DOCSLIB.ORG

Diuretic Treatment of Hypertension

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diuretic Treatment of Hypertension HYPERTENSION Diuretic Treatment of Hypertension 1 3 EHUD GROSSMAN, MD FABIO ANGELI, MD cerebrovascular disease, combination 2 4 PAOLO VERDECCHIA, MD, FACC, FAHA, FESC GIANPAOLO REBOLDI, MD, PHD, MSC 1 therapy of a diuretic (indapamide) and ARI SHAMISS, MD ACE inhibitor (perindopril) reduced the risk of stroke by 43% compared with pla- cebo. Perindopril alone, despite lowering systolic BP by 5 mmHg, decreased stroke lthough thiazide and thiazide-like multiple-drug combinations in patients risk only by a nonsignificant 5%. diuretics are indispensable drugs in with resistant hypertension. The main Several studies attested to the supe- A fi the treatment of hypertension, their argument that will be discussed is the rior ef cacy of diuretic therapy over other role as first-line or even second-line drugs place of diuretics as first-line drugs or add- antihypertensive agents in reducing the is a provoking debate. on drugs in the context of the available risk for stroke (4–6,8,10,11). In the Sec- The European Society of Cardiology/ antihypertensive armamentarium. ond Australian National Blood Pressure European Society of Hypertension (ESC/ The pro side of the controversy will Study (ANBP2) (10), fatal stroke occurred ESH) guidelines recommend that thiazide argue that diuretics should remain the two times more in patients treated with an diuretics should be considered as suitable preferred drugs for initial treatment in ACE inhibitor than in patients treated as b-blockers, calcium antagonists, ACE many hypertensive patients, whereas the with a diuretic. In the Antihypertensive inhibitors, and angiotensin receptor cons side will contend that emerging and Lipid-Lowering Treatment to Prevent blockers for the initiation and mainte- evidence from outcome-based studies is Heart Attack Trial (ALLHAT) (4,5), chlor- nance of antihypertensive treatment (1). casting doubt on the role of these drugs as thalidone was superior to the a-blocker Another European position, en- first-line and even second-line antihyper- doxazosin mesylate in the prevention of dorsed by the British Hypertension Soci- tensive treatment. stroke and was superior to the ACE inhib- ety, is that diuretics and calcium channel itor lisinopril in the prevention of stroke blockers should be first-line drugs in THE PRO SIDE—Lowering blood in black individuals. In the Medical Re- hypertensive patients aged $55 years pressure (BP) has been shown to reduce search Council (MRC) study in 1985, or black patients of any age, whereas the risk of cardiovascular (CV) morbidity bendrofluazide was documented to be al- ACE inhibitors (or angiotensin receptor and mortality. The main benefitoflow- most three times as efficacious as the blockers in the case of intolerance to ering BP is due to the reduction in the risk b-blocker propranolol hydrochloride in ACE inhibitors) should be first-line of stroke and heart failure (HF). In many preventing stroke (8). In the MRC trial drugs in hypertensive patients younger trials in which a reduction in CV events in elderly patients (6), hydrochlorothia- than 55 years of age (http://nice.org.uk/ was documented, antihypertensive ther- zide and amiloride reduced the risk of CG034guidance). apy was diuretic-based (3–8). stroke, whereas b-blockers failed to re- The Seventh Report of the Joint Na- duce the risk of stroke despite a similar tional Committee (JNC VII) on Prevention, Effect of diuretic treatment on lowering of BP. In the International Nifed- Detection, Evaluation, and Treatment of stroke morbidity and mortality ipine GITS Study: Intervention as a Goal High Blood Pressure recommends that In the era of placebo-controlled trials, in Hypertension Treatment (INSIGHT), thiazide diuretics should be preferred several studies attested to the efficacy of 25 mg hydrochlorothiazide plus amiloride drugs in “most” hypertensive patients, ei- diuretics in reducing stroke