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Title: Outcomes in subgroups of hypertensive patients treated with regimens based on valsartan and amlodipine: An analysis of findings from the VALUE trial
Author: Gonzalez-Lopez, L.
Gamez-Nava, J.I.
De La Cerda-Trujillo, L.F.
Rocha-Munoz, A.D.
Zavaleta-Muniz, S.A.
Issue Date: 2013
Abstract: Osteoporosis is a frequent complication of ankylosing spondylitis (AS), with a prevalence from 19% to 62% dependent upon general factors (age, gender, smoking status), biomechanical aspects, specific character-istics of the disease (such as, a longer disease duration, presence of syndesmophytes, severe extra-articular manifestations or involvement of peripheral joints), and finally, factors related to the pro-inflammatory process with an increased in resorption by osteoclasts associated with the stimuli induced by cytokines. Differences in osteoporosis frequencies are observed when it is evaluated exclusively in the axial skeleton or when it is included the forearm in the measurement of bone mineral density (BMD). Vertebral fractures are relevant complications of osteoporosis in AS, with a prevalence varying from 16 to 32%, although these fractures are frequently misdiagnosed in the clinical practice, observed as an unexpected finding in radiographic studies. More recent diagnostic methods to detect vertebral fractures include vertebral morphometry measured with dual photon X-ray absorption (DXA), with a prevalence of osteoporotic fractures in thoracic and lumbar spine of 19%, whereas, in our center vertebral fractures in have been identified in 32%. Interestingly, a high proportion of patients with osteoporotic vertebral fractures have a normal BMD measurement in their lumbar spine being related to the presence of syndesmophytes that act as an artifact for overestimating the BMD in the lumbar spine. Osteoporotic vertebral fractures are associated with a decrease in the global functional capacity and impairment in spine mobility. A multiplicity of cytokines and other molecules participate in the genesis of osteoporosis in AS and constitute potential targets for present and future therapeutic strategies. TNF-? and interleukin-6 (IL-6) are related to a decrease in BMD in early stages of AS whereas, a decrease in serum levels of sclerostin and Dikkoppf (DKK) have been associated with syndesmophytes and the inhibition of bone mass formation. Several adipokines, including leptin and adiponectin, have been related to abnormalities in BMD in other diseases but their contribution to osteoporosis associated with AS has not yet been evaluated. Bone remodeling markers, such as type I collagen N-terminal propeptide (PINP), have been related to disease duration or age, whereas, markers of bone resorption seem to be related to low BMD, although their predictive value for the development of vertebral fractures is still unclear. Treatment with anti-TNF inhibitors is associated with an increase in BMD and an improvement in serum levels of bone remodeling markers. Since there is not enough evidence to consider that the use of anti-TNF inhibitors constitutes a sufficient strategy to decrease the risk of vertebral fractures in AS patients with osteoporosis, the addition of other therapies are therefore required including vitamin D, calcium supple-ments, antiresorptive therapy with biphosphonates or teriparatide in AS with osteoporosis or with a high risk for osteoporotic fractures. Some biphosphonates such as pamidronate offer benefits in some clinical manifestations, improving axial symptoms and peripheral arthritis. In summary, osteoporosis and vertebral fractures in AS are an exciting research area for evaluation of new therapeutic strategies oriented towards prevention and treatment of this relevant complication in AS. " 2013 Nova Science Publishers, Inc.",,,,,,,,,"","",,,,,,,,"Ankylosing Spondylitis: Symptoms, Treatment and Potential Complications",,"1
35",,,,"Scopus",,,,,,,,,,,,"Osteoporosis and vertebral fractures in ankylosing spondylitis: Current concepts and therapeutic challenges",,"Book Chapter" "45215","123456789/35008",,"Ruiz, F., Dpto. Geodinámica y Paleontología, Universidad de Huelva, Avda. Tres de Marzo, s/n, 21071-Huelva, Spain; Abad, M., Dpto. Geodinámica y Paleontología, Universidad de Huelva, Avda. Tres de Marzo, s/n, 21071-Huelva, Spain; Pozo, M., Dpto. Geología y Geoquímica, Facultad de Ciencias, Universidad Autónoma de Madrid, 28049 Madrid, Spain; Carretero, M.I., Dpto. Cristalografía, Mineralogía y Química agrícola, Facultad de Química, Universidad de Sevilla, 41012 Sevilla, Spain; Rodríguez Vidal, J., Dpto. Geodinámica y Paleontología, Universidad de Huelva, Avda. Tres de Marzo, s/n, 21071-Huelva, Spain; Cáceres, L.M., Dpto. Geodinámica y Paleontología, Universidad de Huelva, Avda. Tres de Marzo, s/n, 21071-Huelva, Spain; Font, E., IDL-Facultade de Ciencias, Universidade de Lisboa, Portugal; González-Regalado, M.L., Dpto. Geodinámica y Paleontología, Universidad de Huelva, Avda. Tres de Marzo, s/n, 21071-Huelva, Spain; Toscano, A., Dpto. Geodinámica y Paleontología, Universidad de Huelva, Avda. Tres de Marzo, s/n, 21071-Huelva, Spain; García, E.X., Dpto. Botánica y Zoología, Universidad de Guadalajara, 45510-Zapopan, Mexico",,"Ruiz, F.
