Patient compliance 1-blockers

To circumvent problems, encourage patient compliance, avoid excessive doses, avoid combining sympatholytics and -blockers, and maintain antihypertensive medication in surgical patients. When discontinuing medication, taper the dose slowly, one drug at a time use special caution in patients with coronary artery or cerebrovascular disease. 

Although the p-blockers are well-tolerated drugs and patient compliance is good, there may be problems with their administration, particularly in patients with decompensated hearts and cardiac conductance disturbances. These potential problems and the adverse effect of p-blockers are described in detail in Chapter 11. 

Common effects The (3-blockers may cause CNS side effects such as fatigue, lethargy, insomnia, and hallucinations these drugs can also cause hypotension. The p-blockers may decrease libido and cause impotence drug-induced sexual dysfunction can severely reduce patient compliance (Figure 19.8). 

Convenience, with improved patient compliance. This is particularly appropriate when two drugs are used at constant dose, long term, for an asymptomatic condition, e.g. a thiazide plus a 13-adrenoceptor blocker in mild or moderate h) ertension. The fewer tablets the patients have to take, the more reliably will they use them, especially the elderly—who as a group receive more drugs because they have multiple pathology. 

Monitoring BNP Is the patient taking tile correct dosage of P- blocker No change Review dosage and patient compliance No change in symptoms, risk of cardiac event, more clinic visits... 

H. Petri and J. Urqnhart, Patient compliance with beta-blocker medication in general practice. Pharmacoepid Drug 5 a/33 251-256 (1994). 

Compared with placebo, the combination of hydralazine and isosorbide dinitrate (ISDN) reduced mortality in patients receiving diuretics and digoxin (but not ACE inhibitors or /3-blockers). However, another trial comparing the combination with an ACE inhibitor found that mortality was lower in the ACE inhibitor group. Adverse effects (primarily headache and gastrointestinal complaints) with combined hydralazine-ISDN were common, limiting their use in many patients. Patient compliance also was an important issue because hydralazine-ISDN therapy was given four times daily in these trials. Whether less frequent administration provides equivalent benefit is unknown. 

B. Monotherapy It has been found in large clinical studies that many patients do well on a single drug (eg, an ACE inhibitor, calcium channel blocker, or alpha -blocker). This approach to the treatment of mild and moderate hypertension has become more popular than stepped care because of its simplicity, better patient compliance, and—with modern drugs—a relatively low incidence of toxicity. 

ACC/AHA guidelines (II), the combined use of hydralazine-isosorbide dinitrate may be considered as a therapeutic option in patients with reduced LV dysfunction already taking ACE inhibitors and (3 blockers and with persistent symptoms. Despite the lack of data about this vasodilator combination in patients who are intolerant of ACE inhibitors, the combined use of hydralazine and isosorbide dinitrate may be considered as an additive therapeutic option in such patients, However, compliance with this combination has generally been poor because of the large number of tablets required and the high incidence of adverse reactions. 

Topical CAls offer distinct advantages over other inhibitors of aqueous humor formation. Compared with P-blockers, CAls reduce the nocturnal aqueous flow rate by 25%. P-Blockers lack the ability to suppress aqueous formation below the already reduced flow rate that occurs during sleep. In contrast to systemic CAls, topical CAls lack most of the systemic side effects while producing a comparable ocular hypotensive effect. None of the topical CAls, however, has the ability to reduce lOP to the level achieved by 500 mg of oral acetazolamide.Topical agents are used in place of systemic CAls for chronic treatment of primary and secondary open-angle glaucomas. Other recently developed medications have probably relegated the position of topical CAls to second- or third-line therapy. Cosopt may simplify therapy and improve compliance for patients who require treatment with both timolol and dorzolamide. 

Current guidelines recommend that hydralazine-ISDN should not be used instead of ACE inhibitors as standard therapy in heart failure or substituted for ACE inhibitors in patients who are tolerating an ACE inhibitor. The combined use of hydralazine-ISDN may be considered a therapeutic option in patients unable to take an ACE inhibitor or an ARB because of renal insufficiency, hyperkalemia, or possibly hypotension. However, it should be anticipated that compliance with this regimen will be poor and the risk of adverse effects high. Therefore, given the proven benefits and low risk of adverse effects, many clinicians now prefer ARBs in patients who cannot tolerate an ACE inhibitor. There are no controlled trials evaluating the benefits of adding hydralazine-ISDN therapy to patients who remain symptomatic despite ACE inhibitor and/or /S-blocker treatment. 

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