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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
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Hydralazine is one of most frequently used antihypertensive drugs, particularly for acutely lowering blood pressure in severe preeclampsia. The mechanism is believed to be action as a peripheral vasodilator (i.e., smooth muscle relaxant). Among 40 infants born after first trimester exposure to hydralazine, there was one newborn with a birth defect; two were expected. This is an uncontrolled, unpublished study. The frequency of birth defects was not increased among 107 infants who were exposed to hydralazine during the first trimester in the Swedish Birth Defects Registry (Kallen, 2019).
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.
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.
Immunomodulatory properties of antihypertensive drugs and digitalis glycosides
Published in Expert Review of Cardiovascular Therapy, 2022
Paweł Bryniarski, Katarzyna Nazimek, Janusz Marcinkiewicz
Hydralazine could be used as a hypotensive drug because it relaxes the smooth muscles of blood vessels. This drug also has a neuroprotective effect in Alzheimer’s and Parkinson’s diseases in rats [15]. The most common side effects of hydralazine are pain in the upper limb, back or jaw, chest discomfort or pain, palpitations, nausea, and sweating. Hydralazine can stimulate the production of the circulating anti-inflammatory cytokine IL-10 in peripheral blood mononuclear cells in normal pregnancy [16] (Table 1) Other authors reported the reduction in pro- and anti-inflammatory cytokine’s levels (IL-10, TNF-alpha, and IL-6) in human term placentas during usage of hydralazine in preeclampsia [17]. This medicament may also decrease TNF-alpha concentration, which leads to eNOS mRNA expression, which was tested in human uterine myometrial microvascular endothelial cells [18]. Hydralazine in rats with cardiac ischemia/reperfusion (I/R) injury reduces the oxidative stress, and normalizes levels of CK-MB, LDH and inflammatory markers, and thus exerts cardioprotective effect [19]. It prevents T cells accumulation in the tissues, for example, memory T cells (CD3 (+)/CD45RO (+)) in the aorta and lymph nodes or leukocyte (CD45 (+)) and T-cell (CD3 (+) and CD4 (+)) infiltration in the thoracic lymph nodes, thoracic aorta, and kidney in humanized mice model [20].
Selection of abstracts from Baylor Scott & White Health Central Texas Scholars Day
Published in Baylor University Medical Center Proceedings, 2021
Angela D. Rutherford, Wendy Hegefeld, William Culp, Patrick Lowry, Hania Janek, Shekhar Ghamande, Megan Newman, Austin Metting, J. Scott Thomas, V. Maxanne Flores, Niraj Vora, Christian Cable
Hydralazine is known to be associated with drug-induced lupus, but it can also cause drug-induced anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, which is more severe and frequently involves the kidneys. An 83-year-old woman presented with arthralgias, weakness, and a 20-pound weight loss over 3 months. Labs revealed a creatinine of 4.56 mg/dL. Immunological workup showed low C3 and positivity for ANA with a high titer, as well as for anti-dsDNA, p-ANCA, myeloperoxidase antibody, proteinase 3 antibody, and anti-histone antibody. Positive antibodies raised concern for a secondary cause of the immune process. Hydralazine was discontinued and the patient’s arthralgias resolved. She was treated with steroids and initiated on dialysis. Final renal biopsy revealed renal vasculitis, including crescentic glomerulonephritis that was pauci-immune with one glomerulus containing a segmental area of fibrin. Currently, the patient is off steroids and remains on dialysis with plans for transition to peritoneal dialysis. Although drug cessation is the mainstay of therapy for hydralazine-induced ANCA-associated vasculitis, many patients do not recover renal function, even if additional immunosuppressive agents are utilized. Reports have shown a slight predominance in the elderly and women. Hydralazine should be used with caution, especially in this patient population, and after other therapies have been trialed.