Clinical correlation with failure of endovenous therapy for leg swelling

Vascular ◽  
2017 ◽  
Vol 25 (3) ◽  
pp. 249-252 ◽  
Author(s):  
Ahmad Alsheekh ◽  
Anil Hingorani ◽  
Natalie Marks ◽  
Yuriy Ostrozhynskyy ◽  
Enrico Ascher
Keyword(s):  
Chronic Venous Insufficiency ◽  
Venous Insufficiency ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Iliac Vein ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Venous Stenting ◽  
Persistent Symptoms ◽  
Presenting Symptoms

Background The development and use of minimally invasive procedures provide improved options for the management of symptoms of chronic venous insufficiency. While many patients with iliac venous occlusive disease and superficial venous insufficiency improve with combined iliac venous stenting and correction of superficial venous reflux, some patients have symptoms which persist. The goal of this study was to identify clinical factors related to persistent symptoms in patients with leg swelling after treatment of both iliac vein stenting and thermal ablation. Methods This observational study analyzed data for patients who underwent both iliac vein stent placement as well as endovenous ablation (either RFA or EVLT) as a management for chronic venous insufficiency between February 2012 and February 2014. Follow-up was performed after completion of both procedures and inquiring for improvement of swelling. Statistical analysis performed using Chi-square and student's t-test. Results Of the total 173 patients who underwent both endovenous closure and iliac vein stent placements, 55 (31.8%) patients were men; 29 (16%) patients stated they had no improvement after these procedures. The average age of patients who did not improve was 68.8 (±16.7 SD) years and 66.2 (±13.3 SD) years for patients who improved. Over all, the classification of the presenting symptoms by CEAP classification demonstrated 25.4%, 53.2%, 5.8%, and 15.6%, for C3–C6, respectively. There was no correlation with failure to improve the swelling with: age ( P = .44), gender ( P = .33), presenting symptom ( P = .67), use of calcium channel blockers ( P = .85), nitroglycerin ( P = .86), Plavix ( P = .07), aspirin ( P = .55), Synthyroid ( P = .55), Coumadin ( P = .14), angiotensin receptor blocker ( P = .81), β Blockers ( P = .61), angiotensin converting enzyme inhibitors ( P = .88), furosemide 40 mg ( P = .74), hydrochlorothiazide 12.5 mg ( P = .07), hydrochlorothiazide 25 mg ( P = .48), and EVLT vs. RFA ( P = .91). The use of furosemide (20 mg) was associated with continued swelling ( P = .01). The use of dual diuretics (furosemide and hydrochlorothiazide) was associated with persistent swelling even after these combined endovenous procedures P = .03). Conclusion These preliminary data suggest that the treatment with diuretics may be associated with failure to relieve lower extremity swelling despite combined endovascular therapy for chronic venous insufficiency.

scholarly journals Tianma Gouteng Yin as Adjunctive Treatment for Essential Hypertension: A Systematic Review of Randomized Controlled Trials

2013 ◽  
Vol 2013 ◽  
pp. 1-18 ◽  
Author(s):  
Jie Wang ◽  
Bo Feng ◽  
Xiaochen Yang ◽  
Wei Liu ◽  
Yongmei Liu ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Randomized Clinical Trials ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Data Extraction ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Deficiency Syndrome ◽  
Adjunctive Treatment ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors

Background. Tianma Gouteng Yin (TGY) is widely used for essential hypertension (EH) as adjunctive treatment. Many randomized clinical trials (RCTs) of TGY for EH have been published. However, it has not been evaluated to justify their clinical use and recommendation based on TCM zheng classification.Objectives. To assess the current clinical evidence of TGY as adjunctive treatment for EH with liver yang hyperactivity syndrome (LYHS) and liver-kidney yin deficiency syndrome (LKYDS).Search Strategy. 7 electronic databases were searched until November 20, 2012.Inclusion Criteria. RCTs testing TGY combined with antihypertensive drugs versus antihypertensive drugs were included.Data Extraction and Analyses. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards.Results. 22 RCTs were included. Methodological quality was generally low. Except diuretics treatment group, blood pressure was improved in the other 5 subgroups; zheng was improved in angiotensin converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), and “CCB + ACEI” treatment groups. The safety of TGY is still uncertain.Conclusions. No confirmed conclusion about the effectiveness and safety of TGY as adjunctive treatment for EH with LYHS and LKYDS could be made. More rigorous trials are needed to confirm the results.

