Cardiovascular Diseases
Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar in Handbook of Refugee Health, 2021
Diuretics, ACE inhibitors and beta-blockers are the mainstays of treatment:Furosemide 40 mg daily; up to 80 mg maximum, as needed and tolerated; ideally, electrolytes and renal function should be monitored weekly at initiation and then monitored appropriately.Hydrochlorothiazide can be used in stable patients in resource-limited settings or where other treatments have not been successful.Spironolactone can be added in severe cases. Ideally, potassium should be monitored.ACE inhibitors and beta-blockers should be given at maximum tolerated doses; ACE inhibitors are initial therapy for all heart failure with reduced ejection fraction; beta-blockers should be initiated at low doses after stabilisation of the acute episode, if not previously prescribed.
Abnormalities of Ion Transport and the Pathophysiology of Essential Hypertension: Therapeutic Implications and Future Perspectives
Antonio Coca, Ricardo P. Garay in Ionic Transport in Hypertension: New Perspectives, 2019
Discordant findings have been reported concerning the effect of thiazides on erythrocyte sodium contents.9-11 This is probably due to the fact that thiazides can induce both hypokalemia and reduction of volume expansion. As a result, we investigated this latter action of hydrochlorothiazide on the sodium pump by incubating erythrocytes ex vivo at a fixed, constant external potassium concentration and by measuring pump-mediated sodium efflux. Table 1 shows the results obtained in essential hypertensive patients treated with hydrochlorothiazide for 45 d. It can be seen that hydrochlorothiazide administration induces a clear ex vivo stimulation of sodium pump activity. In vivo, this stimulatory action can be reduced and even inversed by the hypokalemia. Table 1 shows that besides sodium pump stimulation, hydrochlorothiazide administration induces an even more important stimulation of [Na+,K+,Cl−] cotransport activity.
Women's health—hormone replacement treatment
H. Gavras in The Year in Hypertension 2004, 2004
BACKGROUND. This prospective, multicentre, open-label study evaluated the ability of the AT receptor blocker candesartan cilexetil to control BP in hypertensive post-menopausal women and the influence of HRT on this process. Participants included 618 hypertensive post-menopausal women (grade l/ll according to the Sixth Report of the Joint National Committee), with an average age of 52 4.7 years and a last menstrual period at least 1 year before enrollment. One hundred and three participants had received HRT (33% oestrogens only and 67% oestrogens in combination with progestins) for an average of 2 years prior to the study. BP was determined by mercury sphygmomanometer at 4 visits during 6 months of follow-up. Treatment was initiated with 16 mg of candesartan cilexetil at the baseline visit. For women not controlled at the second visit (31.5% of the cohort), 12.5 mg of hydrochlorothiazide were added. Statistically significant decreases in SBP (19.9 11.2 mmHg) and DBP (11.5 7.3 mmHg) were observed overall, and BP control was achieved in 61% of participants. Decreases in SBP and DBP and BP control rates were similar in HRT and no-HRT groups, and there were no differences according to the type of HRT administered.
Vascular legacy beyond blood pressure control: benefits of perindopril/indapamide combination in hypertensive patients with diabetes
Published in Current Medical Research and Opinion, 2018
Bernard I. Lévy, Stefano Taddei
In addition, indapamide has been associated with blood-pressure-independent improvements in endothelial function. In hypertensive patients with diabetes, flow-mediated dilation, a marker of endothelium-dependent vasodilation, was increased by indapamide compared to baseline58. In this study, differences with hydrochlorothiazide treatment were significant despite similar improvements in blood pressure58. Additional evidence of indapamide’s effect on the endothelium has been observed in spontaneously hypertensive rats, where indapamide has been shown to inhibit endothelium-dependent contractions of isolated aorta rings34 and to increase levels of endothelium-derived hyperpolarizing factors (also known as epoxyeicosatrienoic acids) in renal microvessels independently of blood pressure45.
Validation of population pharmacokinetic models: a comparison of internal and external validation approaches for hydrochlorothiazide
Published in Xenobiotica, 2021
Rania Kousovista, Georgia Karali, Katerina Vlasopoulou, Vangelis Karalis
Hydrochlorothiazide (HCTZ) is a thiazide diuretic and is commonly used to treat hypertension and oedema associated with fluid overload in adults and children (Beermann and Groschinsky-Grind 1979; Salvetti and Ghiadoni 2006; Panneer et al. 2010; Herman and Bashir 2020; Mylan Pharmaceuticals 2020). HCTZ acts by inhibiting sodium reabsorption in the renal tubules and increasing the urinary excretion rate of sodium and water, resulting in a decrease in cardiac output and blood volume (Seely and Dirks 1977; Haas 1994). HCTZ is administered orally and the recommended HCTZ dose ranges from 25 mg to 100 mg daily for oedema and 25 to 50 mg daily for hypertension in tablet or capsule form. The efficacy of HCTZ has been studied alone or in combination with an antihypertensive drug that converts enzymes or with angiotensin receptor blockers for the appropriate treatment of hypertension (Zanchetti et al 2006).
Established and recent developments in the pharmacological management of urolithiasis: an overview of the current treatment armamentarium
Published in Expert Opinion on Pharmacotherapy, 2020
Mohamed Abou Chakra, Athanasios E. Dellis, Athanasios G. Papatsoris, Mohamad Moussa
There is a lack of data regarding adverse, long-term side effects of thiazides used for kidney stone prevention. However, the side effect profile of thiazide diuretics has been well studied in the setting of hypertension. Thiazide‐related side effects are more common with longer‐acting compounds, such as chlorthalidone and metolazone. Among the thiazide‐type diuretics, indapamide has the least significant metabolic derangements. Side effects may include hypokalemia, hypomagnesemia and hyperuricemia [54]. A large, prospective, cohort study (12,550 non diabetic adults [45‐ to 64‐ years old] who did not have diabetes concluded that subjects with hypertension who were taking thiazide diuretics were not at greater risk for the subsequent development of diabetes [55]. Adverse effects of thiazide and thiazide‐like diuretics on male sexual function are decreased libido, erectile dysfunction, and difficult ejaculation [56,57]. In addition, hydrochlorothiazide can cause photosensitivity [58]. There is a lack of data on the metabolic effects of thiazides used to prevent recurrent calcium nephrolithiasis. It remains unclear if metabolic effects occur and increase the risk of cardiovascular disease in otherwise healthy patients with recurrent nephrolithiasis on thiazide prophylaxis [59]. Thiazide prescription is associated with decreased urinary citrate, this is caused by thiazide‐induced hypokalemia, which would stimulate citrate reabsorption in the proximal tubules [60,61].
Related Knowledge Centers
- Diuretic
- Edema
- Hypercalciuria
- Renal Tubular Acidosis
- Sodium
- Thiazide
- Antihypertensive Drug
- Hypertension
- Diabetes Insipidus
- Kidney Stone Disease