Clinical Perspective on the Management of Hypertension

2011 ◽  
Vol 2 ◽  
pp. IJCM.S5475
Author(s):  
Muzaffar Iqbal
Keyword(s):  
Blood Pressure ◽  
Pharmacological Treatment ◽  
Antihypertensive Drugs ◽  
Public Health Issue ◽  
Morbidity Rate ◽  
Routine Practice ◽  
Channel Blockers ◽  
Uncomplicated Hypertension ◽  
Cardiovascular Morbidity And Mortality ◽  
Β Blockers

Hypertension is an important medical and public health issue all over the world. It is one of the most prevalent conditions seen today by clinicians in both developed and developing countries. Depending upon progression of systolic and diastolic blood pressure it is classified into stage 1, 2 and 3 hypertension. Life style modifications may be helpful in initial stage but pharmacological treatment is necessary when it become difficult to control it. In routine practice, pharmacological treatment is being selected from diuretics, β-blockers, calcium channel blockers and renin angiotensin system inhibitors either alone or in combination for both initial and maintenance therapy. Choice of drug depends upon favourable effects in specific clinical setting. Thiazide type diuretics are being preferred for most patients with uncomplicated hypertension whereas β-blockers show strong benefits in patients with a variety of cardiovascular complications. ACE-Inhibitors and ARBs are superior to other class in patients with multiple risk factors like obesity, insulin resistance or diabetes. CCBs compared with other class of hypertensive drugs demonstrate similar blood pressure lowering effects and similar reductions in cardiovascular morbidity and mortality but higher incidence of heart failure and fatal myocardial infarction in some patients. Despite the continued decrease in mortality and morbidity rate by these antihypertensive drugs, some documented increasing prevalence of cardiac failure and end stage renal disease remains to be explained.

scholarly journals Hypertension after Kidney Transplantation: Clinical Significance and Therapeutical Aspects

2019 ◽  
Vol 7 (7) ◽  
pp. 1241-1245 ◽  
Author(s):  
Galina Severova-Andreevska ◽  
Ilina Danilovska ◽  
Aleksandar Sikole ◽  
Zivko Popov ◽  
Ninoslav Ivanovski
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Calcineurin Inhibitors ◽  
National Committee ◽  
Channel Blockers ◽  
Angiotensin Ii Receptor ◽  
Post Transplant ◽  
Cardiovascular Morbidity And Mortality ◽  
Receptor Blockers ◽  
Kdigo Guidelines

Most of the kidney transplanted patients develop arterial hypertension after renal transplantation. Together with very well-known and usual risk factors, post-transplant hypertension contributes to the whole cardiovascular morbidity and mortality in the kidney transplant population. The reasons of post-transplant hypertension are factors related to donors and recipients, immunosuppressive therapy like Calcineurin Inhibitors (CNI) and surgery procedures (stenosis and kinking of the renal artery and ureteral obstruction). According to Eighth National Committee (JNC 8) recommendations, blood pressure > 140/90 mmHg is considered as hypertension. The usual antihypertensive drugs used for the control of hypertension are Calcium channel blockers (CCB), Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin –II receptor blockers (ARB), B- blockers and diuretics. Follow the KDIGO guidelines the target blood pressure < 140/90 mmHg for patients without proteinuria and < 125/75 mmHg in patients with proteinuria is recommended. Better control of post-transplant hypertension improves the long-term graft and patient’s survival.

Cardiotoxicity with antihypertensive drugs (literature review) Part 1. Calcium channel blockers and beta-blockers

2021 ◽  
pp. 12-19
Author(s):  
A. N. Esaulenko ◽  
A. Yu. Moiseeva ◽  
A. A. Ivannikov ◽  
I. V. Bratischev ◽  
Kh. G. Alidzhanova
Keyword(s):  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Research Literature ◽  
Channel Blockers ◽  
Distinctive Features ◽  
Experimental Pharmacology ◽  
Myocardial Insufficiency ◽  
Β Blockers

