Treatment Of Hypertension In Patients Research Articles

PP.06.06] PHENOTYPES OF BLOOD PRESSURE IN PATIENTS WITH RHEUMATOID ARTHRITIS

Objective: Patients with rheumatoid arthritis (RA) have increased cardiovascular risk. Arterial hypertension (AH) is highly prevalent, and seems to be under-diagnosed and under-treated among patients with RA. Data on ABPM profile in patients with rheumatoid arthritis are lacking. The aim of the study was to evaluate ABPM parameters and characterize phenotypes of blood pressure (BP) in patients with RA. Design and method: 58 patients with RA (EULAR 2010) without known cardio-vascular disease were examined (76% females, age 55,9 ± 15,8 (M ± SD) years, 10% smokers, 56% with AH, 34% with dyslipidemia). Median duration of RA was 8,5 years (IQR 3–16). Seropositive RA was diagnosed in 69% of patients. All patients received disease-modifying antirheumatic drugs (DMARDs), 22 (38%) - biological treatment. Median duration of AH was 4,0 years (IQR 0–12 years). All patients with AH received antihypertensive treatment. 24-h peripheral and central BP monitoring was performed (BPLab Vasotens, «Petr Telegin»). P < 0.05 was considered significant. Results: Mean office BP was 126 ± 19/78 ± 11 mmHg (peripheral) and 118 ± 20/80 ± 11 mmHg (central). 10 (17%) patients had elevated office BP (>140/90 mmHg). Mean BP values for peripheral and central BP were as follows: 125 ± 13/73 ± 9 and 116 ± 13/75 ± 9 mmHg for 24-h BP; 127 ± 14/74 ± 9 and 117 ± 13/77 ± 9 mmHg for daytime BP; 119 ± 13/69 ± 10 and 112 ± 14/71 ± 10 mmHg for nighttime BP. AH according to daytime BP was found in 14 (24,1%) pts, nighttime BP – in 28 (48,3%) pts, 24-h BP - in 9 (31,0%) pts. Phenotypes of BP were as follows: sustained normotension – in 36 (62,1%), masked hypertension in 12 (20,7%), sustained AH – in 8 (13,8%), white-coat hypertension in 2 (3,4%) patients. Isolated nocturnal AH was observed in 12 (20,7%) pts. 10 (17%) patients had isolated elevated central BP. 20 (34,5%) pts had elevated central SBP according to individual reference values; all patients with high office BP had elevated central BP. Conclusions: High prevalence of AH is observed in patients with RA free of CVD and most of patients have satisfactory control of office BP. Relatively high prevalence of masked and isolated nocturnal hypertension despite antihypertensive treatment are observed in this population. These findings may help to optimize hypertension treatment in patients with RA.

Evaluation and Management of Erectile Dysfunction in the Hypertensive Patient.

The prevalence of hypertension and erectile dysfunction has steadily increased, and greater than 40% of men with erectile dysfunction concurrently share a diagnosis of hypertension. The treatment of the patient with both diseases poses a clinical challenge as both are closely correlated and share multiple overlapping risk factors.To address the recognized knowledge gap among clinicians who care for these patients, we will review the current literature on the diagnosis and treatment of erectile dysfunction in the hypertensive patient and will provide recommendations for the management of this challenging patient population. The pharmacological treatment of hypertension may adversely affect sexual function, and certain treatments for erectile dysfunction are contraindicated or cautioned against with certain antihypertensive agents. In review of the literature, we find that the clinician should opt to use an angiotensin-receptor blocker followed by an angiotensin-converting enzyme inhibitor or calcium channel blocker for the treatment of hypertension in patients with erectile dysfunction. Other agents require careful consideration for adverse effects on sexual function. Men with erectile dysfunction should be assessed for cardiovascular fitness for sexual activity, and PDE-5 inhibitors remain the first-line treatment for erectile dysfunction.

