scholarly journals Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances

2018 ◽  
Vol 11 (1) ◽  
pp. e226045
Author(s):  
Catherine Schuster Bruce ◽  
Gurvinder Rull ◽  
Antoniou Sotiris ◽  
Melvin D Lobo

A 61-year-old man with a 30-year history of uncontrolled hypertension was unable to tolerate conventional antihypertensive medications from all classes. At the time of referral to our centre he had discontinued all antihypertensive drugs and felt well. However, his average home blood pressure (HBP) reading was 179/125 mm Hg and echocardiography demonstrated moderate concentric left ventricular hypertrophy. A novel stratified medicines algorithm was used to guide treatment entailing transdermal clonidine patch therapy instead of tablet formulations. Sixteen months later, his average HBP was 147/106 mm Hg with no side effects and the left ventricular hypertrophy had completely regressed. Our experience has taught us that multiple drug intolerance is a common, often overlooked, cause of non-adherence to antihypertensive medication. This case demonstrates the benefit of a novel approach to optimise blood pressure control and emphasises the important role of hypertension specialists in managing complex, high-risk patients unable to tolerate guideline-based therapy.

Cardiology ◽  
2000 ◽  
Vol 93 (3) ◽  
pp. 149-154 ◽  
Author(s):  
C. Cuspidi ◽  
L. Lonati ◽  
L. Sampieri ◽  
G. Macca ◽  
I. Michev ◽  
...  

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Asdiana Nur ◽  
Fransiska Lintong ◽  
Maya Moningka

Abstract: Left ventricular hypertrophy (LVH) is target organ damage of cardiac with high prevalence in patients with hypertension. Increase of left ventricular mass was caused by increase in wall thickness as compensatory mechanism to minimize wall stress in response to elevated blood pressure. Left Ventricular Mass Index (LVMI) is one of echocardiography parameters used to diagnose LVH. The purpose of this study is to know the correlation between blood pressure and LVMI in patients with hypertension. A cross sectional study was performed at Cardiac Vascular and Brain Centre/ Central General Hospital of Prof. Dr. R. D Kandou. Sample was determined with consecutive sampling. Blood pressure of subjects were measurement and LVMI were taken from medical record. Data were analyzed used SPSS 21. Fifty one subjects, including 34 subjects with adequate blood pressure control and 17 subjects with inadequate blood pressure control are enrolled with ≥60 years old and men (64.7%) mostly found in this study. Pearson Correlation Test found a positive and significant correlation between systolic blood pressure and LVMI (r=0.488;p<0.05) while Spearman Correlation Test found a positive but not significant correlation between diastolic blood pressure and LVMI (r=0.226;p>0.05). In conclusion, there is a positive correlation between blood pressure and LVMI in patients with hypertension but a significant correlation was just found between systolic blood pressure and LVMI.Keywords: hypertension, Left ventricular hypertrophy (LVH), blood pressure, echocardiography, left ventricular mass index (LVMI)Abstrak: Hipertrofi ventrikel kiri (Left Ventricular Hypertrophy= LVH) merupakan kerusakan target organ jantung dengan prevalensi yang tinggi pada penderita hipertensi. Peningkatan massa ventrikel kiri disebabkan oleh penebalan dinding ventrikel kiri sebagai mekanisme kompensasi untuk meminimalkan tegangan dinding akibat respon terhadap peningkatan tekanan darah. Indeks massa ventrikel kiri (Left Ventricular Mass Index= LVMI) merupakan salah satu parameter ekokardiografi yang digunakan dalam mendiagnosa LVH. Tujuan dari penelitian ini adalah mengetahui korelasi antara tekanan darah dan LVMI pada penderita hipertensi. Penelitian dengan desain potong lintang dilakukan di instalasi pusat jantung dan pembuluh darah RSUP Prof Dr. R. D. Kandou. Sampel ditentukan secara consecutive sampling. Pengukuran tekanan darah dilakukan pada subyek penelitian dan LVMI diperoleh dari rekam medik. Data dianalisa menggunakan SPSS 21. Sebanyak 51 subyek penelitian, termasuk 34 subyek dengan hipertensi terkontrol dan 17 subyek dengan hipertensi tidak terkontrol, terdaftar pada penelitian ini dengan usia ≥60 tahun (39,2%) dan pria (64,7%)paling banyak ditemukan.Uji Korelasi Pearson menemukan tekanan darah sistolik mempunyai korelasi positif dan signifikan dengan LVMI (r=0,488;p<0,05) sedangkan uji Korelasi Spearman menemukan korelasi yang positif namun tidak signifikan antara tekanan darah diastolik dan LVMI (r=0,226;p>0,05). kesimpulan dari penelitian ini adalah terdapat korelasi positif antara tekanan darah dan LVMI pada penderita hipertensi, namun hubungan yang signifikan hanya ditemukan antara tekanan darah sistolik dan LVMI.Kata Kunci : hipertensi, hipertrofi ventrikel kiri, tekanan darah, ekokardiografi, indeks massa ventrikel kiri


2019 ◽  
Vol 37 ◽  
pp. e60
Author(s):  
I. Andrikou ◽  
C. Tsioufis ◽  
A. Kasiakogias ◽  
P. Iliakis ◽  
D. Konstantinidis ◽  
...  

Hypertension ◽  
2002 ◽  
Vol 39 (3) ◽  
pp. 744-749 ◽  
Author(s):  
Giuseppe Mancia ◽  
Stefano Carugo ◽  
Guido Grassi ◽  
Arturo Lanzarotti ◽  
Riccardo Schiavina ◽  
...  

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