The effect of hypotensive drugs overdose on cardiovascular system is poorly studied; it should undergo clinical, experimental pharmacology and toxicology together with cardiology. There is too little information about cardiotoxicity of beta-blockers (β-blockers) and calcium channel blockers (CCB) in existing research literature. Intoxication from these groups of drugs causes similar severe hemodynamic abnormalities and myocardial insufficiency, however pathophysiological mechanisms of these abnormalities are not thoroughly studied. The review highlights how difficult it is to identify toxic level and distinctive features of clinical evidence of intoxication. Methods of diagnosis as well as β-blockers and CCB overdose treatment are discussed.

scholarly journals Reaching blood pressure guideline targets with the CNIC polypill in patients with a previous cardiovascular event in Mexico: a post hoc analysis of the SORS study

2020 ◽  
Vol 16 (1) ◽  
pp. 53-60
Author(s):  
Enrique Gómez-Álvarez ◽  
Juan Verdejo ◽  
Salvador Ocampo ◽  
Emilio Ruiz ◽  
Marco A Martinez-Rios
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Prospective Study ◽  
Calcium Antagonists ◽  
Renin Angiotensin System ◽  
Routine Practice ◽  
Angiotensin System ◽  
Post Hoc Analysis ◽  
Β Blockers ◽  
Post Hoc

Aim: To determine the effectiveness of Centro Nacional de Investigaciones Cardiovasculares (CNIC)-polypill (acetylsalicylic acid 100 mg, ramipril 5/10 mg, simvastatin 40 mg) in achieving blood pressure (BP) goals. Patients & methods: A multicenter, observational, one cohort, prospective study. BP targets were analyzed in patients with cardiovascular disease after 12-months treatment with the CNIC polypill. Results: A total of 572 patients (59.4 ± 13.9 years, 57.3% men) were analyzed. At baseline, BP was 147.1 ± 18.1/88.3 ± 10.6 mmHg, 97.1% of patients were taken renin-angiotensin system inhibitors, 5.4% calcium antagonists, 1.9% diuretics and 13.1% β-blockers. The proportion of patients who achieved BP targets increased from 20.1 to 55.4% (p < 0.001). Conclusion: In routine practice, switching from usual care to the CNIC-polypill in patients with cardiovascular disease could facilitate achieving BP goals.

Cardiac Function and Structure in Longitudinal Analysis of Echocardiography in Peritoneal Dialysis Patients

2010 ◽  
Vol 30 (3) ◽  
pp. 353-361 ◽  
Author(s):  
Hiroaki Io ◽  
Yuuki Ro ◽  
Yoshimi Sekiguchi ◽  
Tetsutaro Shimaoka ◽  
Jiro Inuma ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Cardiac Function ◽  
Antihypertensive Drugs ◽  
Vena Cava ◽  
Left Ventricular ◽  
University Hospital ◽  
Wave Flow ◽  
Channel Blockers ◽  
Aggressive Treatment

