DOCSLIB.ORG

Systematic Evidence Review from the Blood Pressure Expert Panel, 2013

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Systematic Evidence Review from the Blood Pressure Expert Panel, 2013 Managing Blood Pressure in Adults Systematic Evidence Review From the Blood Pressure Expert Panel, 2013 Contents Foreword ............................................................................................................................................ vi Blood Pressure Expert Panel ..............................................................................................................vii Section 1: Background and Description of the NHLBI Cardiovascular Risk Reduction Project ............ 1 A. Background .............................................................................................................................. 1 Section 2: Process and Methods Overview ......................................................................................... 3 A. Evidence-Based Approach ....................................................................................................... 3 i. Overview of the Evidence-Based Methodology ................................................................. 3 ii. System for Grading the Body of Evidence ......................................................................... 4 iii. Peer-Review Process ....................................................................................................... 5 B. Critical Question–Based Approach ........................................................................................... 5 i. How the Questions Were Selected ................................................................................... 5 ii. Rationale for the Questions Selected ................................................................................ 5 Section 3: Inclusion/Exclusion Criteria for the Evidence Review ......................................................... 7 A. Literature Search Yield ............................................................................................................. 8 B. Populations Addressed in This Report ..................................................................................... 8 C. Definition of High Blood Pressure or Hypertension ................................................................... 8 D. Limitations ................................................................................................................................ 9 Section 4: Evidence Statements for Critical Question 1 (Pharmacotherapy and BP Thresholds) .................................................................................................................................. 11 Section 5: Evidence Statements for Critical Question 2 (Pharmacotherapy Treatment and BP Goals) .................................................................................................................................... 19 A. Statements for the General Population................................................................................... 19 B. Statements for the Population With Chronic Kidney Disease ................................................. 25 C. Statements for the Population With Diabetes ......................................................................... 28 Section 6: Evidence Statements for Critical Question 3 (Antihypertensive Agents) ........................... 33 A. Statements for the General Population................................................................................... 33 i. Summary of Evidence Statements for the General Population ........................................ 33 B. Other Drug Classes ................................................................................................................ 37 i. ACEIs Versus Other Drugs ............................................................................................. 38 ii. ARBs Versus Other Drugs .............................................................................................. 39 iii. Thiazide and Thiazide-Type Diuretics Versus Other Drugs ............................................. 40 iv. Beta Blockers Versus Other Drugs ................................................................................. 48 v. Calcium Channel Blockers Versus Other Drugs .............................................................. 50 vi. Combination Therapy ...................................................................................................... 52 vii. Other Drug Classes ........................................................................................................ 53 C. Statements for the Population With Chronic Kidney Disease ................................................. 54 i. Comments on Other Studies That Met the Eligibility Criteria But Were Not Addressed in the Above Evidence Statements ................................................................ 56 D. Statements for the Adult Population With Diabetes ................................................................ 57 i. Diuretic Evidence Statements in Diabetes ...................................................................... 57 ii. Beta Blocker Evidence Statements in Diabetes .............................................................. 59 iii. Angiotensin-Converting Enzyme Inhibitors Evidence Statements in Diabetes ................. 60 iv. Calcium Channel Blockers Evidence Statements in Diabetes ......................................... 