Contemporary antihypertensive therapy (original) (raw)
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Current Treatment of Patients with Hypertension
Drugs, 2003
Epidemiological studies have shown that both vascular events, especially among elderly patients systolic and diastolic blood pressure values are di-with isolated systolic hypertension [8,9] or systo-diasrectly and linearly related to the risk of cardio-tolic hypertension. [10] (although in reference 9 and vascular events, and that this relationship is still 10 randomisation was performed according to an detectable for blood pressure values within the nor-alternative scheme). Moreover, a recent overview of mal range. Although blood pressure values are placebo-controlled trials with calcium channel antstrong determinants of the risk of cardiovascular agonists has concluded that, although there is no events, the presence of end-organ damage as well as clear evidence of reductions in coronary artery disthe association with other cardiovascular risk factors ease or heart failure, the estimates of treatment further increases the risk of cardiovascular effects do not exclude the existence of a beneficial events. Therefore, when planning treatment for effect on these major cardiac outcomes and largely patients with hypertension, current guidelines em-preclude the occurrence of adverse effects (includphasise the relevance of risk stratification, based on ing cancer or uncontrolled bleeding). [6,11] However, blood pressure values, the presence of end-organ it is still controversial whether different treatment damage or other cardiovascular risk factors. regimens based on different drug classes can offer additional advantages, beyond a similar degree of Controlled clinical trials have shown the benefit blood pressure control, in the prevention of cardioof blood pressure reduction, which is detectable in vascular morbidity and mortality. young, middle aged and elderly patients, both male and female, with severe, moderate and mild hyper-
Hypertension : a review of antihypertensive medication
2020
This article provides an overview of the changes that have taken place in the diagnosis and management of hypertension over the past decade. Hypertension remains a very common condition seen in South Africa. The approach to the management of hypertension includes necessary lifestyle modifications and a decisive, stepwise escalation process in the pharmacotherapeutic management thereof. Thiazide diuretics are still being promoted by most guidelines to be the initial (first-line) drug of choice, with the addition of other suitable antihypertensive agents, if necessary, and according to any relevant comorbid conditions.
2012
Hypertension, known as a "silent killer" is widely prevalent and a major risk factor for cardiovascular diseases. It afflicts more than one billion population worldwide and is a leading cause of morbidity and mortality. The authors of the chapters look from different angles to hypertension, sharing their new knowledge and experience in the direction of deep understanding and more clarification of the disease providing an invaluable resource not only for clinicians, but also for all medical sciences students and health providers.
one month and then comparing the sum with total monthly prescription drug expenditure approved by the CIHI. The type and dosage of prescribed antihypertensive drugs were also analyzed. Hypertension was diagnosed in 2,342 (26.4%) patients. The monthly costs of prescribed antihypertensive drugs accounted for 52.33% of the total amount approved for medications by the CIHI. 945 (40.0%) hypertensive patients were taking antihypertensive monotherapy. The most frequently prescribed drugs as monotherapy were ACE inhibitors (38.3%), calcium-channel blockers (26.7%), b blockers (18.6%), and diuretics (10.3%). a antagonists (3.6%). Angiotensin receptor blockers (2.5%) were rarely prescribed. As combination therapy, ACE inhibitors and diuretics (30.4%) were most frequently used. More than 50% of the funds allocated to GPs for medications were spent for the treatment of only one disease. The most used antihypertensive drugs were ACE inhibitors.
Update of Diuretics in the Treatment of Hypertension
American Journal of Therapeutics, 2007
Diuretics, which are primarily used to modify the volume and the composition of body fluids, are widely used to treat hypertension. The diuretics include a) the thiazides and thiazide-like agents, which are the most common drugs used to treat high blood pressure (these drugs inhibit sodium reabsorption in the early distal convoluted tubule); b) loop diuretics, such as furosemide, block chloride and sodium reabsorption by inhibition of the Na + /K + /2Cl 2 cotransport system in the thick ascending limb of the loop of Henle; and c) potassium-sparing (retaining) diuretics, including aldosterone receptor blockers (such as spironolactone and eplerenone) and epithelial sodium channel blockers (such as amiloride and triamterene, which interfere with the reabsorption of sodium and excretion of potassium and hydrogen that takes place in the late distal tubule, the connecting tubule, and the cortical collecting duct). Hydrochlorothiazide 12.5 mg once daily or equivalent low dosages of other similar agents reduce blood pressure in approximately one-half to two-thirds of patients who are responsive to this class of drugs; higher doses add little to the effect on blood pressure and also increase side effects. Some combinations of very small doses of thiazide diuretics-for example, 6.25 mg hydrochlorothiazide or 0.625 mg indapamide, with a low dose of an antihypertensive drug of a different class-have average antihypertensive efficacy when used once daily. Furosemide is used in patients with renal failure or severe heart failure and is best given by continuous intravenous infusion. The potassium-sparing diuretics are generally used in combination with thiazide diuretics to treat hypertension.Side effects occur at about the same frequency and severity with equipotent doses of all diuretics. The incidence of side effects is dose-dependent and also increases as a function of the duration of the renal excretory and antihypertensive actions. However, longer-acting diuretics provide better 24-hour control of blood pressure and increase compliance and adherence to the treatment regimen.
