Antihypertensive Medication In Patients Research Articles

Hypertension control and medication increase in primary care.

Over half of treated patients with hypertension are not well controlled. However, little is known about physicians' prescribing behaviour for these patients. Our objective was to clarify whether physicians increase antihypertensive medication in patients with poorly controlled hypertension and what characteristics are predictors of medication increase. This was a retrospective cohort study by surveying medical records in primary care clinics in Tochigi, Japan. Twenty-nine of 79 randomly selected physicians agreed to select 20 consecutive hypertensive patients. This resulted in 547 patients (women 60%; mean (s.d.) age, 68 (12) years) who had blood pressure measurements taken in 1998 and prescription of antihypertensive medication in 1998 and 1999. Mean (s.d.) systolic/diastolic blood pressure was 142 (12)/81 (9) mm Hg and the percentage of patients in good control (<140/90 mm Hg), fair (140-159/90-94) and poor (> or =160/95) were 42%, 47%, and 11%, respectively. Physicians increased medication in 28% of poorly controlled patients (95% confidence interval (CI), 17-41%), which was more than those in fair (12%, 95%CI 8-16%) or good control (7%, 95%CI 4-12%). Multivariate logistic regression analysis showed that systolic and diastolic blood pressures were positively, and the number of kinds of antihypertensive medications and the age of the physician were negatively, associated with an increase in medication. In conclusion, primary care physicians did not increase antihypertensive medication adequately for patients with uncontrolled hypertension. Attempts to understand and to change physicians' prescription behaviour could reduce the burden of uncontrolled hypertension among treated hypertensive patients.

Dosing of Antihypertensive Medications in Patients with Renal Insufficiency

The use of antihypertensive agents in patients with renal insufficiency necessitates careful consideration of dosages, titration, and monitoring. Renal function must be estimated to appropriately make dosage adjustments for antihypertensives that exhibit extensive renal elimination. Thiazide diuretics are useful in mild degrees of renal insufficiency but loop diuretics become necessary as renal function deteriorates further. With either class, low dosages should be used to prevent hypovolemia, hyponatremia, and hypokalemia which may worsen renal blood flow. Angiotensin-converting enzyme (ACE) inhibitors have become popular because they may have unique renal protective properties. All ACE inhibitors except fosinopril require reduced dosages and/or less frequent administration in patients with renal insufficiency. It is often necessary to use a diuretic with an ACE inhibitor and special dosing considerations are important. Due to demographic and physiologic characteristics of patients with renal insufficiency, beta blockers are often reserved for patients with other indications for beta blockers such as ischemic heart disease. Several beta blockers are eliminated primarily by the kidney and dosage reductions are necessary for these agents. Calcium antagonists may also have renal protective effects. Because calcium antagonists are metabolized extensively, significant dosage adjustments are not necessary. Data suggest that antihypertensives may slow the decline in renal insufficiency. The pharmacokinetics of several antihypertensives change with renal impairment because of reduced elimination. Therefore, dosage adjustments, slower titration, and less frequent administration are often necessary.

Increased dietary potassium led to stepwise reductions in antihypertensive medication in patients with well-controlled hypertension

Increased dietary potassium led to stepwise reductions in antihypertensive medication in patients with well-controlled hypertension

Increasing the Dietary Potassium Intake Reduces the Need for Antihypertensive Medication

To determine whether an increase in dietary potassium intake from natural foods reduces the need for antihypertensive medication in patients with essential hypertension. Randomized, controlled trial with 1-year follow-up. Hypertension outpatient clinic of a university hospital. Fifty-four patients with well-controlled hypertension, 47 of whom completed 1 year of follow-up. Patients were randomly assigned to one of two groups and were given dietary advice aimed at selectively increasing potassium intake (group 1) or at keeping their customary diet unchanged (group 2). During a 1-year follow-up period, drug therapy was reduced in stepwise fashion, according to a fixed protocol, provided that blood pressure remained below 160/95 mm Hg. Potassium intake was checked monthly by referring to 3-day food records and by measuring 24-hour urinary potassium excretion. Potassium intake increased in group 1 but did not change in group 2 (P less than 0.001). No change was observed in either urinary sodium excretion or in body weight. After 1 year, the average drug consumption (number of pills per day) relative to that at baseline was 24% in group 1 (95% Cl, 15% to 32%) and 60% in group 2 (Cl, 44% to 76%) (P less than 0.001). By the end of the study, blood pressure could be controlled using less than 50% of the initial therapy in 81% of the patients in group 1 (Cl, 66% to 96%) compared with 29% of the patients in group 2 (Cl, 10% to 48%) (P = 0.001). Patients in group 1 ended the study with a lower number of reported symptoms compared with patients in the control group (P less than 0.001). Increasing the dietary potassium intake from natural foods is a feasible and effective measure to reduce antihypertensive drug treatment.

