Cardiomyopathies in Pregnancy
Afshan B. Hameed, Diana S. Wolfe in 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
Venkatesan Jayaprakash, Daniele Castagnolo, Yusuf Özkay in 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.
Diagnosis, Management, and Treatment of Systemic Hypertension in Youth, Updates from the 2017 American Academy of Pediatrics Clinical Practice Guideline
James M. Rippe in Lifestyle Medicine, 2019
Although, in most cases, treatment using a non-pharmacologic approach is preferred, children who remain hypertensive despite a trial of lifestyle modification or who have symptomatic HTN, Stage 2 hypertension without a clearly modifiable cause, or chronic kidney disease or diabetes mellitus with any stage of HTN, should be considered for treatment with pharmacologic therapy. Therapy should begin with a single agent and at a low dose. Recommended classes of antihypertensive therapy for the treatment of systemic hypertension include angiotensin-converting enzyme inhibitors (ACEi), calcium channel blockers (CCB), diuretic (e.g., hydrochlorothiazide), and angiotensin receptor blockers (ARBs). There exist unique reported benefits for each agent. A summary of the different classes and agents can be found in Table 80.4.
Effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension: A randomized controlled trial
Published in Clinical and Experimental Hypertension, 2020
Nureddin Yuzkat, Celaleddin Soyalp, Omer Turk, Siddik Keskin, Nurcin Gulhas
All patients were given detailed information in the anesthesia clinic before the operation. The patients received regular antihypertensive drug treatment for blood pressure regulation. On the day of surgery, the patients were asked to fast for 8 h, and the surgery was planned as the first case in the morning. Before the surgery, it was requested that the blood pressure (BP) of the patients is 160 mmHg for systolic BP and 100 mmHg for diastolic BP. When elective surgery was postponed when there was a BP higher than systolic 180 mmHg and diastolic 110 mmHg. The postponement of operation was decided by twice blood pressure measurements, 5-minute intervals. All patients were given diazepam (Diazem capsule, Deva, Istanbul, Turkey) orally, at the same time a day before surgery (10 mg diazepam at 10:00 pm).
Moringa oleifera leaf extract induces vasorelaxation via endothelium-dependent hyperpolarization and calcium channel blockade in mesenteric arterial beds isolated from L-NAME hypertensive rats
Published in Clinical and Experimental Hypertension, 2020
Direk Aekthammarat, Patchareewan Pannangpetch, Panot Tangsucharit
Hypertension is prevalent globally and is the most important modifiable risk factor for cardiovascular morbidity and mortality. It is well recognized that many factors influence hypertension, one of which is oxidative stress-induced vascular dysfunction leading to increased systemic vascular resistance. The goal of antihypertensive therapy is to reduce cardiac output and/or (preferably) peripheral vascular resistance (1,2). Vasodilators are drugs that reduce blood pressure by decreasing total peripheral resistance. Depending on the site of action, vasodilators can be divided into two classes: endothelium-dependent (indirect vasodilators) and endothelium-independent (direct vasodilators) (3). Antihypertensive agents that relax vascular smooth muscle appear to be the most efficacious in reducing cardiovascular events and preventing permanent end-organ damage (4).
Treatment of hypertension in the elderly in 2017/2018 - what’s new?
Published in Expert Opinion on Pharmacotherapy, 2019
The second study that contributed to influence the recent recommendations is the Heart Outcomes Prevention Evaluation (HOPE)–3 trial [32]. The goal of this trial was to assess whether antihypertensive therapy reduces the risk of cardiovascular events in persons at intermediate cardiovascular risk and with a lower BP (mean 138/81 mmHg at baseline). The 12,705 participants at intermediate risk who did not have cardiovascular disease were randomized to receive either candesartan at a dose of 16 mg per day plus hydrochlorothiazide at a dose of 12.5 mg per day or placebo. The trial included men 55 years of age or older and women 65 years of age or older. Mean age was actually 65.8 years. Therapy with candesartan/hydrochlorothiazide was not associated with a lower rate of major cardiovascular events than placebo in the overall group of patients. Yet, patients in the upper third of systolic BP (>143.5 mm Hg) had significantly lower rates of the primary endpoint (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) than those in the placebo group. These data suggest that drug therapy reduces the risk of cardiovascular events in patients with uncomplicated mild hypertension only if their systolic BP is above 140 mmHg.
Related Knowledge Centers
- Blood Pressure
- Coronary Artery Disease
- Death
- Myocardial Infarction
- Dementia
- Cardiovascular Disease
- Stroke
- Hypertension
- Medication
- Heart Failure