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Sodium Intake and Hypertension
Published in Austin E. Doyle, Frederick A. O. Mendelsohn, Trefor O. Morgan, Pharmacological and Therapeutic Aspects of Hypertension, 2020
T. O. Morgan, F. A. O. Mendelsohn, A. E. Doyle
The future development would appear to be to develop diuretics which have specific other actions that prevent the development of side effects. Tienylic acid and indanone are examples of such drugs. Indapamide may be a drug possessing antihypertensive action in excess of its diuretic properties. Bumetanide may not cause loss of magnesium, and in certain circumstances this may be advantageous.
Approach to risk stratification in cardio-oncology
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Christopher B. Johnson, Gary Small, Angeline Law, Habibat Garuba
A 64-year-old patient is diagnosed with multiple myeloma and achieves complete remission on a proteasome inhibitor. After 2 years on therapy, he develops severe hypertension refractory to maximum doses of four antihypertensives. Imaging reveals bilateral renal artery stenosis, and he undergoes renal artery angioplasty with perfect angiographic results. Subsequently, his hypertension is well controlled on only two medications. He is referred to cardio-oncology to determine the safety of resuming proteasome inhibitor therapy for his multiple myeloma. His risk factors include hypertension, remote smoking totaling 20 pack years, and dyslipidemia. At the time of his assessment, he has no exertional symptoms, and no history of cardiovascular disease besides his renal artery stenosis with bilateral renal artery angioplasty. Medications at the time of assessment include ASA 81 mg daily, perindopril 8 mg, and indapamide 2.5 mg daily. Physical examination is normal, with a BMI of 23, waist circumference of 80 cm, BP 124/74, no carotid or abdominal bruits, a normal ankle/brachial index, and no extra heart sounds or murmurs.
Blood Pressure Management in the Chronic Post-Stroke Phase
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
With regard to threshold for blood pressure lowering, a subsidiary analysis of the PROGRESS trial investigated the effects of randomised treatment on recurrent stroke by baseline blood pressure levels (Figure 59.2) (17). Blood pressure lowering with combination therapy of perindopril plus indapamide produced similar risk reductions in each of subgroups defined by baseline systolic blood pressure of less than 120, 120−139, 140−159 and 160 mmHg or greater (p homogeneity = 0.5) and those defined by baseline diastolic blood pressure of less than 80, 80−89, 90−99 and 100 mmHg or greater (p homogeneity = 0.2). The effects of single-drug therapy with perindopril alone were also comparable across these subgroups (p homogeneity = 0.2 and 0.8 for systolic and diastolic blood pressure, respectively), but consistently greater benefits were observed with combination compared to single-drug therapy. It is clear that blood pressure-lowering treatment should be considered routinely for patients with a history of stroke or TIA, irrespective of their blood pressure.
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
Although many lifestyle changes such as keeping body mass index within normal limits, regular physical exercise, adoption of a balanced diet, etc. are recommended for the prevention and treatment of hypertension, antihypertensive drug use is still the most common therapy. Antihypertensive drug active ingredients can be used alone or in combination with other active ingredients (An et al. 2021). They are used to regulate blood pressure which is a measure of the force that the blood exerts on the vascular wall. Indapamide is an orally taken antihypertensive drug and is included in the thiazide-type group. It contains a polar sulfamoyl chlorobenzamide and methyl indoline groups in its molecular structure (Pai et al. 2011). Indapamide works as a diuretic by acting on the proximal part of the distal tubes. It is rapidly absorbed after ingestion and metabolized in the liver. Its half-life is biphasic; 14–25 hours. It has little effect on potassium and uric acid excretion. It reveals a similar effect to calcium antagonists. It reduces vascular reactivity with its effect on amines which increase blood pressure and provides a decrease in peripheral vascular resistance (Schiavi et al. 2000; Asil and Atalar 2017).
Ingestion-time differences in the pharmacodynamics of dual-combination hypertension therapies: Systematic review and meta-analysis of published human trials
Published in Chronobiology International, 2022
Ramón G. Hermida-Ayala, Artemio Mojón, José R. Fernández, Michael H. Smolensky, Ramón C. Hermida
Skibitsky et al. (2018) investigated the ingestion-time dependent disparity in the effects of the fixed-dose 160 mg valsartan/1.5 mg indapamide retard (ARB/diuretic) dual-combination in 177 hypertensive patients (median age 64 years) who had experienced an ischemic stroke within the 4 weeks preceding recruitment and who were followed throughout 12 months of different schemes of timed therapy. Patients were randomized to three groups according to the time of treatment: (i) both medications in the morning; (ii) indapamide in the morning and 160 mg valsartan in the evening; and (iii) indapamide in the morning and 80 mg valsartan twice daily, i.e., morning and evening. Highly significant greater reduction of the stiffness of the vascular wall (P < .05), central aortic pressure (P < .05), 24 h, daytime, and nighttime BP means (P < .001), plus significant increase of the sleep-time relative SBP decline (P < .001) was achieved when the entire added daily dose of valsartan was ingested in the evening compared to morning. In a subsequent trial of similar design, the same investigators evaluated the ingestion-time dependent effects of the same fixed-dose valsartan/indapamide retard dual-combination in 116 transient ischemic attack and 119 ischemic stroke hypertensive patients (Skibitsky et al. 2019). In both groups of high-risk patients, adding valsartan in the evening, compared to morning, to indapamide ingested in the morning increased the proportion of patients with controlled BP and better reduced the 24 h, daytime, and nighttime ABP means, stiffness of the vascular wall, and central aortic pressure (always P < .05).
Losartan/hydrochlorothiazide combination is safe and effective for morning hypertension in Very-Elderly patients
Published in Clinical and Experimental Hypertension, 2018
Hiroki Uchiwa, Hisashi Kai, Yoshiko Iwamoto, Takahiro Anegawa, Hidemi Kajimoto, Kenji Fukuda, Tsutomu Imaizumi, Yoshihiro Fukumoto
The most important finding of the present study was that the losartan/HCTZ combination therapy induced a greater reduction in the morning SBP and a higher target achievement rate of the morning BP, as compared with the high-dose losartan therapy in the Very-Elderly patients (Figures 1 and 2). In addition, the beneficial effects found for the Very-Elderly patients were comparable to those observed in the Young/Elderly patients. These observations are in line with the Hypertension in the Very-Elderly Trial (HYVET), which demonstrated that indapamide-based therapy effectively reduced all-cause mortality and cardiovascular events in hypertensive patients who were ≥80 years (16).