Cardioprotective drugs

Stable Coronary Artery Disease ◽

Channel Blockers ◽

Converting Enzyme Inhibitors

Cardioprotective drugs are important in the treatment of patients at risk for or with documented cardiovascular disease. Beta-blockers are indicated after acute coronary syndromes, stable coronary artery disease, heart failure, and arrhythmias. Angiotensin-converting enzyme inhibitors (ACEi) are important in congestive heart failure, stable angina, post-acute myocardial infarction, and secondary prevention after any event or revascularization. Angiotensin receptor blockers are mainly alternative drugs for the same indications in case of intolerance to ACEi. Calcium channel blockers are first line medication for patients with isolated systolic hypertension, black people, and during pregnancy, in the presence of intermittent claudication, asymptomatic atherosclerosis, or metabolic syndrome. A polypill is a combination pill in which multiple medications effective in the prevention of cardiovascular disease (for example statins, antihypertensives, and aspirin) are put together in a single pill.

Role of antihypertensive drugs in the treatment of migraine

Orvosi Hetilap ◽

10.1556/oh.2015.30056 ◽

2015 ◽

Vol 156 (5) ◽

pp. 179-185 ◽

Cited By ~ 2

Author(s):

Gergely Fehér ◽

Gabriella Pusch

Keyword(s):

Enzyme Inhibitors ◽

Beta Blockers ◽

Channel Blockers ◽

Migraine Prevention ◽

Angiotensin Receptor ◽

Receptor Blockers

The treatment of migraine depends on the frequency, severity and concomitant diseases. There are several specific drugs developed for migraine prevention in addition to the additive antimigraine effects of some other non-specific drugs. The aim of this literature-based review is to summarize the possible antimigraine properties of different antihypertensive agents (beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, etc.) focusing on the possible side effects (avoidance of beta blockers in the absence of heart disease, possible antiparkinson effect of calcium channel blockers, additive effect of drugs modifying the renin-angiotensin system activity, etc.). Current evidence supports the use of angiotensin converting enzyme inhibitors (mainly lisinopril) and angiotensin receptor blockers (mainly candesartan) for long-term migraine prevention and blood pressure control. Long-term beta-blocker treatment should be avoided in the absence of ischemic heart disease due to possible unfavourable cardiovascular effects. Orv. Hetil., 2015, 156(5), 179–185.

Heart failure medication after a first hospital admission and risk of heart failure readmission, focus on beta-blockers and renin-angiotensin-aldosterone system medication: A retrospective cohort study in linked databases

PLoS ONE ◽

10.1371/journal.pone.0244231 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244231

Author(s):

Willemien J. Kruik-Kollöffel ◽

Job van der Palen ◽

Carine J. M. Doggen ◽

Marissa C. van Maaren ◽

H. Joost Kruik ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admission ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Post Discharge ◽

Receptor Blockers ◽

Unselected Group

Background This study assessed the association between heart failure (HF) medication (angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB), beta-blockers (BB), mineralocorticoid-receptor antagonists (MRA) and diuretics) and HF readmissions in a real-world unselected group of patients after a first hospital admission for HF. Furthermore we analysed readmission rates for ACEI versus ARB and for carvedilol versus β1-selective BB and we investigated the effect of HF medication in relation to time since discharge. Methods and findings Medication at discharge was determined with dispensing data from the Dutch PHARMO Database Network including 22,476 patients with HF between 2001 and 2015. After adjustment for age, gender, number of medications and year of admission no associations were found for users versus non-users of ACEI/ARB (hazard ratio, HR = 1.01; 95%CI 0.96–1.06), BB (HR = 1.00; 95%CI 0.95–1.05) and readmissions. The risk of readmission for patients prescribed MRA (HR = 1.11; 95%CI 1.05–1.16) or diuretics (HR = 1.17; 95%CI 1.09–1.25) was higher than for non-users. The HR for ARB relative to ACEI was 1.04 (95%CI 0.97–1.12) and for carvedilol relative to β1-selective BB 1.33 (95%CI 1.20–1.46). Post-hoc analyses showed a protective effect shortly after discharge for most medications. For example one month post discharge the HR for ACEI/ARB was 0.77 (95%CI 0.69–0.86). Although we did try to adjust for confounding by indication, probably residual confounding is still present. Conclusions Patients who were prescribed carvedilol have a higher or at least a similar risk of HF readmission compared to β1-selective BB. This study showed that all groups of HF medication -some more pronounced than others- were more effective immediately following discharge.

