scholarly journals Modern Principles of Treatment of Uncontrolled Hypertension

2019 ◽  
Vol 15 (5) ◽  
pp. 736-741 ◽  
Author(s):  
V. I. Podzolkov ◽  
A. I Tarzimanova ◽  
Z. O. Georgadze
Keyword(s):  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
High Efficiency ◽  
Antihypertensive Drugs ◽  
Dual Therapy ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Clinical Situation ◽  
Reduce Blood Pressure ◽  
Uncontrolled Hypertension ◽  
Converting Enzyme Inhibitors

Despite the current possibilities of using different classes of antihypertensive drugs that effectively reduce blood pressure and significantly improve the long-term prognosis of patients, the problem of uncontrolled arterial hypertension has not lost its importance and its solution in a particular clinical situation often remains very difficult. The term "uncontrolled arterial hypertension" can be used in all cases where arterial pressure has not been achieved. The true prevalence of uncontrolled arterial hypertension has not been established, and its study is hampered primarily by the fact that not all patients initially receive antihypertensive therapy that meets generally accepted standards. Currently, the tactics of management of patients with uncontrolled hypertension involves the use of combinations of antihypertensive drugs. Rational combinations, according to the new recommendations for the diagnosis and treatment of arterial hypertension in 2018, remain a combination of blockers of the renin-angiotensin-aldosterone system – angiotensin-converting enzyme inhibitors or receptor blockers to angiotensin with a calcium antagonist or diuretic, preferably in one tablet. With the ineffectiveness of dual therapy needs to be assigned to a third antihypertensive drug. Among the most modern antihypertensive drugs can be considered a triple fixed combination of lisinopril, amlodipine and indapamide. All the components included in the composition of the drug, has proved its high efficiency and safety. Uncontrolled arterial hypertension remains one of the most urgent problems of modern cardiology. Many aspects of it are far from unambiguously interpreted solutions and standards. Until the end, the mechanisms of the formation of uncontrolled course of hypertension remain unexplored, which, in turn, leads to a restriction of the use of drug and non-drug methods in the treatment of this pathology. Rational choice of antihypertensive therapy regimens can significantly improve the quality of treatment of this category of patients.

Arterial hypertension in ophthalmic surgical patients

2021 ◽  
pp. 186-191
Author(s):  
L.V. Pavlyushchenko ◽  
◽  
E.E. Filimonova ◽  
M.A. Esina ◽  
◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Clinical Symptoms ◽  
Antihypertensive Drugs ◽  
High Stress ◽  
Cardiovascular Complications ◽  
Surgical Patients ◽  
Uncontrolled Hypertension ◽  
Standard Dosage

Purpose. Analysis of the frequency and structure of arterial hypertension (AH) among ophthalmic surgical patients, assessment of the adequacy of prescribed antihypertensive therapy. Material and methods. Clinical material is presented by 157 patients with hypertension. Its structure was assessed. Its structure was assessed according to the stage, the degree of increase in the level of blood pressure (BP) and the category of cardiovascular risk. We analyzed the proportion of cases of uncontrolled hypertension, including those with a sudden pronounced individually significant increase in blood pressure without affecting target organs. Results. The prevalence of patients was stage III hypertension (62.4%), grade 3 hypertension (53.5%), with a very high and high risk of cardiovascular complications (73.2 and 20.4%, respectively). 93.6% of patients received antihypertensive therapy, but only 57.1% of them, mostly women (69.1%), regularly took medications and monitored their blood pressure. With a sudden pronounced individually significant increase in blood pressure, we used oral antihypertensive drugs – captopril and nifedipine, which made it possible to achieve a decrease in blood pressure and relief of clinical symptoms in all cases. Conclusion. 33.1% of patients had no hypertension control at the time of hospitalization. The proportion of patients with a sudden pronounced individually significant increase in blood pressure was 12.7%. Typical reasons for loss of control over hypertension were interruptions in taking antihypertensive drugs and high stress levels before surgery. The use of standard dosage captopril and nifedipine was effective in all cases. Key words: arterial hypertension, sudden pronounced individually significant increase in blood pressure, antihypertensive therapy.

