Antihypertensive drugs selection

Renal insufficiency is a late complication of hypertension (354). This is why the choice of the antihypertensive drug selected as the firs (dine treatment of a condition that will persist for many years is so important. From this viewpoint, the fall in blood pressure induced by ACE inhibitors might have beneficial renal effects, in addition to those induced by any decrease in perfusion pressure of the kidneys, especially in diabetic patients (222, 355-358). It is unknown if, independendy of the hemodynamic effect, at an early stage of hypertension and before the initiation of a progressive decrease in renal function, a local decrease in angiotensin II (or increase in bradykinin) explains or direcdy participates in a so-called renoprotective effect (359). 

Recently an imidazoline-like oxazoline was presented as a central acting antihypertensive drug selective for the imidazoline receptors [52] ( fig. 2). At the present time, this substance, rilmenidine, is the prototype of such drugs. Moxonidine was subsequently also proposed in this line [53] (fig.2). 

Diuretics are used in a variety of medical disorders. The primary health care provider selects the type of diuretic diat will most likely be effective for treatment of a specific disorder. In some instances, hypertension may be treated with the administration of an antihypertensive drug and a diuretic. The diuretics used for this combination tiierapy include the loop diuretics and the thiazides and related diuretics. The specific uses of each type of diuretic drug are discussed in the following sections. 

Drug selection for the management of patients with hypertension should be considered as adjunctive to nonpharmacologic approaches for blood pressure lowering, and ultimately the attainment of target blood pressure in many cases maybe more important than the antihypertensive agent used. 

Prazosin and its derivatives that are selective for aj-adrenoceptors are quite useful for the management of primary hypertension. The aj-receptor-selective antagonists can be used alone in mild hypertension. When hypertension is moderate or severe, prazosin is generally administered in combination with a thiazide and a 13-blocker. The antihypertensive actions of prazosin are considerably potentiated by coadministration of thiazides or other types of antihypertensive drugs. 

Table 11-2 Pharmacokinetic Characteristics and Dosage of Selected Oral Antihypertensive Drugs.

Spence JD. Effects of antihypertensive drugs on atherogenic factors possible importance of drug selection in prevention of atherosclerosis. J Cardiovasc Pharmacol 1985 7(Suppl 2) S121-5. 

From the list of antihypertensive drugs below select the one most likely to lower blood sugar. 

The main objective of the project was to identify a new potent and selective dihydropyridine calcium antagonist which was endowed with a sustained duration of action and was amenable to become a once-daily antihypertensive drug. 

Never forget that you are in partnership with your physician, that you have a say in the decision-making process, and that ultimately you will play a major role in your own health destiny. It is ironic that people will be more selective in choosing an auto mechanic than a physician You owe it to yourself and your loved ones to find a doctor with whom you can establish an excellent personal relationship. Does your doctor fully answer your questions, consider your special needs and problems, and leave you with a sense of confidence If not, find another doctor If you have hypertension, controlling that condition will be a lifelong endeavor. And if you require antihypertensive drugs, a great deal of effort will... 

Moxonidine is a selective agonist at imidazoline Ii receptors in the rostroventrolateral medulla and has very little alpha2-adrenoceptor agonist activity. It has similar efficacy to other antihypertensive drugs. Its safety has been evaluated in a number of individual studies and in a systematic review of randomized trials (1). 

Montmorillonite KIO effects regioselective cyclopentylation (68% ori/zo-selectivity) of phenol using cyclopentanol (equation 16). The latter serves as starting material for the preparation of optically active S )-penbutolol, an antihypertensive drug. 

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