Massive Clonidine Ingestion with Hypertension in a 9-Month-Old Infant

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 500-502
Author(s):  
Pablo Yagupsky ◽  
Rafael Gorodischer
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Complete Recovery ◽  
Blocking Agent ◽  
Assisted Ventilation ◽  
Antagonistic Effect ◽  
Arterial Blood ◽  
Clonidine Poisoning ◽  
Adrenergic Blockers ◽  
Adrenergic Blocking

The antihypertensive drug clonidine has a double and antagonistic effect on arterial blood pressure. As a result of activation of peripheral α-adrenergic receptors, it causes a transient increase in blood pressure; by a central action it decreases sympathetic tone which results in sustained bradycardia and hypotension. Both central and peripheral effects are experimentally blocked by tolazoline, an α-adrenergic blocking agent. The toxic symptoms seen in clonidine poisoning are usually produced by the central effect. A case of severe clonidine poisoning in a 9-month-old infant is reported. The clinical picture included coma, miosis, apneic spells, bradycardia, and hypertension. Rapid and complete recovery was obtained with supportive treatment that included assisted ventilation. No adrenergic blockers or antihypertensive drugs were given. Use of tolazoline in cases of clonidine overdose in children remains controversial. Supportive measures alone may be adequate for even the most severe cases.

Regulation of arterial blood pressure in Australian tiger snakes

1978 ◽  
Vol 75 (1) ◽  
pp. 65-79 ◽  
Author(s):  
H. B. Lillywhite ◽  
R. S. Seymour
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Complete Recovery ◽  
Pressure Control ◽  
Pressure Regulation ◽  
Body Temperatures ◽  
Heating And Cooling ◽  
Arterial Blood ◽  
Preferred Temperatures ◽  
Head Up Tilt

1. Blood pressure was measured in the dorsal aorta of restrained, unanaesthetized tiger snakes (Notechis scutatus) at different body temperatures during graded, passive tilt. Aortic blood pressure in horizontal snakes showed no significant change over a range of body temperatures between 18 and 33 degrees C (mean of measurements on 16 snakes = 42.2 +/− I.98 mmHg), while heart rate increased logarithmically (Q10 approximately 2.5). Blood pressure was stable during heating and cooling between body temperatures of 15 and 30 degrees C, but the pressure was 10--50% higher during heating than during cooling. 2. Head-up tilt usually caused a brief fall in pressure at heart level followed by partial or complete recovery and tachycardia. At the cessation of tilt, there was a characteristic overshoot of the blood pressure followed by readjustment to control (pretilt) levels. Head-down tilt typically increased pressure which then either stabilized or returned toward pretilt levels. Heart rate changes during head-down tilt were not consistent in direction or magnitude. Stabilized pressures at mid-body usually increased following head-up tilt and decreased following head-down tilt, indicating physiological adjustment to posture change. Blood pressure control was evident at body temperatures ranging from 10 to 38 degrees C, but was most effective at the higher and behaviourally preferred temperatures. 3. Propranolol lowered heart rate but did not influence pressure in horizontal snakes. During head-up tilt propranolol eliminated or reduced tachycardia and sometimes reduced the efficacy of pressure compensation for tilt. Phentolamine increased heart rate, lowered blood pressure, and eliminated pressure regulation during tilt. The results suggest that sympathetically mediated reflexes assist central blood pressure regulation in the tiger snake, with vasomotor adjustments having greater importance than changes in heart rate.