Abad, M.
Pozo, M.
Carretero, M.I.
Rodriguez Vidal, J.
Caceres, L.M.
Font, E.
Gonzalez-Regalado, M.L.
Toscano, A.
García, E.X.",,"2013",,"The analysis of the geological units and the ostracod assemblages of a long core collected in the southern Doñana National Park (SW Spain) permits to deduce an evolution from shallow marine palaeoenvironments (Lower Pliocene) to a brackish lagoon (Upper Pleistocene-Holocene) and the deposit of aeolian sediments (<1900 yr BP), with an intermediate alluvial stage during the Pleistocene. In the Late Holocene, a tsunamigenic event was detected, with the erosion of aeolian sediments and a subsequent deposit on subtidal environments.",,,,,,"10.3989/egeol.41072.234",,,"","",,,,,,"2",,"Estudios Geologicos",,"173
WOS",,,,,,"Ostracods; Palaeoenvironment; Pliocene-Recent; S Doñana National Park; Spain",,,,,,"Ostracods as palaeoenvironmental tracers: Evolution of the southern area of the Doñana National Park from the Lower Pliocene to Recent [Evolución paleoambiental del sector meridional del Parque Nacional de Doñana desde el Plioceno Inferior a la actualidad]",,"Article" "45216","123456789/35008",,"Reillo, F.C., Centro de Estudios de Género, Universidad de Guadalajara, Mexico",,"Reillo, F.C.",,"2011",,"Heritage tourism has flourished in the last three decades. Its importance has prompted the emergence of different kinds of analysis that have consolidated the heritage tourism as a topic in the academic debate. The present paper shows an anomalous case of heritage tourism: the 'ex haciendas' in the Xalapa area. The discussion of this case allows us to rethink and reopen the implicit assumptions of this topic. In doing so, we can present alternative ways as the old 'haciendas' are being visited and experienced as tourist sites.",,,,,,,,,"","",,,,,,"16",,"Andamios",,"261
WOS",,,,,,"Anomalous cases; Ex haciendas; Heritage tourism; New types of tourism; Xalapa",,,,,,"Other types of heritage tourism. Study case of the ex haciendas in Xalapa region [Otras formas de turismo patrimonial. el caso de las ex haciendas de xalapa]",,"Article" "45217","123456789/35008",,,,"Macías García, L. A.",,"1990",,,,,,,,,,"0187-7674","",,,,,,,"13",,"Confines de relaciones internacionales y ciencia política",,"07-nov",,"3",,"CLASE",,,,,,,,"Precios",,,,"Evolucion reciente de los precios de los articulos de la canasta basica en la zona metropolitana de guadalajara",,"journalArticle" "45218","123456789/35008",,"Elizondo-Montemayor, L., ITESM, Mexico City, Mexico; Cid-García, A., ITESM, Mexico City, Mexico; Pérez-Rodríguez, B.A., Universidad de Monterrey, Mexico City, Mexico; Alarcón-Fuentes, G., National Health Secreatariat of Mexico, Mexico City, Mexico; Pérez-García, I., Universidad de Guadalajara, Guadalajara, Mexico; David, S., University of Michigan Medical School, Ann Arbor, MI, United States",,"Elizondo-Montemayor, L.
Cid-García, A.
Perez-Rodriguez, B.A.
Alarcon-Fuentes, G.
Perez-García, I.
