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Naturopathic Medicine and the Prevention and Treatment of Cardiovascular Disease
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
In the United States, nearly half of all Americans have elevated blood pressures in the prehypertensive (SBP 120–139 or DBP 80–89) to hypertensive (SBP > 140 or DBP > 90) range. This statistic is alarming considering the deleterious effects of high blood pressure and negative sequela including stroke, CVD, and kidney disease. Although antihypertensive medications are effective in the reduction of blood pressure, adherence is often poor and cost can be high.46 Additionally, side effects are common with antihypertensive medications and include hypokalemia, insomnia, depression, dry mouth, bronchospasm, impotence, and headaches.47 It is therefore suggested that prehypertensive and hypertensive patients pursue complementary therapies including diet and lifestyle modifications, and mind-body medicines, to assist in blood pressure control.46
Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
Since the evidence for the efficacy of antihypertensive treatment for mild hypertension during pregnancy is lacking, safety considerations are paramount for clinicians who elect to prescribe antihypertensive medication in this indication. The following areas have been suggested by Ferrer et al. for further research: (i) a better understanding of current practice, (ii) benefits and harms of commonly-used, unproven therapies to be tested in large collaborative multicenter and population-based studies among women with clearly established mild chronic hypertension, (iii) comparison between pharmacologic therapy begun early in the course of pregnancy with a placebo and commonly used alternative therapies, (iv) better surveillance systems that routinely monitor adverse events, and (v) large trials that compare alternative strategies and use clinically important outcomes to establish appropriate and cost-effective methods for monitoring (13).
Eclampsia and Pre-Eclampsia with Severe Features
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Malik Goonewardene
Follow-up depends on the severity of the disease antenatally and the recovery during the postpartum period. The aims of follow-up are to assess the recovery of target organs and to ascertain whether the antenatal development of hypertension and associated complications were part of a long-term disease process. If the woman is continuing antihypertensive therapy, then the aim of therapy is to maintain the systolic BP between 120–130 mmHg and the diastolic BP between 80–90 mmHg. It could take up to three months for the antihypertensives to be safely tailed off. At the end of three months, if the woman is not normotensive without therapy, then she should be referred to a physician for appropriate investigations and management. Up to approximately 13% could have underlying essential hypertension or chronic renal disease undetected antenatally, and depending on the clinical picture, screening for autoimmune diseases and thrombophilias may be indicated as well.
Statin adherence in patients with high cardiovascular risk: a cross-sectional study
Published in Postgraduate Medicine, 2023
Yusuf Cetin Doganer, Umit Aydogan, Umit Kaplan, Suat Gormel, James Edwin Rohrer, Uygar Cagdas Yuksel
Morisky Green Levine Scale (MGLS): It was developed by Morisky et al. to evaluate drug adherence in 1986, and a validity and reliability study of the Turkish version was conducted by Yilmaz [22,23]. The scale consists of four items that are answered as yes/no. Questions of the scale are ‘1. Do you ever forget to take your antihypertensive medicine? 2. Are you careless at times about taking your medicines? 3. When you feel better, do you sometimes stop taking your medicine? 4. Sometimes if you feel worse when you take the medicine, do you stop taking it?.’ The total score of the scale is calculated as the sum of the scores of the four questions. The total score ranges between 0 and 4. If all questions are answered ‘no,’ drug adherence is considered high, if ‘yes’ is answered for one or two questions, drug adherence is considered medium, if yes to three or four questions, drug adherence is considered low [23].
Soluble ACE2 and angiotensin II levels are modulated in hypertensive COVID-19 patients treated with different antihypertension drugs
Published in Blood Pressure, 2022
Mohamed A. Elrayess, Hadeel T. Zedan, Rand A. Alattar, Hatem Abusriwil, Mahmoud Khatib A. A. Al-Ruweidi, Shamma Almuraikhy, Jabeed Parengal, Bassem Alhariri, Hadi M. Yassine, Ali A. Hssain, Arun Nair, Musaed Al Samawi, Alaaeldin Abdelmajid, Jassim Al Suwaidi, Mohamed Omar Saad, Muna Al-Maslamani, Ali S. Omrani, Huseyin C. Yalcin
A variety of antihypertensive drugs are used in the current clinical practice to control blood pressure in hypertensive patients. The RAS-blocking drugs, including angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB), are primarily used to restore cardiac function and decrease angiotensin II levels. In addition to their role in blocking ACE1 and angiotensin II, these drugs can increase ACE2 expression as well [16–18]. Accordingly, ACEi and ARB were thought to predispose CVD patients to infection [19]. A large multi-centre retrospective study concluded that the use of RAS inhibitors did not increase the risk of death in the hospital [20]. Contrary to this, other classes of antihypertension drugs, such as beta-blockers and calcium channel blockers, may exhibit a protective effect in COVID-19 hypertensive patients [20]. Nevertheless, their impact on circulating ACE2, angiotensin II, and the severity of the disease remains unclear. The purpose of this multicenter cross-sectional study is to compare the severity of the disease, the level of circulating ACE2, and the amount of circulating angiotensin II in COVID-19 hypertensive patients who are treated with ACEi, ARB, BB, and CCB. Also, to determine how these drugs affect the levels of circulating ACE2 and angiotensin II.
Quality of life following renal sympathetic denervation in treatment-resistant hypertensive patients: a two-year follow-up study
Published in Scandinavian Cardiovascular Journal, 2022
Tove Aminda Hanssen, Anna Subbotina, Atena Miroslawska, Marit Dahl Solbu, Terje Kristian Steigen
Efficient treatment of hypertension is challenging because of its paradoxical nature, as quality of life (QOL) is mainly negatively affected by the awareness of a disease with adverse consequences and side effects of treatment, more than by the disease itself [13,14]. Adherence to hypertensive treatments is generally low and difficult to assess and manage [15]. The reported side effects of antihypertensive medication include emotional distress, reduced sexual function, nocturia, insomnia, headache, tiredness, and depression [16]. Poorer QOL is reported in patients with TRH compared to non-hypertensive patients, patients with controlled hypertension [17], and normal reference populations [18]. A review article from 2015 concluded that there is substantial evidence that TRH is associated with poorer QOL [14]. However, more research is needed on the factors explaining this association. Moreover, investigations assessing the effects of more aggressive treatment strategies, such as RDN, on health related QOL, are scarce.