Antihypertensive Benefits Research Articles

Antihypertensive intensification benefits diabetic nephropathy

Antihypertensive intensification benefits diabetic nephropathy

Metoprolol: a pharmacoeconomic and quality-of-life evaluation of its use in hypertension, post-myocardial infarction and dilated cardiomyopathy.

Metoprolol is a beta 1-selective adrenoceptor antagonist that is widely used in several indications. A recent investigation has also highlighted a potential role for metoprolol in selected patients with idiopathic dilated cardiomyopathy. Pharmacoeconomic and quality-of-life data for metoprolol are limited to the areas of hypertension, post-myocardial infarction and idiopathic dilated cardiomyopathy. In these settings, metoprolol has shown beneficial effects on morbidity and mortality, or closely-related end-points. Controlled release formulations offer the potential to maximise the confirmed antihypertensive benefits of metoprolol by maintaining clinically effective plasma drug concentrations within a narrow range over a 24-hour interval between doses. Recent data support the use of controlled release metoprolol at the low dose of 50 mg/day. Metoprolol is at least as effective as many other antihypertensive drugs, although compared with thiazide diuretics at relatively high doses in the MAPHY (Metoprolol Atherosclerosis Prevention in Hypertensives) trial, metoprolol was associated with a more favourable effect on mortality. Pharmacoeconomic analysis, also based on the MAPHY trial, indicates that metoprolol is more cost effective than high dose thiazide diuretics in middle-aged men with mild to moderate hypertension. However, the advantage for beta-blockade in this trial is not supported by results of other studies, and the applicability of these data to current medical practice using lower thiazide doses is therefore questionable. Quality of life in patients with mild to moderate hypertension did not deteriorate in most investigations with metoprolol. Furthermore, quality of life was similar for controlled release metoprolol and atenolol. With conventional/matrix-based sustained release metoprolol, quality of life was less satisfactory than with lisinopril but was only marginally different from that with diltiazem (at lower than usual therapeutic doses). Nevertheless, these newer agents have no proven beneficial effect on mortality, and further studies are also warranted with controlled release metoprolol 50 mg/day. When administered post-myocardial infarction, conventional metoprolol was associated with significant improvements in quality of life and was cost saving over a 3-year period. Significant improvements in quality of life were also evident for metoprolol-treated patients with idiopathic dilated cardiomyopathy. In summary, available data support the continued extensive usage of metoprolol as treatment for hypertension and as therapy post-myocardial infarction. Pharmacoeconomic data supporting an advantage for metoprolol over high dose thiazides in hypertension needs further assessment in settings reflecting usual general practice approaches to managing patients with hypertension, while differences in quality of life between metoprolol and other antihypertensive agents appear to be marginal.(ABSTRACT TRUNCATED AT 400 WORDS)

Antihypertensive Therapy

Mild-to-moderate essential hypertension is the most common medical problem seen by physicians in Western populations, and pharmacologic antihypertensive therapy is now usually undertaken. Clinical trials have shown that lowering of elevated blood pressure using diuretics and beta-blockers reduces cardiovascular morbidity and mortality. Despite these benefits, the trials have provided no convincing evidence that the incidence of coronary artery disease or its complications is reduced: Treated hypertensive patients remain at increased cardiovascular risk compared with untreated normotensive subjects. Possible explanations for this disappointing outcome are that the drugs used may themselves have negative effects on serum lipids, glucose, and insulin resistance, thereby outweighing their antihypertensive benefits. An equally important role in this respect may be played by the diseases and therapies most commonly found in association with mild-to-moderate hypertension: hyperlipidemia, type II diabetes, coronary artery disease, left ventricular hypertrophy, cardiac arrhythmias, peripheral arterial disease, and nephropathy. Such conditions may be potent determinants of what constitutes the optimal first-line choice of antihypertensive therapy. Furthermore, the negative effects that antihypertensive drugs can have on quality-of-life factors may result in noncompliance and ineffective long-term treatment. Therefore, in a new therapeutic approach to the treatment of high blood pressure, it would be logical to base antihypertensive therapy on strategies that not only lower the blood pressure but that have beneficial impacts on hemodynamics, vascular and cardiac structure, metabolism, and quality-of-life issues.(ABSTRACT TRUNCATED AT 250 WORDS)