Candesartan, angiotensin II type 1 receptor blocker is able to relieve age-related cognitive impairment.

Candesartan is one of the standard antihypertensive drug belonging to AT1R angiotensin receptor blockers (ARBs) group. Beneficial effects of this drug in the treatment of hypertension are well recognized. In this study we tested a hypothesis that candesartan could alleviate age-related memory decline. Aged and young rats have been treated with candesartan (0.1mg kg-1) for 21days and then underwent a battery of behavioral tests: for assessment of long-term memory (Passive avoidance test - PA), recognition memory (Object recognition test - OR), locomotor functions (Open field - OF) and anxiety behavior (Elevated plus maze - EPM). Aged rats (2-years-old) displayed clear declining tendency in the retrieval of passive avoidance behavior showing thus increased forgetting. Prolonged administration of candesartan significantly (p<0.01) reversed this phenomenon causing recall measured as the avoidance latency, and surprisingly also showed the tendency to recall deterioration observed in the young rats. More optimistic results were achieved in the OR, where candesartan significantly improved recognition memory (p<0.001) of aged rats who performed even better than the young ones (p<0.05). It appears that candesartan potently abolishes some kinds of aging-induced memory impairments and cognitive declines in aged rats, but in some circumstances it may even could increase the damage of memory. It seems that the use of sartans in the treatment of hypertension for patients with associated cognitive impairment, or for people in risk groups for such disorders can be an interesting alternative.

Pulse Wave Velocity Predicts Response to Renal Denervation in Isolated Systolic Hypertension.

BackgroundRenal sympathetic denervation seems to be less effective as a treatment for hypertension in patients with isolated systolic hypertension, a condition associated with elevated central arterial stiffness. Because isolated systolic hypertension can also be caused by wave reflection or increased cardiac output, a more differentiated approach might improve patient preselection for renal sympathetic denervation. We sought to evaluate the additional predictive value of invasive pulse wave velocity for response to renal sympathetic denervation in patients with combined versus isolated systolic hypertension.Methods and ResultsPatients scheduled for renal sympathetic denervation underwent additional invasive measurement of pulse wave velocity and pulse pressure before denervation. Blood pressure was assessed via ambulatory measurement at baseline and after 3 months. In total 109 patients (40 patients with isolated systolic hypertension) were included in our analysis. After 3 months, blood pressure reduction was more pronounced among patients with combined hypertension compared with patients with isolated systolic hypertension (systolic 24‐hour average 9.3±10.5 versus 5.0±11.5 mm Hg, P=0.046). However, when stratifying patients with isolated systolic hypertension by invasive pulse wave velocity, patients in the lowest tertile of pulse wave velocity had comparable blood pressure reduction (12.1±12.6 mm Hg, P=0.006) despite lower baseline blood pressure than patients with combined hypertension (systolic 24‐hour average 154.8±12.5 mm Hg in combined hypertension versus 141.2±8.1, 148.4±10.9, and 150.5±12.7 mm Hg, respectively, by tertiles of pulse wave velocity, P=0.002).ConclusionsExtended assessment of arterial stiffness can help improve patient preselection for renal sympathetic denervation and identify a subgroup of isolated systolic hypertension patients who benefit from sympathetic modulation.

Antihypertensive Treatments in Patients Affected by Aortic Valve Stenosis.

Systemic hypertension and aortic valve stenosis (AVS) are both age-related diseases. Severe aortic stenosis affects ≈2% to 5% of adults age > 65 years. Systemic hypertension is a frequent comorbidity in patients with AVS and is coexistent for a longer period of time before AVS is treated. Essential systemic hypertension, per se, plays an important role in the creation of lesions on the aortic side of the valve, the region of higher exposure to tension stress. The subsequent endothelial defect represents the principal site of inflammatory process and oxidative stress, leading to aortic sclerosis and calcification. In this review, we want to describe the pharmacological features of the common antihypertensive drugs, analysing the recent literature, in order to achieve useful and updated information about the best treatment of systemic hypertension in patients with concomitant severe aortic stenosis.

Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).

In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnoea and the use of erythropoietin-stimulating agents may also be involved. Non-pharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium and volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

Differential Metabolic Effects of Beta-Blockers: an Updated Systematic Review of Nebivolol.

Blood pressure management in hypertensive patients with metabolic abnormalities is challenging, since many of the antihypertensive drugs adversely affect metabolism. Besides effective control of blood pressure in patients with hypertension, third-generation beta-blockers such as nebivolol offer additional benefits for central hemodynamics and neutral or beneficial effects on metabolism. Emerging clinical data suggest that nebivolol also has similar effects on metabolism in obese hypertensive and hypertensive diabetic patients. The present article will provide a systematic analysis of the pathophysiological links among hypertension, insulin resistance, and metabolic syndrome. We will also summarize the available clinical evidence regarding the metabolic effects of beta-blockers in hypertensive patients, with an emphasis on nebivolol. Nebivolol exerts neutral or beneficial effects on insulin sensitivity and lipid metabolism in hypertensive patients, owing to its nitric oxide-mediated vasodilatory and antioxidative properties. Thus, nebivolol could be a favorable therapeutic option for the treatment of hypertension in patients with impaired glucose and lipid metabolism.

Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).

In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

Relationship between gender and clinical characteristics, associated factors, and hypertension treatment in patients with resistant hypertension.

Recent meta-analyses indicate that the pooled prevalence of resistant hypertension (RHT) barely differs between the sexes. However, differences between women and men with RHT in patient characteristics, associated factors, and hypertension (HT) management are still not well-described. In the cross-sectional questionnaire-based observational study we included 7306 hypertensive females and 5069 hypertensive males, ≥ 18 years old, and treated for at least 12 months with antihypertensive drugs. We defined HT control as blood pressure (BP) levels both < 140 mm Hg/< 90 mm Hg. Patients were divided into three groups: controlled HT, uncontrolled HT (not fulfilling the criteria of RHT), and RHT (uncontrolled HT despite using three antihypertensive drugs including diuretic). Cardiovascular (CV) risk was evaluated according to 2013 ESH/ESC guidelines. There were no differences in the rates of controlled HT (47.6% vs. 47.0%), uncontrolled HT (27.3% vs. 28.8%), and RHT (25.1% vs. 24.2%) between women and men, respectively (p = 0.17). Among patients with RHT, women were older than men and had lower diastolic BP and estimated glomerular filtration rate (eGFR) as well as higher pulse pressure (PP). Cerebro-vascular diseases (16.9% vs. 14.3%; p = 0.062), abdominal obesity, and metabolic syndrome (MS, 70.5% vs. 60.1%; p < 0.001) were more frequent among women than men with RHT. Women with RHT had higher rate of high/very high added CV risk in comparison to men. In a multivariate model higher PP, presence of MS, CV disease, and eGFR < 60 mL/min/1.73 m² were related to the presence of RHT both in males and females. In women RHT was also related to abdominal obesity, cerebro-vascular diseases, and diseases causing disability. In men, RHT was additionally related to diseases requiring treatment with non-steroidal anti-inflammatory drugs. Although there were no differences in the rate of RHT between women and men, we identified gender-related differences in CV risk profiles in RHT patients and in factors related with the presence of RHT. When divided into age groups, RHT was less frequent in women aged less than 40 years and aged between 40 and 65 years, and among patients 65 years and older there was a tendency towards a higher rate of HT in women.