61 MANAGING BLOOD PRESSURE IN ADULTS: SYSTEMATIC EVIDENCE REVIEW FROM THE BLOOD PRESSURE EXPERT PANEL, 2013 iii v. Combination Therapy in Diabetes ................................................................................... 62 vi. Evidence Statements for Blacks With Diabetes ............................................................... 63 Appendix A: Methods ................................................................................................................ A–1 Appendix B: Development of Evidence Tables and Summary Tables ....................................... B–1 Appendix C: Search Strategy Overview and Syntax of Queries .................................................C–1 Appendix D: Summary Tables ..................................................................................................D–1 Appendix E: Abbreviations and Acronyms ................................................................................ E–1 Appendix F: Names of Studies .................................................................................................. F–1 References ................................................................................................................................R–1 List of Tables Table 1. Evidence Quality Grading System ......................................................................................... 4 Table 2. Angiotensin-Converting Enzyme Inhibitors (ACEIs) Versus Calcium Channel Blockers (CCBs) ......................................................................................................................................... 33 Table 3. ACEIs Versus Angiotensin II Receptor Blockers (ARBs) ..................................................... 33 Table 4. Beta Blockers Versus ACEIs ............................................................................................... 34 Table 5. Beta Blockers Versus CCBs ............................................................................................... 34 Table 6. Beta Blockers Versus ARBs ................................................................................................ 34 Table 7. CCBs versus ARBs ............................................................................................................. 35 Table 8. Thiazide and Thiazide-Type Diuretics Versus Beta Blockers .............................................. 35 Table 9. Thiazide and Thiazide-Type Diuretics Versus ACEIs .......................................................... 35 Table 10. Thiazide and Thiazide-Type Diuretics Versus CCBs ......................................................... 36 Table 11. Thiazide and Thiazide-Type Diuretics Versus ARBs ......................................................... 36 Table 12. Thiazide and Thiazide-Type Diuretics Versus Alpha Blockers ........................................... 36 Table 13. Combination Therapy: ACEI/CCB Versus ACEI/Diuretic ................................................... 37 Table A–1. Quality Assessment Tool for Controlled Intervention Studies ........................................ A–7 Table B–1. Evidence Quality Grading System ................................................................................ B–3 Table C–1. Examples of Simple Queries ........................................................................................C –1 Table C–2. Attributes, Their Values, and Explanation .....................................................................C –2 Table C–3. Common Macro Queries Used in Search Strategies .................................................... C–2 Table D–1a. Evidence From Randomized Controlled Trials on Initiating Antihypertensive Pharmacological Therapy at SBP Thresholds <140 mmHg ........................................................ D–1 Table D–1b. Evidence From Randomized Controlled Trials on Initiating Antihypertensive Pharmacological Therapy at SBP Thresholds >140 mmHg ........................................................ D–2 Table D–1c. Evidence From Randomized Controlled Trials on Initiating Antihypertensive Pharmacological Therapy at SBP Thresholds ≥160 mmHg ........................................................ D–3 Table D–1d. Evidence From Randomized Controlled Trials on
Load more

Recommended publications
  • Drug Class Review Beta Adrenergic Blockers
    Drug Class Review Beta Adrenergic Blockers Final Report Update 4 July 2009 Update 3: September 2007 Update 2: May 2005 Update 1: September 2004 Original Report: September 2003 The literature on this topic is scanned periodically. The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports. Mark Helfand, MD, MPH Kim Peterson, MS Vivian Christensen, PhD Tracy Dana, MLS Sujata Thakurta, MPA:HA Drug Effectiveness Review Project Marian McDonagh, PharmD, Principal Investigator Oregon Evidence-based Practice Center Mark Helfand, MD, MPH, Director Oregon Health & Science University Copyright © 2009 by Oregon Health & Science University Portland, Oregon 97239. All rights reserved. Final Report Update 4 Drug Effectiveness Review Project TABLE OF CONTENTS INTRODUCTION .......................................................................................................................... 6 Purpose and Limitations of Evidence Reports........................................................................................ 8 Scope and Key Questions .................................................................................................................... 10 METHODS.................................................................................................................................
