Antihypertensive agents complications

Prazosin may be particularly useful when patients cannot tolerate other types of antihypertensive agents or when blood pressure is not well controlled by other drugs. Since prazosin does not significantly influence blood uric acid or glucose levels, it can be used in hypertensive patients whose condition is complicated by gout or diabetes meUitus. Prazosin treatment is associated with favorable effects on plasma lipids. Thus, it may be of particular importance in managing patients with hyperlipidemia. 

The results of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was the deciding evidence that the JNC7 used to justify thiazide diuretics as first-line therapy." It was designed to test the hypothesis that newer antihypertensive agents (an a-blocker, ACE inhibitor, and dihydropyridine CCB) would be superior to thiazide diuretic therapy. The primary objective was to compare the combined end point of fatal coronary heart disease and nonfatal myocardial infarction. Other hypertension-related complications (e.g., heart failure and stroke) were evaluated as secondary end points. This was the largest hypertension trial ever conducted and included 42,418 patients aged 55 years and older with hypertension and one additional cardiovascular risk factor. This prospective, double-blind trial randomized patients to chlorthalidone (a thiazide diuretic), amlodipine (dihydropyridine CCB), doxazosin (a-blocker), or lisinopril (ACE inhibitor) for a mean follow-up of 4.9 years. 

The controversy as to whether antihypertensive therapy really prevents complications and alters the mortality prognosis has definitely been settled in favor of drug treatment. The historic Veterans Administration Cooperative Study on antihypertensive agents showed conclusively that major complications in patients with severe hypertension (diastolic pressure of 115-129 mmHg) were reduced by a factor of 27 (Veterans Administration, 1967, 1970). Even patients with moderate hypertension (105-114 mmHg) were found to have morbidity decreased by 4 1. 

A reduction of atherosclerotic complications is the major objective of long-term therapy with antihypertensive agents [78], Several studies were carried out on the effects of oleic acid and its congeners, such as elaidic and stearic acids, and on the structural properties of membranes. 

Reeves PR, Case DE, Jepson HT et al. (1978) Practolol metabolism in metabolism in human subjects. J Pharmacol Exp Ther 205(2) 489-498 Reinhardt DJ, Waldron JM (1954) Lupus erythematosus-like syndrome complicating hydralazine (Apresoline) therapy. JAMA 155 1491-1492 Riddiough MA (1977) Preventing, detecting and managing adverse reactions of antihypertensive agents in the ambulant patient with essential hypertension. Am J Hosp Pharm 45(5) 465-477... 

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