Blood pressure increment

Edwards N, Blyton DM, Kirjavainen T, Kesby GJ, Sullivan CE. Nasal continuous positive airway pressure reduces sleep-induced blood pressure increments in preeclampsia. Am J Respir Crit Care Med 2000 162 252-257. 

Nicardipine 5 mg/h continuous IV infusion. Titrate by 2.5 mg/h increments every 5-15 min to a maximum of 15 mg/h ° If blood pressure is not reduced and maintained at target range (systolic <185 mmHg and diastolic <110 mmHg), do not administer fibrinolytic... 

Factors that predispose an individual to IHD are listed in Table 4—2. Hypertension, diabetes, dyslipidemia, and cigarette smoking are associated with endothelial dysfunction and potentiate atherosclerosis of the coronary arteries. The risk for IHD increases two-fold for every 20 mm Hg increment in systolic blood pressure and up to eight-fold in the presence of diabetes.5,6 Physical inactivity and obesity independently increase the risk for IHD, in addition to predisposing individuals to other cardiovascular risk factors (e.g., hypertension, dyslipidemia, and diabetes). 

Titration in increments of 0.05 mg/kg/minute every 10-15 minutes as tolerated by blood pressure until the desired therapeutic response has been obtained, limiting symptoms develop, or a dose of 0.20 mg/kg/minute is reached... 

In CEA, the total cost and the total benefits, measured in terms of an efficacy parameter, associated with two or more treatment pathways are added, and the increment is calculated. The incremental costs are then compared (in a ratio) with incremental outcomes (as measured in physical or natural emits). Physical and natural units can include both intermediate (surrogate) clinical endpoints (e.g. millimetres of mercury blood pressure reduction, changes in FEVi) or final endpoints (e.g. deaths averted or life-years gained). In a study that assessed the cost per deaths due to pulmonary embolism averted, Hull and associates reported that subcutaneous administration of... 

The recommended doses represent a compromise between a desirable controlled reversal and the need for prompt response and adequate duration of action. Using higher dosages or shorter intervals between incremental doses may increase the incidence and severity of symptoms related to acute withdrawal such as nausea, vomiting, elevated blood pressure, and anxiety. 

If adequate therapeutic effect is not observed within 5 minutes, repeat loading dose and follow with maintenance infusion increased to 100 mcg/kg/min. Continue titration procedure, repeating loading infusion, increasing maintenance infusion by increments of 50 mcg/kg/min (for 4 minutes). As desired heart rate or a safety endpoint (eg, lowered blood pressure) is approached, omit loading infusion and titrate the maintenance dosage up or down to endpoint. Also, if desired, increase interval between titration steps from 5 to 10 minutes. 

Initial dose 40 mg once daily, alone or in addition to diuretic therapy. Gradually increase dosage in 40 to 80 mg increments until optimum blood pressure reduction is achieved. 

Initial dose - 5 mg twice daily, alone or with other antihypertensive agents. If a satisfactory reduction in blood pressure does not occur within 3 to 4 weeks, adjust dose in increments of 10 mg/day at 3 to 4 week intervals, to a maximum of 60 mg/day. ... 

Give patients in an off state a 0.2 mL (2 mg) test dose where blood pressure can be closely monitored by medical personnel. Check supine and standing blood pressure predose and at 20, 40, and 60 minutes postdose. Do not consider patients who develop clinically significant orthostatic hypotension as candidates for treatment. If the patient tolerates the 0.2 mL (2 mg) dose and responds, use the starting dose of 0.2 mL (2 mg) on an as-needed basis to treat existing off episodes. If needed, the dose can be increased in 0.1 mL (1 mg) increments every few days on an outpatient basis. 

Hypertension PO Initially, 2.5 mg ql2h for 2 days, then increase by 2.5-mg increments at more than 2-day intervals until desired blood pressure is achieved. The average daily dose is 25 mg in 3 divided doses. 