    [Show full text]
  • The In¯Uence of Medication on Erectile Function
    International Journal of Impotence Research (1997) 9, 17±26 ß 1997 Stockton Press All rights reserved 0955-9930/97 $12.00 The in¯uence of medication on erectile function W Meinhardt1, RF Kropman2, P Vermeij3, AAB Lycklama aÁ Nijeholt4 and J Zwartendijk4 1Department of Urology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; 2Department of Urology, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands; 3Pharmacy; and 4Department of Urology, Leiden University Hospital, P.O. Box 9600, 2300 RC Leiden, The Netherlands Keywords: impotence; side-effect; antipsychotic; antihypertensive; physiology; erectile function Introduction stopped their antihypertensive treatment over a ®ve year period, because of side-effects on sexual function.5 In the drug registration procedures sexual Several physiological mechanisms are involved in function is not a major issue. This means that erectile function. A negative in¯uence of prescrip- knowledge of the problem is mainly dependent on tion-drugs on these mechanisms will not always case reports and the lists from side effect registries.6±8 come to the attention of the clinician, whereas a Another way of looking at the problem is drug causing priapism will rarely escape the atten- combining available data on mechanisms of action tion. of drugs with the knowledge of the physiological When erectile function is in¯uenced in a negative mechanisms involved in erectile function. The way compensation may occur. For example, age- advantage of this approach is that remedies may related penile sensory disorders may be compen- evolve from it. sated for by extra stimulation.1 Diminished in¯ux of In this paper we will discuss the subject in the blood will lead to a slower onset of the erection, but following order: may be accepted.
    [Show full text]
  • Health Reports for Mutual Recognition of Medical Prescriptions: State of Play
    The information and views set out in this report are those of the author(s) and do not necessarily reflect the official opinion of the European Union. Neither the European Union institutions and bodies nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein. Executive Agency for Health and Consumers Health Reports for Mutual Recognition of Medical Prescriptions: State of Play 24 January 2012 Final Report Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Acknowledgements Matrix Insight Ltd would like to thank everyone who has contributed to this research. We are especially grateful to the following institutions for their support throughout the study: the Pharmaceutical Group of the European Union (PGEU) including their national member associations in Denmark, France, Germany, Greece, the Netherlands, Poland and the United Kingdom; the European Medical Association (EMANET); the Observatoire Social Européen (OSE); and The Netherlands Institute for Health Service Research (NIVEL). For questions about the report, please contact Dr Gabriele Birnberg ([email protected] ). Matrix Insight | 24 January 2012 2 Health Reports for Mutual Recognition of Medical Prescriptions: State of Play Executive Summary This study has been carried out in the context of Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross- border healthcare (CBHC). The CBHC Directive stipulates that the European Commission shall adopt measures to facilitate the recognition of prescriptions issued in another Member State (Article 11). At the time of submission of this report, the European Commission was preparing an impact assessment with regards to these measures, designed to help implement Article 11.
    [Show full text]
  • )&F1y3x PHARMACEUTICAL APPENDIX to THE
