scholarly journals BLOOD PRESSURE INCREASES INDUCED BY IATROGENESIS, OVER THE COUNTER SUBSTANCES, AND HERBALS PRODUCTS

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Sarah Wang ◽  
Gary Sander
Keyword(s):  
Blood Pressure ◽  
Angiotensin Receptor Blockers ◽  
Angiogenesis Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Increase Blood Pressure ◽  
Normal Range ◽  
Refractory Hypertension ◽  
Drug Induced ◽  
Converting Enzyme Inhibitors ◽  
Over The Counter

A number of both prescription and over the counter drugs, herbal supplements, and miscellaneous substances can increase blood pressure in subjects by degrees that vary substantially within drug classes and individual patients; such increases often remain within the normal range but may cause overt hypertension (BP>140/90) mmHg and even precipitate hypertensive crises. Blood pressure increases are often potentiated by co-existing cardiovascular conditions, age, renal disease, diabetes, obesity, and interactions with other concomitant medications. The need to scrutinize for drugs or other substances that may be contributing to elevated blood pressures or impairing responses to anti-hypertensive medications is critically important, particularly in the evaluation of resistant and refractory hypertension. Anti-hypertensive effects of diuretics, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and β-blockers may be blunted. The drugs most commonly associated with blood pressure elevations are non-steroidal anti-inflammatory agents, sympathomimetic amines, estrogen-containing oral contraceptives, certain antidepressants, angiogenesis inhibitors, and ephedra. Although most drug-induced blood pressure increases do not, in fact, lead to overt hypertension, systolic and diastolic blood pressure elevations of as little as 2 mmHg lead to significant increases in the risk of cardiovascular events. When a medication with the potential to increase blood pressure is added to a patient’s therapeutic regimen, it is most important to monitor for possible changes in blood pressure even within the normal range. An initial diagnosis of hypertension should not be made until a thorough examination of all over the counter products and herbal substances that a patient may be consuming.

scholarly journals Anesthetic Management of the Hypertensive Patient: Part II

2018 ◽  
Vol 65 (3) ◽  
pp. 206-213 ◽  
Author(s):  
Russell Yancey
Keyword(s):  
Blood Pressure ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Anesthetic Management ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Anesthesia Providers ◽  
Treatment Of Hypertension ◽  
Important Health

Hypertension is an important health challenge that affects millions of people across the world today and is a major risk factor for cardiovascular disease. It is critical that anesthesia providers have a working knowledge of the systemic implications of hypertension. This review article will discuss the medical definitions of hypertension, the physiology of maintaining blood pressure, outpatient treatment of hypertension, anesthetic implications, and the common medications used by anesthesia providers in the treatment of hypertension. Part I provided an overview of hypertension and blood pressure regulation. In addition, drugs predominantly affecting control of hypertension via renal mechanisms such as diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and renin-inhibiting agents were discussed. In part II, the remaining major antihypertensive medications will be reviewed as well as anesthetic implications of managing patients with hypertension.

scholarly journals Management of Hypertension in the Elderly Patient at Abidjan Cardiology Institute (Ivory Coast)

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
K. E. Kramoh ◽  
E. Aké-Traboulsi ◽  
C. Konin ◽  
Y. N'goran ◽  
I. Coulibaly ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
The Elderly ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Background. Since the treatment of hypertension is beneficial for the elderly, we have undertaken this study that aims to evaluate the management of hypertension in elderly patient in Côte d'Ivoire.Methods. A retrospective study was conducted among 854 hypertensive elderly patients of Abidjan Cardiology Institute who were followed for a minimum of one year, between January 2000 and December 2009.Results. The patients mean age was years, and 59% were women. At the first presentation, it was mostly systolic-diastolic hypertension (51.8%) and isolated systolic hypertension (38.5%). Mean blood pressure was  mmHg for systolic,  mmHg for diastolic, and  mmHg for pulse pressure. Pulse pressure was ≥60 mmHg in 80.4%. According to the European Guidelines stratification of the cardiovascular risk-excess attributable to high blood pressure, 82.1% of the sample had a very high added risk. The pharmacological therapy was prescribed in 93.5%. More than 66% of patients were receiving ≥2 antihypertensive drugs including fixed-dose combination drugs. The most common agents used were diuretics (63.5%) followed by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in 61.3%. The most common agents used for monotherapy were calcium antagonists. When ≥2 drugs were used, diuretics and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were the most common. Blood pressure control was achieved in 42.6%.Conclusion. The control of elderly hypertension can be effective in Sub-Saharan Africa. He required at least two antihypertensive drugs to meet the recommended blood pressure target.

scholarly journals Anesthetic Management of the Hypertensive Patient: Part I

2018 ◽  
Vol 65 (2) ◽  
pp. 131-138 ◽  
Author(s):  
Russell Yancey
Keyword(s):  
Blood Pressure ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Anesthetic Management ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Anesthesia Providers ◽  
Treatment Of Hypertension ◽  
Important Health

Hypertension is an important health challenge that affects millions of people across the world and is a major risk factor for cardiovascular disease. It is critical that anesthesia providers have a working knowledge of the systemic implications of hypertension. This review article will discuss the medical definitions of hypertension, the physiology of maintaining blood pressure, outpatient treatment of hypertension, anesthetic implications, and the common medications used by anesthesia providers in the treatment of hypertension. Part I will provide an overview of hypertension and blood pressure regulation. In addition, drugs affecting predominantly renal control of hypertension, such as diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and renin-inhibiting agents, will be discussed. In part II, the remaining major antihypertensive medications will be reviewed as well as anesthetic implications of managing patients with hypertension.