Mild to moderate hypotension SC,1M 2-5mg(range 1-10 mg), repeated no more than every 10-15 minutes. Maximum initial dose 5 mg. IV 0.2 mg (range 0.1 to 0.5 mg), given no more frequently than every 10-15 minutes. Maximum initial dose 0.5 mg. Severe hypotension, severe shoch IV Initially, 100-180 mcg/minlVinfusion,withdose titration to the desired MAP and SVR. A maintenance infusion rate of 40-60 mcg/min IV is usually adequate after blood pressure stabilizes. If necessary to produce the desired pressor response, additional phenylephrine in increments of 10 mg or more may be added to the infusion solution and the rate of flow adjusted according to the response of the patient. 

In a report of 122 elderly patients on risperidone, hypotension was noted in 28.7% and symptomatic orthostatic hypotension was noted in 9.8%. Significant decreases in blood pressure occurred with risperidone treatment (p = 0.0001) and were common in patients with cardiovascular disease and those taking an SSRI or valproate (p = 0.03) (502). Hence, like other antipsychotics, risperidone should be prescribed cautiously for elderly patients and those with preexisting cardiac disease. Its hypotensive versus its orthostatic hypotensive effects may be an age-related pharmacodynamic response. Blood pressure, including orthostatic blood pressure, should be monitored routinely until the risperidone dosage is stabilized. Furthermore, when risperidone therapy is initiated in the elderly, dosage should be titrated from 0.25 to 0.5 mg two times a day with increments of 0.25 to 0.5 mg weekly (92). 

In 25 unmedicated subjects with hypertension yohimbine 22 mg increased mean blood pressure by an average of 5 mm Hg, plasma noradrenaline by 66%, and plasma dihydroxyphenylglycol by 25% at 1 hour after administration (3). The magnitude of the pressor response was unrelated to baseline pressure but correlated positively with baseline noradrenaline concentration and with the yohimbine-induced increment in plasma noradrenaline. 

There are three clinical trials using phenylephrine in septic shock evaluating 38 patients. Phenylephrine (0.5 to 9 mcg/kg per minute), when used alone or in combination with dobutamine or low doses of dopamine, improves blood pressure and myocardial performance in fluid-resuscitated septic patients. Incremental doses of phenylephrine over 3 hours result in linear dose-related increases in MAP, SVR, heart rate, and stroke index when administered as a single agent in stable, nonhypotensive but hyperdynamic, volume-resuscitated... 

Figure 12 Effect of GW 1229 on the pressor responses induced by NPY and norepinephrine (NE) in inactin-anesthetized rats. GW 1229 was administered as an intravenous infusion at half log incremental doses (0.1-10 nmol kg 1 min-1) over a 10 min period. Porcine NPY (1 nmol kg-1) and NE (3 nmol kg-1) were administered as an intravenous bolus, 1 min after the end of the compound infusion and peak changes in mean arterial blood pressure (MAP) were recorded. Note the absence of any effect on the pressor response to iv NE. Control MAP changes to NPY and NE were 28 1 and 56 8 mmHg, respectively. Results are shown as percent change of control (mean SE n = 5). P< 0.05 P< 0.01. (Reproduced from Proc. Natl Acad. Sci. USA 1995 92, 9067-9071.)...

Epinephrine infusion (see p 442) may be useful in treating hypotension via combined vasoconstrictor and inotropic actions. Dosing recommendations in one study were 0.25 mcg/kg/min, increasing by increments of 0.25 mcg/kg/min until adequate blood pressure was obtained, along with administration of high-dose diazepam (see below) and mechanical ventilation. 

Several faetors affect the increment of blood pressure in humans among th sodium chloride was reeognized as a major factor. A high level of sodium chloride in the diet has been shown to increase the blood pressure of human and animal models of hypertension (Boon and Aronson 1985). Several investigators noted that the ingestion of nonchloride sodium salts did not cause an elevation of the blood pressure but the ingestion of chloride salts has been shown to be associated with the elevation of the blood pressure. These results indicate that chloride ion plays a key role in the elevation of the blood pressure in human and animal models of hypertension. 

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