Excessive Blood Pressure Reduction Research Articles

Acute gastric ulceration due to excessive reduction of blood pressure in hypertensive patients.

Acute gastric ulceration due to excessive reduction of blood pressure in hypertensive patients.

Treatment of Hypertension and Ischemic Heart Disease

Cardiovascular morbidity and mortality increase as a function of blood pressure, but antihypertensive treatment reduces the rate of both events, thereby representing a preventive means against hypertension-related complications. This prevention, however, does not entirely normalize the risk and appears to be ineffective or only slightly effective against coronary artery disease. This paper reviews the hypotheses that have been advanced to explain the inability of antihypertensive treatment to offer less than complete protection and to provide primary cardioprotection, with emphasis on (a) the lack of full blood pressure control in a large fraction of the hypertensive population, (b) the excessive blood pressure reduction in subjects with ischemic heart disease and dependence of coronary perfusion from a relatively high blood pressure value, and (c) the multifactorial risk profile of coronary artery disease that may make blood pressure reduction alone insufficient in many patients. The last hypothesis is discussed also in relation to the best possible intervention approach to hypertension and to the choice of the antihypertensive agents that may make primary cardioprotection possible.

Treatment of Hypertension and Ischemic Heart Disease

Cardiovascular morbidity and mortality increase as a function of blood pressure, but antihypertensive treatment reduces the rate of both events, thereby representing a preventive means against hypertension-related complications. This prevention, however, does not entirely normalize the risk and appears to be ineffective or only slightly effective against coronary artery disease. This paper reviews the hypotheses that have been advanced to explain the inability of antihypertensive treatment to offer less than complete protection and to provide primary cardioprotection, with emphasis on (a) the lack of full blood pressure control in a large fraction of the hypertensive population, (b) the excessive blood pressure reduction in subjects with ischemic heart disease and dependence of coronary perfusion from a relatively high blood pressure value, and (c) the multifactorial risk profile of coronary artery disease that may make blood pressure reduction alone insufficient in many patients. The last hypothesis is discussed also in relation to the best possible intervention approach to hypertension and to the choice of the antihypertensive agents that may make primary cardioprotection possible.

Recent trend in the research of hypertension in Japan. Acute gastric ulceration due to excessive reduction of blood pressure in hypertensive patients

Recent trend in the research of hypertension in Japan. Acute gastric ulceration due to excessive reduction of blood pressure in hypertensive patients

Effects of the converting enzyme inhibitor captopril on blood coagulation and fibrinolysis in man.

Systematic blood coagulation analyses were conducted in 32 severely hypertensive patients treated with the angiotensin converting enzyme inhibitor captopril. Two hours after the first captopril dose, fibrin monomer complexes had already increased. This rise was even more distinct after 26 h and 1 week. Tests after 6 and 12 months of therapy showed a regression of fibrin monomer complexes to pretreatment values. In several patients with a marked increase in fibrin monomer complexes, the partial thromboplastin time (PTT) became shorter and antiplasmin activity increased. The most pronounced increase in fibrin monomer complexes was seen in patients with a rapid and excessive blood pressure reduction. The concentration of fibrin monomer complexes also rose in 15 healthy normotensive subjects, after a single oral dose of captopril (25 mg). Additionally, the PTT was shortened and antiplasmin significantly rose. An inhibition of fibrinolysis by captopril could be demonstrated by the effect on fibrin plates and thrombus weight after streptokinase. Out of 58 patients with severe hypertension and atherosclerosis treated with captopril, 7 patients suffered vascular complications during antihypertensive therapy: myocardial infarction (n = 2), coronary insufficiency (1), cerebral ischemia (1), renal insufficiency (3). These ischemic lesions may be partly explained by the alterations of coagulation and fibrinolysis under captopril therapy.

Drugs for rapidly lowering blood pressure

In most patients with severe hypertension it is safest to lower the blood pressure gradually over an hour or so using oral medication, e. g. with hydralazine + propranolol. The lowering of blood pressure within minutes is necessary only when life is threatened by hypertensive encephalopathy, dissecting aneurysm of the aorta, continuing cerebral or subarachnoid haemorrhage, acute pulmonary oedema secondary to severe hypertension, or eclampsia. If hypertension is due to raised intracranial pressure it should not be treated unless the intracranial pressure has first been reduced. Rapid or excessive reduction of blood pressure can precipitate cerebral or myocardial infarction, particularly in old people, and in patients with long-standing hypertension.

Parenteral reserpine in treatment of hypertensive emergencies.

The treatment of hypertensive emergencies usually requires a potent drug which will promptly reduce the blood pressure. The condition of the patient and the necessity for a rapid response usually make the oral route of drug administration inappropriate. As a result, the primary problems in therapy are those related to the parenteral route of drug administration and to the use of potent compounds which may produce an excessive reduction in blood pressure. These aspects have heretofore necessitated close supervision of the administration of these drugs. Veratrum alkaloids when administered intravenously are probably the most potent agents for reducing blood pressure in hypertensive patients. Their effect is as marked in the recumbent as in the upright position, a characteristic which makes them particularly suitable for the unconscious or bedfast patient. It is always possible to reduce a markedly elevated blood pressure within 10 to 20 minutes with an intravenous infusion of