Approach to risk stratification in cardio-oncology
Susan F. Dent in Practical Cardio-Oncology, 2019
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.
The Treatment of Hypertension with Nutrition, Nutritional Supplements, Lifestyle and Pharmacologic Therapies
Stephen T. Sinatra, Mark C. Houston in Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
Long-acting ACEIs with tissue selectivity are preferred. This would include all of the ACEIs except captopril, enalapril and lisinopril. An ARB with high affinity for the AT 1 receptor and longer effect on both BP and vascular protection is preferred. These would include most of the ARBs except losartan. The DHP CCBs such as amlodipine and nifedipine are preferred over verapamil and diltiazem. Indapamide is diuretic of choice for a third drug, and then chlorthalidone. However, hydrochlorothiazide (HCTZ) alone or in combination with other agents should be avoided due to its lack of efficacy in reducing CVD and CHD, increase in glucose and risk of type 2 DM, inducing an abnormal lipid profile, increasing homocysteine and causing numerous nutritional deficiencies and other metabolic problems such as hypokalemia, hypomagnesemia and hyponatremia [2–5,11–15].
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Caroline Ashley, Aileen Dunleavy, John Cunningham in The Renal Drug Handbook, 2018
Indapamide is strongly bound to red blood cells, and is taken up by the vascular wall in smooth vascular muscle according to its high lipid solubility. 60–70% of a single oral dose is eliminated by the kidneys and 23% by the gastrointestinal tract. Indapamide is extensively metabolised with 5–7% of unchanged drug found in the urine during the 48 hours following administration. About 16–23% of dose is excreted in the faeces.
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).
COVID-19: a novel menace for the practice of nephrology and how to manage it with minor devastation?
Published in Renal Failure, 2020
Sena Ulu, Ozkan Gungor, Ebru Gok Oguz, Nuri Baris Hasbal, Didem Turgut, Mustafa Arici
Answer: There is limited data about the pharmacokinetics of antivirals (atazanavir, lopinavir/ritonavir, remdesivir, favipiravir, chloroquine, hydroxychloroquine, nitazoxanide, ribavarin, tocilizumab) used in the COVID-19. Concerns may be the followings [32]:ACEIs: Benazepril increases the level of atazanavir, and antiviral drug level monitoring is recommended. Fosinopril may increase the level of lopinavir/ritonavir, but blood level monitoring is not necessary.ARBs: Valsartan increases the level of atazanavir and lopinavir/ritonavir and should be used carefully. Irbesartan and losartan reduce the level of lopinavir/ritonavir slightly.Diuretics: Indapamide increases the blood level of atazanavir and lopinavir/ritonavir; close drug level monitoring is required for concomitant use.Calcium channel blockers: Concomitant use of lercanidipine with atazanavir or lopinavir/ritonavir is contraindicated. Other calcium channel blockers also interact with atazanavir, lopinavir/ritonavir, level monitoring is recommended.
Prospective direct comparison of antihypertensive effect and safety between high-dose amlodipine or indapamide in hypertensive patients uncontrolled by standard doses of angiotensin receptor blockers and amlodipine
Published in Clinical and Experimental Hypertension, 2018
Keisuke Okamura, Kazuyuki Shirai, Nao Totake, Tetsu Okuda, Hidenori Urata
In the present study, the dose of indapamide was selected by each attending physician. It is interesting that the majority of physicians (76%) selected a low dose of 0.5 mg, even though the tablets are 1 mg. It has been demonstrated that administration of a low-dose diuretic has fewer adverse metabolic effects without compromising its depressor effect, and the present result suggests that physicians understand this point.
Related Knowledge Centers
- Ace Inhibitor
- Chlortalidone
- Hydrochlorothiazide
- Kidney Failure
- Sulfonamide
- Hypertension
- Heart Failure
- Thiazide-Like Diuretic
- Medication
- Perindopril