Treatment of Hypertensive Patients with Ventricular Arrhythmias: Comparison and Combination of β-Blocker and Anti-Arrhythmic Therapy

1989 ◽  
Vol 17 (2) ◽  
pp. 113-124
Author(s):  
S. Di Somma ◽  
S. Savonitto ◽  
M. Petitto ◽  
V. Liguori ◽  
C. Magnotta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ventricular Arrhythmias ◽  
Good Effect ◽  
Atrial Arrhythmias ◽  
Once Daily ◽  
Hypertensive Patients ◽  
Effect Of Therapy ◽  
Β Blocker ◽  
Β Blockers ◽  
Exercise Induced

The effect of therapy with atenolol and tocainide, separately or in combination, was studied in 20 patients with hypertension and concomitant ventricular arrhythmias. Patients were given 400 mg tocainide, three times daily, 100 mg atenolol, once daily (plus 25 mg hydrochlorothiazide and 2.5 mg amiloride diuretics if required) and a combination of these treatments. Tocainide alone significantly reduced the incidence of ventricular arrhythmias without affecting atrial arrhythmias. It also controlled exercise-induced arrhythmias in 7/13 (54%) patients. Atenolol significantly reduced atrial arrhythmias and had a good effect on exercise-induced arrhythmias (reduced in 75% of patients), but it did not have a significant effect on ventricular arrhythmias. In 13 patients, despite normalization of blood pressure by atenolol, it was necessary to combine antihypertensive therapy (atenolol) with anti-arrhythmic therapy (tocainide) in order to reduce ventricular arrhythmias. All drugs were well tolerated. It is concluded that, in certain patients, specific anti-arrhythmic treatment may be necessary to control ventricular arrhythmias in hypertensive patients despite normalization of blood pressure by β-blockers.

Effect of Enalapril at Rest and during Isometric and Dynamic Exercise in Essential Hypertensive Patients

1989 ◽  
Vol 17 (1) ◽  
pp. 76-81
Author(s):  
R. Fariello ◽  
E. Boni ◽  
C. Alicandri ◽  
A. Zaninelli ◽  
A. Cantalamessa ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Bicycle Ergometer ◽  
Dynamic Exercise ◽  
Rate Pressure Product ◽  
Angiotensin Converting Enzyme Inhibition ◽  
Maximal Heart Rate ◽  
Once Daily ◽  
Hypertensive Patients ◽  
Hand Grip ◽  
Converting Enzyme Inhibition

Vasodilator drugs reduce peripheral vascular resistance but lead to a secondary baroreflex-mediated chronotropic effect. After angiotensin-converting enzyme inhibition, blood pressure falls without associated tachycardia. In a previous study it was observed that enalapril increased vagal tone in essential hypertensive patients. In order to evaluate the effect of enalapril on sympathetic stimulation 10 mild to moderate hypertensive patients were studied during static (hand grip) and dynamic exercise (bicycle ergometer), after 2 weeks of placebo and after 1 month of treatment with 20–40 mg enalapril once daily. Enalapril significantly reduced blood pressure and the rate–pressure product at rest and at peak dynamic exercise. There was no effect on supine and maximal heart rate. Enalapril also significantly reduced blood pressure during hand grip, but did not interfere with the rate of the increase. Thus, enalapril does not seem to interfere with sympathetic adaptation to stress.

scholarly journals Nebivolol reduces central blood pressure in stage I hypertensive patients: experimental single cohort study

2014 ◽  
Vol 132 (5) ◽  
pp. 290-296 ◽  
Author(s):  
Renan Oliveira Vaz-de-Melo ◽  
Luiz Tadeu Giollo-Júnior ◽  
Débora Dada Martinelli ◽  
Heitor Moreno-Júnior ◽  
Marco Antônio Mota-Gomes ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Antihypertensive Drugs ◽  
Augmentation Index ◽  
Stage I ◽  
Central Blood Pressure ◽  
Hypertensive Patients ◽  
Before And After ◽  
Β Blocker ◽  
Single Cohort

CONTEXT AND OBJECTIVES: Assessment of central blood pressure (BP) has grown substantially over recent years because evidence has shown that central BP is more relevant to cardiovascular outcomes than peripheral BP. Thus, different classes of antihypertensive drugs have different effects on central BP despite similar reductions in brachial BP. The aim of this study was to investigate the effect of nebivolol, a β-blocker with vasodilator properties, on the biochemical and hemodynamic parameters of hypertensive patients.DESIGN AND SETTING: Experimental single cohort study conducted in the outpatient clinic of a university hospital.METHODS: Twenty-six patients were recruited. All of them underwent biochemical and hemodynamic evaluation (BP, heart rate (HR), central BP and augmentation index) before and after 3 months of using nebivolol.RESULTS: 88.5% of the patients were male; their mean age was 49.7 ± 9.3 years and most of them were overweight (29.6 ± 3.1 kg/m2) with large abdominal waist (102.1 ± 7.2 cm). There were significant decreases in peripheral systolic BP (P = 0.0020), diastolic BP (P = 0.0049), HR (P < 0.0001) and central BP (129.9 ± 12.3 versus 122.3 ± 10.3 mmHg; P = 0.0083) after treatment, in comparison with the baseline values. There was no statistical difference in the augmentation index or in the biochemical parameters, from before to after the treatment.CONCLUSIONS: Nebivolol use seems to be associated with significant reduction of central BP in stage I hypertensive patients, in addition to reductions in brachial systolic and diastolic BP.