morbidity 2.5 were as effective as 30 mg nifedipine for ther alone or combined with drugs from and mortality (6,7). In a recent published preventing stroke (12). other classes (2). study from China, indapamide given to In a large meta-analysis, including The present review does not intend to patients with a history of stroke or tran- 48,220 patients, Psaty et al. (13) found negate the important role of diuretics in sient ischemic attack reduced the risk of that high-dose diuretic therapy reduced certain groups of patients (blacks, salt- stroke by 31% (3). In the Perindopril the risk of stroke by 51%, whereas ther- sensitive patients, concomitant heart Protection Against Recurrent Stroke apy with b-blockers reduced the risk by failure) or to underestimate their role in Study (PROGRESS) (9) in patients with only 29% (P = 0.02). Klungel et al. (14) showed that among 1,237 single-drug ccccccccccccccccccccccccccccccccccccccccccccccccc users with no history of CV disease, the From the 1Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, adjusted risk of ischemic stroke was 2 to affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; the 2Divisione di Me- 2 1/2 times higher among users of dicina, Ospedale di Assisi, Assisi, Italy; the 3Struttura Complessa di Cardiologia, Ospedale S. Maria della b-blockers, calcium antagonists, or ACE Misericordia, Perugia, Italy; and the 4Dipartimento di Medicina Interna, Università di Perugia, Perugia, Italy. inhibitors than among users of a diuretic Corresponding author: Paolo Verdecchia, [email protected]. alone. Interestingly, even in patients with This publication is based on the presentations at the 3rd World Congress on Controversies to Consensus in Diabetes, Obesity and Hypertension (CODHy). The Congress and the publication of this supplement were CV disease, diuretics still conferred a lower made possible in part by unrestricted educational grants from AstraZeneca, Boehringer Ingelheim, Bristol- stroke risk than other drugs, although Myers Squibb, Daiichi Sankyo, Eli Lilly, Ethicon Endo-Surgery, Generex Biotechnology, F. Hoffmann-La the difference was considerably smaller. Roche, Janssen-Cilag, Johnson & Johnson, Novo Nordisk, Medtronic, and Pfizer. The recent Avoiding Cardiovascular DOI: 10.2337/dc11-s246 © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly Events Through Combination Therapy cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/ in Patients Living With Systolic Hyper- licenses/by-nc-nd/3.0/ for details. tension (ACCOMPLISH) trial showed care.diabetesjournals.org DIABETES CARE, VOLUME 34, SUPPLEMENT 2, MAY 2011 S313 Diuretics in hypertension that a combination of the ACE inhibitor studies showed the efficacy of diuretics and that this protective effect disappears benazepril with hydrochlorothiazide was in reducing CV morbidity and mortality within 4 months after use is discontinued. less effective in lowering the risk of the in the elderly (6,7,16,19). In the Systolic Thus, in addition to their use to lower BP, predefinedprimaryendpointsthanthe Hypertension in the Elderly Program thiazide plays a major role in the preven- combination of benazepril with amlodipine (SHEP) (7), chlorthalidone reduced in el- tion of osteoporosis and fractures. (15). However, analysis of the benefitfor derly patients with isolated systolic hy- Diuretic therapy can transform non- the individual components of the pri- pertensiontherateoftotalstrokeby dippers to dippers and thereby offer an mary end points showed that, for stroke 36%, the rate of major CV events by additional therapeutic advantage of re- prevention, hydrochlorothiazide and 32%, and the rate of all-cause mortality ducing the risk of CV complications (25). amlodipine were the same. Thus, for stroke by 13%. We have shown in a meta-analysis prevention, a diuretic is superior to some that in the elderly, diuretics are more ef- Diuretic-induced glucose elevations antihypertensive agents. fective than b-blockers in lowering BP Several studies showed that use of thia- (20). Moreover, only