Abstract 3783: Antihypertensive Medications in the Department of Veterans Affairs (VA) 1999–2006

Circulation ◽

10.1161/circ.116.suppl_16.ii_860-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Julio R Lopez ◽

Sonya Wong ◽

Joy L Meier ◽

Fran Cunningham ◽

David Siegel

Keyword(s):

Antihypertensive Medication ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Medication Use ◽

Steady Increase ◽

Channel Blockers ◽

Antihypertensive Medications ◽

Converting Enzyme Inhibitors

Objective: To evaluate national antihypertensive medication use we collected data from 2003–2006 and compared it to previously collected data from 1999 –2002. We examine the cost implications of shifts in antihypertensive medications prescribed. Methods: National VA pharmacy data were used to determine the use of beta blockers (BB), calcium channel blockers (CCB), thiazide diuretics (TD) alone or with K sparing diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and combinations of the aforementioned classes for 2003–2006. Total number of treatment days, determined from days supply of the prescription, was used to determine patterns of use over time. Results: Antihypertensive medication use in the VA represented more than 1.5 billion days in 2006 and increased 2.5 fold from the 577 million estimated for 1999. ACEI were most commonly used, representing 31.8% and 31.7% of treatment days in 1999 and 2006, respectively. In the ACEI class lisinopril is the most commonly used drug. Increases in use from 1999 to 2006 were 21.2% to 25.2% for BB, 14.4% to 17.8% for TD, and 1.2% to 5.2% for ARB. Decreases in use from 1999 to 2006 were 26.7% to 17.6% for CCB. The decline in CCB was inversely correlated to the increase in BB or TD (p<0.001). Shifts in medication use are estimated to save the VA $33 million annually. Conclusions: ACEI remain the most prescribed antihypertensive drug class in the VA, followed by BB, TD, CCB, and ARBs. TD use shows a slow steady increase while CCB use continues to decline. These findings suggest that VA has increasing adherence to JNC7 and VA HTN guidelines.

Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes

American Journal of Nephrology ◽

10.1159/000491828 ◽

2018 ◽

Vol 48 (1) ◽

pp. 56-64 ◽

Cited By ~ 3

Author(s):

Ke Wang ◽

Leila R. Zelnick ◽

Peter B. Imrey ◽

Ian H. deBoer ◽

Jonathan Himmelfarb ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Lower Risk ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Channel Blockers ◽

Medication History ◽

Fistula Maturation

Background: The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. However, approximately half of AVFs fail to mature. The use of angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) exerts favorable endothelial effects and may promote AVF maturation. We tested associations of ACE-I and ARBs, CCBs, beta-blockers, and diuretics with the maturation of newly created AVFs. Methods: We evaluated 602 participants from the Hemodialysis Fistula Maturation Study, a multi-center, prospective cohort study of AVF maturation. We ascertained the use of each medication class within 45 days of AVF creation surgery. We defined maturation outcomes by clinical use within 9 months of surgery or 4 weeks of initiating hemodialysis. Results: Unassisted AVF maturation failure without intervention occurred in 54.0% of participants, and overall AVF maturation failure (with or without intervention) occurred in 30.1%. After covariate adjustment, CCB use was associated with a 25% lower risk of overall AVF maturation failure (95% CI 3%–41% lower) but a non-significant 10% lower risk of unassisted maturation failure (95% CI 23% lower to 5% higher). ACE-I/ARB, beta-blocker, and diuretic use was not significantly associated with AVF maturation outcomes. None of the antihypertensive medication classes were associated with changes in AVF diameter or blood flow over 6 weeks following surgery. Conclusions: CCB use may be associated with a lower risk of overall AVF maturation failure. Further studies are needed to determine whether CCBs might play a causal role in improving AVF maturation outcomes.

Beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?