scholarly journals Genome Wide Analysis Approach Suggests Chromosome 2 Locus to be Associated with Thiazide and Thiazide Like-Diuretics Blood Pressure Response

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Sonal Singh ◽  
Caitrin W. McDonough ◽  
Yan Gong ◽  
Kent R. Bailey ◽  
Eric Boerwinkle ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Protein Interaction ◽  
Interaction Analysis ◽  
Inositol Phosphate ◽  
Meta Analysis ◽  
Hypertensive Patients ◽  
Protein Protein Interaction ◽  
Genome Wide ◽  
A Genome ◽  
Β Blockers

AbstractChlorthalidone (CTD) is more potent than hydrochlorothiazide (HCTZ) in reducing blood pressure (BP) in hypertensive patients, though both are plagued with BP response variability. However, there is a void in the literature regarding the genetic determinants contributing to the variability observed in BP response to CTD. We performed a discovery genome wide association analysis of BP response post CTD treatment in African Americans (AA) and European Americans (EA) from the Pharmacogenomic Evaluation of Antihypertensive Responses-2 (PEAR-2) study and replication in an independent cohort of AA and EA treated with HCTZ from the PEAR study, followed by a race specific meta-analysis of the two studies. Successfully replicated SNPs were further validated in beta-blocker treated participants from PEAR-2 and PEAR for opposite direction of association. The replicated and validated signals were further evaluated by protein-protein interaction network analysis. An intronic SNP rs79237970 in the WDR92 (eQTL for PPP3R1) was significantly associated with better DBP response to CTD (p = 5.76 × 10−6, β = −15.75) in the AA cohort. This SNP further replicated in PEAR (p = 0.00046, β = −9.815) with a genome wide significant meta-analysis p-value of 8.49 × 10−9. This variant was further validated for opposite association in two β-blockers treated cohorts from PEAR-2 metoprolol (p = 9.9 × 10−3, β = 7.47) and PEAR atenolol (p = 0.04, β = 4.36) for association with DBP. Studies have implicated WDR92 in coronary artery damage. PPP3R1 is the regulatory subunit of the calcineurin complex. Use of calcineurin inhibitors is associated with HTN. Studies have also shown polymorphisms in PPP3R1 to be associated with ventricular hypertrophy in AA hypertensive patients. Protein-protein interaction analysis further identified important hypertension related pathways such as inositol phosphate-mediated signaling and calcineurin-NFAT signaling cascade as important biological process associated with PPP3R1 which further strengthen the potential importance of this signal. These data collectively suggest that WDR92 and PPP3R1 are novel candidates that may help explain the genetic underpinnings of BP response of thiazide and thiazide-like diuretics and help identify the patients better suited for thiazide and thiazide-like diuretics compared to β-blockers for improved BP management. This may further help advance personalized approaches to antihypertensive therapy.

scholarly journals Effect of Different Blood-Pressure-Lowering Regimens on the Blood Pressure Control among Hypertensive Patients Treated in Hospital Conditions

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Anna Paczkowska ◽  
Karolina Hoffmann ◽  
Krzysztof Kus ◽  
Dorota Kopciuch ◽  
Tomasz Zaprutko ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drug ◽  
Blood Pressure Control ◽  
Combined Treatment ◽  
Pressure Control ◽  
Antihypertensive Drug Therapy ◽  
Blood Pressure Lowering ◽  
Hypertensive Patients ◽  
Pressure Lowering ◽  
Β Blockers

Background. Scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals. Objectives. The aim of the study was to evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hospitalized hypertensive patients. Methodology. A cross-sectional retrospective study consisted of 204 patients aged 18–65 years admitted to the hospital due to hypertension between January 2018 and December 2018. The study was based on analysis of electronic records, obtained from the medical database of the selected healthcare facility. Results. As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg). Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). The most frequently prescribed antihypertensive drug combinations included bitherapies such as diuretics + ACEI and ACEI + β-blockers and tritherapy such as diuretics + β-blockers and calcium channel antagonists and diuretics + ACEI and ARBs. The highest blood-pressure lowering effects were observed among patients receiving combination therapy of a ACEI, a diuretic, and a ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy ( p = 0.0001 ). Conclusion. During their hospital stay, vast majority of patients (65.19%) achieved normal values of blood pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies.

scholarly journals The role of nebivolol in the management of hypertensive patients: from pharmacological profile to treatment guidelines

2021 ◽  
Author(s):  
Claudio Ferri
Keyword(s):  
Treatment Guidelines ◽  
Metabolic Effects ◽  
Third Generation ◽  
Pharmacological Profile ◽  
Good Tolerability ◽  
Hypertensive Patients ◽  
Β Blocker ◽  
Β Blockers ◽  
Treatment Step

According to the most recent international guidelines, β-blockers maintain a central role in the management of hypertension, being recommended at any treatment step when there is a specific indication, such as heart failure, angina, postacute myocardial infarction, atrial fibrillation or pregnancy. However, β-blockers are not a homogeneous class: individual molecules differ in terms of pharmacological and clinical profile and are therefore suitable for different patient subtypes. In particular nebivolol, a third generation β1-selective β-blocker with vasodilating properties, neutral metabolic effects and good tolerability, proved to have advantages over other β-blockers, which makes the drug suitable in a wide variety of hypertensive patients with or without comorbidities.

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