diuretics reduced zide diuretic increases glucose levels Effect of diuretic treatment on HF the risk of coronary heart disease and all- (4,12,26), but in these studies, the second Thiazide diuretic is very effective in pre- cause mortality (20). The ALLHAT study, drug was a b-blocker that impaired glu- venting the development of HF in hyper- which showed superiority of diuretics cose metabolism. The Atherosclerosis tensive patients. In a large meta-analysis over other antihypertensive agents in Risk in Communities (ARIC) study as- that included 18 long-term placebo- some secondary end points (see above), sessed the incidence of new-onset diabe- controlled randomized trials, high-dose was not defined as a study of the elderly, tes (NOD) after 3 and 6 years in 12,550 diuretic therapy reduced the risk of HF by but 57.5% of the participants were age adults who did not have diabetes. Patients 83% and low-dose diuretic reduced the $65 years; therefore, this study is con- who received thiazide diuretics were not risk of HF by 42% (13). In the Hyperten- sidered a study in the elderly (4,5). The at greater risk for the subsequent devel- sion in the Very Elderly Trial (HYVET), only exception was the ANBP2 study, in opment of diabetes than the subjects with indapamide reduced the rate of HF by which treatment with an ACE inhibitor in hypertension who were not receiving any 64% in very elderly patients with hyper- older subjects, particularly men, led to antihypertensive therapy (27). In this tension (16). In INSIGHT, diuretic was better outcomes than treatment with di- study, only subjects with hypertension more effective than nifedipine in prevent- uretic agents, despite similar reductions who were taking b-blockers had a 28% ing nonfatal HF (12). In the ALLHAT of BP (10). It is noteworthy that the design higher risk of subsequent diabetes. In study, chlorthalidone was superior to of the ANBP2 study was less rigorous than the ACCOMPLISH study, the effects of doxazosin, lisinopril, and amlodipine in other studies, since it was a prospective, the two treatment arms on glucose levels preventing HF (4,5).
Load more

Recommended publications
  • Angiotensin-Converting Enzyme Inhibitors Or Angiotensin II Receptor Blockers and the Risk of Developing Rheumatoid Arthritis in Antihypertensive Drug Users
    Jong, H.J.I. de, Vandebriel, R.J., Saldi, S.R.F., Dijk, L. van, Loveren, H. van, Cohen Tervaert, J.W., Klungel, O.H. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and the risk of developing rheumatoid arthritis in antihypertensive drug users. Pharmacoepidemiology and Drug Safety: 2012, 21(8), 835-843 Postprint Version 1.0 Journal website http://dx.doi.org/10.1002/pds.3291 Pubmed link http://www.ncbi.nlm.nih.gov/pubmed/22674737 DOI 10.1002/pds.3291 This is a NIVEL certified Post Print, more info at http://www.nivel.eu Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and the risk of developing rheumatoid arthritis in antihypertensive drug users†‡ HILDA J. I. DE JONG1,2,3, ROB J. VANDEBRIEL1, SITI R. F. SALDI3, LISET VAN DIJK4, HENK VAN LOVEREN1,2, JAN WILLEM COHEN TERVAERT5, OLAF H. KLUNGEL3,* ABSTRACT Purpose: Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are effective in the treatment of cardiovascular disease. Next to effects on hypertension and cardiac function, these drugs have anti-inflammatory and immunomodulating properties which may either facilitate or protect against the development of autoimmunity, potentially resulting in autoimmune diseases. Therefore, we determined in the current study the association between ACE inhibitor and ARB use and incident rheumatoid arthritis (RA). Methods: A matched case–control study was conducted among patients treated with antihypertensive drugs using the Netherlands Information Network of General Practice (LINH) database in 2001–2006. Cases were patients with a first-time diagnosis of RA. Each case was matched to five controls for age, sex, and index date, which was selected 1 year before the first diagnosis of RA.
