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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Angiotensin-converting enzyme (ACE) inhibitors are a class of drugs used to treat hypertension (see Table 3.4). The ACE inhibitor group should be considered contraindicated for use during pregnancy because of the risks discussed later (Shotan et al., 1994). Risks associated with ACE inhibitors are second and third trimester events. First trimester exposures do not seem to present a significant risk for congenital anomalies, but this is an unknown area. The risk of severe birth defects was significantly increased (OR = 1.63) among 30 infants whose mothers used ACE-inhibitors in the Swedish Birth Defects Registry (Kallen, 2019).
Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Patients with SBP consistently ≥160 mmHg and/or DBP ≥110 (severe HTN) should be placed on antihypertensive medication; this includes those women with pre-eclampsia or its complications (HELLP, etc.). As stated earlier in this chapter, it is appropriate to initiate therapy at lower blood pressures in patients with evidence of end-organ damage (renal, cardiovascular, etc.) and diabetes. Target BP should be 140–150 mmHg systolic and about 90 mmHg diastolic. ACE inhibitors are contraindicated in pregnancy. Any patient requiring antihypertensive agents may be placed on home BP monitoring if managed as an outpatient. There are no trials on this intervention in pre-eclampsia.
Herbal Food Product Development and Characteristics
Published in Anil K. Sharma, Raj K. Keservani, Surya Prakash Gautam, Herbal Product Development, 2020
Medicinal herbs are reported to have hypotensive/antihypertensive potential. These herbs may help in regulation of blood pressure by stimulating the physiological systems in humans. The antioxidant properties of herbs are due to the presence of some vitamins, terpenoids, carotenoids, flavonoids, and phytoestrogens. Herbs and spices containing antioxidants are thyme, basil, saffron, cinnamon, clove, ginger, mint, oregano, dill, rosemary, and sage. Garlic, celery, tea, lavender, murungai, basil, kudzu, ginger, radish, ajwain, rauwolfia, and sesame are few examples of herbs having hypotensive properties. The antioxidant activity of herbs and spices is most often due to phenolic acids (gallic, protocatechuic, caffeic and rosmarinic acids, rosmanol, and rosmadial), flavonoids (quercetin, catechin, naringenin, kaempferol, epicatechin), phenolic diterpenes (carnosol, carnosic acid gallate, epigallocatechin gallate, and rutin), volatile oils (eugenol, carvacrol, thymol, menthol, safrole, 1,8-cineole, p-cymene, cinnamaldehyde, α-terpineol, myristicin, and piperine), and phenylpropanoids (thymol, eugenol, carvacrol, p-cymene) (Frankel, 2012). Angiotensin converting enzyme (ACE) inhibitors present in herbs may inhibit ACE (component of the blood pressure-regulating renin− angiotensin system) and thus lowering the blood pressure.
Understanding the role of chronopharmacology for drug optimization: what do we know?
Published in Expert Review of Clinical Pharmacology, 2023
Akio Fujimura, Kentaro Ushijima
Angiotensin-converting enzyme (ACE) inhibitors have characteristic adverse effects, including troublesome dry cough, which is mediated via the action of bradykinin and a common reason for cessation of treatment with these agents. In one study, enalapril, an ACE inhibitor, was administered orally to 12 hypertensive patients at 10:00 or 22:00 in a crossover manner, and dry cough was detected in two patients after dosing at 10:00 but not after dosing at 22:00 [67]. Considering that the plasma bradykinin concentration was elevated only in patients in that study who complained of dry cough, it was anticipated that a change in dosing time from morning to evening would ameliorate dry cough in patients on ACE inhibitor therapy. Subsequent study supported the idea [68]. Twenty-one patients with hypertension and three patients with congestive heart failure were participated in this study. They received enalapril (an ACE inhibitor) once daily in the morning and complained of dry cough. After changing a dosing-time from morning to evening, the frequency of dry cough was changed as follows: disappeared − 4 patients, ameliorated − 16 patients, unchanged − 4 patients, elevated – non). The rate of continuation of ACE inhibitor therapy is relatively low at 45% after 6 months of treatment [69] and might be improved by application of chronotherapy.
Benefit and risk evaluation of quinapril hydrochloride
Published in Expert Opinion on Drug Safety, 2023
Maryam Barkhordarian, Jannel A. Lawrence, Sebahat Ulusan, Muhammed Ibrahim Erbay, Wilbert S. Aronow, Rahul Gupta
Quinapril is contraindicated in patients with hyperkalemia, bilateral renal artery stenosis, acute kidney injury, hypovolemia, and aortic valve stenosis [2]. In addition, in pregnancy, quinapril is contraindicated since it can lead to fetal lung hypoplasia, fetal renal hypoplasia or failure, and death [2,53]. A study on pregnancy outcomes after in-utero exposure to ACE inhibitors and ARBs shows that using these drugs in clinically recommended doses for humans in the first trimester of pregnancy does not represent a major teratogenic risk [54]. However, increased fetal and neonatal mortality was observed when quinapril was used in the second and third trimesters of pregnancy [50]. In addition, the use of quinapril in infants and children with congenital heart disease shows that quinapril was well tolerated, and the only side effect of the drug was an episode of tachycardia [55].
Angiotensin converting enzyme inhibitor potentiates the hypoglycaemic effect of NG-nitro-L-arginine methyl ester (L-NAME) in rats
Published in Archives of Physiology and Biochemistry, 2022
Esther Oluwasola Aluko, Victor Udo Nna, Adesoji Adedipe Fasanmade
The present study observed a significant increase in blood pressure in L-NAME treated rats at the eighth week and at the end of the study, consistent with documented data (Nyadjeu et al.2013, Salami et al.2017). The effect of L-NAME on blood pressure increases with time, as this study observed that the blood pressure recorded at the end of the study was significantly higher than that recorded at the eighth week. L-NAME has been reported to have dose and time dependent effect on blood pressure (Arnal et al. 1992, Rodriguez-Gomez et al. 2003). Ramipril effectively restored the blood pressure of the hypertensive group towards normal, despite being co-administered with L-NAME. ACE inhibitor has been demonstrated to assuage L-NAME hypertension (Linz et al. 1995, Herman and Bhimji 2017). ACE catalyses the conversion of angiotensin I to angiotensin II and has also been reported to cause the deactivation of kallikrein–kinin system which is known to stimulate the production of NO (Mombouli and Vanhoutte 1995), and prostaglandin release (Mombouli et al. 1992). Thus, ACE inhibitor augments NO production besides it inhibitory effect on angiotensin II production, and these consequently decrease blood pressure.