das classes farmacológicas de anti-hipertensores mais indicadas no tratamento do diabético hipertenso. Métodos: Revisão bibliográfica incluindo tratados de referência e artigos recentemente publicados nas áreas da Diabetologia e Hipertensão Arterial. Conclusões: Os anti-hipertensores de primeira linha deverão ser os inibidores da enzima de conversão da angiotensina I, devido aos seus efeitos protectores renais e cardiovasculares, ou os antagonistas dos receptores de angiotensina II, caso haja intolerância ou contra-indicação aos primeiros. A estes podem-se associar diuréticos tiazídicos em baixa dose. Numa segunda linha do arsenal terapêutico temos os β-bloqueantes e os bloqueadores dos canais de cálcio. Os diuréticos de ansa, agentes centrais e α-bloqueantes são fármacos de terceira linha a ser empregues face a casos de hipertensão arterial resistente às classes anteriores e/ou em casos específicos.
Adult Still's Disease has systemic consequences, an inflammatory origin and unknown etiology. Knowledge about this disease is still limited, but some evolution has occurred in the last few years.Using a clinical case as example, the purpose of this paper is to review actual knowledge about Adult Still's Disease, giving special relevance to the most recent findings.Search in Pubmed and Cochrane database (1970-2009) for the terms Adultonset Still's Disease for all available papers. Those considered clinically and historically relevant were selected. An additional search was done in scientific journals and textbooks and other web sites. The information was analysed, using a clinical case in an atypical age as illustration.Adult Still's Disease as multiple manifestations, being fever, evanescent skin rash and arthralgia the most typical. Laboratorial parameters are inespecific, but high glycosilated ferritin is highly suggestive. Non-steroid anti-inflammatory, corticoids, immunosuppressors, and recent biological agents are used in treatment.Being uncommon, actual knowledge about this disease is based in isolated descriptions or very short series. There are no specific guidelines, but diagnostic criteria have been improved in recent years, as have the insights in pathophysiology and therapeutic resources.
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