scholarly journals Ace inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension

2001 ◽  
Vol 14 (3) ◽  
pp. 241-247 ◽  
Author(s):  
T Morgan
Keyword(s):  
Ace Inhibitors ◽  
Systolic Hypertension ◽  
Beta Blockers ◽  
Calcium Blockers

ASSESSMENT OF THE SITUATION OF USE OF BLOOD PRESSURED DRUGS IN THE TREATMENT OF HIGH BLOOD PRESSURE FOR OUTCOME PATIENTS AT NAM DINH PROVINCIAL HOSPITAL IN JANUARY 2021

2021 ◽  
Vol 62 (6) ◽  
Author(s):  
Nguyen Thi Khanh ◽  
Nguyen Thi Tuyet Duong
Keyword(s):  
Ace Inhibitors ◽  
Antihypertensive Effect ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Cross Sectional ◽  
Calcium Blockers ◽  
Common Combination ◽  
Selection Of

Hypertension is a disease that seriously affects the health and life expectancy of the community, playing a major etiological role in target organ damage. The selection of antihypertensive drugs to ensure reasonable safety and effectiveness is always a matter of concern of the medical industry. Applying the cross-sectional method on 2,640 patients being examined and treated for hypertension at Nam Dinh general hospital, it was found that 54.67% female patients accounted for the majority. The age of disease in both sexes is over 50 years old with a relatively high frequency of comorbidities. Most of them were prescribed drug combinations in treatment 77,9%. The group of ACE inhibitors + calcium blockers is the most common combination. ACE inhibitors are also the most commonly prescribed drugs in monotherapy. 11,4% of cases had adverse drug interactions, the most dangerous combination is UCMC + Potassium chloride and UCMC + Spironolactone causing hypokalemia. The most common interaction between beta-blockers and calcium blockers increases the antihypertensive effect.

The role of cardio-protective agents in breast cancer patients to prevent anthracycline induced cardiotoxicity: a systematic review and network meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Jeyaprakash ◽  
S Sangha ◽  
K Robeldo ◽  
K Ellenberger ◽  
S Sivapathan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Ace Inhibitors ◽  
Ace Inhibitor ◽  
Beta Blockers ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Breast Cancer Patients ◽  
Protective Agents ◽  
Cardio Protection

Abstract Background Anthracycline (ANT)-based chemotherapy for breast malignancies have significantly improved cancer outcomes. However, the cardiotoxicity induced by ANTs in the breast cancer population has increased major adverse cardiac events. While randomised controlled trials (RCTs) have explored different primary preventative agents to confer cardio-protection pre chemotherapy, comparisons between agents has been limited. It is unclear which drug is the most efficacious in preserving Left Ventricular Ejection Fraction (LVEF) amongst this population. Purpose To perform a network meta-analysis of RCTs comparing the impact on LVEF of various prophylactic cardio-protective agents, when prescribed to breast cancer patients prior to ANT-based chemotherapy. Methods Two independent authors performed a literature search as per the PRISMA guidelines using four databases (CENTRAL, Cochrane Reviews, MEDLINE, SCOPUS), to find RCTS evaluating cardio protective agents. The trial population was limited to patients with breast cancer without prior ANT exposure. Trials were only included if the cardio-protective agents were commenced prior to ANT dosing. The assessed outcome was a mean change in LVEF pre and post ANT dosing, compared to placebo prevention. Extracted data included age, ANT dose, and LVEF pre and post chemotherapy. The Cochrane Risk of Bias tool was used to appraise included RCTs. Results From 2807 search results, we identified twelve RCTs which evaluated 1126 patients. Seven studies assessed beta-blockers alone and two assessed combination ACE inhibitors and beta blockers. Individual studies assessing ACE inhibitors, spironolactone or rosuvastatin alone were also included. All patients were female with an average age of 50.5 and average ANT dose of 412 mg/m2. Our network meta-analysis showed beta-blockers showed significant protection with higher LVEF than placebo by 2.38% [0.52, 4.25]. ACE inhibitors showed a similar magnitude of LVEF preservation 2.59% [−0.20, 5.38] but not statistically significant due to wider CI because of lower sample size (n=250). Spironolactone showed a statistically significant preservation in LVEF by 12.80% [3.44, 22.16], however this was based on a single study (n=83), with marked measurement bias and deviations from intended intervention. All included trials had an intermediate or high risk of bias, with marked heterogeneity in ANT dosing and LVEF monitoring. Conclusion Beta-blockers minimise LVEF decline when administered prior to anthracycline chemotherapy, compared against alternate agents. Data may be underpowered to demonstrate the benefit of ACE inhibitor and combination beta blocker/ACE inhibitor prescription. The quality of RCT data to date is limited by a high risk of bias and significant heterogeneity between RCA reporting. This analysis is likely to inform clinical practice, and allow clinicians to prescribe primary cardio-protection in patients at high risk of cardiotoxicity. Funding Acknowledgement Type of funding source: None