♦ BackgroundEchocardiography is widely used for the evaluation of cardiac structures and function. The prognostic value of assessment of left cardiac atrium (LA) size in peritoneal dialysis (PD) patients is still unclear. The objective of the present study is to investigate prospectively a longitudinal monitoring of echocardiography parameters after start of PD. We also investigated a correlation study among plasma atrial natriuretic peptide (ANP) level, LA size, and cardiac function undergoing aggressive treatment.♦ MethodsCorrelation among plasma ANP, LA size, and cardiac function was prospectively analyzed by Doppler echocardiography in 32 PD patients in Juntendo University Hospital, Tokyo. Measurement of these parameters was performed at 0, 6, 12, 18, and 24 months after start of PD. All patients were treated with an angiotensin type 1 receptor blocker to control blood pressure to less than 140/90 mmHg. Other antihypertensive drugs such as diuretics and/or calcium channel blockers were added if blood pressure rose to over 140/90 mmHg. Hemoglobin and hematocrit levels were targeted at 10.0 g/dL and 30.0% respectively with recombinant human erythropoietin treatment. A diuretic was added or patients decreased their water intake if ANP was more than 43.0 pg/mL or LA diameter (LAD) more than 39 mm, and for other basic markers of volume status. Cardiac function was measured before and after drainage of PD fluid to evaluate the influence of cardiac function.♦ ResultsLAD at start of dialysis (36 ± 4.6 mm) decreased significantly to 33 ± 3.3 mm ( p < 0.05), 33 ± 3.2 mm ( p < 0.05), and 33 ± 3.6 mm ( p < 0.05) after 6, 12, and 24 months, respectively. Ejection fraction after 6 months was significantly increased compared with that at start of dialysis ( p < 0.05). Left ventricular mass index (LVMI) after 6, 12, and 24 months was significantly decreased compared with that at start of dialysis ( p < 0.05). ANP was 56 ± 39 pg/mL at start of dialysis and decreased significantly to 33 ± 19 pg/mL after 24 months ( p < 0.05). ANP was significantly correlated with LAD ( r = 0.412, p < 0.01), transmitral A wave flow velocity ( r = 0.429, p < 0.01), and LVMI ( r = 0.426, p < 0.01). Instillation of the dialysis fluid did not affect any parameters except inferior vena cava dimension.♦ ConclusionsThis study demonstrates a reduction in LA size and LVMI in PD patients followed over 24 months. Left ventricular structure, contraction, and compliance were well preserved in PD patients undergoing aggressive treatment based on measurements of plasma ANP and LAD.

scholarly journals The safety of antihypertensive drugs. Retrospective analysis of adverse reactions based on a regional database

2021 ◽  
Vol 27 (2) ◽  
pp. 216-228
Author(s):  
A. V. Matveev ◽  
A. E. Krasheninnikov ◽  
A. V. Ushakov ◽  
E. A. Egorova ◽  
A. G. Dormidor
Keyword(s):  
Calcium Channel ◽  
Retrospective Analysis ◽  
Calcium Channel Blockers ◽  
Adverse Reactions ◽  
Antihypertensive Drugs ◽  
Channel Blockers ◽  
Drug Reactions ◽  
Life Threatening ◽  
Β Blockers ◽  
Design And Methods

Objective. To analyze adverse drug reactions (ADR) occuring in patients taking antihypertensive drugs (AHD).Design and methods. We have analyzed 459 cases of ADR caused by AHD and recorded in the regional database (register) called ARCADe (Adverse Reactions in Crimea, Autonomic Database) during 2011–2018 years.Results. Out of all ADR, 304 cases (3,9 4,4 4,9 % of the total number of cases) were associated with AHD affecting renin-angiotensin-aldosterone system,101 (1,2 1,5 1,8 %) — with calcium channel blockers, and 54 cases (0,6 0,8 1,0 %) — with β-blockers. In the majority of cases, the ADRs were attributed to Enalapril (85 cases) and Amlodipine (76 cases). The analysis of the outcomes showed that serious reactions (life-threatening conditions, hospitalization, and disability) occurred in 72 cases. The remaining 387 ADRs were not considered serious. The majority of reported ADRs were unavoidable reactions of mild severity.

scholarly journals Cost effectiveness analysis of anti-hypertensive drugs used for chronic kidney disease patients

2019 ◽  
Vol 10 (4) ◽  
pp. 2820-2825
Author(s):  
Mohamed Saleem TS ◽  
Sreeja N ◽  
Kiran Karthik J ◽  
Bhanu Sree K
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Antihypertensive Drugs ◽  
Incremental Cost Effectiveness Ratio ◽  
Channel Blockers ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Β Blockers

