Using of urapidil for correction of arterial hypertension in cataract surgery

2021 ◽  
pp. 176-181
Author(s):  
E.A. Bachinin ◽  
◽  
D.Y. Ignatenko ◽  
M.V. Stolyarov ◽  
S.I. Utkin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Comparative Analysis ◽  
Side Effects ◽  
Arterial Hypertension ◽  
Cataract Surgery ◽  
Key Words ◽  
Treatment Of Hypertension ◽  
Group 10 ◽  
Intraoperative Hypertension

Purpose. Comparative analysis of clinical efficacy of urapidil and droperidol for relief of arterial hypertension (AH) during cataract surgery. Material and methods. The study included 30 patients who underwent relief of intraoperative hypertension with urapidil or droperidol in combination with sedation. According to method of treatment of hypertension, 3 groups of patients were distinguished: 1st group – 10 patients whom were injected only with urapidil, 2nd group – 10 patients whom were injected urapidil against the background of sedation; 3rd group – 10 patients whom received droperidol against the background of sedation. Results. We relieved intraoperative rise in blood pressure and avoided complications associated with it, in all 3 groups. Using of urapidil did not cause side effects from cardiovascular, respiratory and nervous systems. The dose of urapidil was reduced when used in conjunction with sedatives. Droperidol has been shown to be effective in patients with cognitive impairment with signs of arousal. Conclusion. The applied methods of relief of intraoperative AH were effective in all patients. Urapidil for correction of AH in outpatients is justified due to its effectiveness and safety. Droperidol for treatment of AH is preferable for patients with unstable psychoemotional status, agitation. Such patients should be monitored in hospital. Key words: urapidil, ebrantil, droperidol, intraoperative arterial hypertension, ophthalmosurgery.

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

Arterial hypertension + past stroke – a case report

2021 ◽  
Vol 14 (3) ◽  
pp. 324-326
Author(s):  
Maria Łukasiewicz ◽  
Marta Swarowska-Skuza
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Chronic Disease ◽  
Side Effects ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Systolic Hypertension ◽  
The Elderly ◽  
Isolated Systolic Hypertension ◽  
Special Group

Arterial hypertension, as a very widespread chronic disease, and thus differing in both pathomechanism and course in patients, requires a significant individualization of pharmacotherapy. One such special group is the elderly. Both the low-renin pathomechanism of arterial hypertension and its phenotype (isolated systolic hypertension) imply the choice of a specific pharmacotherapy. Additionally, in this group, side effects should be observed much more vigilantly, while target blood pressure values should be treated more liberally. An example of antihypertensive therapy in a patient belonging to the group described is presented in the following case.

scholarly journals COGNITIVE IMPAIRMENT, THEIR DYNAMICS AND STRUCTURE IN THE ACUTE AND RECOVERY PERIODS OF STROKE, DEPENDING ON ARTERIAL HYPERTENSION SEVERITY AND DURATION

2018 ◽  
Vol 13 (3-4) ◽  
pp. 22-27
Author(s):  
T.M. Cherenko ◽  
Yu.L. Heletyuk
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Arterial Hypertension ◽  
Blood Pressure Monitoring ◽  
Cognitive Status ◽  
Neurological Deficits ◽  
Stroke Patients ◽  
Mean Values ◽  
Post Stroke ◽  
The Mean