Abstract P118: Use of Statins and Antihypertensive Medications in Relation to Recurrence of Atrial Fibrillation and Progression to Permanent Atrial Fibrillation

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Evan L Thacker ◽  
Paul N Jensen ◽  
Bruce M Psaty ◽  
Barbara McKnight ◽  
W. T Longstreth ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ace Inhibitors ◽  
Beta Blockers ◽  
Medication Use ◽  
Hazard Ratios ◽  
One Year ◽  
Healthy User Bias ◽  
Statin Use

Objective. We sought to determine among people whose initial atrial fibrillation (AF) terminated whether use of statins, beta-blockers, and ACE inhibitors or ARBs was associated with lower risk of recurrent AF or progression to permanent AF. Methods. In Group Health, an integrated health care system, we identified an inception cohort of people aged 30-84 with newly diagnosed AF in 2001-2004 whose initial AF terminated within six months. Follow-up was through 2009. Medication use throughout follow-up was determined from the pharmacy database. Recurrent AF and permanent AF were determined from medical records and ECG and procedure code databases. Permanent AF was defined as AF present on two dates at least six months apart with no evidence of sinus rhythm in between. Cox proportional hazards models were used to estimate hazard ratios. We compared current statin use with nonuse. To reduce healthy user bias, we compared statin use one year prior with nonuse one year prior. To reduce confounding by indication, we compared beta-blocker use with nondihydropyridine calcium channel blocker use. We compared current ACE inhibitor or ARB use with nonuse. Results. Analyses included 1,511 people. Mean age was 70 years and 51% were men. Statins were used for 36% of person-time, beta-blockers for 48%, and ACE inhibitors or ARBs for 42%. Five-year cumulative incidence of recurrent AF was 74% and of permanent AF was 24%. Current statin use vs. nonuse was associated with lower permanent AF risk. However, statin use vs. nonuse one year prior was not associated with permanent AF ( Table ). Use of beta-blockers and ACE inhibitors or ARBs was not associated with recurrent AF or permanent AF. Adjusted hazard ratios of recurrent AF and permanent AF according to medication use. Medication use Recurrent AF Adjusted HR * (95% CI) Permanent AF Adjusted HR * (95% CI) Statins -- current use analysis Nonuse 1.00 (reference) 1.00 (reference) Current use 0.96 (0.82, 1.12) 0.76 (0.58, 0.99) Statins -- lagged analysis Nonuse one year prior 1.00 (reference) 1.00 (reference) Use one year prior 0.94 (0.79, 1.13) 0.98 (0.74, 1.30) Beta-blockers Current nondihydropyridine CCB use 1.00 (reference) 1.00 (reference) Current beta-blocker use 0.91 (0.74, 1.12) 1.04 (0.69, 1.56) ACE inhibitors or ARBs Nonuse 1.00 (reference) 1.00 (reference) Current use 0.99 (0.86, 1.14) 0.98 (0.77, 1.25) * Adjusted for age, sex, BMI, diabetes, hypertension, coronary heart disease, valvular heart disease, heart failure, prior stroke, and chronic kidney disease. Conclusion. The lagged statin analysis suggests that the association of current statin use with lower permanent AF risk may have been due to an acute effect of statins that did not persist after discontinuation of use, or to a healthy user bias. We found little evidence that use of statins, beta-blockers, or ACE inhibitors or ARBs reduces risk of recurrent AF or permanent AF.