Diabetes and hypertension: too many guidelines, not enough data

The early diagnosis, appropriate management, and pharmacological treatment of hypertension in those with diabetes mellitus are key in preventing and reducing the significant risk of cardiovascular disease-related morbidity and mortality in this patient population. Despite the universal recognition of the importance of hypertension management in those with diabetes mellitus, there still remains controversy on the appropriate blood pressure at which to initiate pharmacologic therapy and, once initiated, what blood pressure goal to achieve. This paper will review current blood pressure recommendations published in recent major guidelines as well as examine evidence-based medicine used to form the basis of these guidelines for the treatment of hypertension in patients with diabetes mellitus. In addition, we will summarize relevant major clinical studies, which may have a significant impact on future guidelines, published in the interval time since the release of previous major guidelines.

Correction.

HomeHypertensionVol. 68, No. 4Correction Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published1 Oct 2016https://doi.org/10.1161/HYP.0000000000000051Hypertension. 2016;68:e61This article corrects the followingTreatment of Hypertension in Patients With Coronary Artery DiseaseIn the article by Rosendorff et al, “Treatment of Hypertension in Patients With Coronary Artery Disease: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension,” which published online March 31, 2015, and appeared in the June 2015 issue of the journal (Hypertension. 2015;65:1372–1407. DOI: 10.1161/HYP.0000000000000018), several corrections were needed.On page 1376, in Table 2, the footnotes, in the third paragraph, the first sentence read, “†Chlorthalidone is preferred. Loop diuretic should be used in the presence of HF (New York Heart Association class III or IV) or chronic kidney disease with glomerular filtration rate <30 mL·min−1·m−2.” It has been updated to read, “†Chlorthalidone is preferred. Loop diuretic should be used in the presence of HF (New York Heart Association class III or IV) or chronic kidney disease with glomerular filtration rate <30 mL·min−1·1.73 m−2.”On page 1376, in Table 3:The first row (<150/90 Age >80 y IIa/B) has been deleted.The second row, in the third column, the “Class/Level of Evidence” read, “I/A.” It has been updated to read, “IIa/B.”The fifth row, in the third column, the “Class/Level of Evidence” read, “IIb/C.” It has been updated to read, “IIb/B.”The sixth row, in the third column, the “Class/Level of Evidence” read, “IIb/C.” It has been updated to read, “IIb/B.”These corrections have been made to the current online version of the article, which is available at http://hyper.ahajournals.org/content/65/6/1372.full. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesTreatment of Hypertension in Patients With Coronary Artery DiseaseClive Rosendorff, et al. Hypertension. 2015;65:1372-1407 October 2016Vol 68, Issue 4 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/HYP.0000000000000051PMID: 27605563 Originally publishedOctober 1, 2016 PDF download Advertisement

Correction to: Treatment of Hypertension in Patients With Coronary Artery Disease: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension.

In the article by Rosendorff et al, “Treatment of Hypertension in Patients With Coronary Artery Disease: A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension,” which published online March 31, 2015, and appeared in the May 12, 2015, issue of the journal ( Circulation …

Use of renin angiotensin system inhibitors in patients with chronic kidney disease.

Current guidelines recommend renin angiotensin system inhibitors (RASI) as key components of treatment of hypertension in patients with chronic kidney disease (CKD), because of their effect on reducing the future rate of loss of glomerular filtration rate (GFR). A common risk of RASI in CKD is a haemodynamically mediated, and reversible, fall in GFR of varying severity and duration, any time after commencement of the Inhibitors. A benefit of the acute reduction in filtration rate with RASI may be a reduction in the future rate of loss in GFR: the greatest benefit likely to be in those patients with a greater rate of loss of GFR prior to, and a lesser acute loss of GFR after, introduction of RASI; and in those patients with significant proteinuria. An acute loss of GFR of >25% following the introduction of RASI is an indication to cease the RASI. An acute loss of GFR < 25% requires consideration of the likely risks of the lower GFR and benefits of any future reduced rate of loss of GFR. A fall in GFR in patients while on RASI is usually associated with a remediable cause. When the cause for the fall in GFR is not revealed, and the fall is less than 25%, hopeful expectancy is recommended. Hyperkalaemia in patients with CKD on RASI is more common with more severe disease, potassium retaining diuretics and hypoaldosteronism. Treatment should be modified to maintain a plasma potassium <6 mmol/L.