    [Show full text]
  • Angiotensin-Converting Enzyme (ACE) Inhibitors Single Entity Agents
    Therapeutic Class Overview Angiotensin-Converting Enzyme (ACE) Inhibitors Single Entity Agents Therapeutic Class Overview/Summary: The renin-angiotensin-aldosterone system (RAAS) is the most important component in the homeostatic regulation of blood pressure.1,2 Excessive activity of the RAAS may lead to hypertension and disorders of fluid and electrolyte imbalance.3 Renin catalyzes the conversion of angiotensinogen to angiotensin I. Angiotensin I is then cleaved to angiotensin II by angiotensin- converting enzyme (ACE). Angiotensin II may also be generated through other pathways (angiotensin I convertase).1 Angiotensin II can increase blood pressure by direct vasoconstriction and through actions on the brain and autonomic nervous system.1,3 In addition, angiotensin II stimulates aldosterone synthesis from the adrenal cortex, leading to sodium and water reabsorption. Angiotensin II exerts other detrimental cardiovascular effects including ventricular hypertrophy, remodeling and myocyte apoptosis.1,2 The ACE inhibitors block the conversion of angiotensin I to angiotensin II, and also inhibit the breakdown of bradykinin, a potent vasodilator.4 Evidence-based guidelines recognize the important role that ACE inhibitors play in the treatment of hypertension and other cardiovascular and renal diseases. With the exception of Epaned® (enalapril solution) and Qbrelis® (lisinopril solution), all of the ACE inhibitors are available generically. Table 1. Current Medications Available in Therapeutic Class5-19 Generic Food and Drug Administration
    [Show full text]
  • Association of Hypertensive Status and Its Drug Treatment with Lipid and Haemostatic Factors in Middle-Aged Men: the PRIME Study
    Journal of Human Hypertension (2000) 14, 511–518 2000 Macmillan Publishers Ltd All rights reserved 0950-9240/00 $15.00 www.nature.com/jhh ORIGINAL ARTICLE Association of hypertensive status and its drug treatment with lipid and haemostatic factors in middle-aged men: the PRIME Study P Marques-Vidal1, M Montaye2, B Haas3, A Bingham4, A Evans5, I Juhan-Vague6, J Ferrie`res1, G Luc2, P Amouyel2, D Arveiler3, D McMaster5, JB Ruidavets1, J-M Bard2, PY Scarabin4 and P Ducimetie`re4 1INSERM U518, Faculte´ de Me´decine Purpan, Toulouse, France; 2MONICA-Lille, Institut Pasteur de Lille, Lille, France; 3MONICA-Strasbourg, Laboratoire d’Epide´miologie et de Sante´ Publique, Strasbourg, France; 4INSERM U258, Hoˆ pital Broussais, Paris, France; 5Belfast-MONICA, Department of Epidemiology, The Queen’s University of Belfast, UK; 6Laboratory of Haematology, La Timone Hospital, Marseille, France Aims: To assess the association of hypertensive status this effect remained after multivariate adjustment. Cal- and antihypertensive drug treatment with lipid and hae- cium channel blockers decreased total cholesterol and mostatic levels in middle-aged men. apoproteins A-I and B; those differences remained sig- Methods and results: Hypertensive status, antihyperten- nificant after multivariate adjustment. ACE inhibitors sive drug treatment, total and high-density lipoprotein decreased total cholesterol, triglycerides, apoprotein B (HDL) cholesterol, triglyceride, apoproteins A-I and B, and LpE:B; and this effect remained after multivariate lipoparticles LpA-I,
    [Show full text]
  • Ace Inhibitors (Angiotensin-Converting Enzyme)