Relevance. Cognitive impairment is common in the post-stroke period. Different characteristics of arterial hypertension (AH), namely its severity, duration and variability of blood pressure, can affect the development of cognitive impairment in stroke patients. Objective: to investigate cognitive impairment, their dynamics and structure in acute and recovering stroke periods, depending on the arterial hypertension severity and duration. Materials and methods. 150 patients with a primary ischemic stroke and history of hypertension: 74 (49,3 %) women and 76 (50,7 %) men, the mean age (67,4±0,7) years have been examined. Neurological deficits was evaluated by the NIHSS scale. The cognitive status was evaluated by the MMSE scale at the end of an acute period of 21 days and 1 year. Diagnosis of hypertension was based on the clinical and instrumental examination results and medical documents. Daily blood pressure monitoring was using on admission and every 4 hours during 6 days of acute stroke stage. Mean SBP, mean DBP, maximum SBP and DBP, standard deviation (SD) of SBP and DBP were studied. Results. By the mean score on the MMSE scale, there are differences in patients during acute post-stroke period, depending on the severity of hypertension: 27,2±0,6 points in the case of hypertension stage 1, 24,3±0,6 in the case of hypertension stage 2 and 20,7±0,8 in case of AH stage 3, (p=0.001). By this indicator, patients with different AH duration were different: 26,4±0,9 points; 25,1±0,5 points; 20,5±0,7 points, respectively. The significance of these differences by the mean values of MMSE score was obtained in patients with a duration of AH less than 5 years and more than 10 years, as well as when comparing the group of "6-10 years" and "over 10 years" (p=0,001). Significant differences in the structure of cognitive deficits severity, depending on the hypertension stage and its duration, were observed only in patients with moderate and severe stroke (p=0,006). Cognitive deterioration a year after a stroke was observed in 40 (31,5 %) patients. They have significantly higher mean values SD 1-3, SD 1-6, SBP on the first day after a stroke, and duration of hypertension. Conclusions. The relationship between the degree of intellectual decline and the duration of hypertension (r=0,592, p=0,001), severity of hypertension (r=0,459, p=0,001) was found. The severity of the neurological deficiency affects the structure of cognitive impairment at discharge in patients with different severity and duration of hypertension, and higher mean values of the variability of blood pressure from 1 to 6 days, SBP on the first day after stroke and higher duration of hypertension in the history is associated with a negative dynamics of cognitive impairment in stroke patients in a year after stroke.

Nutritional management of hypertension: controversies and frontiers Proceedings of one more meeting?

1986 ◽  
Vol 64 (6) ◽  
pp. 770-771
Author(s):  
Frans H. H. Leenen
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Side Effects ◽  
Antihypertensive Therapy ◽  
Mild Hypertension ◽  
Severe Hypertension ◽  
Nutritional Management ◽  
Blood Pressure Elevation ◽  
Cardiovascular Morbidity And Mortality ◽  
Treatment Of Hypertension

In recent years antihypertensive therapy has evolved from treatment for a relatively small number of patients with severe hypertension to treatment for millions of people with mild to severe hypertension. We now treat not only patients at high risk for future cardiovascular morbidity and mortality, of whom nearly all are benefitting from antihypertensive therapy, but also much larger groups of patients each individually at low risk. In this latter group only a small percentage actually benefits from antihypertensive therapy. For example, in the Australian trial in subjects with mild hypertension and no other evidence of cardiovascular disease, only two excess deaths were prevented at the expense of 1000 patient-years of drug treatment (Australian Therapeutic Trial 1980). For most individual members of this group normalizing their mild blood pressure elevation appears to offer no benefit, yet all of them are exposed to antihypertensive therapy and its side effects. When instituting antihypertensive pharmacotherapy in patients with mild hypertension one has to be concerned about these side effects, not just the objective ones (e.g., effects on plasma lipoproteins or glucose which may offset any gains to be obtained by lowering blood pressure), but also subjective ones (e.g., fatigue, impotence) which may markedly affect the quality of life.Nonpharmacologic, in particular nutritional, management of mild hypertension has intuitively major appeal for "lowering blood pressure without side effects." Many studies have evaluated the effects of dietary changes on blood pressure. Several recent symposia have addressed the issue of nutrition and hypertension. Despite this, the report from the first Consensus Development Conference of the Canadian Hypertension Society ("on the management of mild hypertension in Canada") states "Because of conflicting evidence and problems with patient compliance, the conference had difficulty reaching consensus on the effectiveness of salt restriction and, for the obese, of weight reduction in lowering blood pressure" (Logan 1984).This issue of the Canadian Journal of Physiology and Pharmacology contains the proceedings of a workshop "Nutritional Management of Hypertension: Controversies and Frontiers," held in Harrison Hot Springs, British Columbia, September 6–7, 1985. This workshop was organized under the auspices of the Canadian Hypertension Society and made possible by generous financial support from ICI Pharma, Canada (general sponsorship) as well as from the National Institute of Nutrition for the obesity session, and from the Dairy Bureau of Canada for the sodium–calcium session.To define more clearly the controversies and uncertainties, this workshop was organized in a different way than previous meetings dealing with this issue. A clinical scientist working in a particular area was invited to outline the evidence in favour of a given dietary manipulation for the treatment of hypertension, and another one to outline the evidence against. This evaluation would particularly concern evidence regarding "efficacy" and "effectiveness". A discussant then presented an evaluation of the two position papers, followed by a general discussion and a summary by the session chairman. This type of scrutiny of our current knowledge was done for sodium restriction, calcium supplementation, and weight loss. As part of this evaluation two speakers addressed the closely related issues of practical aspects of diet management (e.g. compliance) and the consequences–risks of weight loss in relation to the pathophysiology of obesity.In the last part of the workshop possible future developments in nutrition and hypertension were reviewed, such as "nutrition in the young, early intervention?," vegetarian approach to hypertension, role of dietary fats, and proteins and precursors.The organizing committee very much appreciated that Dr. David Sackett was willing to serve as the scientific chairman of this workshop, to summarize the present "state of the art" on diet modulation in the management of hypertension as well as to propose recommendations for treatment of hypertension in clinical practice and for future research directions.It was a pleasure for me to serve as chairman of the organizing committee. As President of the Canadian Hypertension Society I would like to thank all session chairmen, speakers, discussants, and participants for their enthusiasm and eagerness to explore the topic of nutrition and hypertension. I hope that the scientific information and insight that the proceedings of this workshop offer will convey their commitment.

