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Hypertension
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Measurement of left ventricular hypertrophy has been useful and is incorporated in recent ongoing trials. Measurement of carotid or aortic augmentation from the arterial pressure pulse waveform has been related to adverse cardiovascular function, to left ventricular hypertrophy and to morbidity and mortality (London et al., 2001; Safar et al., 2002a). Hashimoto et al. (2007a, 2008a) have shown that indices determined from the pulse waveform can better predict reduction in LV mass with antihypertensive therapy than brachial artery cuff measurements in the clinic or at home. Williams et al. have shown that beneficial effects of amlodipine over atenolol in the ASCOT trial (Dahlof et al., 2005) are explicable on the basis of greater reduction in aortic systolic and pulse pressure (Williams et al., 2006). Roman et al. (2007, 2009) have shown that central aortic blood pressure predicts better outcomes than brachial pressure in the Strong Heart study. These and other studies are considered in Chapter 17. It is prudent to note that some drug classes including protease inhibitors (Schillaci et al., 2005), and nonsteroidal inflammatory agents (Barnes et al., 2012) may have an adverse effect on aortic stiffness and wave reflection in older subjects. Such may explain cardiovascular ill effects of “coxibs”, which resulted in withdrawal of Vioxx from the market in 2004.
Coronary Artery Disease
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Calcium channel blockers are used for persistent symptoms after nitrates are used, or if they cannot be tolerated. These blockers are best used if there is concurrent coronary spasm or hypertension. The dihydropyridines, including amlodipine, felodipine, and nifedipine do not have chronotropic effects, but have widely different negative inotropic effects. The shorter-acting dihydropyridines can cause reflex tachycardia. They are linked to more deaths of patients with CAD, and are not used alone to treat stable angina.
Case 6
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
One year later, Mrs Leigh has her blood pressure rechecked by the GP. She is happy with the amlodipine and does not think that she has had any side effects from it, but her clinic blood pressure is still 150/92 mmHg. Mrs Leigh asks the GP if she will need to start taking more tablets.
The effect of medical ozone therapy in addition to ovarian detorsion in ischemia reperfusion model
Published in Journal of Obstetrics and Gynaecology, 2022
Sema Süzen Çaypınar, Sema Karakaş, Cihan Kaya, Damlanur Sakız, Salim Sezer, Murat Ekin
In an experimental ovarian I/R model, Oral et al. studied the effect of montelukast, a leukotriene receptor antagonist. They evaluated ovarian tissue concentrations of superoxide dismutase (SOD), glutathione (GSH), lipid peroxidation (LPO), and myeloperoxidase (MPO) activity with the histopathological examination (Oral et al. 2011). They concluded that montelukast at different doses could protect ovarian tissue injury by improving antioxidant enzyme levels. In another experimental study, Halici et al. evaluated the effect of amlodipine with doses varying 3 mg/kg and 5 mg/kg. They observed less ovarian tissue damage in different dose regimens compared to controls (Halici et al. 2008). Likewise, Arikan et al. created an experimental ovarian I/R model and measured tissue malondialdehyde (MDA) levels. They concluded that tadalafil, a selective PDE-5 inhibitor, could effectively prevent tissue damage induced by I/R (Arikan et al. 2010). Kumtepe et al. investigated an angiotensin 2 type 1 receptor blocker telmisartan in the protective effect on ovarian I/R damage. They reported that telmisartan at 10 mg/kg and 20 mg/kg doses could reduce free oxygen radicals, iNOS activity, and MPO level (Kumtepe et al. 2010). Although there are mounting studies regarding preventive approaches for ovarian I/R injury, there is still no clinical evidence of any medications that could reduce I/R damage after conservative ovarian surgery.
Ingestion-time differences in the pharmacodynamics of dual-combination hypertension therapies: Systematic review and meta-analysis of published human trials
Published in Chronobiology International, 2022
Ramón G. Hermida-Ayala, Artemio Mojón, José R. Fernández, Michael H. Smolensky, Ramón C. Hermida
Meng et al. (2010) researched the ingestion-time differences in effects of the fosinopril/amlodipine (ACEI/CCB) dual-combination in a trial of 40 hypertensive patients (22 men/18 women, 52.7 ± 11.1 years of age) whose BP remained uncontrolled when either one of the medications was ingested as a monotherapy in the morning. Patients were randomized into two groups for 4 weeks of therapy; those of Group-A routinely ingested 5 mg amlodipine in the morning (07:00–08:00 h) and 10 mg fosinopril at bedtime, and those of Group-B consistently ingested the two medications together in the morning. The nighttime SBP/DBP means of the Group-A patients were reduced by a substantially, almost 3-fold, greater amount than those of the Group-B patients (−22.4/-17.4 vs. −7.6/-6.3 mmHg; P < .001). Additionally, normalization of the 24 h BP dipper patterning was highly successful in Group-A, but not in Group-B, patients, i.e., the sleep-time relative SBP decline was increased by 5.7% (P < .001) in Group-A towards the more normal dipper 24 h SBP profile, but actually decreased by a similar 5.7% amount (P < .001) in Group-B participants towards the more abnormal non-dipper 24 h SBP profile.
An anchored simulated treatment comparison of uptitration of amlodipine compared with a low-dose combination treatment with amlodipine 5 mg/bisoprolol 5 mg for patients with hypertension suboptimally controlled by amlodipine 5 mg monotherapy
Published in Current Medical Research and Opinion, 2022
Caroline Foch, Jan Feifel, Ulrike Gottwald-Hostalek
Briefly (see the online Supplementary material for more details), NCT00558428 was a multicenter, multinational, 8-week randomized, double-blind, parallel-arm study that evaluated the efficacy and safety of telmisartan 40 mg/amlodipine 5 mg, telmisartan 80 mg/amlodipine 5 mg, amlodipine 10 mg, and amlodipine 5 mg, in adult patients with hypertension uncontrolled on amlodipine 5 mg monotherapy. All patients underwent a 6-week run-in treatment with amlodipine 5 mg. Patients who failed to respond adequately to treatment with amlodipine monotherapy (DBP <90 mm Hg) were randomized (1:1:1:1) to one of the four treatment arms6. Baseline characteristics of patients in the amlodipine 10 mg arm are shown in Table 1, and of patients in the amlodipine 5 mg arm in Supplementary material.