Antihypertensives monotherapy

TrostBN, WeidmannP. 5 years of antihypertensive monotherapy with the calcium antagonist nitrendipine do not alter carbohydrate homeostasis in diabetic patients. Diabetes Res Clin Pract( m) 5 (Suppl 1), S511. 

Aliskiren blocks the renin-angiotensin-aldosterone system at its point of a activation, which results in reduced plasma renin activity and BP. It provides BP reductions comparable to an ACE inhibitor, ARB, or CCB. It also has additive antihypertensive effects when used in combination with thiazides, ACE inhibitors, ARBs, or CCBs. It is approved for monotherapy or in combination with other agents. 

Rasilez contains aliskiren, which is a renin inhibitor used in hypertension as monotherapy or in combination with other antihypertensives. It is to be used with caution in patients taking concomitant diuretics, on a low-sodium diet or who are dehydrated and in patients with a glomerular filtration rate less than 30 mL/minute. Aliskiren may cause diarrhoea as a side-effect and it should be administered with or after food. It exists in two dosage strengths, 150 mg and 300 mg. 

Dihydralazine and minoxidil (via its sulfate-conjugated metabolite) dilate arterioles and are used in antihypertensive therapy. They are, however, unsuitable for monotherapy because of compensatory circulatory reflexes. The mechanism of action of dihydralazine is unclear. Minoxidil probably activates K channels, leading to hyperpolarization of smooth muscle cells. Particular adverse reactions are lupus erythematosus with dihydralazine and hirsutism with minoxidil—used topically for the treatment of baldness (alopecia androg-enetica). 

Angiotensin-converting enzyme inhibitors have turned out to be very effective antihypertensive drugs that have begun to overtake )3-adrenoblockers, especially in monotherapy of hypertension. 

Hypertension - Administer with or without food. The usual recommended starting dose is 16 mg once daily when used as monotherapy in patients who are not volume-depleted. Candesartan can be administered once or twice daily with total daily doses ranging from 8 to 32 mg. Most of the antihypertensive effect is present within 2 weeks maximal blood pressure reduction generally is obtained within 4 to 6 weeks of treatment. 

C. Although still highly controversial, the initial use of a thiazide diuretic for monotherapy has been recommended by the Joint National Committee on Detection, Evaluation and treatment of High Blood Pressure. Triamterene and Aldactone are rarely used alone and exhibit no antihypertensive activity. A recent study found that the loop diuretics bumetanide and furosemide effectively reduced blood pressure. Serum lipid levels were less affected than with thiazide diuretics or chlorthalidone. However, thiazide diuretics are a more conservative and approved approach for the initial treatment of hypertension that avoid the more dramatic fluid and electrolyte shifts that occur with loop diuretics. 

In two retrospective case studies of 24 child and adult patients, Sanberg et al. (1998) and Silver et al. (2000) reported that mecamylamine (a nicotine antagonist used as an antihypertensive) in doses up to 5 mg daily significantly reduced tic severity in 22 of 24 patients, with many patients also reporting improved mood and irritability, but details of concomitant medication and duration of treatment were unclear. However, an 8 week double-blind, placebo-controlled study of 61 subjects with TS using mecamylamine at up to 7.5 mg/day as a monotherapy found no significant dif-... 

Vasodilators work best in combination with other antihypertensive drugs that oppose the compensatory cardiovascular responses. (See Monotherapy versus Polypharmacy in Hypertension.)... 

Antihypertensive Dose Ranges as Monotherapy for the Angiotensin-Converting Enzyme Inhibitors Shown in Figure 2... 

Non-selective non-steroidal inflammatory drugs can attenuate the antihypertensive effects of ACE inhibitors and increase the risk of renal insufficiency. In 2278 patients taking NSAIDs, 328 taking ACE inhibitors, and 162 taking both, no nephrotoxicity was found in patients taking monotherapy, but there were three cases of reversible renal insufficiency in patients taking the combination (120). 

Schulte KL, Fischer M, Lenz T, Meyer-SabeUek W. Efficacy and tolerability of candesartan cilexetil monotherapy or in combination with other antihypertensive drugs. Results of the AURA study. Clin Drug Invest 1999 18 453-60. 

Initial therapy choices for hypertension in diabetes mellitus usually include angiotensin-converting enzyme inhibitors or an angiotensin receptor blocker due to their well documented renoprotective effects. Currently, angiotensin receptor blockers have less robust data to support cardiovascular reduction compared to other therapeutic choices, yet the data that exists appears to be positive in patients with type 2 DM. Also, diuretics have shown superior results to an ACE inhibitor in the ALLHAT trial. The ADA currently recommends the use of any class (ACE inhibitors, angiotensin receptor blockers, /3-blockers, diuretics, or calcium channel blockers) of antihypertensive medication that has shown benefit in prevention of poor cardiovascular outcomes. Choice of monotherapy may not be important, as an average of two to three antihypertensive medications are needed to reach blood pressure goals. 

Because of the availability of a number of drugs that lower BP without producing this degree of orthostatic hypotension, guanadrel is not employed in the monotherapy of hypertension, and is used chiefly as an additional agent in patients who have not achieved a satisfactory antihypertensive effect on multiple other agents. The need to... 

REGIMEN FOR ADMINISTRATION OF THE THIAZIDE-CLASS DIURETICS IN HYPERTENSION When a thiazide diuretic is used as the sole antihypertensive drug (monotherapy), its dose-response curve for lowering blood pressure in patients with hypertension should be... 

THERAPEUTIC USES Receptor antagonists are not recommended as monotherapy for hypertensive patients. They rather are used primarily in conjunction with diuretics, /3 blockers, and other antihypertensive agents. /3 Receptor antagonists enhance the efficacy of the blockers. 

Compared with other classes of antihypertensive agents, there is a greater frequency of achieving blood pressure control with Ca channel blockers as monotherapy in elderly subjects and in African Americans, population groups in which the low renin status is more prevalent. Ca " channel blockers are effective in lowering blood pressure and decreasing cardiovascular events in the elderly with isolated systolic hypertension. Indeed, these drugs may be a preferred treatment in these patients. 

Monotherapy with these mixed-acting antihypertensive drugs reduces blood pressure as effectively as other major antihypertensives and their combinations (15,16,17). In the stepped-care approach to antihypertensive drug therapy, mixed a/p-blockers are recommended for initial management of mild to moderate hypertension (step 1). Both drugs effectively lower blood pressure in essential and renal hypertension. Carvediioi also is effective in ischemic heart disease. 

Clonidine, guanabenz, and guanfacine are used in the management of mild to moderate hypertension (1,6). They have been used as monotherapy or to achieve lower dosages in combination with other classes of antihypertensive agents. 

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