scholarly journals Clinical and Pharmacological Approaches to the Prescription of Centrally Acting Antihypertensive Drugs for Uncontrolled Arterial Hypertension

2020 ◽  
Vol 16 (5) ◽  
pp. 815-821
Author(s):  
A. V. Strygin ◽  
B. E. Tolkachev ◽  
A. O. Strygina ◽  
A. M. Dotsenko
Keyword(s):  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Hypotensive Effect ◽  
Optimal Choice ◽  
Clinical Settings ◽  
Hypertensive Urgency ◽  
Drug Of Choice ◽  
Target Organs ◽  
Life Threatening ◽  
Hypertensive Therapy

Episodes of rapid increase in blood pressure due to uncontrolled arterial hypertension, previously known as a hypertensive urgency, is common clinical condition which many of practicing physicians are encountered daily. As a rule, these conditions are not life-threatening, however they could lead to target-organs damage if not promptly relieved. Therefore, clear evidence-based recommendations of optimal antihypertensive drug administration in these situations would provide more safe and effective therapy. Despite that, definite expert consensus regarding optimal choice of antihypertensive drugs to manage these patients have not been reached so far. The aim of the current review was to assess the results obtained from clinical trials regarding the safety and efficacy of moxonidine for urgent hypertensive therapy in patients with uncontrolled arterial hypertension admitted to emergency healthcare units as well as in those at the prehospital stage. Performed literature-based analysis revealed enough evidences proving that moxonidine can be administered in a single dose of 0.4 mg as a drug of choice in situations where prompt and stable hypotensive effect is desired. Results of comparative studies designed to closely match real clinical settings indicate that more adequate and sustainable therapeutic effect is achieved after moxonidine administration in comparison to other frequently used antihypertensive drugs.

scholarly journals Features of the use of torasemide in arterial hypertension

2017 ◽  
Vol 14 (4) ◽  
pp. 27-31
Author(s):  
G A Baryshnikova ◽  
S A Chorbinskajya
Keyword(s):  
Arterial Hypertension ◽  
Loop Diuretic ◽  
Antihypertensive Drugs ◽  
Antihypertensive Efficacy ◽  
Electrolyte Balance ◽  
Good Tolerability ◽  
Antihypertensive Action ◽  
Target Organs ◽  
Negative Effect ◽  
Positive Effect

The article deals with the choice of diuretic in arterial hypertension and presents data on the antihypertensive efficacy of the loop diuretic torasemide. Data on the mechanisms of antihypertensive action of torasemide are presented, including a unique antialdosterone effect. The article reports on the absence of a negative effect of the drug on carbohydrate, lipid, purine metabolism and electrolyte balance, positive effect on the target organs, very good tolerability. It is advisable to use torasemide more widely in a "non-diuretic" dose (2.5-5 mg / day) for the treatment of arterial hypertension as in monotherapy as in combination with other antihypertensive drugs.

scholarly journals Multi-aspect approach to the optimization of pharmacotherapy of patients with arterial hypertension of high and very high risk

2018 ◽  
Vol 4 (4) ◽  
pp. 53-64
Author(s):  
Svetlana Gridina
Keyword(s):  
High Risk ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Antihypertensive Drugs ◽  
Treatment Options ◽  
Hypotensive Effect ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Hypotensive Action ◽  
Very High

Introduction: Personalization of pharmacotherapy of cardiovascular diseases is one of the urgent problems of cardiology. Material and methods: The study includes 120 patients with grades 2-3 arterial hypertension with the criteria of high and very high risk of developing cardiovascular complications. The patients were randomized into three groups with differentstarting regimens of pharmacotherapy – fixed and free combinations of ACE inhibitors and dihydropyridine CCB. Evaluation of the efficacy, safety and individualization of a therapy was carried out by using pharmacokinetic, pharmacoeconomic, sonographic, and laboratory methods. Results and discussion: Antihypertensive treatment with the inclusion of Amlodipine and Lisinopril or Ramipril in patients with arterial hypertension, having a slow and very slow oxidative metabolism phenotype, is characterized by the development of a more pronounced hypotensive effect in this group of patients (p<0.05-0.001) (Δ% SBP from 12.7 to 24.6 and from 19.6 to 27.9, respectively; Δ% DBP from 10.6 to 19.1 and from 15.9 to 23.6, respectively) in comparison to the group of patients with a fast phenotype (Δ% SBP from 6.42 to 9.34; Δ% DBP from 1.04 to 5.66), which allows administering a personalized pharmacotherapy. For patients with arterial hypertension of high and very high risk, the use of a fixed combination of Amlodipine and Lisinopril as a basic variant of the two-four-component therapy compared with treatment options based on free combinations of the studied drugs provided a significantly more pronounced decrease in systolic blood pressure (24.9%, 17.8 %, 19.0%, respectively, p<0.01), a greater degree of regression of left ventricular myocardial hypertrophy (8.70%, 5.67%, 5.84%, respectively, p<0.05), significant (p<0.05-0.001) improvement in a number of parameters of the patients’ quality of life, and was characterized by the greatest economic efficiency according to various criteria of hypotensive action. Conclusion: The results obtained in the study demonstrate the advantages of a fixed combination over free combinations of antihypertensive drugs and demonstrate the possibility of a pharmacokinetic approach to individualization of pharmacotherapy.