Cost effectiveness analysis branch of pharmacoeconomics is a technique used to aid in decision making between alternatives. A prospective observational study would be conducted in the nephrology department at O.P, Patients with CKD with hypertension, with or deprived of diabetes are included in the study. Patients with drug-induced renal disease or unknown cause. Pregnant women with chronic kidney disease are excluded from the study. The research was conducted in150 patients in which common are men. The mean age of the research people was found to be 51.2 ±7. 02. .It was observed that calcium channel blockers 127 (84.6%), diuretics 51 (34%), α agonists 33 (22%), β blockers 21 (14%), α blockers 17 (11.3%), α+β blockers 10 (6.6%), Angiotensin receptor blockers 3 (2%) and angiotensin-converting enzyme inhibitors 1 (0.6%) were the numerous antihypertensive drugs given to the study people. Incremental Cost-Effectiveness Ratio was assessed, and it was observed that Rs.31.80 was extra required while using diuretics than Calcium Channel Blockers for achieving respective maintenance value. The major classes of antihypertensive drugs prescribed in all of them are CCB+α agonist was found most effective CCB+ Diuretics were the second most effective. Incremental Cost-Effectiveness Ratio was calculated, and it was found that  Rs.4.40 was Extra needed to attaining essential upkeep of blood pressure. Pharmacoeconomic study shows that Calcium channel blockers were the utmost cost-effective antihypertensive in CKD patients when linked to other antihypertensive drugs. In two-drug combination therapy, CCB+α agonist was found most effective.

scholarly journals A comparative study on the adherence to anti-hypertensive medications in urban and rural areas of Hubballi

2019 ◽  
Vol 6 (4) ◽  
pp. 1701 ◽  
Author(s):  
Pratibha Rao Katapadi ◽  
Dattatreya D. Bant
Keyword(s):  
Blood Pressure ◽  
Rural Areas ◽  
Rural Population ◽  
Antihypertensive Drugs ◽  
Cross Sectional Study ◽  
Uncontrolled Hypertension ◽  
Public Health Issue ◽  
Antihypertensive Medications ◽  
Cross Sectional ◽  
Hypertensive Patients

Background: Hypertension is a significant public health issue worldwide and can have deleterious effects on the health when it is not under control. Adherence to antihypertensive medications is thus necessary for better control of blood pressure and to reduce the risk of complications. There are various factors which support or hinder the patient’s adherence to anti- hypertensive treatment. Thus this study was done to reflect the factors influencing the adherence to antihypertensive drugs among urban and rural population.Methods: A community based cross sectional study was conducted in urban and rural field practice areas of Karnataka Institute of Medical Sciences, Hubballi. A semi-structured questionnaire was used for data collection among the known hypertensive patients. The data was entered in Microsoft Excel and analysed using SPSS software.Results: Most of the hypertensive patients were aged 45 and above (89.5%). A total of 73.5% of the participants were adherent to antihypertensive medications and adherence was more among urban (76%) as compared to rural population (71%). Knowledge regarding complications of uncontrolled hypertension was the major factor for adherence in both the areas. The mean systolic and diastolic blood pressure was controlled in patients who were adherent.Conclusions: There is a higher level of adherence to antihypertensive medications in urban population as compared to rural population of Hubballi. The findings suggest patient factors, clinical factors and socio-demographic factors play an important role in determining the adherence to the medication.

Sex differences in antihypertensive drug use and blood pressure control

2019 ◽  
Vol 95 (1124) ◽  
pp. 295-299
Author(s):  
Junwen Wang ◽  
Weihong Jiang ◽  
Manju Sharma ◽  
Yuyan Wu ◽  
Jiayin Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Sex Differences ◽  
Drug Use ◽  
Antihypertensive Drug ◽  
Antihypertensive Drugs ◽  
Age Groups ◽  
Channel Blockers ◽  
Elderly Age ◽  
Converting Enzyme Inhibitors ◽  
Males And Females

