Renal disease heart failure and

Hypertension is a sustained, reproducible increase in blood pressure. Hypertension is one of the most common diseases affecting adults living in industrialized nations. In the United States, for example, hypertension occurs in approximately 30% of the general population aged 20 and over.44 The prevalence of this disease can be even higher in certain subpopulations (e.g., 41% in African Americans), and the incidence of hypertension increases with age.44,45 If left untreated, the sustained increase in blood pressure associated with hypertension can lead to cardiovascular problems (stroke, heart failure), renal disease, and blindness.15,22 108 111 These and other medical problems ultimately lead to an increased mortality rate in hypertensive individuals. 

Diuretics are highly efficient drugs for the treatment of edema associated with congestive heart failure. They are also used to increase the volume of urine excreted by the kidneys [9]. For example, duranide, 81, a dichlorinated benzene disulfonamide, is an oral carbonic anhydrase inhibitor. Duranide reduces intraocular pressure by partially suppressing the secretion of aqueous humor [11]. Diuril, 82, has an antihypertensive activity and is issued to control blood pressure [9]. Edecrin, 83, is an unsaturated ketone derivative of an aryloxyacetic acid. Edecrin is used in the treatment of the edema associated with congestive heart failure, renal disease, and cirrhosis of the liver [11]. Amiloride, 84, is also used as an adjunctive treatment with thiazide diuretics in congestive heart failure hypertension. 

Metformin is contraindicated in patients with heart failure, renal disease, hypersensitivity to metformin, and acute or chronic metabolic acidosis, including ketoacidosis. The drug is also contraindicated in patients older than 80 years and during pregnancy (Pregnancy Category B) and lactation. 

Half-life. Plasma half-life, about 1 to 3 hours, increased in subjects with renal failure, congestive heart failure, liver disease, and in neonates (up to about 20 hours). 

Thomson PD, Rowland M, Melmon KL. The influence of heart failure, liver disease, and renal failure on the disposition of hdocaine in man. Am Heart J 1971 82(3) 417-21. 

The rationale underlying the treatment of chronic HTN concerns its association with atherosclerosis and the increased risk of stroke, heart failure, renal diseases, peripheral vascular disease, and coronary artery disease. Except in severe HTN, there is no rash to start drug Rx prior to lifestyle changes because the goals are long term. Factors in hypertension include decreases in vagal tone, increases in sympathetic tone, increased renin-angiotensin activity, and water retention. 

It is a quinazoline-derived nonthiazide diuretic. It is found to be more effective in comparison to the thiazide-like diuretics in the treatment of edema in such patients who have a histoiy of compromised renal function. It is extensively indicated for hypertension, edema accompanying congestive heart failure, renal disease including the nephrotic syndrome and other conditions of retarded renal function. 

National and international trends over the past 15 years depict modest improvements in the treatment and/or control of blood pressure (BP) for hypertensive patients. This observation is made despite efforts to promote awareness, treatment, and the means available to aggressively manage high blood pressure. Over 65 million Americans have hypertension, which was listed as the primary cause of death for over 261,000 individuals in the United States in 2002.1 Hypertension is also a significant cause of end-stage renal disease and heart failure. National and international organizations continually refine their recommendations of how... 

Fluid overload occurs commonly in patients with renal failure, often in the absence of associated heart disease. If salt and water intake is not controlled in the patient who is oliguric or anaemic, plasma volume and symptoms of congestive heart failure ensue. Hypertension and coronary heart disease with increasing age contributes to the congestive heart failure. Diuretics like loop-diuretics or metolazone may be of value. Digitalis should be used with caution in patients on dialysis as cardiac arrhythmias may ensue in patients receiving dialysis in the presence of hypokalemia. 

Although U-II appears to play only a minor role in health, evidence is accumulating that it is involved in cardiovascular and other diseases. In particular, it has been reported that plasma U-II levels are increased in hypertension, heart failure, diabetes mellitus, and renal failure. In addition, the first study using a UT receptor antagonist in humans suggests that palosuran may benefit diabetic patients with renal disease. 