scholarly journals Enalapril in therapy of arterial hypertension in patients with juvenile obesity

1994 ◽  
Vol 40 (6) ◽  
pp. 25-26 ◽  
Author(s):  
Ye. V. Malyghina ◽  
G. A. Gherasimov ◽  
T. M. Atamanova
Keyword(s):  
Arterial Hypertension ◽  
Enzyme Inhibitors ◽  
Plasma Renin ◽  
Blood Lipid ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Hypotensive Effect ◽  
Negative Effects ◽  
Converting Enzyme Inhibitors ◽  
Drug Of Choice ◽  
Juvenile Obesity

Clinical efficacy of enalapril, a drug belonging to a group of angiotensin-converting enzyme inhibitors, was studied in patients with pubertal juvenile dyspituitarism (juvenile obesity) coursing with arterial hypertension. A reactive increase of plasma renin activity and reduced concentration of plasma aldosterone were revealed. The drug was characterized by a pronounced hypotensive effect. No negative effects on the blood lipid spectrum or carbohydrate metabolism were observed. The study showed that enalapril may be a drug of choice in the treatment of the hypertensive syndrome in patients with juvenile obesity.

scholarly journals Evidence-Based Information Which Could Influence Arterial Hypertension Treatment Approach after Publication of SPRINT Trial Results

Kardiologiia ◽  
2020 ◽  
Vol 60 (8) ◽  
pp. 130-140
Author(s):  
S. R. Gilyarevsky ◽  
N. G. Bendeliani ◽  
M. V. Golshmid ◽  
G. Yu. Zaharova ◽  
I. M. Kuzmina ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Treatment Approach ◽  
Secondary Analysis ◽  
Clinical Situation ◽  
Optimum Level ◽  
Target Organs ◽  
Selection Of ◽  
Continue Smoking

The article discusses results of secondary analysis of the data obtained in the SPRINT study and published in recent years. Unresolved issues in the tactics of managing patients with arterial hypertension are discussed. One of such issues is choosing an optimum level of blood pressure (BP) for a subgroup of patients with certain characteristics, including elderly and senile patients, patients with chronic kidney disease, and patients with arterial hypertension who continue smoking. The article discusses calculation of a threshold of risk for complications of cardiovascular diseases, at which a maximum advantage of intensified regimens of antihypertensive therapy could be achieved. In addition, the article addresses approaches to selection of antihypertensive drugs in the current conditions. The authors discussed the role of candesartan in the treatment of arterial hypertension, a sartan most studied in a broad range of patients. The issue of a rapid increase in BP without a damage to target organs is addressed; evidence for the role of captopril in such clinical situation is provided.

Fixed combination in patients with arterial hypertension: focus on antihypertensive and nephroprotective properties of fixed combination of lisinopril and amlodipine (clinical example)

2020 ◽  
pp. 19-28
Author(s):  
E. Yu. Ebzeeva ◽  
O. D. Ostroumova ◽  
N. M. Doldo ◽  
E. E. Pavleeva
Keyword(s):  
Kidney Disease ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drugs ◽  
Adult Population ◽  
Secondary Damage ◽  
Dihydropyridine Calcium Channel Blocker ◽  
Based Medicine ◽  
Modern Population

Arterial hypertension (AH) remains one of the most significant medical and social problems in the world, its prevalence among the adult population is 30–45%. Along with this, the modern population is characterized by a high incidence of chronic kidney disease (CKD), including due to their secondary damage in the framework of hypertension. In turn, CKD is an important independent risk factor for the development and progression of cardiovascular diseases, including fatal ones. The use of existing approaches to nephroprotection in the treatment of patients with hypertension will significantly improve the prognosis both in patients with risk factors for developing renal dysfunction and in patients with pre-existing kidney disease. According to current recommendations for hypertension in such clinical situations, therapy should begin with fixed combinations of antihypertensive drugs. The combination of an angiotensin converting enzyme inhibitor (ACE) and a dihydropyridine calcium channel blocker (CCВ) demonstrated the greatest effectiveness according to evidence-based medicine in patients with high-risk hypertension, including from the standpoint of nephroprotection. In the presented clinical case, the successful use of a fixed combination of ACE and CCВ in a patient with hypertension and microalbuminuria is described.