Primary vagally mediated decelerations in heart rate during tonic rapid eye movement sleep in cats

1998 ◽  
Vol 274 (4) ◽  
pp. R1136-R1141 ◽  
Author(s):  
Richard L. Verrier ◽  
T. Rern Lau ◽  
Umesha Wallooppillai ◽  
James Quattrochi ◽  
Bruce D. Nearing ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Eye Movement ◽  
Arterial Blood Pressure ◽  
Rem Sleep ◽  
Blocking Agent ◽  
Rapid Eye Movement ◽  
Arterial Blood ◽  
State Dependent ◽  
Hippocampal Theta

Rapid eye movement (REM) sleep results in profound state-dependent alterations in heart rate. The present study describes a novel phenomenon of a primary deceleration in heart rate that is not preceded or followed by increases in heart rate or arterial blood pressure and occurs primarily during tonic REM sleep. The goals were to characterize the primary decelerations and to provide insights on the underlying central and peripheral autonomic mechanisms. Cats were chronically implanted with electrodes to record electroencephalogram, pontogeniculooccipital wave activity in lateral geniculate nucleus, hippocampal theta rhythm, electromyogram, electrooculogram, respiration (diaphragm), and electrocardiogram. Arterial blood pressure was monitored from a carotid artery catheter. R-R interval fluctuations were continuously tracked using customized software. The muscarinic blocking agent glycopyrrolate (0.1 mg/kg iv) and the β-adrenergic blocking agent atenolol (0.3 mg/kg iv) were administered in alternating sequence with a 90- to 120-min interval. Glycopyrrolate immediately eliminated the decelerations during REM sleep. Atenolol alone had no effect on their frequency. These findings suggest that a change in the centrally induced pattern of autonomic activity to the heart is responsible for the primary decelerations, namely, a bursting of cardiac vagal efferent fiber activity.

Clinical Evaluation of Atenolol in Hypertension

1976 ◽  
Vol 51 (s3) ◽  
pp. 513s-515s
Author(s):  
L. Hansson ◽  
B. E. Karlberg ◽  
H. Åberg ◽  
A. Westerlund ◽  
N. C. Henningsen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Blocking Agent ◽  
Long Term Results ◽  
Double Blind ◽  
Hypertensive Patients ◽  
Arterial Blood ◽  
Obstructive Airways Disease ◽  
Blind Comparison

1. Atenolol (ICI 66.082, Tenormin) is a new β-adrenoreceptor-blocking agent, devoid of intrinsic sympathomimetic and membrane-stabilizing properties. It does not cross the blood—brain barrier. 2. Atenolol given to hypertensive patients in initial open trials reduced arterial blood pressure significantly. 3. A double-blind comparison between atenolol and placebo in forty-five patients with essential hypertension demonstrated that atenolol gave a statistically significant reduction of blood pressure (Δ 28/15 mmHg, P < 0·005). 4. The optimum anti-hypertensive dose of atenolol in patients with mild to moderately severe essential hypertension was 200 mg daily. 5. Atenolol was compared with propranolol in thirty patients with essential hypertension. No statistically significant differences of anti-hypertensive effect were observed between the two drugs. 6. Long-term results (up to 2 years) in 117 hypertensive patients indicate that drug tolerance is good. No serious toxic effects were observed. 7. In four of twelve hypertensive patients with obstructive airways disease atenolol had to be withdrawn owing to deterioration of ventilatory function.

Beta2-mediated hypotension and myocardial injury

1982 ◽  
Vol 60 (8) ◽  
pp. 1144-1148 ◽  
Author(s):  
Alison Brown-Lukacsko ◽  
Peter Lukacsko
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Arterial Blood Pressure ◽  
Myocardial Injury ◽  
Elevated Serum ◽  
Blocking Agent ◽  
Arterial Blood ◽  
Ganglionic Blocking ◽  
Elevated Heart Rate ◽  
Stimulation Of

