Antihypertensive Drugs. William B. Abrams, M.D., F.G.C.P.·. The current treatment of essential hypertension is based on the following concepts: (1) a single. The article analyzes the prescribed antihypertensive drugs classes and their combination between the amount of antihypertensive drugs. Hypertension, Antihypertensive Drugs and Atherosclerosis. By WILLIAM HOLLANDER, M.D.. HYPERTENSION is one of the major precursors of atherosclerotic.
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been made to initiate antihypertensive treatment, choice of medicine should be based on . antihypertensive drugs may be required to achieve adequate blood . Antihypertensive drugs are frequently used by pa- tients and may influence conduct of anaesthesia. • Relatively few drug classes are used to. Choices of antihypertensive drugs and goals of therapy. The ultimate goal of . from: musicmarkup.info 6. Dahlof B.
Adverse effects of this class of drugs include sedation, drying of the nasal mucosa and rebound hypertension. Endothelium receptor blockers[ edit ] Bosentan belongs to a new class of drug and works by blocking endothelin receptors. It is specifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe heart failure. Choice of initial medication[ edit ] For mild blood pressure elevation, consensus guidelines call for medically supervised lifestyle changes and observation before recommending initiation of drug therapy. However, according to the American Hypertension Association, evidence of sustained damage to the body may be present even prior to observed elevation of blood pressure. Therefore, the use of hypertensive medications may be started in individuals with apparent normal blood pressures but who show evidence of hypertension-related nephropathy, proteinuria, atherosclerotic vascular disease, as well as other evidence of hypertension-related organ damage. If lifestyle changes are ineffective, then drug therapy is initiated, often requiring more than one agent to effectively lower hypertension.
Pharmacologic Treatment In the general nonblack population, including those with diabetes, initial anti-hypertensive treatment should include a thiazide diuretic, calcium channel blocker, angiotensin-converting enzyme ACE inhibitor, or angiotensin receptor blocker ARB.
In the general black population, including those with diabetes, initial treatment should include a thiazide diuretic or calcium channel blocker. If the target blood pressure is not reached within one month after initiating therapy, the dosage of the initial medication should be increased or a second medication should be added thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB; do not combine an ACE inhibitor with an ARB.
Blood pressure should be monitored and the treatment regimen adjusted until the target blood pressure is reached.
A third drug should be added if necessary; however, if the target blood pressure cannot be achieved using only the drug classes listed above, antihypertensive drugs from other classes can be used e.
Referral to a physician with expertise in treating hypertension may be necessary for patients who do not reach the target blood pressure using these strategies.
Adults with CKD and hypertension should receive an ACE inhibitor or ARB as initial or add-on therapy, based on moderate evidence that these medications improve kidney-related outcomes in these patients. In brief, the present cohort consisted of all Ontario residents 66 years of age or older who received a new prescription for an antihypertensive agent between July 1, , and March 31, , and did not have diabetes mellitus or another condition for which an antihypertensive drug may be prescribed for a nonblood pressure-lowering indication such as coronary disease, heart failure or renal dysfunction.
All patients were followed for two years after their initial antihypertensive prescription to determine antihypertensive polytherapy.
Each prescription was assumed to last days, and polytherapy was defined as the addition of another antihypertensive drug class within days from the date of the last prescription for the initial antihypertensive drug class prescribed.
Combination agents that consisted of drugs from two different subclasses were separated and counted as one prescription in each respective subclass when assessing polytherapy.
Annual proportions of patients treated with polytherapy were calculated and compared between years.
For the purposes of the present report, the focus was on five major antihypertensive drug classes: thiazide and thiazide-like diuretics hereafter referred to as diuretics , beta-blockers, ACE inhibitors, calcium channel blockers and angiotensin receptor blockers. These include: diuretics with beta-blockers, ACE inhibitors or angiotensin receptor blockers; beta-blockers with calcium channel blockers; and calcium channel blockers with ACE inhibitors or angiotensin receptor blockers.
These include: diuretics with calcium channel blockers; beta-blockers with ACE inhibitors or angiotensin receptor blockers; and ACE inhibitors with angiotensin receptor blockers.
RESULTS The cohort consisted of , newly treated elderly hypertensive patients who did not have diabetes or other comorbidities such as heart failure or coronary disease that would mandate treatment with a particular antihypertensive drug class.
There were no statistical differences observed for the other critical outcomes addressed: persistent high blood pressure RR 0. Nitrates versus magnesium sulfate A small trial 36 women comparing isosorbide with magnesium sulfate reported no case of eclampsia in association with either drug and showed no statistically significant differences between them for the proxy outcome of persistent high blood pressure RR 0.
Nimodipine versus magnesium sulfate Compared with magnesium sulfate, nimodipine was statistically significantly more likely to be associated with eclampsia two trials, women; RR 2. No statistical differences were observed for any other critical or proxy outcomes addressed: coagulopathy one trial, women; RR 1. The quality of evidence for these outcomes ranges between very-low- to low quality, mainly because the principal study women was at high risk of bias EB Table Nifedipine versus chlorpromazine One small trial 60 women comparing nifedipine with chlorpromazine showed no statistically significant differences for the critical and proxy outcomes addressed: eclampsia 55 women; RR 2.
Nifedipine versus prasozin One trial women comparing nifedipine with prasozin showed no statistically significant differences for any of the critical or proxy outcomes addressed: HELLP syndrome one trial, women; RR 1.
No case of eclampsia was recorded in either arms of the trial. This trial had moderate risk of bias, few events in addition to its small sample size and thus yielded generally very-low-quality evidence for the critical and proxy outcomes EB Table Nitroglycerine versus nifedipine One small trial 32 women compared nitroglycerine administered as an infusion with sublingual nifedipine.
No case of maternal or perinatal death was recorded in the trial. Although this trial had little or no risk of bias, the very small sample size and few events resulted in generally low-quality evidence for the reported critical outcomes EB Table In summary, the analysis of the evidence related to the multiple comparisons of antihypertensive drugs for very high hypertension during pregnancy is complicated by its low quality which is due primarily to the small samples used in the trials, rare events as outcomes and variations in the administered drug regimens.
Hydralazine is the most studied drug, though in the comparison with calcium channel blockers nifedipine and isradipine the latter have been associated with a greater reduction in the risk of persistent high blood pressure. Diuretics for preventing pre-eclampsia Evidence related to the effects of diuretics on the prevention of pre-eclampsia came from a Cochrane systematic review of five RCTs involving women in the USA.
Two trials women recruited only women with normal blood pressure, one trial 20 women recruited only those with chronic hypertension while the other two trials women did not report on blood pressure status at trial entry. In all trials thiazide diuretics were compared with placebo or no treatment. When diuretics were compared with placebo or no treatment, there were no statistically significant differences in the critical or proxy outcomes: new or worsening hypertension two trials, women; RR 0.
There was no case of eclampsia in both the intervention and control arms of one trial that reported it as an outcome measure. All the trials providing this evidence had moderate risk of bias, relatively small sample sizes and sparse events resulting in generally low overall quality of evidence for the critical outcomes EB Table The adaptation and implementation processes may include the development or revision of existing national guidelines or protocols based on this recommendation.
The recommendation should be adapted into a locally appropriate document that can meet the specific needs of each country and health service.
Any changes should be made in an explicit and transparent manner. A set of interventions should be established to ensure that an enabling environment is created for the use of the recommendations including, for example, the availability of low-dose aspirin in antenatal care settings , and that the behaviour of the healthcare practitioner changes towards the use of this evidence-based practice.
In this process, the role of local professional societies is important and an all-inclusive and participatory process should be encouraged.