scholarly journals Comparative proteinuria management of different angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for normotensive patients with CKD: a Bayesian network meta-analysis

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8575
Author(s):  
Huizhen Ye ◽  
Zhihao Huo ◽  
Peiyi Ye ◽  
Guanqing Xiao ◽  
Zhe Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Combination Therapy ◽  
Bayesian Network ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Blood Pressure Reduction ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

Background Both angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are blood pressure-lowering agents, but they are also being used to control proteinuria in early chronic kidney disease (CKD) patients. However, clinically, some patients present merely proteinuria without hypertension. No guidelines pointed out how to select treatments for proteinuria in normotensive patients. Thus, we conducted a Bayesian network analysis to evaluate the relative effects of different kinds of ACEI or ARB or their combination on proteinuria and blood pressure reduction. Methods The protocol was registered in PROSPERO with ID CRD42017073721. A comprehensive literature database query was carried out systematically according to PICOS strategies. The primary outcome was reduction in proteinuria, and the secondary outcomes were eGFR reduction and blood pressure reduction. Random-effects pairwise and Bayesian network meta-analyses were used to estimate the effect of different regimens. Results A total of 14 RCTs with 1,098 patients were included in the analysis. All treatment strategies of ACEI, ARB or their combination had significantly greater efficacy in reducing proteinuria than placebo in normotensive CKD patients. The combination therapy of olmesartan+temocapril had the highest probability (22%) of being the most effective treatment to reduce proteinuria in normotensive CKD patients. Olmesartan and lisinopril ranked second (12%), and temocapril ranked third (15%) but reduced blood pressure less than placebo. For IgA nephropathy, the combination therapy of olmesartan+temocapril also had the highest probability (43%) of being the best antiproteinuric treatment, while enalapril had the highest probability (58%) of being the best antiproteinuric therapy for diabetic nephropathy. Conclusions The combination therapy of olmesartan plus temocapril appeared to be the most efficacious for reducing proteinuria in normotensive CKD patients and IgA nephropathy, but the clinical application should be balanced against potential harms. Temocapril can be an option when practitioners are searching for more proteinuria reduction but less blood pressure variation. In normotensive diabetic nephropathy, monotherapy with the ACEI enalapril seems to be the most efficacious intervention for reducing albuminuria. Future studies are required to give a more definitive recommendation.

scholarly journals The Crosstalk between SARS-CoV-2 Infection and the RAA System in Essential Hypertension—Analyses Using Systems Approach

2021 ◽  
Vol 22 (19) ◽  
pp. 10518
Author(s):  
Dorota Formanowicz ◽  
Kaja Gutowska ◽  
Bartłomiej Szawulak ◽  
Piotr Formanowicz
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Arterial Hypertension ◽  
Systems Approach ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Reduce Blood Pressure ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Patients

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has affected and continues to affect millions of people across the world. Patients with essential arterial hypertension and renal complications are at particular risk of the fatal course of this infection. In our study, we have modeled the selected processes in a patient with essential hypertension and chronic kidney disease (CKD) suffering from COVID-19, emphasizing the function of the renin-angiotensin-aldosterone (RAA) system. The model has been built in the language of Petri nets theory. Using the systems approach, we have analyzed how COVID-19 may affect the studied organism, and we have checked whether the administration of selected anti-hypertensive drugs (angiotensin-converting enzyme inhibitors (ACEIs) and/or angiotensin receptor blockers (ARBs)) may impact the severity of the infection. Besides, we have assessed whether these drugs effectively lower blood pressure in the case of SARS-CoV-2 infection affecting essential hypertensive patients. Our research has shown that neither the ACEIs nor the ARBs worsens the course infection. However, when assessing the treatment of hypertension in the active SARS-CoV-2 infection, we have observed that ARBs might not effectively reduce blood pressure; they may even have the slightly opposite effect. On the other hand, we have confirmed the effectiveness of arterial hypertension treatment in patients receiving ACEIs. Moreover, we have found that the simultaneous use of ARBs and ACEIs averages the effects of taking both drugs, thus leading to only a slight decrease in blood pressure. We are a way from suggesting that ARBs in all hypertensive patients with COVID-19 are ineffective, but we have shown that research in this area should still be continued.

Modern principles of treatment of arterial hypertension in patients with chronic kidney disease and glomerulonephritis

2021 ◽  
pp. 12-16
Author(s):  
N. V. Teplova ◽  
E. M. Evsikov ◽  
N. G. Artamonova ◽  
G. A. Chervyakova ◽  
A. G. Dzheksembekov
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Enzyme Inhibitors ◽  
Blood Pressure Monitoring ◽  
Angiotensin Receptor Blockers ◽  
Blood Pressure Reduction ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Hypotensive Therapy

The literature review presents current international data on the principles of choice of hypotensive therapy tactics in patients with chronic kidney disease and glomerulonephritis. safe levels of blood pressure reduction, reflected in the regulatory documents of European and American nephrological and cardiological associations, methods of their control are discussed. Data on the nephroprotective effects of the main classes of hypotensive drugs – angiotensin-converting enzyme inhibitors and angiotensin receptor blockers – are presented. The necessity of monitoring the safety of hypotensive therapy in glomerulonephritis with chronic kidney disease using methods of blood pressure monitoring is emphasized.

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