scholarly journals Baroreflex activation therapy for resistant hypertension: results from mid-term prospective ambulatory blood pressure registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Sindt ◽  
T Madej ◽  
S Grimm ◽  
M Knaut
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Pressure Drop ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Drug Resistant ◽  
Baroreflex Activation Therapy ◽  
Activation Therapy ◽  
Resistant Arterial Hypertension

Abstract Objectives First generation baroreflex activation therapy (BAT) devices showed clinical efficacy in patients with drug-resistant arterial hypertension (AHT), but the safety profile was insufficient. Data regarding efficacy of second-generation devices were generated mostly from office blood pressure (BP) measurements or short-term 24-hour ambulatory blood pressure measurements (ABPM). We present a mid-term prospective registry to evaluate the efficacy and safety of recent BAT devices. Purpose The purpose of our study was to find a method that helps patients with drug-resistant arterial hypertension to control their blood pressure. Further we sought to reduce the overall amount of antihypertensive drugs to lessen side effects, as well as the effects of polypharmacy. Methods All patients receiving Barostim neo between November 2013 and June 2019 for resistant AHT were prospectively included into this observational study. ABPM was performed at baseline, in 3-month intervals in the first year after BAT implantation and in 6-month intervals afterwards for up to 42 months. Patients were assigned into two groups of responders and non-responders. Non-responders had a mean blood pressure drop (BPD) below 5mmHg. Responders in turn were categorized into 3 sub-groups (low-BPD between 5–9 mmHg, medium-BPD between 10–19 mmHg and high-BPD ≥20 mmHg). The primary efficacy end-points were changes in systolic and diastolic BP and number of antihypertensive medications. The primary safety end point was BAT-related major adverse events (MAE). Results 64 patients (mean age 63 years, 67% males) were included. Only patients who completed a 24-hour ABPM during a follow up were counted in the statistical analysis. We had an overall responder rate of 67.8%. Out of those 15.4% had low-BPD, 38.4% medium-BPD and 46.2% had a high-BPD. Systolic BP decreased over the 3.5-years period from 168±17 mmHg to 149±19 mmHg (n=19, mean change −18.8 mmHg; 95% confidence interval [CI]: −29.32 to −8.36; p<0.0007). Diastolic BP decreased from 97±16 to 85±12 mmHg (n=19, mean change −11.7 mmHg; 95% CI: −19.2 to −4.2; p<0.0021). The mean number of antihypertensive drugs was reduced from 6.9±1.3 to 5.2±1.5 (n=19, mean change −1.7; 95% CI: −0.8 to −0.27; p<0.0009). The time course of primary end-points is shown in Fig.1. Freedom from BAT-related MAE was 93.5%. 4 perioperative complications (1 pocket bleeding, 1 pocket infection, 1 N. hypoglossus palsy, 1 hoarseness) resolved without residual side effects. There were five non BAT related deaths (7,8%) in the follow up period. Conclusion Systolic and diastolic ABP, as well as number and dosage of antihypertensive drugs decreased significantly during 3.5-years follow-up after Barostim neo implantation in 64 consecutive patients (of whom 62 completed at least one follow-up). No MAE associated with BAT were observed after the perioperative period. However, further controlled trials are needed to confirm the long-term efficacy of BAT. Figure 1. Mean blood pressure drop Funding Acknowledgement Type of funding source: None

Terminal ileum resection as a trigger for Strongyloides stercoralis hyperinfection and ensuing serial sepsis in a 37-year-old patient with complicated Crohnʼs disease: a case report

2018 ◽  
Vol 56 (04) ◽  
pp. 380-383 ◽  
Author(s):  
Mirjana Topić ◽  
Silvija Čuković-Čavka ◽  
Marko Brinar ◽  
Mirjana Kalauz ◽  
Ivica Škrlec ◽  
...  
Keyword(s):  
Terminal Ileum ◽  
Skin Penetration ◽  
Strongyloides Stercoralis ◽  
Developed Countries ◽  
Clinical Settings ◽  
Solid Organ ◽  
Transplant Patients ◽  
Skin Contact ◽  
Life Threatening ◽  
The Tropics