Drugs in the management of hypertension. Part III
American Heart Journal, 1976
The vasodilator drugs act directly on vascular smooth muscle to produce vasodilatation and reduction in peripheral resistance. They include hydralazine, diazoxide, minoxidil, guancydine, and sodium nitroprusside. With the exception of sodium nitroprusside, these drugs have a selective effect on arterioles with little if any effect on venous capacitance vessels. This selective dilatation of arterioles results in an increase in venous return, which triggers a reflex increase in heart rate and stroke volume mediated through the sympathetic nervous system. As a result they share several common side effects due to increased cardiac action. These include palpitation, headache, and the capacity to precipitate angina pectoris in patients with coronary disease. In addition, drugs in this group share an ability to stimulate renin release and promote sodium retention. Increased cardiac output and sodium retention both act to reduce the hypotensive effects of vasodilatation. In most circumstances, drugs in this group should be use d together with propranolol and diuretics which counteract these effects, enhance the effectiveness of vasodilatation, and minimize side effects. Of the vasodilators, only hydralazine is available for oral use in the United States at present. Minoxidil and guancydine have given promising results in clinical trials. Diazoxide and sodium nitroprusside are available only for intravenous use, although diazoxide has been shown to be effective given orally, s:~
Current issues on the management of hypertension
1996
Hypertension is one of the most prevalent vascular diseases in the general population and is a major contributor to cardiovascular mortality and morbidity. Recent clinical trials have confirmed the benefits of treatment of hypertension to prevent stroke, congestive heart failure, and left ventricular hypertrophy. Despite the availability of many newer agent, blood pressure continues to be inadequately controlled in the majority of the hypertensive patients. There is still a lot of controversy in some of the issues in the management of hypertension. The present article summarizes some of the recent studies and published guidelines in the management of hypertension and provides some insight to these questions. Although the answers to some of these questions are still unclear, ongoing large scale studies should soon provide additional answers to these questions.
Journal of Nursing Ufpe Online, 2015
Objective: to analyze pharmacotherapy treatment with hypertensive group. Method: study of action research, carried out from March 2012 to November 2013 in a Family Health Center in Sobral-CE, with a group of hypertensive patients. For data collection, an interview, the Moriski-Green test and educational activities, and the data analyzed by thematic categorization were conducted. The research project was approved by the Ethics Committee in Research, CAAE 11156213.6.0000.5053. Results: the results show that hypertensive patients have low degree of adherence to medication treatment, and the forgetfulness and carelessness of the time are the main factors associated with inadequate adherence to medicine therapy. Conclusion: the results showed the need to develop health promotion actions for hypertensive become aware of the importance of properly adhere to treatment regimens. Descriptors: Hypertension; Pharmacotherapy; Health Promotion; Patient Cooperation. RESUMO Objetivo: analisar a adesão ao tratamento farmacoterápico mediante ação com grupo de hipertensos. Método: estudo de pesquisa-ação, desenvolvido no período de março de 2012 a novembro de 2013 em um Centro de Saúde da Família de Sobral-CE, com um grupo de hipertensos. Para coleta de dados, foi realizada entrevista, o teste de Moriski-Green e de ações educativas, sendo os dados analisados por de categorização temática. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, CAAE nº 11156213.6.0000.5053. Resultados: os resultados demonstram que os hipertensos apresentam baixo grau de adesão ao tratamento medicamentoso, sendo o esquecimento e o descuido quanto ao horário os principais fatores associados a não adesão adequada ao tratamento medicamentoso. Conclusão: os resultados mostraram a necessidade de desenvolver ações de promoção em saúde para que os hipertensos se conscientizem da importância de aderir adequadamente aos regimes terapêuticos. Descritores: Hipertensão; Farmacoterapia; Promoção em Saúde; Cooperação do Paciente. RESUMEN Objetivo: analizar la adhesión al tratamiento farmacológico mediante acción con grupo de hipertensos. Método: estudio de investigación-acción, desarrollado en el período de marzo de 2012 a noviembre de 2012 en un Centro de Salud de la Familia de Sobral-CE, con un grupo de hipertensos. Para recolección de datos, fue realizada entrevista, el test de Moriski-Green y de acciones educativas, siendo los datos analizados por de categorización temática. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAAE nº 11156213.6.0000.5053. Resultados: los resultados demuestran que los hipertensos presentan bajo grado de adhesión al tratamiento medicamentoso, siendo el olvido y el descuido del horario son los principales factores asociados a no adhesión adecuada al tratamiento medicamentoso. Conclusión: los resultados mostraron la necesidad de desarrollar acciones de promoción en salud para que los hipertensos tomen conciencia de la importancia de adherir adecuadamente a los regímenes terapéuticos. Descriptores: Hipertensión; Fármaco-terapia; Promoción en Salud; Cooperación del Paciente.