Hypertension therapy

Scrip-Hypertension Therapy, Kesearch andMarket Opportunities, 2nd ed., PJB Pubbcations Ltd., Pharmabooks, Ltd., New York, 1991. 

Koenig MA, Geocadin RG, de Grouchy M, Glasgow J, Vimal S, Restrepo L, Wityk RJ. Safety of induced hypertension therapy in patients with acute ischemic stroke. Neurocrit Care 2006 4(l) 3-7. 

All patients taking these drugs for long-term hypertension therapy should first receive both a diuretic and a /1-blocker. The diuretic minimizes the side effect of sodium and water retention. Direct vasodilators can precipitate angina in patients with underlying coronary artery disease unless the baroreceptor reflex mechanism is completely blocked with a /3-blocker. Nondihydropyridine CCBs can be used as an alternative to /3-blockers in patients with contraindications to /3-blockers. 

Hypertension therapy suggests wide use of diuretics, including thiazide diuretics, drugs related to them, such as metolazone (21.3.20) and indapamide (21.3.26), furosemide (21.4.11), loop diuretics, as well as potassium sparing diuretics—spironolactone (21.5.8), triamterene (21.5.13), and amyloride (21.5.18). 

The most frequently used antiadrenergic drugs for hypertension therapy are the fi-adrenoblockers. Despite the fact that they have been used for many years, their mechanism of action is not completely understood. Only one thing is clear—they are competitive antagonists of adrenaline and noradrenaline on cardiac j3-adrenergic receptors. 

Unlike other adrenoblockers, labetalol lowers blood pressure more by lowering resistance of peripheral vessels than by suppressing myocardial function. This, along with a reduction in pressure, fails to change heart rate. Currently, eight of the most frequently used j8-adrenoblock-ers in medicine are used for hypertension therapy, and their syntheses are described in Chapter 12. They are propranolol (12.1.3), metoprolol (12.1.5), acebutol (12.1.6), athenolol (12.1.7), nadolol (12.1.8), pindolol (12.1.9), timolol (12.1.10), and labetalol (12.1.12). 

Agents used in hypertension therapy are listed in the following tables ... 

The patient had been started on anti-hypertensive therapy in hospital and has not been checked since... 

The adverse event needs to be clinically significant enough that the risk-benefit of therapy is percieved to be altered. In this regard, the acceptable risk-benefit profile of anti-cancer therapies is markedly diflFerent than, for example, that of anti-hypertension therapy. 

Dibenamine has been employed with excellent results in the diagnosis and preoperative therapy of pheochromocytoma (90, 91). The pressor response evoked by the histamine test in these patients is completely blocked and reversed, and the injection of Dibenamine at 72-hour intervals has been found to provide complete symptomatic relief. In human essential hypertension, therapy with Dibenamine produces a very significant fall in both systolic and diastolic pressures in some patients (see 12). In severe hypertension, particularly the malignant form, the drug has been found to lower the blood pressure significantly in most cases, but rarely to return it to the normotensive range. However,... 

Six drugs (including nimodipine) used together in a program of hypertension therapy were determined simultaneously by HPLC [24], The tablets were extracted with methanol, and felodipne was added as an internal standard. A column (25 cm x 4 mm i.d.) of Jasco Metaphase ODS silica (5 pm) was used with a mobile phase (flow rate of 1.5 mL/min) of 10 mM phosphate buffer of pH 4.5/acetonitrile (1 1). Detection was effected at 250 nm, and the linear operational range was found to be 25-3200 ng/mL. 

Optimizing Anti hypertensive Therapy by Angiotensin Receptor Blockers 157... 

Hexamethonium was the first orally active drug to treat hypertension. Like all agents in this group it blocks sympathetic and parasympathetic systems alike. Severe side effects have rendered them of historical interest only in hypertension therapy. 

Qureshi Al, Suarez JI, Bhardwaj A, Yahia AM, Tamargo RJ, Ulatowski JA. 2000. Early predictors of outcome in patients receiving hypervolemic and hypertensive therapy for symptomatic vasospasm after subarachnoid hemorrhage. Crit. Care Med. 28 824-29... 

Erickson, S.R. Slaughter, R. Halapy, H. Pharmacists ability to influence outcomes of hypertensive therapy. Pharmacotherapy 1997, 17, 140-147. 

For many pharmacists, their first encounter with the terminology quality of life was in the 1986 New England Journal of Medicine article by Croog et alJ entitled The effects of hypertensive therapy on the quality of life. The authors found that antihypertensive agents had different effects on the quality of life and that these differences can be meaningfully assessed with available psychosocial measures. Currently, the clinical community is more aware of patient-based measures and the potential uses of health status assessments. Curriculum of many schools of pharmacy now includes some information on outcomes of patient care beyond just the traditional biological measures. 

Another target of pulmonary hypertension therapies is endothelin (Figure 8.5), which is elevated in this disease, correlates to disease severity, and is localized immunohistochemically to the plexogenic lesions. There are two endothelin receptors ETa and ETb. ETa is found primarily on vascular SM cells, mediates the vasoconstrictive and mitogenic response, and is a direct target of both ETa-specific and nonspecific endothelin... 

Pharmacologically, the ability (i) to selectively deliver dopamine to peripheral kidney receptors without eliciting complications due to the presence of dopamine receptors in the central nervous system (CNS) and (ii) to maintain a supply of nonmetabolized dopamine would be advantageous in cardiovascular hypertension therapy (6). The additional issues presented by this type of application include the dimensions of the dendrimer encapsulated dopamine and the targetting of the unit to the appropriate dopamine receptor sites. 

With the availability of newer drugs that are both effective and well tolerated, the use of reserpine has diminished because of its CNS side effects. Nonetheless, there has been some interest in using reserpine at low doses, in combination with diuretics, in hypertension therapy, especially in the elderly. Reserpine is used once daily with a diuretic, and several weeks are necessary to achieve a maximum effect. The daily dose should be limited to 0.25 mg or less, and as little as 0.05 mg/day may be effective when a diuretic is also used. Reserpine is considerably less expensive than many other antihypertensive drugs thus, it is still used in developing nations. 

Anti-hypertensive therapy to prevent stroke (ages 40-69) 940... 

Fig. 5.9 Prediction of infarct growth. A 65-year-old man, improving clinically at 5 h postictus, was monitored in the Neurology ICU based on his labile blood pressure, a fixed left M2 occlusion on CTA, and a significant core/penumbra mismatch on CTP/MRP. His 24-h follow-up DWI showed a small infarction. However, 24 h after cessation of hypertensive therapy there was infarct growth into the region of penumbra. Admission CTA (top) CTP (CBV/CBF/ MTT) at 4.5 h second row) MR-perfusion weighted imaging (MR-PWI) (CBV/CBF/MTT) at 5.25 h (third row) DWI at 24 h (fourth row) and follow-up DWI at 48 h (bottom). The CTP and MR-PWI demonstrate a mismatch between the CBV (no abnormality) and the CBF/MTT penumbra (arrows). After cessation of hypertensive therapy, the DWI abnormahty grows into the region predicted by the CBF/MTT maps...

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