scholarly journals P1688 Rare cause of acute heart failure in patient with scleroderma

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A M F Ali ◽  
A M Abo El Soud
Keyword(s):  
Pericardial Effusion ◽  
Diastolic Dysfunction ◽  
Ace Inhibitors ◽  
Atrial Tachycardia ◽  
Troponin I ◽  
Systolic Function ◽  
Beta Blockers ◽  
Specific Treatment ◽  
Lower Limbs ◽  
Aldosterone Antagonists

Abstract A 32-year old female patient, known to have scleroderma, presented with symptoms of recurrent attacks of palpitations, dyspnea (NYHA class III) & dizziness for 3 days before presentation. No chest pain or syncope. Physical examination at presentation revealed hemodynamic instability (BP: 80/50 mmHg, HR: 200 bpm/ regular thready pulse with fine bilateral basal chest crackles. ECG revealed ventricular tachycardia (figure 1), so electrical cardioversion was immediately done upon which the reverted to multifocal atrial tachycardia with RBBB and restoration of hemodynamics and disappearance of chest crackles. She also had thickening of the fingertips’ skin, amputated tip of the right middle finger with severe associated Raynaud’s phenomenon, skin tightness of both upper and lower limbs, Buccal buckling with limited mouth opening (figure 2 and 3). Renal function and serum electrolytes were normal with elevated troponin I, creatine kinase and CK-MB serum levels. Echocardiogram showed mild concentric LV hypertrophy with normal internal dimensions and severely impaired systolic function (EF∼ 20%) with severe global hypokinesia . The RV was also dilated and impaired (TAPSE∼8 mm). Mild pericardial effusion with no chamber collapse (Figure 4, 5 and 6). Coronary angiography revealed normal epicardial coronaries. Echocardiography one month prior to presentation revealed normal LV dimensions, preserved systolic function and mild diastolic dysfunction with no resting wall motion abnormalities, upper normal RV size with preserved RV systolic function and mild elevation of pulmonary artery systolic pressure. The presence of new acute biventricular failure in the absence of CAD and elevated cardiac biomarkers are highly suggestive of acute myocarditis. Medical therapy included loop diuretics, angiotensin-converting-enzyme inhibitor, beta-blocker and aldosterone receptor antagonist. She was discharged in NYHA I-II, with normal cardiac enzymes and left ventricle ejection fraction of 30% and resolution of the pericardial effusion. Discussion Scleroderma is rarely present with impaired LV contractility but more commonly presented with diastolic dysfunction (in up to 40% of cases) (1,2). This case was presented with acute myopericarditis with severe biventricular systolic dysfunction which is very rare with scleroderma and only mentioned in few case studies, so no consensus on specific treatment. Few patients with myocarditis and scleroderma were treated with immunosuppressants along with diuretics, beta-blockers, and ACE inhibitors with most of them showed improvement clinically with recovery of systolic function after 12 months of follow up (3). We noted improvement of patient symptoms within few days of diuretics, beta-blockers, Aldosterone antagonists and ACE inhibitors. This case had baseline conduction abnormalities (RBBB with multifocal atrial tachycardia) which could be present in up to 20% of cases (4). Abstract P1688 Figure.

scholarly journals Endothelial dysfunction: Mechanisms of development and therapeutic options