    Medication Instructions Ace Inhibitors (Angiotensin-Converting Enzyme) Generic Brand Benazepril Lotensin Captopril Capoten Enalapril Vasotec Fosinopril Monopril Lisinopril Prinivil, Zestril Do not Moexipril Univasc Quinapril Accupril stop taking Ramipril Altace this medicine Trandolapril Mavik About this Medicine unless told ACE inhibitors are used to treat both high blood pressure (hypertension) and heart failure (HF). They block an enzyme that causes blood vessels to constrict. This to do so allows the blood vessels to relax and dilate. Untreated, high blood pressure can damage to your heart, kidneys and may lead to stroke or heart failure. In HF, using by your an ACE inhibitor can: • Protect your heart from further injury doctor. • Improve your health • Reduce your symptoms • Can prevent heart failure. Generic forms of ACE Inhibitors (benazepril, captopril, enalapril, fosinopril, and lisinopril) may be purchased at a lower price. There are no “generics” for Accupril, Altace Mavik, and of Univasc. Thus their prices are higher. Ask your doctor if one of the generic ACE Inhibitors would work for you. How to Take Use this drug as directed by your doctor. It is best to take these drugs, especially captopril, on an empty stomach one hour before or two hours after meals (unless otherwise instructed by your doctor). Side Effects Along with needed effects, a drug may cause some unwanted effects. Many people will not have any side effects. Most of these side effects are mild and short-lived. Check with your doctor if any of the following side effects occur: • Fever and chills • Hoarseness • Swelling of face, mouth, hands or feet or any trouble in swallowing or breathing • Dizziness or lightheadedness (often a problem with the first dose) Report these side effects if they persist: • Cough – dry or continuing • Loss of taste, diarrhea, nausea, headache or unusual fatigue • Fast or irregular heartbeat, dizziness, lightheadedness • Skin rash Special Guidelines • Sodium in the diet may cause you to retain fluid and increase your blood pressure.
    [Show full text]
  • The Role of Intercalated Cell Nedd4–2 in BP Regulation, Ion Transport, and Transporter Expression
    BASIC RESEARCH www.jasn.org The Role of Intercalated Cell Nedd4–2 in BP Regulation, Ion Transport, and Transporter Expression Masayoshi Nanami,1 Truyen D. Pham,1 Young Hee Kim,1 Baoli Yang,2 Roy L. Sutliff,3 Olivier Staub,4,5 Janet D. Klein,1 Karen I. Lopez-Cayuqueo,6,7 Regine Chambrey,8 Annie Y. Park,1 Xiaonan Wang,1 Vladimir Pech,1 Jill W. Verlander,9 and Susan M. Wall1,10 Due to the number of contributing authors, the affiliations are listed at the end of this article. ABSTRACT Background Nedd4–2 is an E3 ubiquitin-protein ligase that associates with transport proteins, causing their ubiquitylation, and then internalization and degradation. Previous research has suggested a corre- lation between Nedd4–2 and BP. In this study, we explored the effect of intercalated cell (IC) Nedd4–2 gene ablation on IC transporter abundance and function and on BP. Methods We generated IC Nedd4–2 knockout mice using Cre-lox technology and produced global pen- 2/2 drin/Nedd4–2 null mice by breeding global Nedd4–2 null (Nedd4–2 ) mice with global pendrin null 2/2 (Slc26a4 ) mice. Mice ate a diet with 1%–4% NaCl; BP was measured by tail cuff and radiotelemetry. We 2 measured transepithelial transport of Cl and total CO2 and transepithelial voltage in cortical collecting ducts perfused in vitro. Transporter abundance was detected with immunoblots, immunohistochemistry, and immunogold cytochemistry. 2 2 Results IC Nedd4–2 gene ablation markedly increased electroneutral Cl /HCO3 exchange in the cortical col- lecting duct, although benzamil-, thiazide-, and bafilomycin-sensitive ion flux changed very little.