scholarly journals Multicenter randomized open study of the effectiveness of changed life quality and therapy with angiotensin-converting enzyme inhibitors (quinapril) in obese patients with arterial hypertension (ECO)

2003 ◽  
Vol 9 (6) ◽  
pp. 196-198
Author(s):  
Yu. N. Belenkov ◽  
I. Ye. Chazova ◽  
V. B. Mychka
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drugs ◽  
Main Task ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Increased Risk

The wide spread of obesity in the populate in, and the increased risk of cardiovascular events, and type 2 diabetes mellitus (DM) in this group of patients served as the basis of the ECO study. Therapeutic approaches to treating arterial hypertension (AH) in patients with metabolic syndrome and type 2 DM have their peculiarities. Properly chosen antihypertensive therapy may also contribute to not only its good antihypertensive effect, but to better carbohydrate and lipid metabolic parameters. A decrease in weight may lead to the lowering of blood pressure and to the normalization of metabolic disorders. Obesity is pathogenetically related to AH, and it is apparent that the use of the newest and effective antihypertensive drugs will not be rather effective without concurrent treatment of obesity. But the main task of the study was to provide an opportunity to physician to be, from his/her own experience, convinced of the effectiveness of nondrug measures and their combination with antihypertensive therapy with the drug of choice (the angiotensin-converting enzyme inhibitor quinapril) in treating this group of patients. With this study, the authors would like to pay the attention of physicians and patients to the problem of obesity and All and to the hazard presented by these diseases.

scholarly journals Antihypertensive therapy features in multimorbid outpatients

2021 ◽  
Vol 26 (6) ◽  
pp. 688-698
Author(s):  
N. V. Izmozherova ◽  
A. A. Popov ◽  
V. M. Bakhtin ◽  
M. A. Shambatov
Keyword(s):  
Antihypertensive Therapy ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cross Sectional Study ◽  
Charlson Index ◽  
Converting Enzyme Inhibitors ◽  
Cross Sectional ◽  
Group 2 ◽  
Group 1

Objective. To assess the characteristics of antihypertensive therapy (AHT) in outpatient patients in relation to comorbidities and multimorbidity level. Design and methods. A cross-sectional study included 140 patients with diagnosed hypertension (HTN). We performed a standardized complaints and medical history registration, questionnaire survey, anthropometry, office blood pressure (BP) assessment. Based on Charlson index the patients were divided into 2 groups: group 1 with moderate multimorbidity (≤ 4 points), group 2 with high multimorbidity level (≥ 5 points). The data are presented as median and proportions with bi-directional 95 % confidence interval. Results. In the sampling of 100 (64,3 71,4 78,6 %) women and 40 (21,4 28,6 35,7 %) men median age was 65 68 70, median Charlson index was 4 5 5. Group with moderate multimorbidity included 63 patients. High multimorbidity group included 77 subjects. HTN degree did not differ between the groups. Subjects from group 2 had higher level of cardiovascular risk (χ2 = 17,2, df = 2, p = 0,00018) and were more likely to have a history of HTN-associated clinical conditions (χ2 = 27,1, df = 2, p = 0,00000). By the time of examination, AHT was started in 137 (95,097,9 100,0%) patients. Monotherapy was ongoing in 20 cases (8,814,3 20,4%), combined AHT was prescribed to 117 (79,6 85,4 91,2 %) persons: 50 (21,2 36,5 43,8 %) patients received 2 drugs, 67 (40,9 48,9 56,9 %) patients received ≥ drugs. Number of antihypertensive drugs was higher in patients of group 2 than in group 1 (χ2 = 6,7, df = 2, p = 0,036). Drug number was not associated with HTN degree (χ2 = 3,8, df = 4, p = 0,44). Patients from group 2 were more likely to take β1-blockers (p = 0,027) and moxonidine (p = 0,042). Non-steroid anti-inflammatory drugs (NSAIDs) reduced the frequency of achieving the target BP level in patients treated by angiotensin converting enzyme inhibitors (p = 0,002). The frequency of achieving target BP was 42,9 50,7 58,6 %, it was independent of the number of prescribed drugs (p = 0,07) and did not differ in the groups of moderate and high multimorbidity (p = 0,87). Conclusions. Multimorbid patients require combined antihypertensive drugs to control hypertension. Multimorbidity level, comorbidities and drug-to-drug interactions should be taken into account during individualized HTN management. NSAID significantly affect the effectiveness of antihypertensive therapy.