Desynchronizing effects of comorbid pathology: psoriasis and arterial hypertension

2014 ◽  
Vol 20 (29) ◽  
pp. 21-24
Author(s):  
Рагозин ◽  
Roman Ragozin
Keyword(s):  
Blood Pressure ◽  
Comparative Analysis ◽  
Arterial Hypertension ◽  
Diurnal Variation ◽  
Diastolic Blood Pressure ◽  
Biological Rhythms ◽  
Northern Region ◽  
Rhythmic Pattern ◽  
Ultradian Rhythms

The paper describes the results of the analysis of biological rhythms of blood pressure in patients with living in the northern region. The comparative analysis of chronograms of blood pressure shows that rhythmic pattern changes with the appearing of short ultradian rhythms, the decrease of phases dispersion of the studied arameters, reducing synchronization between systolic and diastolic blood pressure and diurnal variation of synchronization re observed in patients with psoriasis.

scholarly journals Diuretics in treatment of patients with arterial hypertension

2009 ◽  
Vol 6 (4) ◽  
pp. 9-12
Author(s):  
Irina Evgen'evna Chazova ◽  
Lyudmila Gennadievna Ratova
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Disease Process ◽  
Low Doses ◽  
Treatment Of Hypertension ◽  
Artery Disease ◽  
High Doses

Since all cardiovascular risk factors contribute to coronary artery disease in patients with arterial hypertension, they should all be considered in the management of this disease process. Thiazides diuretics when used at high doses, negatively impact lipid and glucose metabolism. These findings have resulted in decreased use of diuretics in favor of newer agents such as ACE inhibitors and calcium antagonists. However, recent data have demonstrated that when used at low doses (6.25 or 25 mg of hydrochlorothiazide), diuretics lack significant metabolic side effects while bringing about significant reductions in blood pressure. Thus, at these doses, hydrochlorothiazide is a useful drug in the treatment of hypertension, both as monotherapy and in combination therapy.

scholarly journals A Comparison of Labetalol and Nitroglycerin for The Management of Intraoperative Hypertension in Ambulatory Surgical Patients Who Underwent Cataract Surgery

2019 ◽  
Author(s):  
Mehdi Sanatkar ◽  
Hossein Sadrossadat ◽  
Mehrdad Goudarzi ◽  
Ebrahim Espahbod ◽  
Masoumeh Zangeneh
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Cataract Surgery ◽  
Topical Anesthesia ◽  
Surgical Patients ◽  
Baseline Heart Rate ◽  
Repeat Dose ◽  
Hypotension Episode ◽  
Intraoperative Hypertension

