Anti-hypertensive therapy

The patient had been started on anti-hypertensive therapy in hospital and has not been checked since... 

The adverse event needs to be clinically significant enough that the risk-benefit of therapy is percieved to be altered. In this regard, the acceptable risk-benefit profile of anti-cancer therapies is markedly diflFerent than, for example, that of anti-hypertension therapy. 

Optimizing Anti hypertensive Therapy by Angiotensin Receptor Blockers 157... 

Anti-hypertensive therapy to prevent stroke (ages 40-69) 940... 

Following initiation of anti hypertensive therapy with thiazide diuretics, transient hypercalcemia has been seen in over one-third of patients (87). Two percent of patients receiving long-term thiazide diuretics administration had persistent hypercalcemia (68). In the elderly (especially women), combined administration of thiazides with vitamin 0 supplements (for osteoporosis) can have synergistic effects on the elevation of serum calcium levels resulting in severe hypercalcemia (69). Similarly, if the patient is predisposed to hypercalcemia (IHPT, 2HPT or immobilization), thiazides can precipitate significant and sustained hypercalcemia (68,70). 

Weinberg JM, Appel U, Bakris G, Gassman JJ, Greene T, Kendrick CA, Wang X, Lash J, Lewis JA, Pogue V, Thornley-Brown D, Phillips RA. Risk of hyperkalaemia in nondiabetic patients with chronic kidney disease receiving anti-hypertensive therapy. Arch Intern Med 2009 169(17) 1587-94. 

A variety of therapeutic agents or chemical substances may increase blood pressure... When use of a chemical agent which increases blood pressure is mandatory, anti-hypertensive therapy may facilitate continued use of this agent (Grossman et al. 2015). 

Explain why blood pressure determinations are important during therapy with an anti hypertensive drug. 

Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of an anti hypertensive drug. 

Determine if drug therapy may be contributing to ARF. Consider not only drugs that can directly cause ARF (e.g., aminoglycosides, amphotericin B, NSAIDs, cyclosporine, tacrolimus, ACE inhibitors, and ARBs), but also drugs that can predispose a patient to nephrotoxicity or prerenal ARF (i.e., diuretics and anti hypertensive agents). 

McCombs, J., et al., "The Costs of Interrupting Anti-Hypertensive Drug Therapy in A Medicaid Population," Med. Care, 32, 214-226 (1994). 

Figure 10. Anti-hypertensive effect of ICI 66082 (300 mg daily) in hypertensive patients, divided according to their plasma renin concentration determined recumbent in the morning (from. Meekers, A. Missotten, R. Fagard, D. Demuynck, C. Harvengt, P. Pas, L. Billiet, and A. Amery in Archives Internationales de Pharma-codynamie et de Therapie)...

Transfer to orai anti hypertensives - If treatment includes transfer to an oral antihypertensive other than nicardipine, generally initiate therapy upon discontinuation of the infusion. If oral nicardipine is to be used, administer the first dose of a 3-times-daily regimen 1 hour prior to discontinuation of the infusion. 

The drug should not be given to patients who are at risk for mental depression and should be withdrawn if depression occurs during therapy. Concomitant treatment with tricyclic antidepressants may block the anti hypertensive effect of clonidine. The interaction is believed to be due to cr-adrenoceptor-blocking actions of the tricyclics. 

PROCAINAMIDE ANTI HYPERTENSIVES AND HEART FAILURE DRUGS-ACE INHIBITORS Possible T risk of leukopenia Uncertain at present Monitor FBC before starting treatment, 2-weekly for 3 months after initiation of therapy, then periodically thereafter... 

CENTRALLY ACTING ANTI HYPERTENSIVES TCAs 1. Possibly hypotensive effect of donidine and moxonidine antagonized by TCAs (some cases of hypertensive crisis) 2. Conversely, donidine and moxonidine may exacerbate the sedative effects of TCAs, particularly during initiation of therapy Uncertain 1. Monitor BP at least weekly until stable 2. Warn patients of the risk of sedation and advise them to avoid driving or operating machinery if they suffer from sedation... 

ANTIHYPERTENSIVES AND HEART FAILURE DRUGS ANTI HYPERTENSIVES AND HEART FAILURE DRUGS t hypotensive effect. Episodes of severe first dose 1 BP when alpha-blockers are added to ACE inhibitors Additive hypotensive effect may be used therapeutically Monitor BP at least weekly until stable, particularly on initiation of therapy. Consider starting therapy at night... 

Sowers JR, White WB, Pitt B et al.The Effects of cyclooxygenase-2 inhibitors and nonsteroidal anti-inflammatory therapy on 24-hour blood pressure in patients with hypertension, osteoarthritis, and type 2 diabetes mellitus. Archives of internal Medicine 2005 165 161-168. 

The three main diuretic classes are thiazide, loop, and potassium-sparing diuretics (Table 10-1). Thiazide diuretics are considered one of the first-line agents for the treatment of HTN. Acutely, thiazide diuretics lower blood pressure by inhibiting sodium chloride cotransporters in the ascending loop of Henie and distal tubule, increasing sodium excretion and causing diuresis. The reduction in plasma volume decreases cardiac output and consequently reduces blood pressure. However, with continued therapy, the plasma volume returns to pretreatment level and there is a decrease in peripheral vascular resistance, which is responsible for the long-term anti hypertensive effects. The most common indication for thiazide diuretics is HTN. 

CHAPTER 43 CHRONIC KIDNEY DISEASE PROGRESSION-MODIEYING THERAPIES 809 TABLE 43—4. Effects of Anti hypertensive Agents on Renal Blood Flow (RBF) and Glomerular Filtration Rate (GFR)... 

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