Livedo reticularis sometimes occurs in patients taking amantadine and usually clears within 1 month after the drug is withdrawn. Other dermatologic reactions have also been described. Peripheral edema, another well-recognized complication, is not accompanied by signs of cardiac, hepatic, or renal disease and responds to diuretics. Other adverse reactions to amantadine include headache, heart failure, postural hypotension, urinary retention, and gastrointestinal disturbances (eg, anorexia, nausea, constipation, and dry mouth). 

Acute and chronic bronchitis, pneumonia, upper respiratory infection, pulmonary emphysema, pulmonary heart disease, heart failure, acute nephritis and renal failure, chronic nephritis, gastritis, hypothyroidism, hypoadrenalism, fibromyalgia, rheumatic arthritis and rheumatoid arthritis. 

The role of the sympathetic nervous system in renal injury, end-stage renal disease, and renovascular hypertension are discussed through a literature review accompanying sympathetic nerve mechanisms in hypertension and obesity. Relevant studies of sympathetic nerve activity and 32-adrenoceptor polymorphism might contribute to the onset and maintenance of renal injury in healthy subjects and in patients with chronic heart failure and cardiovascular events in ESRD patients. A better understanding of the relationships of sympathetic nerve activity with renal injury might help clinical implications (treatment) for renal injury in hypertensive patients and hypertension in patients with ESRD. Recently, the role of denervation of renal sympathetic nerve in refractory hypertension has been examined and showed its efficacy in humans. The outcome from the study have not been established, but a number of animal studies show theoretical benefits for those patients in the acute phase. Further studies are needed to clarify the relationships between the sympathetic nerve activity and renal injury. 

However, these data are limited and must be interpreted with caution, since NSAIDs have significant toxic effects on the kidney only in patients at risk (that is those with volume depletion, heart failure, cirrhosis, intrinsic renal disease, and hypercalcemia), in whom the secretion of vasodilator prostaglandins is increased in an attempt to counteract the effect of increased renal vasoconstrictors, such as angiotensin II. 

Water retention due to sodium chloride (salt) is a common manifestation that leads to weight gain. Edema is also found in patients with cardiac heart failure, renal insufficiency, liver cirrhosis, and hypo-proteinemia. When large doses are used to treat neoplastic diseases, compounds with 17-alkyl substitutions can cause cholestatic hepatitis at high doses, jaundice is the most common clinical feature with accumulation of bile in the bile capillaries. Jaundice usually develops after 2-5 months of therapy. It can be detected by increases in plasma aspartate aminotransferase and alkaline phosphatase. 

Clinicians rely mainly on blood urea nitrogen (BUN) and serum creatinine measurements to evaluate patients with renal failure. Yet the correlation between symptoms and blood levels is at best approximate. In acute renal failure the underlying disease and its associated complications often dominate the clinical picture and determine the prognosis, and it is unclear at what level of nitrogen retention symptoms may be attributed to uremia. Clinicians generally institute dialysis when the BUN exceeds 100 mg/dl or the serum creatinine exceeds 10 mg/dl, but sometimes earlier or later, and early dialysis has not been shown to confer distinct benefits. In chronic renal failure, patients may be quite asymptomatic despite very high BUN and serum creatinine levels. Many so called uremic symptoms may be more properly attributed to anemia, heart failure, nephrotic edema and hypoproteinemia, hypertension, malnutrition, or uncontrolled diabetes or its complications, such as gastroparesis, diarrhea, and neuropathy. 

THERAPEUTIC USES Thiazide diuretics are used to treat edema associated with heart (congestive heart failure), liver (cirrhosis), and renal (nephrotic syndrome, chronic renal failure, and acute glomerulonephritis) disease. With the possible exceptions of metolazone and indapamide, most thiazide diuretics are ineffective when the GFR is <30-40 mL/min. 

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