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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
Arguments have been made both for and against treating mild elevations of diastolic pressure in young adults. Antihypertensive therapy reduces morbidity and mortality from stroke, coronary artery disease, heart failure, and renal failure for all degrees of hypertension, but the benefit is modest for mild hypertension and is concentrated primarily on those with hypercholesterolemia, glucose intolerance, left ventricular hypertrophy, and cigarette smoking (4).
Cardiomyopathies in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Goals of guideline-directed medial therapy are outlined in in Box 12.3. A chart of recommended medical therapy is shown in Table 12.4. Beta-blockers are generally considered safe with the caveat that fetal growth should be monitored. ACE inhibitors, angiotensin receptor blockers, neprilysin inhibitors, and ivabradine are contraindicated [80]. Fluid and sodium restriction is recommended for all patients, and loop diuretics for symptomatic relief of pulmonary congestion or significant edema. Digoxin can also be added for symptomatic improvement. Antihypertensive therapy is also recommended for hypertensive patients. Serial echocardiograms, serial measurement of natriuretic peptides, and fetal ultrasounds should be followed during pregnancy [54]. Brain natriuretic peptide (BNP) levels appear to be stable in uncomplicated pregnancy although may also be increased in hypertensive disorders of pregnancy [81,82]. A self-assessment tool for decompensation with PPCM has been validated (see Table 12.2) [66].
Recent Advances in Repositioning Non-Antibiotics against Tuberculosis and other Neglected Tropical Diseases
Published in Venkatesan Jayaprakash, Daniele Castagnolo, Yusuf Özkay, Medicinal Chemistry of Neglected and Tropical Diseases, 2019
Antihypertensive therapy aims to mitigate adverse cardiovascular events associated with high blood pressure such as stroke and myocardial infarction. Antihypertensives are categorized into various classes including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, angiotensin-receptor blockers (ARBs) and diuretics (Aronow 2012). A number of cardiovascular agents including amlodipine 57, dobutamine 58 and nifedipine 59 exhibit promising antimicrobial properties against a range of pathogenic microorganisms (Figure 5) (Mazumdar et al. 2010). Among calcium-channel blockers, verapamil 60, a known mycobacterial efflux pump inhibitor with antitubercular-potentiating effects, holds great potential as adjunctive therapy of TB (Figure 5). Examples of antimicrobial antihypertensives and MICs of antitubercular verapamil analogues aMIC90bMIC99.
The Impact of Timing of Fixed Dose Triple Antihypertensive Combinations on Ambulatory Blood Pressure Monitoring Parameters
Published in Clinical and Experimental Hypertension, 2023
Cigdem Ileri, Zekeriya Dogan, Beste Ozben, Latife Bircan, Aycan Acet, Taner Sen
Grade−2 hypertension often requires antihypertensive combination treatment according to recent guidelines (4). Starting antihypertensive therapy with a drug combination is associated with a greater reduction of BP, an earlier achievement of therapeutic goals, and a higher proportion of patients achieving targets with favorable implications on cardiovascular events. However, one-fourth to one-third of hypertensive patients fail to achieve BP control even with dual-combination therapies, requiring three or more antihypertensive agents (15). In our study, patients in all groups had good BP control under triple antihypertensive treatment regimens. Similar to our study, the 24-h antihypertensive efficacy of a triple fixed-dose combination of an ACEI or ARB with a diuretic and a calcium channel blocker has been shown in several studies (16,17). Potent antihypertensive efficacy might be attributed to increasing adherence to therapy with the formation of a single-pill concept.
Sex and gender differences in the treatment of arterial hypertension
Published in Expert Review of Clinical Pharmacology, 2023
Juan Tamargo, Ricardo Caballero, Eva Delpón Mosquera
Major clinical practice guidelines concluded that there is currently no substantial evidence for differential effects of antihypertensive therapy based on sex or gender and that both women and men obtain comparable benefits in terms of CV morbidity and mortality as a result of the reduction in BP [1,2]. The Blood Pressure Lowering Treatment Trialists’ Collaboration analyzed 31 clinical trials (103,268 men, 87,349 women) and concluded that was no evidence that men and women obtained different levels of cardiovascular protection from BP lowering or that regimens based on angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs), or diuretics/beta-blockers were more effective in women than in men [81]. These findings had a great influence on the recommendations of the major clinical practice guidelines [1,2]. However, in this study, ACEIs were less effective than CCBs for stroke prevention in women, while among men all drug classes were equally effective in stroke prevention, but because the large number of statistical comparisons performed and the borderline statistical significance, the authors considered that this SGRD might be a chance finding given the large number of comparisons made. The study did not find a difference between the subgroups when age was categorized as either <65 and ≥65 years, but it was recognized that the latter comparison was limited by the small number of events in the younger age-group.
Contribution of single-pill combinations in the management of hypertension: perspectives from China, Europe and the USA
Published in Current Medical Research and Opinion, 2023
Ulrike Gottwald-Hostalek, Ningling Sun
The most recent guideline for the management of hypertension from China dates from 201863, with a separate but complementary guideline published in the following year64. Any of the five main classes of antihypertensive agents (ACEI, ARBs, CCB, diuretics, BBs) may be used to initiate pharmacologic antihypertensive therapy, with the individual patient presentation driving the choice of initial treatment. Combination therapy is generally reserved for more severe hypertension, although low-dose antihypertensive therapy can be considered at any level of severity of hypertension. These guidelines are about to be updated and the optimal combination therapy recommended in clinical practice in China are CCB + ARB, CCB + ACEI, ARB + thiazide, ACEI + thiazide, CCB + thiazide, and CCB + BB (CCBs are dihydropiridine in each case). US65 and European2,3 guidelines are broadly similar, but for the exclusion of BB from initiation of therapy in the absence of compelling indications, such as stable ischaemic heart disease or stable congestive heart failure with reduced ejection fraction. The US guideline also takes a similar approach to the 2018 guideline from China on the use of drug combinations to initiate antihypertensive therapy, although the guideline from China lists the SPCs available there.