David, S.",,"2007",,"Introduction: In countries such as Mexico, outcome-based education has flourished only in a few schools. The Mexican Association of Medical Schools committed to defining a set of national outcomes and standards for all Mexican medical graduates. Methods: During the XLVIII ordinary national meeting of this association, 120 faculty members and deans of medical schools worked collaboratively and identified, by consensus, the preliminary version of the national outcomes and minimum essential requirements, as a means of defining the national outcome-based profile for Mexican medical graduates. Results: The nine outcomes are: (1) clinical skills; (2) communication skills; (3) public health and health systems; (4) scientific bases of medicine; (5) information management; (6) critical thinking and research; (7) teaching skills; (8) administrative and legal aspects of medical practice; and (9) values, attitudes, professionalism, and ethics. Conclusion: The deans and faculty members of the Mexican medical schools are well aware of the diversity in the quality of medical education offered by different schools. The preliminary version of a national set of outcomes has been defined, and a final version will be created during the next national meetings of the Association. The greatest challenge however, will be its implementation into a new educational model in each school.",,,,,,"10.1080/01421590701691411",,,"","",,,,,,"7",,"Medical Teacher",,"691
WOS",,,,,,,,,,,,"Outcome-based national profile of Mexico's medical graduates",,"Article" "45219","123456789/35008",,"Zanchetti, A., Centro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milan, Ospedale Maggiore, Milan, Italy, Centro di Fisiologia Clinica e Ipertensione, Via F. Sforza, 35, 20122 Milano, Italy; Julius, S., University of Michigan, Ann Arbor, MI, United States; Kjeldsen, S., University of Michigan, Ann Arbor, MI, United States, Ullevaal University Hospital, Oslo, Norway; McInnes, G.T., University of Glasgow, Glasgow, United Kingdom; Hua, T., Novartis Pharma, East Hanover, NJ, United States; Weber, M., State University of New York, New York, NY, United States; Laragh, J.H., Cornell Medical Center, New York, NY, United States; Plat, F., Novartis Pharma AG, Basel, Switzerland; Battegay, E., University Hospital, Basel, Switzerland; Calvo-Vargas, C., Hospital Civil Juan I, Menchaca University of Guadalajara, Guadalajara, Mexico; Cie?li?ski, A., Karol Marcinkowski University, Pozna?, Poland; Degaute, J.P., Hospital Erasme, Brussels, Belgium; Holwerda, N.J., Sint Elisabeth Ziekenhuis, Tilburg, Netherlands; Kobalava, J., Russian University of People Friendship, Moscow, Russian Federation; Pedersen, O.L., Viborg Hospital, Viborg, Denmark; Rudyatmoko, F.P., J.I. Sutorejo-Utara F. 24, Surabaya, Indonesia; Siamopoulos, K.C., University of Ioannina, Ioannina, Greece; Starset, A., Akershus University Hospital, Nordbyhagen, Norway",,"Zanchetti, A.
Julius, S.
Kjeldsen, S.
McInnes, G.T.
Hua, T.
Weber, M.
Laragh, J.H.
Plat, F.
Battegay, E.
Calvo-Vargas, C.
Cieslinski, A.
Degaute, J.P.
Holwerda, N.J.
Kobalava, J.
Pedersen, O.L.
Rudyatmoko, F.P.
Siamopoulos, K.C.
Storset, O.",,"2006",,"BACKGROUND: In the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial the primary outcome (cardiac morbidity and mortality) did not differ between valsartan and amlodipine-based treatment groups, although systolic blood pressure (SBP) and diastolic blood pressure reductions were significantly more pronounced with amlodipine. Stroke incidence was non-significantly, and myocardial infarction was significantly lower in the amlodipine-based regimen, whereas cardiac failure was non-significantly lower on valsartan. OBJECTIVES: The study protocol specified additional analyses of the primary endpoint according to: sex; age; race; geographical region; smoking status; type 2 diabetes; total cholesterol; left ventricular hypertrophy; proteinuria; serum creatinine; a history of coronary heart disease; a history of stroke or transient ischemic attack; and a history of peripheral artery disease. Additional subgroups were isolated systolic hypertension and classes of antihypertensive agents used immediately before randomization. METHODS: The 15 245 hypertensive patients participating in VALUE were divided into subgroups according to baseline characteristics. Treatment by subgroup interaction analyses were carried out by a Cox proportional hazard model. Within each subgroup, treatment effects were assessed by hazard ratios and 95% confidence intervals. RESULTS: For cardiac mortality and morbidity, the only significant subgroup by treatment interaction was of sex (P = 0.016), with the hazard ratio indicating a relative excess of cardiac events with valsartan treatment in women but not in men, but SBP differences in favour of amlodipine were distinctly greater in women. No other subgroup showed a significant difference in the composite cardiac outcome between valsartan and amlodipine-based treatments. For secondary endpoints, a sex-related significant interaction was found for heart failure (P < 0.0001), with men but not women having a lower incidence of heart failure with valsartan. CONCLUSION: As in the whole VALUE cohort, in no subgroup of patients were there differences in the incidence of the composite cardiac endpoint with valsartan and amlodipine-based treatments, despite a greater blood pressure decrease in the amlodipine group. The only exception was sex, in which the amlodipine-based regimen was more effective than valsartan in women, but not in men, whereas the valsartan regimen was more effective in preventing cardiac failure in men than in women. " 2006 Lippincott Williams & Wilkins, Inc.
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