This study was designed to investigate the importance of beta2 receptor mediated hypotension in the pathogenesis of myocardial injury. The effect of isoproterenol and the putative beta2 agonist albuterol on arterial blood pressure, heart rate, the myocardial content of ATP and cAMP, and the serum content of MB-CPK was examined in conscious rats. Isoproterenol (5.25 mg/kg, s.c.) and albuterol (45 mg/kg, s.c.) lowered blood pressure and elevated heart rate to the same extent. Also, both agonists increased the myocardial content of cAMP, decreased the myocardial content of ATP, and elevated serum MB-CPK. The beta1 antagonist practolol, but not the ganglionic blocking agent chlorisondamine, attenuated the elevation in heart rate to albuterol without reducing its effect on blood pressure. Practolol, but not chlorisondamine, abolished the effects of albuterol on cAMP, ATP, and MB-CPK. These data suggest that the myocardial injury which is associated with an increased heart rate and changes in cAMP, ATP, and MB-CPK following the administration of albuterol is not the result of beta2-mediated hypotension, but is due to stimulation of myocardial beta1 receptors.

scholarly journals PHARMACOEPIDEMIOLOGY OF USING OF ANTIHYPERTENSIVE DRUGS BY FAMILY PHYSICIANS

2020 ◽  
pp. 94-99
Author(s):  
B. G. Khojakuliev ◽  
O. A. Orazgylyjov ◽  
T. Khojageldiev ◽  
M. K. Kurdova
Keyword(s):  
Blood Pressure ◽  
Calcium Antagonists ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Reduce Blood Pressure ◽  
Outpatient Basis ◽  
Family Doctors ◽  
Rational Use ◽  
Adrenergic Blockers ◽  
Selection Of

The purpose of the study: to study the features of the rational use of antihypertensive drugs (AHP) by family doctors on an outpatient basis and their analysis of compliance with current international recommendations.Materials and methods: According to questionnaires specially developed for studying the pharmacoepidemiology of hypertension, interviews were conducted with family doctors working in health houses located in different regions of the country and the specifics of their appointment of hypertension to patients with hypertension were studied. The duration of medical experience of doctors is on average 22.6 ± 11.0 years.Results: The main drugs in the prescription structure were ACE inhibitors (19.7%), beta-blockers (19.6%), calcium antagonists (19.1%, diuretics (18.9%) ARBs (12.8%). central action drugs – 8.5%, alpha-adrenergic blockers – 1.4%. ACE inhibitor administration structure: enalapril – 33.8%, lisinopril – 26.3%, captopril – 23.3%, perindopril – 10.1 %, ramipril – 4.7%, the rest - 1.3% Of the beta-blockers: atenolol – 35.7%, bisoprolol – 34.7%, propranolol -15.7%, metoprolol - 8.0%, nebivolol – 4.3% and carvedilol 1.7%. The structure of the appointment of calcium antagonists: amlodipine – 38,3%, nifedipine – 29.6%, verapamil 16.8%, nifedipine SR and verapamil SR 5.7% each, diltheazem 2.1%, the share of all the others no more than 1.8%. Diuretic structure: hydrochlorothiazide – 36.0 %, furosemide – 28.8%, spironolactone – 18.6%, indapamide – 13.5%, torasemide – 2.1%, acetazolamide – 0.9%. The main proportion of ARB was losartan (84.0%) valsartan (8.7%), candesartan (4.2%), all the rest – 3.1%. 38.1% of family doctors still prescribe a centrally acting drug – clofellin, an imidazoline receptor agonist moxonidine (physiotens) is prescribed by family doctors very rarely (1.8%).73.2% of respondents seek to reduce blood pressure to 140/90 mm Hg. Art., and the rest are limited to lowering blood pressure to a «working» level. 33.7% of family doctors start hypertension with monotherapy with the selection of an effective dose of one drug. 40.6% of doctors prefer free combination of AHP, 54.7% consider fixed combinations to be convenient, the rest are low-dose combinations.Conclusion: Our study confirms the need for further improvement of the rational use of AHP by family doctors

scholarly journals Nebivolol - A Review

1970 ◽  
Vol 6 (2) ◽  
pp. 93-96
Author(s):  
Uzzal Kanti Das ◽  
Syed Ali Ahsan ◽  
Mohammad Salman ◽  
Mohammad Ferdous Ur Rahaman ◽  
Md Mizanur Rahman Khan ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Blood Pressure ◽  
Arterial Stiffness ◽  
Antihypertensive Drugs ◽  
Peripheral Resistance ◽  
Blood Pressure Lowering Effect ◽  
Pressure Lowering ◽  
Β Blocker ◽  
General Response ◽  
Adrenergic Blocking