    )&f1y3X PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE )&f1y3X PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 3 Table 1. This table enumerates products described by International Non-proprietary Names (INN) which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service (CAS) registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known. Product CAS No. Product CAS No. ABAMECTIN 65195-55-3 ACTODIGIN 36983-69-4 ABANOQUIL 90402-40-7 ADAFENOXATE 82168-26-1 ABCIXIMAB 143653-53-6 ADAMEXINE 54785-02-3 ABECARNIL 111841-85-1 ADAPALENE 106685-40-9 ABITESARTAN 137882-98-5 ADAPROLOL 101479-70-3 ABLUKAST 96566-25-5 ADATANSERIN 127266-56-2 ABUNIDAZOLE 91017-58-2 ADEFOVIR 106941-25-7 ACADESINE 2627-69-2 ADELMIDROL 1675-66-7 ACAMPROSATE 77337-76-9 ADEMETIONINE 17176-17-9 ACAPRAZINE 55485-20-6 ADENOSINE PHOSPHATE 61-19-8 ACARBOSE 56180-94-0 ADIBENDAN 100510-33-6 ACEBROCHOL 514-50-1 ADICILLIN 525-94-0 ACEBURIC ACID 26976-72-7 ADIMOLOL 78459-19-5 ACEBUTOLOL 37517-30-9 ADINAZOLAM 37115-32-5 ACECAINIDE 32795-44-1 ADIPHENINE 64-95-9 ACECARBROMAL 77-66-7 ADIPIODONE 606-17-7 ACECLIDINE 827-61-2 ADITEREN 56066-19-4 ACECLOFENAC 89796-99-6 ADITOPRIM 56066-63-8 ACEDAPSONE 77-46-3 ADOSOPINE 88124-26-9 ACEDIASULFONE SODIUM 127-60-6 ADOZELESIN 110314-48-2 ACEDOBEN 556-08-1 ADRAFINIL 63547-13-7 ACEFLURANOL 80595-73-9 ADRENALONE
    [Show full text]
  • PHARMACEUTICAL APPENDIX to the TARIFF SCHEDULE 2 Table 1
    Harmonized Tariff Schedule of the United States (2020) Revision 19 Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE HARMONIZED TARIFF SCHEDULE Harmonized Tariff Schedule of the United States (2020) Revision 19 Annotated for Statistical Reporting Purposes PHARMACEUTICAL APPENDIX TO THE TARIFF SCHEDULE 2 Table 1. This table enumerates products described by International Non-proprietary Names INN which shall be entered free of duty under general note 13 to the tariff schedule. The Chemical Abstracts Service CAS registry numbers also set forth in this table are included to assist in the identification of the products concerned. For purposes of the tariff schedule, any references to a product enumerated in this table includes such product by whatever name known.
    [Show full text]
  • Acrolein As a Novel Therapeutic Target for Motor and Sensory Deficits in Spinal Cord Injury
    [Downloaded free from http://www.nrronline.org on Wednesday, September 11, 2019, IP: 128.210.106.129] NEURAL REGENERATION RESEARCH April 2014,Volume 9,Issue 7 www.nrronline.org SPECIAL ISSUE Acrolein as a novel therapeutic target for motor and sensory deficits in spinal cord injury Jonghyuck Park1, 2, Breanne Muratori2, Riyi Shi1, 2 1 Department of Basic Medical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA 2 Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA Abstract Corresponding author: In the hours to weeks following traumatic spinal cord injuries (SCI), biochemical processes are Riyi Shi, M.D., Ph.D., initiated that further damage the tissue within and surrounding the initial injury site: a process Department of Basic Medical Sciences, termed secondary injury. Acrolein, a highly reactive unsaturated aldehyde, has been shown to play College of Veterinary Medicine, Purdue a major role in the secondary injury by contributing significantly to both motor and sensory defi- University, West Lafayette, IN 47907, cits. In particular, efforts have been made to elucidate the mechanisms of acrolein-mediated dam- USA, [email protected]. age at the cellular level and the resulting paralysis and neuropathic pain. In this review, we will highlight the recent developments in the understanding of the mechanisms of acrolein in motor doi:10.4103/1673-5374.131564 and sensory dysfunction in animal models of SCI. We will also discuss the therapeutic benefits of http://www.nrronline.org/ using acrolein scavengers to attenuate acrolein-mediated neuronal damage following SCI. Accepted: 2014-04-08 Key Words: oxidative stress; spinal cord injury; 3-hydrxypropyl mercapturic acid; acrolein-lysine ad- duct; hydralazine Park J, Muratori B, Shi RY.