    [Show full text]
  • Deprescribing for Older Patients
    CMAJ Review CME Deprescribing for older patients Christopher Frank MD, Erica Weir MD MSc See related editorial at www.cmaj.ca/lookup/doi:10.1503/cmaj.122099 and articles at www.cmaj.ca/lookup/doi:10.1503/cmaj.122012 and www.cmaj.ca/lookup/doi:10.1503/cmaj.130523 he principles that guide optimal prescribing outcomes related to medications than other older Competing interests: None for older patients1,2 (Box 1) include depre- patients. They are also more likely to have limited declared. scribing medications that are no longer indi- life expectancy than well older people of similar This article has been peer T 17 cated, appropriate or aligned with evolving goals of age. Medication lists tend to lengthen as patients reviewed. care. Deprescribing is a relatively new term that age, and there are few guidelines to inform medi- Correspondence to: focuses attention on the sometimes overlooked step cation management in the context of polyphar- Christopher Frank, frankc in medication review of stopping medications to macy, multiple morbidities and age-related @providencecare.ca improve outcomes and decrease risks associated changes to pharmacokinetics and pharmacody- CMAJ 2014. DOI:10.1503 with polypharmacy in older people.3–5 These risks namics (Box 1). All prescribers contributing to the /cmaj.131873 include nonadherence,6 adverse drug reactions,7 medication list need to be alert to “prescribing functional and cognitive decline,8 and falls.9,10 In inertia”18 (the tendency to automatically renew a Canada, more than 50% of older people living in medication even when the original indication is long-term care facilities and 27% of those living in no longer present) and should view polypharmacy the community take more than five medications a as an impetus to deprescribe when appropriate.
    [Show full text]
  • Comparing the Efficacy of Angiotensin Converting Enzyme In- Hibitors with Calcium Channel Blockers on the Treatment of Di- Abetic Nephropathy: a Meta-Analysis
    Iran J Public Health, Vol. 48, No.2, Feb 2019, pp.189-197 Review Article Comparing the Efficacy of Angiotensin Converting Enzyme In- hibitors with Calcium Channel Blockers on the Treatment of Di- abetic Nephropathy: A Meta-Analysis *Zhaowei ZHANG 1, Chunlin CHEN 2, Shiwen LV 1, Yalan ZHU 1, Tianzi FANG 1 1. Department of Pharmacy, Jin Hua Municipal Central Hospital, Jin Hua 32100, China 2. College of Chemistry and Bio-Engineering, Yi Chun University, Yi Chun 336000, China *Corresponding Author: Email: [email protected] (Received 21 Mar 2018; accepted 11 Jun 2018) Abstract Background: The angiotensin-converting enzyme inhibitors (ACEIs) could improve the symptoms of diabetic nephropathy. Whether the calcium channel blockers (CCBs) could be as effective as ACEIs on treating diabetic nephropathy is controversial. Here, we aimed to compare the efficacy of ACEIs with CCBs on the treatment of diabetic nephropathy by performing a meta-analysis of randomized controlled trials (RCTs). Methods: The Pubmed, Medline, Embase and The Cochrane Database were searched up to July 2017 for eli- gible randomized clinical trials studies. Effect sizes were summarized as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (P-value<0.05). Results: Seven RCTs involving 430 participants comparing ACEIs with CCBs were included. No benefit was seen in comparative group of ACEIs on systolic blood pressure（SBP） (MD=1.05 mmHg; 95% CI: -0.97 to 3.08, P=0.31), diastolic blood pressure (DBP) (MD= -0.34 mmHg; 95% CI: -1.2 to 0.51, P=0.43), urinary al- bumin excretion rates (UAER) (MD=1.91μg/min; 95% CI: -10.3 to 14.12, P=0.76), 24-h urine protein (24-UP) (SMD=-0.26; 95%CI: -0.55 to 0.03, P=0.08), glomerular filtration rate (GFR) (SMD=0.01; 95% CI: -0.38 to 0.41, P=0.95).