Background: This is a prospective randomized blinded clinical trial comparing the efficacy and safety of labetalol and nitroglycerin for the management of intraoperative hypertension in ambulatory surgical patients who underwent cataract surgery. Methods: A total of 80 hypertensive patients (systolic blood pressure> 200 mmHg or diastolic blood pressure>100 mmHg) who had increased blood pressure during cataract surgery under topical anesthesia were reviewed. Patients were randomized to receive nitroglycerin (group N, n=40) or labetalol (group L, n=40). The initial dose of nitroglycerin was a bolus of 2 µg/kg and repeat dose of 1ug/kg intravenously every 5 minutes. Labetalol was administered as a bolus of 5 mg followed by 5 mg intravenously as needed every five minutes up to maximum dose of 1 mg/kg. Results: Systolic blood pressure decreased from 21.4±8.6 mm Hg (200 to 260 mm Hg) to 18.8±6.4 mm Hg with administration of nitroglycerin. Labetalol reduced systolic blood pressure from 21.4±6.7 mm Hg (201 to 258 mm Hg) to 17.6±11.6 (p=0.02). Nitroglycerin increased baseline heart rate from 68±8 beats/min to 82±6 beats/min (p=0.04), however, in the labetalol group heart rate reduced from control 72±6 to 64±9 beats/min (P<0.05). The hypotension episode was 18 (45%) cases in the nitroglycerin group and 2 (5%) cases in the labetalol group respectively (p<0.05). The mean of systolic blood pressure during their stay in the recovery room in nitroglycerin group was 20.7±9.6 mm Hg and in labetalol group was 18.5±10.2 mm Hg (p<0.05). Conclusion: Nitroglycerin may produce reflex tachycardia and episode of hypotension especially in elderly patients intraoperatively. Labetalol is a safe and effective antihypertensive agent for management of increased blood pressure during cataract surgery with topical anesthesia.

scholarly journals Treatment of hypertension in older patients

2020 ◽  
Vol 27 (4) ◽  
pp. 90-98
Author(s):  
O. M. Kovalyova
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Older Patients ◽  
Age Groups ◽  
Blood Pressure Targets ◽  
Clinical Investigations ◽  
Treatment Of Hypertension ◽  
American Society ◽  
European Society Of Cardiology ◽  
Randomised Controlled

The article is dedicated to the strategy of management of arterial hypertension in older patients based on the Guidelines of the International Society of Hypertension, the European Society of Cardiology, the European and the American Society of Hypertension, the American College of Physicians and the American Academy of Family Physicians. According to the results of epidemiological and clinical investigations is shown the influence of high blood pressure on cardiovascular outcomes and mortality in the population of older persons. Due to the analyses of randomised controlled trials is pointed out the convicing data the need for differtntiated control of blood pressure according to the level of arterial hypertension and factors of cardiovascular risk. The methodology of initial antihypertensive therapy in persons of different age groups is taken in comparative aspects. The main discussed questions related to the blood pressure targets in the dynamics of antihypertensive treatment in patients 65–79 years and age ≥ 80 years are emphasized. The requirements for individual medical tactics of older hypertensive patients taken into account anamnesis, fit and mental state, clinical features, comorbidity, complications and hypertension-mediated organ damages are recommended.

scholarly journals Fixed combination of lercanidipine with enalapril - pharmacological features, clinical feasibility, advantages in the treatment of hypertension

2021 ◽  
pp. 21-24
Author(s):  
P. О. Lazarev
Keyword(s):  
Oxidative Stress ◽  
Blood Pressure ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Antihypertensive Drugs ◽  
Mechanisms Of Action ◽  
High Efficacy ◽  
National Guidelines ◽  
Treatment Of Hypertension ◽  
And Oxidative Stress

According to current international and national guidelines for the management of arterial hypertension preference is given to the use of fixed combinations of antihypertensive drugs of different classes, thus increasing the effectiveness of therapy acting in a complementary manner to affect different pathogenic mechanisms of arterial hypertension and reducing the frequency of side effects. A fixed combination of lercanidipine and enalapril contains antihypertensive drugs that have complementary mechanisms of action. This combination effectively reduces blood pressure, has high efficacy and tolerability, it may provide an additive effect on macro- and microvascular structures, arterial stiffness and oxidative stress. It has a beneficial influence on renal function, especially in patients with comorbidities.

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