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Diagnosis, Management, and Treatment of Systemic Hypertension in Youth, Updates from the 2017 American Academy of Pediatrics Clinical Practice Guideline
Published in James M. Rippe, Lifestyle Medicine, 2019
Carissa M. Baker-Smith, Samuel Gidding
Ideally, once one antihypertensive agent is started at a low dose, the best option is to increase the dose and then, if needed, add another agent after the dose of the first agent has been maximized. Lifestyle intervention is reinforced regardless. And even though his BP is improved, he should continue his antihypertensive medication.
Cardiovascular drug therapy in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
William H. Frishman, Wilbert S. Aronow, Angela Cheng-Lai
ACE inhibitors are effective antihypertensive agents. A meta-analysis of 109 treatment studies showed that ACE inhibitors are more effective than other antihypertensive drugs in decreasing LV mass (89). Older hypertensive patients with HF associated with reduced (49–51) or normal (54) LV ejection fraction, LV hypertrophy, or diabetes mellitus should initially be treated with an ACE inhibitor. ACE inhibitors decrease mortality in patients with HF associated with reduced LV ejection fraction (49–51). The Survival and Ventricular Enlargement (SAVE) trial (90) and the combined Studies of Left Ventricular Dysfunction (SOLVD) treatment and prevention trials (91) also demonstrated that ACE inhibitors such as captopril or enalapril should be standard therapy for most patients with significant LV systolic dysfunction with or without symptomatic HF. In addition, ACE inhibitor therapy has been shown to be beneficial in the treatment of elderly patients (mean age 80 years) with HF caused by prior MI associated with normal LV ejection fraction (54). High-dose ACE inhibitor therapy remains the standard of care in the management of HF with reduced ejection fraction. Low-dose ACE inhibitor therapy has been studied in HF with reduced ejection fraction, but with less favorable results. For example, a trial compared low (2.5–5.0 mg/day) with high-dose lisinopril (32.5–35.0 mg/day), with the latter being associated with a more significant reduction in mortality and all-cause hospitalization rate (92).
Diabetic nephropathy
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Elisabeth R. Mathiesen, Lene Ringholm, Peter Damm
Whether treatment with ACE inhibitors or angiotensin II receptor antagonists in early pregnancy is associated with increased risk of congenital malformations is currently being debated.39,55–57 However, treatment with ACE inhibitors during the last part of pregnancy is associated with abnormal fetal renal development and neonatal renal failure.55,58 Treatment with ACE inhibitors or angiotensin II receptor antagonists should therefore ideally be stopped prior to conception,55,58 but if these drugs are given during organogenesis, interruption of pregnancy is not indicated on this background.56 If the severity of diabetic nephropathy indicates continuous treatment with inhibitors of the renin–angiotensin system, in the case of unplanned pregnancy, a shift to other antihypertensive agents can successfully take place in early pregnancy when the pregnancy test is positive.5 Types of antihypertensive agents that are considered safe in pregnancy are methyldopa, beta-blockers (such as labetalol), and the calcium antagonists nifedipine and diltiazem.4 Although the use of diuretics throughout pregnancy is controversial,59 we have good clinical experience with continuation of diuretic treatment initiated before pregnancy in stable doses during pregnancy in women with diabetic nephropathy.4,60
Factors influencing blood pressure variability in postmenopausal women: evidence from the China Health and Nutrition Survey
Published in Clinical and Experimental Hypertension, 2023
Zhonge Tao, Quanxin Qu, Jing Li, Xiaolin Li
It is well-known that systemic HTN is an important indication for use of antihypertensive drugs (37). In our study, antihypertensive agents were confirmed to be a predominant predictor for SBP and DBP changes in postmenopausal women. There are studies suggesting that antihypertensive agents can effectively control the blood pressure in most patients when complemented by lifestyle modifications (38,39). The guidelines also propose that the initial antihypertensive drug should be given at the lowest dose and then increased gradually to the maximum tolerated dose according to blood pressure responses (23). Additionally, unmarried/divorced status was also found to be linked with a higher risk of blood pressure variability in postmenopausal women. Many cross-sectional studies have revealed an independent association between marital status and HTN (40–42). Compared with their married counterparts, never married/divorced women had an increased risk of developing HTN (43). The mechanisms underlying the effect of marital status on HTN may be partially explained by psychopathological factors, health behaviors (diet, physical activity, and adherence), biological mediators, neuroendocrine, and immune pathways (22,44).
Assessment of the genotoxic effects of antihypertensive drug active ingredient indapamide in human lymphocytes
Published in Drug and Chemical Toxicology, 2023
Ece Avuloglu-Yilmaz, Deniz Yuzbasioglu, Fatma Unal
Antihypertensive agents have been prescribed to the majority of hypertensive patients and used for a long time. However, there is no study investigating the potential genetic effect of indapamide, one of the antihypertensive drugs, in human lymphocytes. Concentrations of indapamide used in this study did not cause any statistically significant increase in CA and MN frequencies. In the SCE test, while indapamide did not affect the frequency during the 24-hour treatment, it induced a significant increase in the two highest concentrations at the 48-hour treatment. Indapamide significantly decreased the MI at almost all the concentrations applied (except 18.75 µg/ml, 48 h) (Avuloglu-Yilmaz et al. 2016). In the comet assay, an increase in DNA damage was found to be significant only at the highest concentrations. Based on our findings, it can be stated that indapamide may not have a significant genotoxic effect in vitro human lymphocytes at the concentrations and treatment periods used.
New and developing pharmacotherapies for hypertension
Published in Expert Review of Cardiovascular Therapy, 2022
Christian Höcht, Miguel A Allo, Ariel Héctor Polizio, Marcela A Morettón, Andrea Carranza, Diego A Chiappetta, Marcelo Roberto Choi
Several antihypertensive agents with novel mechanisms of action are under development for the management of arterial hypertension, mainly for patients with difficult-to-control and resistant hypertension. Considering that several comparative clinical trials have demonstrated the superiority of sacubitril/valsartan over ARBs in BP reduction and target organ damage, this drug gained approval for the management of hypertension in several countries. On the other hand, SGLT2 inhibitors and nonsteroidal MRA emerge as a therapeutic option for BP control in patients with type 2 diabetes or CKD, respectively. To date, phase 3 clinical trials are ongoing to establish the efficacy and safety of firibastat and aprocitentan in patients with difficult-to-control or resistant hypertension. Advances in the knowledge of the role of gut dysbiosis in the development and maintenance of hypertension will allow in the next future the expansion of non-pharmacological strategies with the introduction of prebiotics and probiotics. Finally, the control of BP can also be improved by the design of NDDSs able to increase drug bioavailability and to sustain antihypertensive drug levels allowing a stable antihypertensive response.