    [Show full text]
  • Icatibant Compared to Steroids and Antihistamines for ACE-Inhibitor-Induced Angioedema
    KNOWLEDGE TO PRACTICE DES CONNAISSANCES ÀLA PRATIQUE CJEM Journal Club Icatibant Compared to Steroids and Antihistamines for ACE-Inhibitor-Induced Angioedema Reviewed by: Tudor Botnaru, MD, CM*; Antony Robert, MD, MASc*; Salvatore Mottillo, MD, MSc* syndromes, and acute heart failure NYHA class III or Article chosen IV,aswellasthosepregnantandlactating,were Bas M, Greve J, Stelter K, et al. A Randomized Trial of excluded. Icatibant in ACE-Inhibitor-Induced Angioedema. N Engl J Med 2015;372:418-25. doi:10.1056/NEJMoa1312524. STUDY DESIGN This was an industry and government funded, multi-centre, Keywords: angioedema, icatibant, corticosteroids, ACE-inhibitor, antihistamines double-blind, double-dummy randomized phase 2 study. Block randomization was performed online. Patients were randomly assigned in a 1:1 ratio. Primary investigators and BACKGROUND patients were blinded to the treatment. Investigators who were responsible for the randomization, study-drug administration, and assessment of injection site reactions Angiotensin-converting-enzyme-inhibitor (ACEI) induced were aware of study assignments. Patients in the treatment angioedema occurs in 0.68% of those taking the group received icatibant 30 mg subcutaneously and those in medication1 and accounts for one-third of angioedema the control group (standard therapy group) received pre- cases treated in the emergency department. Upper airway dnisolone 500 mg and clemastine 2 mg (an antihistamine) compromise, potentially leading to acute laryngeal intravenously. Patients assessed the intensity of symptoms obstruction and death, may occur in up to 10% of cases.1,2 at several intervals within 48 hours. Blinded investigators Standard therapy consists of glucocorticoids and anti- further assessed the signs and symptoms. If there was no histamines.
    [Show full text]
  • Interaction of the Sympathetic Nervous System with Other Pressor Systems in Antihypertensive Therapy
    Journal of Clinical and Basic Cardiology An Independent International Scientific Journal Journal of Clinical and Basic Cardiology 2001; 4 (3), 185-192 Interaction of the Sympathetic Nervous System with other Pressor Systems in Antihypertensive Therapy Wenzel RR, Baumgart D, Bruck H, Erbel R, Heemann U Mitchell A, Philipp Th, Schaefers RF Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Indexed in Chemical Abstracts EMBASE/Excerpta Medica Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria FOCUS ON SYMPATHETIC TONE Interaction of SNS J Clin Basic Cardiol 2001; 4: 185 Interaction of the Sympathetic Nervous System with Other Pressor Systems in Antihypertensive Therapy R. R. Wenzel1, H. Bruck1, A. Mitchell1, R. F. Schaefers1, D. Baumgart2, R. Erbel2, U. Heemann1, Th. Philipp1 Regulation of blood pressure homeostasis and cardiac function is importantly regulated by the sympathetic nervous system (SNS) and other pressor systems including the renin-angiotensin system (RAS) and the vascular endothelium. Increases in SNS activity increase mortality in patients with hypertension, coronary artery disease and congestive heart failure. This review summarizes some of the interactions between the main pressor systems, ie, the SNS, the RAS and the vascular endothelium including the endothelin-system. Different classes of cardiovascular drugs interfere differently with the SNS and the other pressor systems. Beta-blockers, ACE-inhibitors and diuretics have no major effect on central SNS activity. Pure vasodilators including nitrates, alpha-blockers and DHP-calcium channel blockers increase SNS activity. In contrast, central sympatholytic drugs including moxonidine re- duce SNS activity. The effects of angiotensin-II receptor antagonist on SNS activity in humans are not clear, experimental data are discussed in this review.
    [Show full text]
  • Angiotensin Modulators/Calcium Channel Blocker Combinations Review 02/05/2009
    Angiotensin Modulators/Calcium Channel Blocker Combinations Review 02/05/2009 Copyright © 2004 - 2009 by Provider Synergies, L.L.C. All rights reserved. Printed in the United States of America. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage and retrieval system without the express written consent of Provider Synergies, L.L.C. All requests for permission should be mailed to: Attention: Copyright Administrator Intellectual Property Department Provider Synergies, L.L.C. 5181 Natorp Blvd., Suite 205 Mason, Ohio 45040 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Comments and suggestions may be sent to [email protected].
