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Management of Hypertension in Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Jesse Kane, Clive Goulbourne, Hal A. Skopicki
Hydralazine is a direct arteriolar vasodilator that has the potential to induce reflex tachycardia and coronary artery steal syndrome and can have deleterious outcomes in patients with significant underlying coronary artery disease or aortic dissection. When utilized in these scenarios, concomitant beta-blocker use should be considered. Hydralazine has an intermediated onset of action within 10–30 min and its effects last up to 12–24 hours.69,70
Hypertension
Published in Kate McCombe, Lara Wijayasiri, Paul Hatton, David Bogod, The Primary FRCA Structured Oral Examination Study Guide 2, 2017
Kate McCombe, Lara Wijayasiri, Paul Hatton, David Bogod
How would you manage such a case?Pre-operative: An assessment should identify and optimise patient factors prior to elective surgery.Intra-operative: This requires an assessment to identify the cause followed by the required intervention, e.g. increase depth of anaesthesia, supplemental analgesia. Administration of antihypertensive medications may be required intra-operatively.Drugs that can be used to bring down BP in the acute setting include: β-Blockers – esmolol is an ultra-short-acting agent given by infusion. Labetalol has α and β effects and is typically given as slow boluses titrated to effect.Hydralazine – a directly acting vasodilator (arteries > veins) that can be administered if β-blockers are contraindicated.GTN – a short-acting vasodilator (veins > arteries), and tolerance develops within 24 hours.Sodium nitroprusside – an arteriolar vasodilator. It is light sensitive and prolonged use can lead to cyanide accumulation.Remifentanil – a synthetic opioid that causes a decrease in mean arterial pressure and heart rate. Profound bradycardia can limit its use.
Concomitant rapidly progressive glomerulonephritis and acute rheumatic fever after streptococcus infection: a case report
Published in Paediatrics and International Child Health, 2022
Suwanna Pornrattanarungsi, Sudarat Eursiriwan, Yupaporn Amornchaicharoensuk, Chutima Chavanisakun, Ornatcha Sirimongkolchaiyakul
Generally, high-dose corticosteroid treatment is controversial in the management of RPGN owing to APSGN [6]; nevertheless, pulse methylprednisolone with subsequent tapering to treat valvular inflammation secondary to recurrent ARF was prescribed as this strategy restricts deterioration of renal function. The RPGN resolved gradually without long-term complications. With regard to the choice of antihypertensive medication for concomitant kidney and heart disease, a loop diuretic is usually the first-line medication to control hypertension in glomerulonephritis. However, hydralazine was prescribed as the second medication because it acts as an arteriolar vasodilator which reduces peripheral vascular resistance and increases stroke volume and cardiac output. This helps to control both blood pressure and volume overload from mitral and aortic regurgitation.
Treatment of severe hypertension during pregnancy: we still do not know what the best option is
Published in Hypertension in Pregnancy, 2020
Dagmar Wertaschnigg, Rui Wang, Maya Reddy, Fabricio Da Silva Costa, Ben Willem J. Mol, Daniel L. Rolnik
Hydralazine is a direct arteriolar vasodilator and crosses the placental barrier. It does not seem to influence utero-placental perfusion, as maternal and fetal doppler indices have been shown to be stable after initiation of treatment (28–30). A meta-analysis of 21 trials with 893 women compared hydralazine with other anti-hypertensive options. Although not significant, in two trials (n = 126), hydralazine showed a trend toward lower rates of persistent severe hypertension in comparison to labetalol (relative risk 0.29, 95% CI 0.08–1.04). When compared with calcium-channel blockers (four trials with 350 women), there was a trend toward more persistent hypertension (relative risk 1.41, 95% CI 0.95–2.09) in the hydralazine group (29). However, there was significant heterogeneity in outcome measures as well as varying quality between the trials. These non-significant trends may, however, serve as clinical equipoise for future studies. Maternal side effects including headache, flushing, palpitations, and tachycardia were more often seen with hydralazine compared to other anti-hypertensives (29). In addition, several adverse outcomes (maternal hypotension (relative risk 3.29, 95% CI 1.50–7.23, 13 trials), placental abruption (relative risk 4.17, 95% CI 1.19–14.28, five trials), cesarean section (relative risk 1.30, 95% CI 1.08–1.59, 14 trials) and abnormal fetal heart rate patterns (relative risk 2.04, 95% CI 1.32–3.16, 12 trials)) were more frequently reported in women who received hydralazine when compared with all anti-hypertensives (29). As a conclusion of this meta-analysis, the authors do not recommend hydralazine as first-line treatment, but the heterogeneity of the studies included makes this recommendation questionable.
Accurate assessment of right heart function before and after long-term left ventricular assist device implantation
Published in Expert Review of Cardiovascular Therapy, 2020
Michael Dandel, Mariano Francisco del Maria Javier, Eva Maria del Javier Delmo, Roland Hetzer
In patients whose ECHO and RHC parameters remain stable during short-term moderate reduction of RVAD flow but become unstable during the short interruption of RV unloading and in whom the LAIRV does not exceed the value of 14, there is further need for RV support. Returning to the initial RVAD settings and continuation of full RV unloading for several days is therefore necessary before another off-pump trial. After a failed weaning attempt, additional facilitation of RV recovery might be attained by enhancing pulmonary arteriolar vasodilator therapy for further reduction of the PVR.