2006 ◽  
Vol 59 (7-8) ◽  
pp. 335-341 ◽  
Author(s):  
Srdjan Pesic ◽  
Miroslav Radenkovic ◽  
Leposava Grbovic
Keyword(s):  
Endothelial Dysfunction ◽  
Ace Inhibitors ◽  
Vascular Endothelial Cells ◽  
Beta Blockers ◽  
Phosphodiesterase Inhibitors ◽  
Initial Step ◽  
Endothelial Damage ◽  
Lipid Lowering ◽  
Organic Nitrates ◽  
Vascular Protection

Introduction. Vascular endothelial cells play a key role in cardiovascular regulation by producing a number of potent vasoactive agents, including the vasodilator molecule nitric oxide (NO) and the vasoconstrictor peptide endothelin (ET). Endothelial dysfunction. Endothelial dysfunction is recognized as the initial step in the atherosclerotic process. Impairment of NO synthesis, or increased inactivation of NO by superoxide radicals, may account for the increased peripheral vascular tone, as well as contribute to the clinical consequences of different pathophysiological conditions-which include vascular hypertrophy, increased platelet and monocyte adhesion to the endothelium, atherosclerosis, myocardial infarction and stroke. To date, most interventions attempting to improve endothelial dysfunction have targeted one or more of the numerous risk factors that can cause endothelial damage: hypertension (ACE inhibitors and calcium antagonists), hypercholesterolemia (lipid-lowering agents), cigarette smoking (cessation), sedentary lifestyle (increased physical activity), menopause (estrogen replacement therapy), and diabetes mellitus (control of metabolic abnormalities). Several pharmacologic agents have been suggested to achieve vascular protection through mechanisms that go beyond their primary therapeutic actions (ACE-and HMG-CoA reductase inhibitors). Beneficial changes to the endothelium might result from promotion of vasorelaxation, inhibition of vasoconstriction, reduction in the production of free radicals, or other mechanisms that protect the endothelium from injury. Conclusion. This study deals with the results of many experimental and clinical investigations. The possibility of using different classes of drugs was also established, including ACE inhibitors, Ca-antagonists, AT and endothelin receptor antagonists, direct activator of adenyl cyclase, statins, antioxidants, L-arginine, phosphodiesterase inhibitors, beta-blockers and organic nitrates. .

Pre-fracture medication use as a predictor of 30-day mortality in hip fracture patients: an analysis of 141,201 patients

2019 ◽  
Vol 30 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Christopher Jantzen ◽  
Christian M Madsen ◽  
Bo Abrahamsen ◽  
Susanne Van Der Mark ◽  
Benn R Duus ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Ace Inhibitors ◽  
Beta Blockers ◽  
Channel Blockers ◽  
Prescription Database ◽  
Fracture Type ◽  
Co Morbidity ◽  
Morbidity Index

Purpose: To evaluate the predictive value of pre-fracture medication usage on 30-day mortality following a hip fracture. Methods: Information on age, sex, fracture type, time of death and Charlson co-morbidity index (CCI) was collected from the Danish National Patient Registry on all patients above 60 years, sustaining a hip fracture during the period January 1995 to December 2013. Information on drug usage was obtained from the Danish National Prescription Database. Hazard ratios were calculated with 30-day mortality as the outcome. A univariate and 3 multivariate analyses were conducted with increasing adjustments, starting with age, sex and fracture type, adding co-morbidity and dose in the latter. Results: 141,201 patients were included and a total of 12 drugs/drug groups were identified for analysis. Increased mortality was evident in all analyses for antiarrhythmics, beta blockers, proton pump inhibitors, loop diuretics, opioids, acetaminophen and for psycholeptics. For ACE-inhibitors, increased mortality was found in all analyses, except after adjustment for co-morbidity and dose. For thiazide diuretics, a significantly reduced mortality was evident in all but the univariate analyses while NSAIDs and statins were associated with a significantly reduced mortality in all analyses. For calcium channel blockers, an insignificant decrease was found after adjustment for dose. Further analysis showed a dose-response relationship for all drugs except ACE-inhibitors and calcium channel blockers. Conclusion: The study shows a correlation between pre-fracture usage of certain drugs and 30 day mortality after a hip fracture.

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