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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
Refractory hypertension should signal the need for agents that may target additional pathways. The PATHWAY2 study suggested a beneficial role of the mineralocorticoid antagonist spironolactone (compared with placebo, bisoprolol, and doxazosin) in improving cardiovascular outcomes in drug-resistant hypertension.54 More patients achieved controlled (<130/80 mmHg) BP with spironolactone, whereas eplerenone also effectively improved BP55 and was as effective as amlodipine in lowering systolic BP and pulse pressure in older patients with hypertension and widened pulse pressure.56
The adrenal cortex
Published in Martin Andrew Crook, Clinical Biochemistry & Metabolic Medicine, 2013
The treatment of IAH is usually medical, and the mineralocorticoid antagonist spironolactone has proved useful, sometimes in conjunction with a thiazide diuretic. The treatment of choice for unilateral variants of PH such as APA is usually surgical by adrenalectomy.
Managing the elderly patient with hypertension: current strategies, challenges, and considerations
Published in Expert Review of Cardiovascular Therapy, 2020
For white and other non-black elderly patients with primary hypertension, the first antihypertensive drug should be a thiazide diuretic (preferably chlorthalidone) or a calcium channel blocker [27]. The first and if needed second antihypertensive drug should be a thiazide diuretic plus a calcium channel blocker. If a third antihypertensive drug is needed, the patient should be treated with the thiazide diuretic plus a calcium channel blocker plus an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker [27]. For black elderly patients with primary hypertension, these recommendations are identical [27]. A thiazide diuretic and a calcium channel blocker are considered to be more efficacious than an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker as initial antihypertensive therapy for elderly patients with primary hypertension [27]. If a fourth antihypertensive drug is needed to control hypertension in elderly patients, it should be a mineralocorticoid antagonist [27]. The choice of antihypertensive drug therapy would be modified depending on comorbidity, as discussed below and in more detail in the 2017 ACC/AHA guidelines [27].
Managing comorbid cardiovascular disease and sleep apnea with pharmacotherapy
Published in Expert Opinion on Pharmacotherapy, 2018
Jacek Wolf, Krzysztof Narkiewicz
Surprisingly, several compounds are characterized by dual effectiveness, as was shown with respect to diuretics. Administration of diuretics to treat hypertension not only efficiently lowers BP but also attenuates OSA severity, evidenced by decreases in AHIs. However, the evidence is not robust and increased doses of diuretics should be administered with particular caution; electrolyte imbalances may have an adverse effect on cardiac rhythm. In patients with coexisting difficult-to-treat hypertension and OSA, clinicians may consider early administration of a mineralocorticoid antagonist.