Coronary artery disease agents lowering

Bethanechol, like any muscarinic agent, has negative inotropic, chronotropic and dro-motropic effects. It may also cause systemic vasodilatation, decreased TPR, and dramatically lowered blood pressure. In a healthy person, sympathetic reflexes would compensate for these effects. However, such reflexes would worsen symptoms in a patient with cardiovascular dysfunction. Bethanechol s use is therefore contraindicated in patients with pronounced bradycardia, hypotension, coronary artery disease, or any type of cardiac disease. 

Hypertension is the most common cardiovascular disease. Thus, the third National Health and Nutrition Examination Survey (NHANES III), conducted from 1992 to 1994, found that 27% of the USA adult population had hypertension. The prevalence varies with age, race, education, and many other variables. Sustained arterial hypertension damages blood vessels in kidney, heart, and brain and leads to an increased incidence of renal failure, coronary disease, cardiac failure, and stroke. Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels and to substantially reduce morbidity and mortality rates. Many effective drugs are available. Knowledge of their antihypertensive mechanisms and sites of action allows accurate prediction of efficacy and toxicity. As a result, rational use of these agents, alone or in combination, can lower blood pressure with minimal risk of serious toxicity in most patients. 

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