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Koracevic G, Perisic Z, Stanojkovic M, Stojanovic M, Zdravkovic M, Tomasevic M, Djordjevic D, Mladenovic K, Koracevic M, Trkulja J. A Discrepancy: Calcium Channel Blockers Are Effective for the Treatment of Hypertensive Left Ventricular Hypertrophy but Not as Effective for Prevention of Heart Failure. Med Princ Pract 2022; 31:454-462. [PMID: 36044874 PMCID: PMC9801368 DOI: 10.1159/000526792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/25/2022] [Indexed: 01/03/2023] Open
Abstract
Arterial hypertension (HTN) is important due to its high prevalence, morbidity, and mortality rates. Calcium channel blockers (CCBs) are the first-line antihypertensive drugs. HTN can lead to heart failure (HF) by causing hypertensive left ventricular hypertrophy (HTN LVH). CCBs are recommended for the treatment of HTN LVH. The aim of this study was to analyze the status of CCBs regarding (1) HTN LVH treatment and (2) capability to prevent HTN-induced HF in the guidelines. For this narrative review, the following databases were searched: Medline, Scopus, Science Direct, Springer, SAGE, Wiley, Oxford Journals, Cambridge, and Google Scholar. CCBs are effective antihypertensive drugs and a very good therapeutic option for HTN LVH as they can cause reverse LVH remodeling. Consequently, we may expect that CCBs would prevent HF. However, evidence suggests that CCBs confer less protection from HF than other first-line antihypertensive drugs. A negative inotropic action of nondihydropyridine CCBs may contribute to suboptimal protection against HF. This discrepancy is clinically relevant because CCBs are in one of the two recommended (single pill) combinations for the initial treatment of HTN. LVH is a strong risk factor for HF in HTN patients. When LVH arises, the risk of HF increases dramatically. CCBs are inferior to renin-angiotensin-aldosterone system blockers but still very effective in bringing about regression of HTN LVH; consequently, CCBs are expected to protect from HF. On the contrary, CCBs protect from HF less effectively than other first-line antihypertensive drugs. This discrepancy needs to be investigated further to improve clinical practice.
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Affiliation(s)
- Goran Koracevic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Department for Cardiovascular Diseases, University Clinical Center Nis, Nis, Serbia
| | - Zoran Perisic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Department for Cardiovascular Diseases, University Clinical Center Nis, Nis, Serbia
| | | | - Milovan Stojanovic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia
- *Milovan Stojanovic,
| | | | - Miloje Tomasevic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic for Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dragan Djordjevic
- Faculty of Medicine, University of Nis, Nis, Serbia
- Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia
| | - Katarina Mladenovic
- Faculty of Science, Department of Biology and Ecology, University of Kragujevac, Kragujevac, Serbia
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Milenkovic S, Stanojkovic M. [Hawkins type III fracture: dislocation of the talus and fracture of the medial malleolus treated by distraction external fixation]. Unfallchirurg 2007; 111:112-6. [PMID: 17874059 DOI: 10.1007/s00113-007-1311-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
These injuries are extremely rare and severe. The literature describes only individual cases of such injuries. We report a case of a displaced fracture of the talar neck with a complete posterior dislocation and rotation of the body of the talus (Hawkins type III) associated with medial malleolus fracture, treated with the method of urgent open reduction and internal fixation of the talar neck and medial malleolus as well as with the method of distraction external fixation.A 26-year-old male was injured after a fall from a height of over 8 m and was admitted as an emergency to the University Orthopedic and Traumatology Clinic in Nis. Surgery was performed within 4 h postinjury. He was mobilized with crutches with non-weight bearing. The external fixator was removed 10 weeks postsurgery, when physical therapy was initiated. The follow-up was 3 years. There were neither early nor late postoperative complications. Three years postinjury, movements in the ankle joint were satisfactory (plantar flexion 35 degrees , dorsal flexion up to 10 degrees , moderately limited movements in the subtalar joint). There were no signs of avascular necrosis; the patient walked normally and went back to physical work 2 years postinjury. Urgent open reduction and internal fixation of the Hawkins type III fracture with dislocation of the talus and distraction external fixation can play an important role in the prevention of avascular necrosis of the talus and other complications which follow this injury.
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Affiliation(s)
- S Milenkovic
- University Orthopaedic & Traumatology, Clinic Nis, B. Taskovic 48, 18000 Nis, Serbien.
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