Pharmacology of vasodilators

ESC CardioMed ◽  
2018 ◽  
pp. 180-184
Author(s):  
Stéphane Laurent
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Organic Nitrates ◽  
Channel Blockers ◽  
Resistance Arteries ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Small Resistance ◽  
Direct Acting

Antihypertensive and antianginal agents are differentially able to vasodilate small resistance arteries, large conducting arteries, and epicardial coronary arteries. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and alpha-adrenergic antagonists are not addressed here, since they are discussed in specific chapters. This chapter discusses the pharmacology of calcium channel blockers, nitrovasodilators, and direct-acting vasodilators. Dihydropyridines, such as nifedipine and amlodipine, are compared to the non-dihydropyridine agents verapamil and diltiazem. Organic nitrates, such as nitroglycerine and isosorbide dinitrate, are compared to inorganic nitrates, such as sodium nitroprusside. Molsidomine and nicorandil are also discussed. Finally, the pharmacology of direct-acting vasodilators focuses on minoxidil and hydralazine. Pharmacology of mechanisms of action is detailed to better understand therapeutic indications and side effects.

scholarly journals PRESCRIPTION PATTERN OF CARDIOVASCULAR AND/OR ANTIDIABETIC DRUGS IN ABUJA DISTRICT HOSPITALS

2019 ◽  
pp. 21-27
Author(s):  
NKEIRUKA GRACE OSUAFOR ◽  
CHINWE VERONICA UKWE ◽  
MATTEW JEGBEFUME OKONTA
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Age Groups ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
World Health ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Prescribing Indicators ◽  
Prescription Pattern ◽  
District Hospitals

Objective: The study aimed to describe the prescription pattern of cardiovascular and/or anti-diabetic drugs and adherence to the World Health Organization (WHO) prescribing indicators in Abuja District Hospitals. Methods: This descriptive retrospective study was carried out in Asokoro and Maitama District Hospitals Abuja. One thousand and nine prescriptions that contained a cardiovascular drug (CVD) and/or anti-diabetic drug issued between June 2017 and May 2018 from the Medical Outpatient Department were analyzed. Data were collected from the pharmacy electronic database, prescription pattern and adherence to WHO prescribing indicators were assessed. The analysis was done using descriptive statistics. Results were presented as percentages, means, and standard deviations. Results: The frequency of treatment was higher among women (58.8%) and the age group of 41–60 (54.8%). The average number of drugs prescribed was 3.3±1.6: the percentage of drugs prescribed in generic was (64%) and (78.8%) were from the Essential Drug List (EDL). Calcium Channel Blockers (CCB, 71.7%) and Biguanides (B, 92.4%) were the most prescribed CVD and anti-diabetic drug. The majority of the CVD (74.5%) and diabetes (63.6%) patients were on combination therapy. The most frequent CVD combination was CCB plus Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (29.7%). Compared to men, the proportion of females taking one or more CVD (61.3%) or antidiabetic (56.4%) was higher. Conclusion: The prescribing indicators are not optimal in Abuja district hospitals. Women received more treatment for cardiovascular and diabetes diseases than men while the age range of 41-60 was more treated than other age groups.

scholarly journals Suppression of Aldosterone Synthesis and Secretion by Channel Antagonists

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Keiichi Ikeda ◽  
Tsuyoshi Isaka ◽  
Kouki Fujioka ◽  
Yoshinobu Manome ◽  
Katsuyoshi Tojo
Keyword(s):  
Angiotensin Ii ◽  
Enzyme Inhibitors ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin ◽  
Aldosterone Production ◽  
Ras Inhibitors