AbstractThe nematode Strongyloides stercoralis, outside the tropics and subtropics present in small endemic foci, can cause an infection after direct skin contact with contaminated soil containing infective filariform larvae and, rarely, after intimate interhuman contact or after transplantation of an infected solid organ. Following skin penetration, migration, and maturation through several stages, a small number of invasive filariform larvae can develop anew in the gut lumen, perpetuating new cycles of penetration, tissue migration, and reproduction, without leaving the host.In a state of immunosuppression, autoinfection can progress to life-threatening hyperinfection and/or infection disseminated through virtually any organ. In developed countries, the most frequently recognized risk for severe hyperinfection is corticosteroid therapy, but this has been also described in malnourished, alcoholic, cancer, and transplant patients. Due to the frequent need for immunosuppressive therapy, patients suffering from inflammatory bowel disease (IBD) are susceptible to develop overwhelming strongyloidiasis. Strongyloidiasis can be easily overlooked in clinical settings, and in many European regions there is poor insight into the epidemiological burden of this disease.We present a case of S. stercoralis hyperinfection that triggered 3 successive episodes of sepsis caused by pathogens of the gut flora in a young patient suffering from stenotic form of Crohn’s disease. S. stercoralis hyperinfection occurred in the corticosteroid-free period, shortly after resection of the terminal ileum, which was probably the trigger for the overwhelming course. The patient was successfully treated with 10-day albendazole therapy.

INFLUENCE OF DIFFERENT CLASSES OF ANTIHYPERTENSIVE DRUGS ON INSULIN RESISTANCE IN PATIENTS WITH MILD AND MODERATE ARTERIAL HYPERTENSION

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e189
Author(s):  
O. Rekovets ◽  
Y. Sirenko ◽  
O. Torbas ◽  
S. Kushnir ◽  
G. Primak ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs

scholarly journals Masked arterial hypertension: prevalence, pathophysiological determinants and clinical significance

2019 ◽  
pp. 92-98 ◽  
Author(s):  
В. I. Geltser ◽  
V. N. Kotelnikov ◽  
О. О. Vetrova ◽  
R. S. Karpov
Keyword(s):  
Arterial Hypertension ◽  
Cardiovascular Complications ◽  
Hypertension Prevalence ◽  
Rational Pharmacotherapy ◽  
Maximum Reduction ◽  
Target Organs ◽  
Rf Exposure ◽  
Increased Risk ◽  
Water Salt ◽  
Hemostatic Disorders

In most modern studies, masked arterial hypertension (MAH) is characterized as a poorly diagnosed, latent clinical condition predisposing to subclinical damage to target organs and an increased risk of cardiovascular complications. The prevalence of MAH among the population depends on gender, age, anthropometric and socioeconomic factors, profession, race and other characteristics. The most important risk factors (RF) of MAH and its pathophysiological determinants include genetic polymorphism, subclinical non-specific inflammation, hemostatic disorders, obesity, metabolic syndrome, water-salt imbalance, dyslipidemia, hyperuricemia. A defined value has latent dysfunction of the mechanisms that provide circulatory homeostasis, the detection of which is possible by the hemodynamic response to psycho-emotional, hypoxic, hypocapnic, orthostatic effects. Aggressiveness of RF exposure and the consequences of their implementation are evaluated by the rate of development of cardiovascular events and mortality, which indicate an unfavorable prognosis of “uncontrolled” MAH. The maximum reduction of the RF effects and rational pharmacotherapy can significantly improve its clinical prospects.

scholarly journals Tactical approaches to the treatment of arterial hypertension in the European part of the Russian Federation. EPOHA study 2017

Kardiologiia ◽  
2019 ◽  
Vol 59 (11S) ◽  
pp. 77-84
Author(s):  
Yu. V. Badin
Keyword(s):  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Russian Federation ◽  
Antihypertensive Treatment ◽  
Antihypertensive Drugs ◽  
European Part ◽  
Frequency Of Use ◽  
Two Component ◽  
The Russian Federation ◽  
Real Clinical Practice

Aim. Analysis of antihypertensive treatment among different groups of patients with arterial hypertension from “EPOCHA” study 2017. Materials and methods. EPOCHA study is a representative sample of the European part of the Russian Federation was created in 2002 and re-examined in 2017. Results. 34.6% of the effectively treated (ET) patients had one antihypertensive drug and 32,2% of the ineffective treatment (IT) patients, p=0.16. Two-component antihypertensive therapy was 45.9% and 44.9%, respectively, p=0.56. Three antihypertensive drugs had 17.9% of the ET patients and 20.7% of the IT patients, p=0.05. Four antihypertensive drugs had 1.6% of the ET patients and 2.2% of the IT patients. The frequency of use of renin-angiotensin-aldosterone system blockers in the group of ET patients was 85.0%, which was significantly lower than 91.6% in the group of IT patients, р<0.0001. Conclusion. EPOCHA study shows that structure of antihypertensive therapy does not differ between ET and IT patients what is caused lack of medical supervision for patients with hypertension in real clinical practice.

Sign in / Sign up

Export Citation Format

Share Document