Classes of antihypertensive agents and mortality in hypertensive patients with type 2 diabetes—Network meta-analysis of randomized trials

AimsThe aim of this study was to evaluate the effects of antihypertensive drug classes in mortality in patients with type 2 diabetes. MethodsMEDLINE, EMBASE, Clinical Trials and Cochrane Library were searched for randomized trials comparing thiazides, beta-blockers, calcium channel blockers (CCBs), angiotensin-converting inhibitors (ACEi) and angiotensin-receptor blockers (ARBs), alone or in combination for hypertension treatment in patients with type 2 diabetes. Outcomes were overall and cardiovascular mortality. Network meta-analysis was used to obtain pooled effect estimate. ResultsA total of 27 studies, comprising 49,418 participants, 5647 total and 1306 cardiovascular deaths were included. No differences in total or cardiovascular mortality were observed with isolated antihypertensive drug classes compared to each other or placebo. The ACEi and CCB combination showed evidence of reduction in cardiovascular mortality comparing to placebo [median HR, 95% credibility intervals: 0.16, 0.01–0.82], betablockers (0.20, 0.02–0.98), CCBs (0.21, 0.02–0.97) and ARBs (0.18, 0.02–0.91). In included trials, this combination was the treatment that most consistently achieved both lower systolic and diastolic end of study blood pressure. ConclusionsThere is no benefit of a single antihypertensive class in reduction of mortality in hypertensive patients with type 2 diabetes. Reduction of cardiovascular mortality observed in patients treated with ACEi and CCB combination may be related to lower blood pressure levels.

Hypertension: When should we treat hypertension in patients with diabetes?

Diabetes mellitus and hypertension are closely related, and guidelines have recommended aggressive treatment of hypertension in patients with diabetes. However, no single clinical trial is conclusive. An extensive review of the use of blood-pressure-lowering drugs in patients with diabetes supports treating blood pressure >140/90 mmHg, whereas reducing blood pressure in people with normal or high–normal blood pressure might have untoward effects.

Abstract 157: Gender Differences in the Ambulatory Treatment of Hypertension in Patients with Heart Failure

Background: We investigated gender-specific differences in treatment of hypertension (HTN), and how they may affect outcomes in congestive heart failure (CHF) patients. Methods: Records of 194 (100 male, 94 female) unselected consecutive patients with HTN enrolled in the CHF clinic were reviewed. Left ventricular ejection fraction (LVEF) was compared to LVEF at time of enrollment in the clinic. The average interval between the two echocardiograms was 30 months. Results: ANOVA, chi-square, and logistic regression analyses demonstrated that men were more likely than women to have baseline LVEF ≤35%, (50% vs. 36%, p=0.108), coronary artery disease (63% vs. 43%, p=0.004), diabetes mellitus (p=0.095), and be ever smokers (66% vs. 40%, p&lt;0.0001). Factors such as age, peripheral vascular disease, hyperlipidemia, serum K+, creatinine clearance, body mass index, and heart rate were similar in both genders. Optimal BP control noted during the most recent visit was more often achieved in men (59% vs. 46%, p=0.002). Remarkably, during follow up, more men experienced decline in LV dysfunction (29% vs. 18%, p=0.081), women were more likely to have no change in LVEF (51% vs 34%, p=0.081), and men were only slightly more likely to show improvement (37% vs. 31%, p=0.081). There was no gender difference in utilization of angiotensin converting enzyme inhibitors (ACE), beta blockers (BB), or aldosterone receptor antagonists (ARA). Women were more likely to be treated with angiotensin receptor blockers (ARBs, p=0.054) and men were more likely to be on diuretics (57% vs. 43%, p=0.069). Conclusions: In patients with HTN enrolled in the HF clinic, male gender was associated with increased cardiovascular comorbidities and lower LVEF at baseline. Despite improved blood pressure control and similar utilization of evidence-based therapy, men experienced more decline in LVEF, had LV systolic function that was less likely to remain unchanged, and were only slightly more likely to demonstrate improvement of LVEF compared to women. This study suggests a potential gender-related pharmacodynamic difference in response to guideline therapy, or perhaps the manifestation of an already described gender difference of adaptation to chronic elevated after load.