Current Opinion in Anaesthesiology ◽

10.1097/aco.0b013e32833eeb19 ◽

2010 ◽

Vol 23 (6) ◽

pp. 687-690 ◽

Cited By ~ 26

Author(s):

Ian Smith ◽

Ian Jackson

Keyword(s):

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Channel Blockers ◽

Converting Enzyme ◽

Angiotensin Receptor ◽

Receptor Blockers

Epidemiology and treatment of chronic heart failure; use of bisoprolol

Orvosi Hetilap ◽

10.1556/oh.2013.29741 ◽

2013 ◽

Vol 154 (44) ◽

pp. 1731-1734

Author(s):

Viktor Nagy

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Beta Blockers ◽

Converting Enzyme ◽

Receptor Blockers

The prevalence of chronic heart failure in Hungary is 1.6% in the adult population, but it occurs in 15–20% of subjects over 80 years of age. The base of treatment of heart failure is the blockade of the neuro-hormonal system, which includes the use of angiotensin converting enzyme inhibitors (angiotensin receptor blockers in case of angiotensin converting enzyme inhibitors intolerance), beta receptor blockers and mineralocorticoid receptor antagonists. Because of their negative inotropic effect, beta blockers were neglected for a long time from the treatment of heart failure. However, during the past decades several studies have demonstrated that beta blockers decrease mortality in patients with heart failure. The effectiveness of bisoprolol in reducing mortality has also also been documented in a number of studies. Orv. Hetil., 154 (44), 1731–1734.

Medical management: pharmacological therapy

ESC CardioMed ◽

10.1093/med/9780198784906.003.0337 ◽

2018 ◽

pp. 1387-1393 ◽

Cited By ~ 1

Author(s):

Aviv A. Shaul ◽

David Hasdai

Keyword(s):

Enzyme Inhibitors ◽

Beta Blockers ◽

Pharmacological Therapy ◽

Channel Blockers ◽

Converting Enzyme ◽

Receptor Blockers ◽

Symptom Status

The current armamentarium for the treatment of chronic ischaemic heart disease includes agents that are used to relieve angina or attenuate ischaemia, as well as agents that are administered regardless of symptom status to ameliorate prognosis. Beta blockers and calcium channel blockers are the mainstay treatments for angina and ischaemia relief. Adjunct therapy includes nitrates, ivabradine, ranolazine, nicorandil, and trimetazidine. Aspirin (alternatively, clopidogrel), statins (possibly with ezetimibe), and angiotensin-converting enzyme inhibitors (alternatively, angiotensin receptor blockers), are the mainstay agents to improve outcomes.

Tata Laksana Non Imunosupresan Sindrom Nefrotik pada Anak

Sari Pediatri ◽

10.14238/sp19.1.2017.53-62 ◽

2017 ◽

Vol 19 (1) ◽

pp. 53

Author(s):

Sudung Oloan Pardede

Keyword(s):

Enzyme Inhibitors ◽

Beta Blockers ◽

Channel Blockers ◽

Angiotensin Receptor ◽

Recommended Daily Allowance ◽

Receptor Blockers ◽

Daily Allowance

Sindrom nefrotik adalah keadaan klinis yang terdiri atas proteinuria masif, hipoalbuminemia (< 2,5 g/dL), edema, dan hiperkolesterolemia. Terapi utama sindrom nefrotik adalah imunosupresan terutama kortikosteroid. Pada sindrom nefrotik relaps sering atau dependen steroid, dan sindrom nefrotik resisten steroid, selain steroid diberikan juga imunosupresan lain seperti siklofosfamid, siklosporin, mikofenolat mofetil, takrolimus, atau pun levamisol. Selain pemberian imunosupresan diperlukan terapi suportif, yang meliputi terapi diitetik, tata laksana edema, hipertensi, hipovolemia, trombosis, hiperlipidemia, dan infeksi. Tata laksana diitetik terdiri atas kalori yang adekuat, protein sesuai recommended daily allowance, lemak low saturated, dan rendah garam. Komposisi zat gizi yang dianjurkan terdiri atas 10-14% protein; 40-50% lemak poly- dan monounsaturated, 40-50% karbohidrat. Tata laksana edema terdiri atas restriksi cairan, pemberian diuretik, dan infus albumin jika perlu. Infeksi yang sering terjadi pada sindrom nefrotik adalah selulitis peritonitis, dan pneumonia yang diterapi dengan antibiotik sefotaksim, seftriakson, ko-amoksiklav. Antihipertensi yang digunakan pada anak umumnya diuretik, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, (amblodipin, nifedipin, isradipin), alpha-symphatetic agents, beta blockers dan vasodilator. Aktivitas fisik tidak perlu dibatasi, dan pada edema ringan atau tidak berat tidak perlu dilarang pergi ke sekolah