Exercise Training Combined With Antihypertensive Drug Therapy

We studied exercise training combined with the use of antihypertensive drugs and examined the following questions. (1) Are there additive antihypertensive benefits with exercise and drug therapy combined? (2) Does drug therapy limit exercise-induced lipid improvements? (3) Does exercise that includes weight training and walking/jogging affect the left ventricle? Fifty-two hypertensive men were randomly assigned, double-blind, to diltiazem hydrochloride, sustained release (360 mg daily), propranolol hydrochloride (240 mg daily), or placebo and exercised three times per week for 10 weeks. Baseline blood pressure (145/97 mm Hg) fell after training (131/84 mm Hg) in all groups. Exercise decreased total and low-density lipoprotein cholesterol levels in all groups. Increases in the levels of high-density lipoprotein cholesterol were similar in placebo and diltiazem groups, whereas the propranolol group changed in an opposite direction. In all groups, left ventricular mass increased with training, while diastolic function was unchanged. We conclude that (1) drug therapy provided no additive benefit to the antihypertensive effects of exercise, (2) propranolol limited improvements in high-density lipoprotein cholesterol, and (3) exercise did not adversely affect the left ventricle.

Are the antihypertensive benefits of diuretics negated by their adverse effects?

Are the antihypertensive benefits of diuretics negated by their adverse effects?

Metoprolol in the Treatment DF Mild to Moderate Hypertension in Pregnancy-Effects on the Mother

The benefits of antihypertensive drugs in the treatment of mild to moderate hypertension in pregnancy are disputed. In a placebo-controlled double-blind study, the effects of metoprolol in the treatment of pregnant women with blood pressures (BP) of ≤ 140/90 mmHg or an increase of 30/15 mmHg or more during pregnancy were evaluated. Fifty-two women with hypertension diagnosed before the 37th gestational week were randomly allocated to either treatment with metoprolol, a beta-1-selective adrenoceptor blocking agent, or placebo. The treatment groups were comparable concerning age, parity, gestational age at entry and pre-eclampsia at entry. The mothers with albuminuria and serum-uric acid concentrations ≥ 350 μmol1/1 before or during treatment formed the pre-eclamptic (PE) group (n=22), while the rest of the hypertensive women were regarded as “other” hypertensives (OH, n=30). Pulse rates decreased in the metoprolol treated group. Mean BP was significantly reduced during metoprolol treatment in the OH group ...

Antihypertensive action of propranolol: Specific antirenin responses in high and normal renin forms of essential, renal, renovascular and malignant hypertension

The antihypertensive effect of propranolol was evaluated in 96 patients with various forms of hypertension preclassified according to plasma renin activity considered in relation to urinary sodium excretion. In essential hypertension (no = 74) 74 percent of high-renin patients (14 of 19) exhibited striking blood pressure reductions and 66 percent of normal-renin patients (25 of 38) achieved diastolic pressures less than or equal to 95 mm Hg. In sharp contrast, propranolol was completely ineffective in 17 low-renin patients. In all 11 patients with unilateral renal artery or parenchymal disease propranolol also lowered blood pressure in proportion to control renin levels. The response was predictive of the antihypertensive benefit of surgery even in six “normal” renin patients. In eight patients with high-renin malignant hypertension, propranolol normalized renin, aldosterone and potassium levels and produced dramatic though often incomplete blood pressure correction. In one low-renin patient with the malignant syndrone propranolol was ineffective. Regardless of etiology, antihypertensive effectiveness of propranolol correlated with control renin levels and with the decrement in renin secretion. Thus, a simple biochemical measurement indexed against sodium excretion predicted antihypertensive drug responsiveness. These observations expose, for the first time, a role for renin in a major fraction of patients with essential hypertension. Renin-induced vasoconstriction appears to cause the hypertension in high renin and also in some normal renin patients in whom renin may be inappropriately high for sodium balance. The antihypertensive action of propranolol strikes at both vasoconstrictor and volume components of hypertension since inhibition of renin secretion naturally retards aldosterone secretion, thus preventing compensatory salt and water retention which often vitiates hypotensive therapy. Accordingly, propranolol added to either vasodilator or diuretic agents ought to improve hypotensive effect by curtailing reactive increases in renin and aldosterone: this should also reduce diuretic-induced potassium loss. Propranolol given alone may prove effective in a sizeable fraction of all hypertensive disorders and without inducing the dehydrated hyperreninemic state caused by diuretics. Therefore propranolol may prove to be an alternate first approach, except in lowrenin hypertensions where this type of therapy is ineffective and contraindicated.