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.

scholarly journals Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

2021 ◽  
Vol 10 (4) ◽  
pp. 771
Author(s):  
In-Jeong Cho ◽  
Jeong-Hun Shin ◽  
Mi-Hyang Jung ◽  
Chae Young Kang ◽  
Jinseub Hwang ◽  
...  
Keyword(s):  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Incident Cancer ◽  
Increased Risk ◽  
Risk Of Cancer

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696–0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775–0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs.

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.

scholarly journals Effects of Antihypertensive Drugs Use on Risk and Prognosis of Colorectal Cancer: A Meta-Analysis of 37 Observational Studies

2022 ◽  
Vol 12 ◽  
Author(s):  
Yujiao Deng ◽  
Yuxiu Xie ◽  
Meng Wang ◽  
Peng Xu ◽  
Bajin Wei ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Progression Free Survival ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Free Survival ◽  
Receptor Blockers

Background: Antihypertensive drugs might play a key role in the risk and poor prognosis of colorectal cancer. However, current epidemiologic evidence remains inconsistent. The aim of this study is to quantify the association between antihypertensive drugs and colorectal cancer.Methods: To identify available studies, we systematically searched electronic databases: PubMed, Web of Science, Embase, Cochrane Library. The risk estimates and their corresponding 95% confidence intervals (CIs) were collected and analyzed by using random-effects models. Heterogeneity test and sensitivity analysis were also performed.Results: Overall, 37 observational studies were included in this analysis (26 studies with cohort design, three studies with nested case-control design, and 8 studies with case-control design). Antihypertensive drugs did not present a significant effect on the risk or overall survival of patients with colorectal cancer [Risk ratio (RR) = 1.00, 95% CI: 0.95–1.04; Hazard ratio (HR) = 0.93, 95% CI: 0.84–1.02]. In the subgroup analysis, diuretics use was significantly associated with a worse overall survival of patients with colorectal cancer (HR = 1.27; 95% CI: 1.14–1.40). However, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers was associated with improved progression-free survival of patients who suffered from colorectal cancer (HR = 0.83; 95% CI: 0.72–0.95).Conclusion: Antihypertensive drug usage did not influence the risk and overall survival of patients with colorectal cancer in general. Further investigation reminded us that diuretics use might reduce the overall survival time in colorectal cancer patients, whereas those who took Angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers had a longer progression-free survival.

scholarly journals Antihypertensive therapy: controlling the processes of replicative cell senescence

2020 ◽  
Vol 25 ◽  
pp. 3974
Author(s):  
E. N. Dudinskaya ◽  
L. V. Machekhina ◽  
K. A. Eruslanova ◽  
O. A. Dogotar ◽  
L. P. Ryltseva ◽  
...  
Keyword(s):  
Antihypertensive Therapy ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Telomerase Activity ◽  
Biological Aging ◽  
Vascular Aging ◽  
Converting Enzyme Inhibitors ◽  
The Past ◽  
Vascular Ageing ◽  
And Oxidative Stress

The review includes data over the past 20 years on the mechanisms of the influence of hypertension and related interdependent conditions, such as insulin resistance, chronic inflammation and oxidative stress on the vascular ageing. The review also discusses modern concepts of the interaction of biological and vascular aging, as well as possible ways of their reversal. The central indicators of biological aging in this review are telomere length and telomerase activity. The article discusses antihypertensive therapy as a possible way to slow down both vascular and biological aging, and describes the results of modern studies on the effect of various antihypertensives, including angiotensin-converting enzyme inhibitors, sartans and others, on the telomeres.

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