scholarly journals Expert consensus. Effect of antihypertensive therapy on cognitive functions

2021 ◽  
Vol 18 (1) ◽  
pp. 5-12
Author(s):  
Olga D. Ostroumova ◽  
Vladimir A. Parfenov ◽  
Tatiana M. Ostroumova ◽  
Nikolay N. Yakhno ◽  
Irina E. Chazova ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Antihypertensive Therapy ◽  
Randomized Clinical Trials ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Drug Prevention ◽  
Expert Consensus ◽  
Alzheimers Disease ◽  
People With Dementia ◽  
Receptor Blockers

Arterial hypertension (AH) is the major modifiable risk factor for cognitive impairment (CI), including dementia, CI in cerebrovascular and neurodegenerative diseases, including Alzheimers disease. By 2050, the number of people with dementia will approximately 3 times increase due to the aging population and limited opportunities for drug prevention and treatment of severe CI. In connection with the above, it seems necessary to create an expert consensus, which would summarize the evidence-based medicine data available to date on the effect of antihypertensive therapy (AHT) on cognitive function (CF). In the expert consensus, the data of prospective randomized clinical trials, observational and population studies, meta-analyzes on the effect of AHT on the risk of dementia and CI progression, including certain CF, were summarized and analyzed. The consensus considers the effect of antihypertensive drugs (AHD) on various cognitive domains. Literature data give evidence that AHT reduces the risk for dementia, including vascular dementia, reduces the risk of for dementia in Alzheimers disease, as well as reduces the risk and can prevent the progression of non-dementia CI. The effect of AHT on various CF has been little studied. Most meta-analyzes did not reveal the benefits of any class of AHD; however, one study demonstrated the advantage of angiotensin receptor blockers, while another study diuretics. The consensus emphasizes that, given the high incidence of AH in the general population, AHT may be one of the most effective ways to prevent CI or delay CI progression. The effect of different classes of AHD on CF requires further study. It is necessary to conduct a larger number of well-designed randomized clinical trials that would assess the state of executive functions in patients with AH.

scholarly journals Treatment of hypertension during the COVID-19 pandemic: questions about the blockade of the renin-angiotensin-aldosterone system

2021 ◽  
pp. 59-67
Author(s):  
S. G. Kanorskiy
Keyword(s):  
Clinical Trials ◽  
Ace Inhibitors ◽  
Randomized Clinical Trials ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin Aldosterone System ◽  
Uncomplicated Hypertension ◽  
Renin Angiotensin ◽  
Risk Of Death

Arterial hypertension was one of the most common comorbidities associated with a high risk of death in hospitalized patients with COVID-19. Patients with hypertension are routinely and according to standards treated with angiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARB) II. ACE inhibitors or ARB II are included in fixed combinations of antihypertensive drugs recommended for patients with uncomplicated hypertension, as well as when combined with various comorbidities. During the COVID-19 pandemic, there were suggestions about the potential for a negative effect of drugs of these classes on the course and outcomes of a new coronavirus infection. There was a need for a quick response from the most reputable medical organizations to the question of the use of ACE inhibitors and ARB II during the COVID-19 pandemic. The expert position was soon published despite the lack of evidence from randomized clinical trials. Was there any reason for concern about the treatment of ACE inhibitors and ARB II for COVID-19? What are the relationships between the renin-angiotensin-aldosterone system (RAAS) and COVID-19? Is there any new data from clinical trials that can confirm or deny the previously presented position of professional societies regarding the use of RAAS blockers in COVID-19? What is the role of the difference in the mechanism of action of an ACE inhibitor and ARB II in COVID-19? Is it possible that RAAS blockers will be helpful in treating COVID-19? Will the tactics of hypertension pharmacotherapy change in the near future? In this review article, modern concepts on this problem are discussed and answers to the listed questions reflecting the achieved level of knowledge are formulated.

scholarly journals Blood Pressure Control: Stroke and Stroke Prevention

2005 ◽  
Vol 6 (1_suppl) ◽  
pp. S8-S11
Author(s):  
Hans-Christoph Diener
Keyword(s):  
Blood Pressure ◽  
Stroke Prevention ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Pressure Control ◽  
Angiotensin Receptor ◽  
Risk Of Death ◽  
Pressure Lowering ◽  
Receptor Blockers

Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention. All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention. Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP) increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences. The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

scholarly journals Azilsartan: Current Evidence and Perspectives in Management of Hypertension

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Akshyaya Pradhan ◽  
Ashish Tiwari ◽  
Rishi Sethi
Keyword(s):  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Financial Burden ◽  
Daily Practice ◽  
Current Evidence ◽  
Hypertension Management ◽  
Angiotensin Receptor ◽  
Global Pandemic ◽  
Receptor Blockers

Hypertension continues to be global pandemic with huge mortality, morbidity, and financial burden on the health system. Unfortunately, most patients with hypertension would eventually require two or more drugs in combination to achieve their target blood pressure (BP). To this end, emergence of more potent antihypertensive drugs is a welcome sign. Angiotensin receptor blockers (ARBs) are cornerstones of hypertension management in daily practice. Among all ARBs, azilsartan is proven to be more potent in most of the head-to-head trials till date. Azilsartan is the latest ARB approved for hypertension with greater potency and minimal side effects. This review highlights the role of azilsartan in management of hypertension in the current era.

scholarly journals New targets and old therapies for arterial hypertension

2019 ◽  
pp. 46-52
Author(s):  
S. R. Gilyarevsky ◽  
N. G. Bendeliani ◽  
M. V. Golshmid ◽  
G. Yu. Zakharova ◽  
I. M. Kuzmina ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Arterial Hypertension ◽  
Randomized Clinical Trials ◽  
Antihypertensive Drugs ◽  
Experimental Studies ◽  
The Elderly ◽  
Published Data ◽  
Efficacy And Safety ◽  
Adoption And Implementation ◽  
Moderate Cognitive Impairment

The article discusses approaches to the choice of antihypertensive drugs, which may be based on the adoption and implementation of new clinical guidelines for the management of patients with arterial hypertension. This paper provides data on the efficacy and safety of candesartan, an antihypertensive drug, which advantages were identified during a large number of randomized clinical trials. It discusses the recently published data on the effectiveness of more intensive regimens of antihypertensive therapy to reduce the risk of moderate cognitive impairment in patients with arterial hypertension. In this regard, the authors provide data of the previously completed studies, which showed the effect of candesartan on the rate of cognitive decline in patients with arterial hypertension in the elderly and senile age. The features of the pharmacological characteristics of candesaratan that can remotely explain its clinical efficacy are considered. The data of experimental studies of candesartan in animals, which contribute to the concept of the possible effects of candesartan, are presented.

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