BackgroundHypertension is the most important modifiable cardiovascular risk factor. Epidemiological studies have shown the benefits of lowering blood pressure (BP), but BP control is a major challenge. Furthermore, there are significant sex differences in antihypertensive drug use and BP control. This study examined sex differences in antihypertensive drug use and BP control, with the aim of reducing the complications of hypertension and improving quality of life.MethodsThe study was performed in our outpatient hypertension clinic, and included 1529 patients without secondary hypertension or comorbidities. The study, investigated BP control rates and patterns of antihypertensive drug use in male and female. All data were collected using structured questionnaires and patient measurements.ResultsThe study included 713 males and 816 females in this study. Fewer females had hypertension in the younger age group (16.2% vs 11.6%; p>0.05), but this difference disappeared in middle-aged (47.8% vs 49.9 %; p<0.05) and elderly age groups (36.0% vs 38.5%; p<0.05). BP control rates differed between males and females (35.6% in male, 31.9% in female, p<0.01). There was an overall difference in BP control rates between males and females (35.6% in males, 31.9% in females, p<0.01). In this aged 18–44 years, angiotensin converting enzyme inhibitors (ACEIs) showed the best control rate in males, while calcium channel blockers (CCBs) were least effective (61.5% with ACEIs, 28.6% with CCBs; p<0.05). In this aged 45–64 years, diuretics (DUs) showed the best control rate in females, while CCBs were least effective (47.5% with DUs, 28.3% with CCBs; p<0.05).ConclusionsSex plays an important role in BP control. In those aged 18–44 years, males using ACEIs showed best control rates. In those aged 45–64 years, females using DUs showed best control rates. Our study provides a basis with the selection of antihypertensive drugs according to sex and age.

SCOPE AND NEED OF COMBINATION OF ANTIHYPERTENSIVE DRUGS

INDIAN DRUGS ◽  
2012 ◽  
Vol 49 (05) ◽  
pp. 5-19
Author(s):  
S. R Pattan ◽  
◽  
A. O. Zanwar ◽  
N. B Wabale ◽  
U. B. Shetkar
Keyword(s):  
Blood Pressure ◽  
Ace Inhibitors ◽  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Blood Pressure Reduction ◽  
Pressure Control ◽  
Channel Blockers ◽  
Once Daily ◽  
First Line Therapy ◽  
Dose Combination

The recommendation for first-line therapy for hypertension remains a beta blocker or diuretic given in a low dosage. A target blood pressure of less than 140/90 mm Hg is achieved in about 50 percent of patients treated with monotherapy; two or more agents from different pharmacological classes are often needed to achieve adequate blood pressure control. Single-dose combination antihypertension therapyis an important option that combines efficacy of blood pressure reduction and a low side effect profilewith convenient once-daily dosing to enhance compliance. Combination antihypertensives include combined agents from the following pharmacological classes: diuretics and potassium-sparing diuretics,beta blockers and diuretics, angiotensin-converting enzyme (ACE) inhibitors and diuretics, angiotensin-II antagonists and diuretics and calcium channel blockers and ACE inhibitors.

scholarly journals Utilization patterns of antihypertensive drugs in the management of hypertension among patients with chronic kidney disease at a tertiary hospital

2021 ◽  
Vol 10 (5) ◽  
pp. 466
Author(s):  
Abdulrahman Al-Mirza ◽  
Hamad R. Al-Subhi ◽  
Aly M. Abdelrahman
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antihypertensive Drugs ◽  
Study Cohort ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Hypertensive Patients ◽  
Significant Difference ◽  
Utilization Patterns ◽  
Β Blockers

Background: Objective of the current investigation was to identify the utilization patterns of antihypertensive drugs among hypertensive patients with chronic kidney disease at Sultan Qaboos university hospital.Methods: This is a retrospective study of the utilization patterns of antihypertensive drugs that were prescribed to 181 hypertensive patients with CKD. Patients’ data and drugs’ data were collected from the hospital track care system and analysed.Results: The results show that diuretics were prescribed for 63.53% of the patients followed by β-blockers (61.3%). Drugs were prescribed orally to 90% of the patients. Furosemide was prescribed to 55.8% of patients followed by amlodipine (55.2%). The majority of the patients were on multiple antihypertensive medications (84%). There was no significant difference between drug utilization in patients with albuminuria and those without albuminuria. Among patients with CKD stages two and three, β-blockers were the most common antihypertensive drugs being utilized. Among patients with stage 4 and stage 5, calcium channel blockers and diuretics were the most common antihypertensive drugs being utilized. The prescription of angiotensin II receptor blockers and direct vasodilators showed a significant difference among different stages of CKD.Conclusions: This study showed that diuretics were the most commonly prescribed antihypertensive drugs among the study cohort. The majority of the patients were on multiple antihypertensive medications.

Sign in / Sign up

Export Citation Format

Share Document