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The Treatment of Hypertension with Nutrition, Nutritional Supplements, Lifestyle and Pharmacologic Therapies
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Nutrition, nutraceutical supplements, antioxidants, vitamins, minerals and natural compounds in food produce physiologic effects that mimic specific classes of antihypertensive medications, improve vascular biology and lower BP [2–14]. These natural compounds can be classified into the major antihypertensive drug groups such as diuretics, serum aldosterone receptor antagonists (SARAs), beta-blockers, central alpha agonists, calcium channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRI) [2–14].
Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Most antihypertensive drugs are effective at reducing blood pressure, with little evidence that one is any better or worse than another [2, 30, 99]. Types of medications for acute management of hypertension include the following (Table 1.4).Labetalol: 20 mg IV bolus, then 40, 80, 80 mg as needed, every 10 minutes (maximum 220 mg total dose).Hydralazine: 5 to 10 mg IV (or IM) every 20 minutes. Change to another drug if no success by 30 mg (maximum dose). Hydralazine may be associated with more maternal side effects and NRFHT than IV labetalol or oral nifedipine [100].Nifedipine: 10 to 20 mg orally, may repeat in 30 minutes. This drug is associated with diuresis when used postpartum. Nifedipine and magnesium sulfate can probably be used simultaneously.Sodium nitroprusside (rarely needed): Start at 0.25 μ/kg/min to a maximum of 5 μ/kg/min.
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
Nearly all nonpregnant women can achieve adequate blood pressure control with many of these medications. Considerations about safety during pregnancy are as important as the patient’s hemodynamic status. Experience has shown that, except for the ACE inhibitors, the drugs currently prescribed do not alone pose any additional risk of perinatal morbidity or mortality. A detailed description of the different classes of antihypertensive drugs is presented elsewhere, but experience with their use during pregnancy is summarized below (3).
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.
Adherence and blood pressure control in patients with primary aldosteronism
Published in Blood Pressure, 2022
Thi Minh Phuong Nikrýnová Nguyen, Branislav Štrauch, Ondřej Petrák, Zuzana Krátká, Robert Holaj, Ivana Kurcová, Věra Marešová, Alena Pilková, Jan Hartinger, Petr Waldauf, Tomáš Zelinka, Jiří Widimský
Initial period of pharmacotherapy with antihypertensive drugs might be critical for adherence to medication. Newly diagnosed hypertensive patients have >40% likelihood of interruption of therapy after 3 months. In a study with 13,303 hypertensive patients on monotherapy, 42.6% withdrew from the drug therapy within 3 months [5]. Younger age might be an important factor for nonadherence with antihypertensive treatment as well. Nonadherence to therapy in NHANES register was 12 times more frequent in hypertensive subjects below 30 years of age compared to middle aged or older population (above 50 years of age). Male gender was also a risk factor for nonadherence in this study (OR 1.31) [6]. Diuretic therapy may possess further risk factors as we have found in our collaborative study with our allied UK centre [7].
Clinical characteristics do not reliably identify non-adherence in patients with uncontrolled hypertension
Published in Blood Pressure, 2022
Eline H. Groenland, Indranil Dasgupta, Frank L. J. Visseren, Kim C. M. van der Elst, Nathan Lorde, Alexander J. Lawson, Michiel L. Bots, Wilko Spiering
For the development of the clinical screening tool, we used data from 495 consecutive patients with uncontrolled hypertension referred to the outpatient clinic of the Vascular Medicine department of the University Medical Centre Utrecht (UMCU) between November 2017 and November 2020. Patients were referred for diagnostic evaluation and/or treatment advice if BP targets were not met despite BP lowering treatment and/or suffered from target-organ damage. All patients underwent diagnostic evaluation according to a standardised protocol to identify underlying causes of hypertension. The details of this protocol have been described elsewhere [16]. Patients who were prescribed at least one antihypertensive drug were included in this study. Patients in whom no biochemical drug screening was performed were excluded (n = 14): nine patients were evaluated in early November before the biochemical drug screening was fully implemented, two patients used candesartan which could not be analysed by the LC-MS/MS assay, and the results from three patients were missing for unknown reasons.