    [Show full text]
  • (12) Patent Application Publication (10) Pub. No.: US 2012/0115729 A1 Qin Et Al
    US 201201.15729A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2012/0115729 A1 Qin et al. (43) Pub. Date: May 10, 2012 (54) PROCESS FOR FORMING FILMS, FIBERS, Publication Classification AND BEADS FROM CHITNOUS BOMASS (51) Int. Cl (75) Inventors: Ying Qin, Tuscaloosa, AL (US); AOIN 25/00 (2006.01) Robin D. Rogers, Tuscaloosa, AL A6II 47/36 (2006.01) AL(US); (US) Daniel T. Daly, Tuscaloosa, tish 9.8 (2006.01)C (52) U.S. Cl. ............ 504/358:536/20: 514/777; 426/658 (73) Assignee: THE BOARD OF TRUSTEES OF THE UNIVERSITY OF 57 ABSTRACT ALABAMA, Tuscaloosa, AL (US) (57) Disclosed is a process for forming films, fibers, and beads (21) Appl. No.: 13/375,245 comprising a chitinous mass, for example, chitin, chitosan obtained from one or more biomasses. The disclosed process (22) PCT Filed: Jun. 1, 2010 can be used to prepare films, fibers, and beads comprising only polymers, i.e., chitin, obtained from a suitable biomass, (86). PCT No.: PCT/US 10/36904 or the films, fibers, and beads can comprise a mixture of polymers obtained from a suitable biomass and a naturally S3712). (4) (c)(1), Date: Jan. 26, 2012 occurring and/or synthetic polymer. Disclosed herein are the (2), (4) Date: an. AO. films, fibers, and beads obtained from the disclosed process. O O This Abstract is presented solely to aid in searching the sub Related U.S. Application Data ject matter disclosed herein and is not intended to define, (60)60) Provisional applicationpp No. 61/182,833,sy- - - s filed on Jun.
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 6,784,177 B2 Cohn Et Al
    USOO6784177B2 (12) United States Patent (10) Patent No.: US 6,784,177 B2 Cohn et al. (45) Date of Patent: Aug. 31, 2004 (54) METHODS USING HYDRALAZINE Massie et al., The American Journal of Cardiology, COMPOUNDS AND SOSORBIDE 40:794-801 (1977). DINTRATE OR ISOSORBIDE Kaplan et al., Annals of Internal Medicine, 84:639-645 MONONTRATE (1976). Bauer et al., Circulation, 84(1):35-39 (1991). (75) Inventors: Jay N. Cohn, Minneapolis, MN (US); The SOLVD Investigators, The New England Journal of Medicine, 327(10):685–691 (1992). Peter Carson, Chevy Chase, MD (US) Ziesche et al., Circulation, 87(6):VI56-VI64 (1993). Rector et al., Circulation, 87(6):VI71-VI77 (1993). (73) Assignee: Nitro Med, Inc., Bedford, MA (US) Carson et al., Journal of Cardiac Failure, 5(3):178-187 (Sep. 10, 1999). (*) Notice: Subject to any disclaimer, the term of this Dries et al, The New England Journal of Medicine, patent is extended or adjusted under 35 340(8):609-616 (Feb. 25, 1999). U.S.C. 154(b) by 18 days. Freedman et al, Drugs, 54 (Supplement 3):41-50 (1997). Sherman et al., Cardiologia, 42(2):177-187 (1997). (21) Appl. No.: 10/210,113 Biegelson et al., Coronary Artery Disease, 10:241-256 (1999). (22) Filed: Aug. 2, 2002 Rudd et al, Am. J. Physiol., 277(46):H732–H739 (1999). (65) Prior Publication Data Hammerman et al, Am. J. Physiol., 277(46):H1579–1592 (1999). US 2004/0023967 A1 Feb. 5, 2004 LoScalzo et al., Transactions of the American and Climato logical ASS., 111:158-163 (2000).