Aldosterone, a specific mineralocorticoid receptor (MR) agonist and a key player in the development of hypertension, is synthesized as a final product of renin-angiotensin-aldosterone system. Hypertension can be generally treated by negating the effects of angiotensin II through the use of angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin II type 1 receptor antagonists (ARBs). However, the efficacy of angiotensin II blockade by such drugs is sometimes diminished by the so-called “aldosterone breakthrough” effect, by which ACE-Is or ARBs (renin-angiotensin system (RAS) inhibitors) gradually lose their effectiveness against hypertension due to the overproduction of aldosterone, known as primary aldosteronism. Although MR antagonists are used to antagonize the effects of aldosterone, these drugs may, however, give rise to life-threatening adverse actions, such as hyperkalemia, particularly when used in conjunction with RAS inhibitors. Recently, several groups have reported that some dihydropyridine Ca2+channel blockers (CCBs) have inhibitory actions on aldosterone production inin vitroand in the clinical setting. Therefore, the use of such dihydropyridine CCBs to treat aldosterone-related hypertension may prove beneficial to circumvent such therapeutic problems. In this paper, we discuss the mechanism of action of CCBs on aldosterone production and clinical perspectives for CCB use to inhibit MR activity in hypertensive patients.

Risk of Cerebral Hypoperfusion with Antihypertensive Therapy

DICP ◽  
1989 ◽  
Vol 23 (12) ◽  
pp. 957-962 ◽  
Author(s):  
Susan C. Eagan ◽  
Lance W. Payne ◽  
Susan C. Houtekier
Keyword(s):  
Antihypertensive Therapy ◽  
Antihypertensive Medication ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cerebral Hypoperfusion ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Populations At Risk ◽  
Treatment Of Hypertension

The effective treatment of hypertension is a major factor in the declining incidence of stroke in North America. There are subsets of patients, however, in which antihypertensive therapy may actually cause cerebral ischemia and infarction. Elderly patients and those with malignant hypertension, acute stroke, and occlusive cerebrovascular disease appear to be the populations at greatest risk of iatrogenic stroke. This article reviews the effect of beta-blockers, angiotensin-converting enzyme inhibitors, direct vasodilators, and calcium-channel blockers on cerebral blood flow in various populations. Although many investigations have been performed, it remains difficult to predict the risk of cerebral hypoperfusion due to antihypertensive medication in an individual patient. It is best for practitioners to be aware of the patient populations at risk and treat high blood pressure cautiously in these patients.

scholarly journals Role of antihypertensive drugs in the treatment of migraine

2015 ◽  
Vol 156 (5) ◽  
pp. 179-185 ◽  
Author(s):  
Gergely Fehér ◽  
Gabriella Pusch
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Migraine Prevention ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
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.

scholarly journals The Risk of Cancer in Users of Statins

2004 ◽  
Vol 22 (12) ◽  
pp. 2388-2394 ◽  
Author(s):  
Matthijs R. Graaf ◽  
Annette B. Beiderbeck ◽  
Antoine C.G. Egberts ◽  
Dick J. Richel ◽  
Henk-Jan Guchelaar
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Geographic Region ◽  
Lipid Lowering ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Defined Daily Doses ◽  
Incident Cancer ◽  
Risk Of Cancer ◽  
Study Base

Purpose Several preclinical studies suggested a role for 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) in the treatment of cancer. The objective of this study was to compare the risk of incident cancer between users of statins and users of other cardiovascular medication. Methods Data were used from the PHARMO database, containing drug dispensing records from community pharmacies and linked hospital discharge records for residents of eight Dutch cities. The study base included all patients with one or more prescriptions for cardiovascular drugs in the period between January 1, 1985 and December 31, 1998. Cases were identified as patients in the study base with a diagnosis of incident cancer and matched with four to six controls on sex, year of birth, geographic region, duration of follow-up, and index date. The analysis was adjusted for diabetes mellitus; prior hospitalizations; comorbidity; and use of diuretics, angiotensin-converting enzyme inhibitors, calcium-channel blockers, nonsteroidal anti-inflammatory drugs, sex hormones, and other lipid-lowering drug therapies. Results In the study base, 3,129 patients were identified and matched to 16,976 controls. Statin use was associated with a risk reduction of cancer of 20% (adjusted odds ratio [OR], 0.80; 95% CI, 0.66 to 0.96). Our data suggest that statins are protective when used longer than 4 years (adjusted OR, 0.64; 95% CI, 0.44 to 0.93) or when more than 1,350 defined daily doses are taken (adjusted OR, 0.60; 95% CI, 0.40 to 0.91). Conclusion This observational study suggests that statins may have a protective effect against cancer.

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