Metabolic Effects of Various Antihypertensive Agents

Mortality resulting from coronary artery disease and sudden death has not been significantly reduced by the use of antihypertensive medications in patients with hypertension, despite evidence that hypertension is a major risk factor for myocardial infarction. One possible reason is that the drugs used may have adverse metabolic effects that negate the beneficial effect of lowering blood pressure. Diuretics and beta-blocking agents produce a wide range of biochemical or metabolic alterations-e.g., changes in plasma potassium and in lipoprotein profiles. In general, fewer or less marked alterations are associated with the use of angiotensin-converting enzyme inhibitors, alpha-adrenergic blockers, and slow calcium channel blocking drugs. The effects of these agents alone and in combination and their potential relationship with coronary adverse events are reviewed. Although the clinical relevance of these alterations has yet to be fully determined, it is rational to suggest that given or current knowledge, the antihypertensive agent selected for use should be an effective, well-tolerated drug with a minimum of adverse biochemical or metabolic effects.

Proximal tubular actions of metolazone and chlorothiazide.

ARTICLESProximal tubular actions of metolazone and chlorothiazidePC Fernandez, and JB PuschettPC Fernandez, and JB PuschettPublished Online:01 Oct 1973https://doi.org/10.1152/ajplegacy.1973.225.4.954MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByPersonalizing the Diuretic Treatment of Hypertension: the Need for More Clinical and Research Attention21 March 2015 | Current Hypertension Reports, Vol. 17, No. 4Distal Convoluted Tubule23 December 2014Physiology and Pathophysiology of Diuretic ActionMetolazone and Its Role in Edema ManagementCongestive Heart Failure, Vol. 9, No. 2DiuretikaDosing of Antihypertensive Medications in Patients with Renal Insufficiency8 March 2013 | The Journal of Clinical Pharmacology, Vol. 35, No. 1Clinical Uses of DiureticsThiazide DiureticsEffects of Diuretics on Renal Function1 January 2011Diuretics in the Therapy of Hypertension: Current StatusThe American Journal of the Medical Sciences, Vol. 304, No. 5Addition of metolazone to overcome tolerance to furosemide in infants with bronchopulmonary dysplasiaThe Journal of Pediatrics, Vol. 120, No. 6Effect of diuretics on cell potassium transport: An electron microprobe studyKidney International, Vol. 37, No. 6Inhibition by volume expansion of phosphate uptake by the renal proximal tubule brush border membraneBiochemical Pharmacology, Vol. 38, No. 2Some Effects of Metolazone on Electrolyte Transport18 January 2010 | Upsala Journal of Medical Sciences, Vol. 92, No. 1Brush Border Membrane Phosphate Transport Effects of Volume ExpansionDiuretic effects on renal brush border membrane transport and metabolismLife Sciences, Vol. 37, No. 18Tubular action of diuretics: Distal effects on electrolyte transport and acidificationKidney International, Vol. 28, No. 3Combined Effect of Bumetanide and Metolazone in Normal Volunteers8 March 2013 | The Journal of Clinical Pharmacology, Vol. 25, No. 5Site and mechanism of the action of diuretics13 March 2009 | Acta Pharmacologica et Toxicologica, Vol. 54Die Anwendung von Diuretika bei der akuten und chronischen HerzinsuffizienzInsights into intrarenal sites and mechanisms of action of diuretic agentsAmerican Heart Journal, Vol. 106, No. 1The pharmacology of diureticsRenal Tubular Secretion and Effects of Chlorothiazide, Hydrochlorothiazide and Clopamide: A Study in the Avian Kidney13 March 2009 | Acta Pharmacologica et Toxicologica, Vol. 51, No. 3Diuretic potency of combined hydrochlorothiazide and furosemide therapy in patients with azotemiaThe American Journal of Medicine, Vol. 72, No. 6Search for pharmaceutically interesting quinazoline derivatives: Efforts and results (1969–1980)Changes in Intrarenal Sodium Handling during Saluretic Treatment in Patients with Essential Hypertension24 April 2009 | Acta Medica Scandinavica, Vol. 210, No. 1-6Role of Extracellular Fluid Volume Expansion and Diuretics in Renal Handling of PhosphateThe Effects of Parathyroid Hormone on Renal Phosphate HandlingMechanism of the Phosphaturia due to ChlorothiazideClearance and micropuncture studies of the diuretic xipamide in dogsEuropean Journal of Pharmacology, Vol. 54, No. 1-2DIURETIC ACTION OF METOLAZONE IN DOGSJapanese Journal of Pharmacology, Vol. 29, No. 1Renal Tubular Effects of Vitamin D and Its Metabolites22 June 2013Kidney Function in Calcium and Phosphate MetabolismSite of action of diuretic drugsKidney International, Vol. 11, No. 1Acute effects of parathyroid hormone on proximal bicarbonate transport in the dogKidney International, Vol. 9, No. 6Metolazone, a diuretic agentAmerican Heart Journal, Vol. 91, No. 2Study of Renal Action of Diuretics by Micropuncture TechniquesRenal function and diuretic therapy in infants and children. Part IIThe Journal of Pediatrics, Vol. 86, No. 5Re-evaluation of microelectrode methodology for the in vitro determination of pH and bicarbonate concentrationKidney International, Vol. 6, No. 2 More from this issue > Volume 225Issue 4October 1973Pages 954-961 Copyright & PermissionsCopyright © 1973 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1973.225.4.954PubMed4743385History Published online 1 October 1973 Published in print 1 October 1973 Metrics