    [Show full text]
  • Drug Name Plate Number Well Location % Inhibition, Screen Axitinib 1 1 20 Gefitinib (ZD1839) 1 2 70 Sorafenib Tosylate 1 3 21 Cr
    Drug Name Plate Number Well Location % Inhibition, Screen Axitinib 1 1 20 Gefitinib (ZD1839) 1 2 70 Sorafenib Tosylate 1 3 21 Crizotinib (PF-02341066) 1 4 55 Docetaxel 1 5 98 Anastrozole 1 6 25 Cladribine 1 7 23 Methotrexate 1 8 -187 Letrozole 1 9 65 Entecavir Hydrate 1 10 48 Roxadustat (FG-4592) 1 11 19 Imatinib Mesylate (STI571) 1 12 0 Sunitinib Malate 1 13 34 Vismodegib (GDC-0449) 1 14 64 Paclitaxel 1 15 89 Aprepitant 1 16 94 Decitabine 1 17 -79 Bendamustine HCl 1 18 19 Temozolomide 1 19 -111 Nepafenac 1 20 24 Nintedanib (BIBF 1120) 1 21 -43 Lapatinib (GW-572016) Ditosylate 1 22 88 Temsirolimus (CCI-779, NSC 683864) 1 23 96 Belinostat (PXD101) 1 24 46 Capecitabine 1 25 19 Bicalutamide 1 26 83 Dutasteride 1 27 68 Epirubicin HCl 1 28 -59 Tamoxifen 1 29 30 Rufinamide 1 30 96 Afatinib (BIBW2992) 1 31 -54 Lenalidomide (CC-5013) 1 32 19 Vorinostat (SAHA, MK0683) 1 33 38 Rucaparib (AG-014699,PF-01367338) phosphate1 34 14 Lenvatinib (E7080) 1 35 80 Fulvestrant 1 36 76 Melatonin 1 37 15 Etoposide 1 38 -69 Vincristine sulfate 1 39 61 Posaconazole 1 40 97 Bortezomib (PS-341) 1 41 71 Panobinostat (LBH589) 1 42 41 Entinostat (MS-275) 1 43 26 Cabozantinib (XL184, BMS-907351) 1 44 79 Valproic acid sodium salt (Sodium valproate) 1 45 7 Raltitrexed 1 46 39 Bisoprolol fumarate 1 47 -23 Raloxifene HCl 1 48 97 Agomelatine 1 49 35 Prasugrel 1 50 -24 Bosutinib (SKI-606) 1 51 85 Nilotinib (AMN-107) 1 52 99 Enzastaurin (LY317615) 1 53 -12 Everolimus (RAD001) 1 54 94 Regorafenib (BAY 73-4506) 1 55 24 Thalidomide 1 56 40 Tivozanib (AV-951) 1 57 86 Fludarabine
    [Show full text]
  • Association of Oral Anticoagulants and Proton Pump Inhibitor Cotherapy with Hospitalization for Upper Gastrointestinal Tract Bleeding
    Supplementary Online Content Ray WA, Chung CP, Murray KT, et al. Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding. JAMA. doi:10.1001/jama.2018.17242 eAppendix. PPI Co-therapy and Anticoagulant-Related UGI Bleeds This supplementary material has been provided by the authors to give readers additional information about their work. Downloaded From: https://jamanetwork.com/ on 10/02/2021 Appendix: PPI Co-therapy and Anticoagulant-Related UGI Bleeds Table 1A Exclusions: end-stage renal disease Diagnosis or procedure code for dialysis or end-stage renal disease outside of the hospital 28521 – anemia in ckd 5855 – Stage V , ckd 5856 – end stage renal disease V451 – Renal dialysis status V560 – Extracorporeal dialysis V561 – fitting & adjustment of extracorporeal dialysis catheter 99673 – complications due to renal dialysis CPT-4 Procedure Codes 36825 arteriovenous fistula autogenous gr 36830 creation of arteriovenous fistula; 36831 thrombectomy, arteriovenous fistula without revision, autogenous or 36832 revision of an arteriovenous fistula, with or without thrombectomy, 36833 revision, arteriovenous fistula; with thrombectomy, autogenous or nonaut 36834 plastic repair of arteriovenous aneurysm (separate procedure) 36835 insertion of thomas shunt 36838 distal revascularization & interval ligation, upper extremity 36840 insertion mandril 36845 anastomosis mandril 36860 cannula declotting; 36861 cannula declotting; 36870 thrombectomy, percutaneous, arteriovenous
