Response with hypertension

G protein p-3 subunit Truncated protein with increased signal transduction in carriers of the 825T allele. Associated with hypertension and with the response to thiazide diuretics. 

Figure 1. Cardiac output and blood pressure response in patient with hypertension...

Patients with 11/1-hydroxylase deficiency present with features of androgen excess, including masculinization of female newborns and precocious puberty in male children. There are two human isozymes that are responsible for cortisol and aldosterone synthesis, respectively. The CYP11B1 enzyme (p45011B) converts DOC to corticosterone (B) and 11-deoxycortisol (S or 11-dihydrocortisol) to cortisol (F). It is also capable of 18-hydroxylating DOC but cannot convert to aldosterone. The latter transformation is carried out by CYP11B2 (also known as aldosterone synthase), which encompasses activity for 18-hydroxylation and subsequent 18-oxidation. When CAH is associated with hypertension, deficient lljS-hydroxylase (CYP11B1) is suspected at this time more than ten mutations have been defined in affected individuals [103]. 

Caffeine temporarily increases blood pressure, but the body readily compensates and adjusts back to its normal blood pressure. Flowever, people with hypertension may have a more sensitive response to the drug, as caffeine may raise the blood pressure to a higher level in those with chronic high blood pressure. 

Cushman WC, Reda DJ, Perry HM, Williams D, Abdellatif M, Materson BJ. Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. Arch Intern Med 2000 160 825-831. 

Coronary Drug Project Research Group (1980). Influence of adherence to treatment and response to cholesterol on mortality in the Coronary Drug Project. New England Journal of Medicine 303 1038-1041 Dahlof B, Lindholm LH, Hansson L etal. (1991). Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-hypertension). Lancet 338 1281-1285 Davis KL, Thai LJ, Gamzu ER et al. (1992). 

ANTI HYPERTENSIVES AND HEART FAILURE DRUGS ALCOHOL 1. Acute alcohol ingestion may t hypotensive effects 2. Chronic moderate/ heavy drinking 1 hypotensive effect 1. Additive hypotensive effect. 2. Chronic alcohol excess is associated with hypertension Monitor BP closely as unpredictable responses can occur. Advise patients to drink only in moderation and avoid large variations in the amount of alcohol drunk... 

NITRATES OESTROGENS 1 antihypertensive effect of nitrates Oestrogens may cause fluid retention, and use of oestrogens with hypertension needs to be closely monitored Monitor BP at least weekly until stable watch for poor response to nitrates... 

Systemic Effects. Ocular administration of phenylephrine has been reported to induce acute hypertension (see Table 8-2). Sixty patients were studied after three applications of the 10% solution in each eye at 10-minute intervals.Thirty minutes after the last drop, systolic elevations of 10 to 40 mm Hg and diastolic elevations of 10 to 30 mm Hg occurred in all subjects. In each case pulse rate decreased 10 to 20 beats per minute. In contrast to these observations, however, other investigators reported a lack of systemic vasopressor response with the 10% concentration. 

Doses of naloxone over 1 pg/kg should be given with caution, especially to patients with hypertension. Massive release of catecholamines in response to pain after administration of naloxone can trigger left ventricular failure, partly by causing a shift in fluid from the intravascular to the interstitial space. Thus, alpha-blockers such as phento-lamine have been postulated to be beneficial in its management (SEDA-17, 88). A fatal case of pulmonary edema followed the use of naloxone in a young man (9), although the causal link was disputed (10). 

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