Nebivolol is a vasodilating β-blocker, which can be distinguished from other β-blockers by its haemodynamic profile. It combines β-adrenergic blocking activity with a vasodilating effect mediated by the endothelial Larginine nitric oxide (NO) pathway. The blood pressure lowering effect of nebivolol is linked to a reduction in peripheral resistance and an increase in stroke volume and preservation of cardiac output. Clinical trials have demonstrated that nebivolol reduces blood pressure similarly to atenolol, bisoprolol, amlodipine, nifedipine, lisinopril, and hydrochlorothiazide. The tolerability of nebivolol is similar to or better than that of these agents. In general, response rates to treatment are higher and the frequency and severity of adverse events are either comparable or lower with nebivolol. Endothelium-derived NO is important in the regulation of large arterial stiffness, which in turn is a major risk factor for cardiovascular disease. Therefore, antihypertensive drugs, such as nebivolol, that also improve endothelial function and decrease arterial stiffness, may contribute to a reduction in cardiovascular risk.Key words: Vasodilating β-blocker; nitric oxide (NO); peripheral resistance; arterial stiffness DOI: 10.3329/uhj.v6i2.7254University Heart Journal Vol. 6, No. 2, July 2010 pp.93-96

scholarly journals HYPERTENSION: AN AYURVEDIC PERSPECTIVE

2021 ◽  
Vol 9 (8) ◽  
pp. 1748-1753
Author(s):  
Anshika Rao
Keyword(s):  
Blood Pressure ◽  
High Blood Pressure ◽  
Antihypertensive Drugs ◽  
Medical Condition ◽  
Good Health ◽  
Chronic Medical Condition ◽  
Public Health Issue ◽  
Arterial Blood ◽  
Prime Concern ◽  
The World

Hypertension (HTN) is a major public health issue worldwide, because of its high prevalence and concomitant increase in the risk of disease. In the contemporary situation Hypertension is the most critical disease in the world. If we focus on the present situation then we can see that due to rapid globalization we are facing Hypertension. Due to rapid modernization, people are leading more stressful lives. As a result, hypertension is one of the wide- spread disorders which came across in practice. Ab. India is labelled as the global capital of hypertension. Nowa- days, not only lifestyle disorders are becoming more common, but they are also affecting younger populations. Hence, the population at risk shifts from 40+ to maybe 30+ or even younger. Hypertension results from a variety of reasons like stress, obesity, genetic factors, overuse of the salts in the diet and ageing etc. As we all know, Hy- pertension is called a silent killer because it rarely exhibits symptoms before it damages the heart, brain or kidney. Though a lot of potent antihypertensive drugs are available today in modern medicine, none of them is free from untoward effects. The principal focus of Ayurveda is on maintaining good health and adopting a healthy way of life. In Ayurveda, there is no description of such a single disease that can resemble hypertension. As per Ayurve- dic principles, in case of an unknown disease, the physician should try to understand the nature of the disease through Dosha, Dushya and Samprapti; then should initiate the treatment. So, it becomes our prime concern to understand hypertension thoroughly with an Ayurvedic perspective. Hypertension (HTN or HT), also known as High blood pressure or arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. Hypertension is one of the major causes of cardiovascular morbidity and mortalityworldwide. It is a global health problem affecting people of different ethnicity and ages around the world. It is an asymptomatic medical condition in which systemic arterial blood pressure is elevated beyond the normal value. Keywords: High Blood Pressure, Lifestyle disorders, Silent killer.

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