    [Show full text]
  • Ovid MEDLINE(R)
    Supplementary material BMJ Open Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily <1946 to September 16, 2019> # Searches Results 1 exp Hypertension/ 247434 2 hypertens*.tw,kf. 420857 3 ((high* or elevat* or greater* or control*) adj4 (blood or systolic or diastolic) adj4 68657 pressure*).tw,kf. 4 1 or 2 or 3 501365 5 Sex Characteristics/ 52287 6 Sex/ 7632 7 Sex ratio/ 9049 8 Sex Factors/ 254781 9 ((sex* or gender* or man or men or male* or woman or women or female*) adj3 336361 (difference* or different or characteristic* or ratio* or factor* or imbalanc* or issue* or specific* or disparit* or dependen* or dimorphism* or gap or gaps or influenc* or discrepan* or distribut* or composition*)).tw,kf. 10 or/5-9 559186 11 4 and 10 24653 12 exp Antihypertensive Agents/ 254343 13 (antihypertensiv* or anti-hypertensiv* or ((anti?hyperten* or anti-hyperten*) adj5 52111 (therap* or treat* or effective*))).tw,kf. 14 Calcium Channel Blockers/ 36287 15 (calcium adj2 (channel* or exogenous*) adj2 (block* or inhibitor* or 20534 antagonist*)).tw,kf. 16 (agatoxin or amlodipine or anipamil or aranidipine or atagabalin or azelnidipine or 86627 azidodiltiazem or azidopamil or azidopine or belfosdil or benidipine or bepridil or brinazarone or calciseptine or caroverine or cilnidipine or clentiazem or clevidipine or columbianadin or conotoxin or cronidipine or darodipine or deacetyl n nordiltiazem or deacetyl n o dinordiltiazem or deacetyl o nordiltiazem or deacetyldiltiazem or dealkylnorverapamil or dealkylverapamil
    [Show full text]
  • Un Novedoso Enfoque Para El Diseño De Fármacos Antimicrobianos Asistido Por Computadora
    TOMOCOMD-CARDD: Un Novedoso Enfoque para el Diseño de Fármacos Antimicrobianos Asistido por Computadora Autora: Yasnay Valdés Rodríguez. Tutores: Prof. Dr. Yovani Marrero Ponce. Prof. MSc. Ricardo Medina Marrero. 2005-2006 La ignorancia afirma o niega rotundamente; la ciencia duda… Voltaire (1694-1778) Quiero dedicar este trabajo a todas aquellas personas que me aprecian y desean lo mejor para mi, especialmente a mis padres. A mi padre Dedico este trabajo con mucho amor, por hacerme comprender que siempre se puede llegar mas lejos, y que no hay nada imposible, solamente hay que luchar... A mi madre Por su infinita bondad, por su sacrificio inigualable. A mis familiares Por todo su apoyo y ayuda que me han mostrado incondicionalmente. A mi hermano Por ser mi fuente de inspiración. A la humanidad “...porque si supiera que el mundo se acaba mañana, yo, hoy todavía, plantaría un árbol” Quiero agradecer a todas aquellas personas que me han ayudado a realizar este sueño: A mis padres por todo el sacrificio realizado, y aún parecerles poco, los amo mucho. A mi madre por estar siempre a mi lado en los buenos y malos momentos ayudándome a levantarme en cualquier recaída. A mi padre por guiarme en la vida y brindarme sus consejos siempre útiles, por darme fuerza y vitalidad. A mi mayor tesoro, mi hermano, que me alumbra de esperanza día a día. A mis tías y primos que me ayudaron mucho, aún estando lejos. A mi novio que me apoyo en todas mis decisiones y con paciencia supo ayudarme. A mis tutores y cotutores que siempre me dieron la mano; especialmente a Yovani por su paciencia, a quien debo gran parte de mi formación como profesional por sus exigencias.
    [Show full text]