Hypertension benefits

Cardiovascular Blood pressure changes, tachycardia, phlebitis, stroke, myocardial infarction, and collapse have been associated with intravenous immunoglobulin in patients at risk [39 , 40, 43, 45, 52 , 53 . One patient with impairment of preexisting hypertension benefited from increasing the administration period from 2 to 3 days [54. ... 

Performance of an acquisition during the portal phase of enhancement of a CT enables evaluation of portal and variceal anatomy and of portosystemic shunts without the need for an additional injection of contrast material. Three-dimensional reconstruction of portal-phase CT angiograms enhances the perception of the courses and anatomic relationships of varices and shunts, and the presence and extension of portal thrombosis (Henseler et al. 2001). SSD can be very useful for displaying variceal anatomy during the portal phase. Also, 3D-MR angiography can detect the presence and the extension of collateral vessel pathways. Patients with portal hypertension benefit from the use of MR angiog-... 

Nifedipine, verapamil, and diltiazem are all efficacious in the treatment of mild and moderate hypertension, but nifedipine is more efficacious than diltiazem and verapamil in the control of severe hypertension. Nifedipine does not cause significant reflex tachycardia or orthostatic hypotension. Nifedipine benefits the older and black patients and patients with low PRA. 

One study (83) indicated that in mildly hypertensive male patients treated with an antihypertensive dmg, those below the age of 50 or having no clinical evidence of cardiovascular disease had no significant improvement from cardiovascular diseases within 3.3 years those over the age of 50 or having pre-existing cardiovascular disease benefited significantly. 

Finally, drug treatment in the elderly is of great importance and warrants special attention with regard to safety and tolerability, since systolic blood pressure is recognized as an important target for treatment, particularly in older persons. The benefits of antihypertensive treatment in the elderly and in patients with isolated systolic hypertension are greater than in younger persons. 

As a result of such studies hypertension has been operationally defined as the blood pressure level above which therapeutic intervention has clinical benefit. As increasingly aggressive intervention has continued to demonstrate benefits, this level has gradually reduced over time and is commonly defined as systolic blood pressure>l40 mmHg and/or diastolic blood pressure >90 mmHg (Table 1). Isolated systolic hypertension is defined as systolic blood pressure >140 mmHg and diastolic blood pressure <90 mmHg. 

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

Like dyslipidemia, hypertension is a major, modifiable risk factor for the development of IHD and related complications. Unfortunately, awareness, treatment, and control of blood pressure are not nearly enough.30 Aggressive identification and control of hypertension is warranted in patients with IHD to minimize the risk of major adverse cardiac events. Goal blood pressure in patients with IHD is less than 140/90 mm Hg or less than 130/80 mm Hg in patients with diabetes. Because of their cardioprotective benefits, 3-blockers and ACE inhibitors (or ARBs in ACE-inhibitor-intolerant patients), either alone or in combination, are appropriate for most patients with both hypertension and IHD. 

Examples abound regarding the role of serendipity in the discovery of new therapeutic approaches, which on closer examination usually turned out to be the result of clinicians paying attention to unexpected clinical effects rather than discounting them. For example, lithium was tried first for hypertension, chlorpro-mazine was initially developed as an anesthetic, and imipramine was originally regarded as an antihistamine and an antipsychotic agent. Without astute clinical observations, these drugs would not have found their niche, nor would clozapine have been revived for the benefit of millions of the most difficult to treat schizophrenic patients. Other examples include the expanded indications of newer... 

Selection of drug therapy should follow the JNC 7 guidelines, but the treatment approach in some patient populations may be slightly different. In these situations, alternative agents may have unique properties that benefit a coexisting condition, but the data may not be based on evidence from outcome studies in hypertension. 

No evidence exists for the superior efficacy of one antihypertensive agent versus another. For women with severe hypertension (diastolic blood pressure greater than or equal to 100 mm Hg), the benefit of drug therapy may outweigh the risks. 

FIGURE 59-1. Pharmacotherapy treatment algorithm. A select population of individuals, based on body mass index (BMI) and waist circumference (WC) together with concurrent risk factors, may benefit from medication therapy as an adjunct to a program of weight loss that includes diet, exercise, and behavioral modification. (CHD, coronary heart disease DM, diabetes mellitus, HTN, hypertension INC WC, >40 inches for males and >35 inches for females LCD, low-calorie diet.)... 

The pharmacological mechanisms of action of NO donors that contribute to their benefit in coronary artery disease, congestive heart failure, and hypertension are listed in Table 11.1. These actions can be grouped into five categories vasodilation, decrease in myocardial oxygen consumption, improvement in hemodynamic performance,... 

Many disorders benefit from exercise (Pederson Saltin, 2005). These include asthma, cancer, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), depression, type 1 diabetes melUtus, type 2 diabetes melUtus, hypertension, intermittent claudication, osteoarthritis, osteoporosis, rheumatoid arthritis and obesity. 

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