    [Show full text]
  • Effect of Exogenous Glucocorticoid on Osmotically Stimulated Antidiuretic
    European Journal of Endocrinology (2006) 155 845–848 ISSN 0804-4643 CLINICAL STUDY Effect of exogenous glucocorticoid on osmotically stimulated antidiuretic hormone secretion and on water reabsorption in man Volker Ba¨hr1, Norma Franzen1, Wolfgang Oelkers2, Andreas F H Pfeiffer1 and Sven Diederich1,2 1Department of Endocrinology, Diabetes and Nutrition, Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany and 2Endokrinologikum Berlin, Centre for Endocrine and Metabolic Diseases, Berlin, Germany (Correspondence should be addressed to V Ba¨hr; Email: [email protected]) Abstract Objective: Glucocorticoids exert tonic suppression of antidiuretic hormone (ADH) secretion. Hypocortisolism in secondary adrenocortical insufficiency can result in a clinical picture similar to the syndrome of inappropriate ADH secretion. On the other hand, in vitro and in vivo results provide evidence for ADH suppression in states of hypercortisolism. To test the hypothesis that ADH suppression is of relevance during glucocorticoid therapy, we investigated the influence of prednisolone on the osmotic stimulation of ADH. Design and methods: Seven healthy men were subjected to water deprivation tests with the measurement of plasma ADH (pADH) and osmolality (posmol) before and after glucocorticoid treatment (5 days 30 mg prednisolone per day). Results: Before glucocorticoid treatment, the volunteers showed a normal test with an adequate increase of pADH (basal 0.54G0.2 to 1.9G0.72 pg/ml (meanGS.D.)) in relation to posmol(basal 283.3G8.5 to 293.7G6 mosmol/kg). After prednisolone intake, pADH was attenuated (!0.4 pg/ml) in spite of an increase of posmol from 289.3G3.6 to 297.0G5.5 mosmol/kg.
    [Show full text]
  • Actual Place of Diuretics in Hypertension Treatment
    Mini Review J Cardiol & Cardiovasc Ther Volume 3 Issue 4 - March 2017 Copyright © All rights are reserved by Farouk Abcha DOI: 10.19080/JOCCT.2017.03.555616 Actual Place of Diuretics in Hypertension Treatment Farouk Abcha, Marouane Boukhris*, Zied Ibn Elhadj, Lobna Laroussi, Faouzi Addad, Afef Ben Halima and Salem Kachboura Cardiology Department of Abderrahmen Mami Hospital, University of Tunis El Manar, Tunisia Submission: February 03, 2017; Published: March 07, 2017 *Corresponding author: Marouane Boukhris, Cardiology Department of Abderrahmen Mami Hospital, Ariana, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia, Tel: ; Email: Abstract Diuretics represent a large and heterogeneous class of drugs, differing from each other by structure, site and mechanism of action. Diuretics are widely used, and have several indications in different cardiovascular disorders, particularly in hypertension and heart failure. Despite the large number of available anti-hypertensive drugs, diuretics remained a cornerstone of hypertension treatment. In the current editorial, we assessed the actual place of different diuretics in the hypertension guidelines focusing on the concept of tailored approach in prescribing them for hypertensive patients. Keywords: Diuretics; Hypertension; Hydrochlorothiazide; Indapamide; Guidelines Introduction Diuretics represent a large and heterogeneous class of drugs, differing from each other by structure, site and mechanism of action. Diuretics are widely used, and have several indications in different cardiovascular disorders, particularly in hypertension and heart failure. Despite the large number of available anti-hypertensive drugs, diuretics remained a cornerstone of hypertension treatment [1]. Indeed, they are the second most commonly prescribed class of antihypertensive medication. For instance, 12% of US adults were prescribed a diuretic, and the relative increase in prescriptions from 1999 through 2012 was 1.4 [2].
    [Show full text]