Abstract WMP36: Management of Hypertension in Primary Care Safety-net Clinics in the United States: A Comparison of Community Health Centers and Private Physician’s Offices

Introduction: Community health centers (CHCs) provide care to a disproportionate share of vulnerable populations who are at highest risk for uncontrolled hypertension. It is unknown how hypertension treatment at CHCs reflects guideline-concordant therapy compared to private practice. Methods: We used the National Ambulatory Medical Care Surveys (NAMCS) from 2006 to 2010 to examine four guideline-concordant treatment practices in non-pregnant adults with hypertension: Initiation of a new medication for uncontrolled hypertension, use of fixed-dose combination drugs for patients on multiple antihypertensive medications, use of thiazide diuretics among patients with uncontrolled hypertension on ≥3 antihypertensive medications, and use of aldosterone antagonist for resistant hypertension, comparing use at CHCs to private physician’s offices overall and by payer group. Results: Medicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension (AOR 1.0, 95% CI 0.6-1.9), while Medicaid patients at private physicians’ offices were less likely to receive a new medication compared to the privately insured (AOR 0.3, 95% CI 0.1-0.6). Use of fixed-dose combination drugs was lower at CHCs (AOR 0.6, 95% CI 0.4 – 0.9). There was no difference in thiazide use (adjusted OR 0.7, 95% CI 0.4 – 1.5). Aldosterone antagonist use in resistant hypertension was extremely low in both settings (&lt; 3%). Conclusion: Compared to private practice, CHCs are more likely to intensify hypertension treatment for patients with Medicaid but less likely to use fixed-dose combination drugs for patients taking multiple medications. Increasing physician use of fixed-dose combination drugs may be particularly helpful in improving hypertension control at CHCs where there are higher rates of uncontrolled hypertension.

ВИБІР РАЦІОНАЛЬНИХ ДОПОМІЖНИХ РЕЧОВИН З МЕТОЮ СТВОРЕННЯ ТАБЛЕТОК «ГІПЕРТРИЛ» МЕТОДОМ ПРЯМОГО ПРЕСУВАННЯ Повідомлення 1. «Дослідження впливу допоміжних речовин на технологічні характеристики порошкових мас»

CHOICE OF RATIONAL EXCIPIENTS TO CREATE "HYPERTRIL" TABLETS BY DIRECT PRESSING Report 1. “Investigation of the effect of excipients on the technological characteristics of the hypertril's powder masses” N.V. Parnyuk, L.I. Kucherenko, O. O. Portna Zaporozhye State Medical University, Zaporozhye Key words: hypertril, excipients, powders masses, direct pressing Introduction Cardiovascular diseases are the most common cause of death in the Ukraine and in the world, but in the Ukrainian society awareness of the risk factors is very low, and mortality - is very high. Arterial hypertension (AH) is the most common among the pathologies of the cardiovascular system. Staff members of SPA "Farmatron" (Zaporizhzhia) in collaboration with the Department of Pharmaceutical Chemistry of Zaporizhzhia State Medical University synthesized new original compound bromide 1- (β- phenylethyl)-4-amino-1,2,4-triazole and got the certificate of trademark called "Hypertril". During pharmacological studies, we revealed that hypertril has combined properties of cardioselective s 1 - adrenoceptor blocking agent and peripheral vasodilator, thus showing antihypertensive, antiischemic and antioxidant properties. Systematic preclinical studies of hypertril as antihypertensive drug made it possible to establish ED (effective dose) of 50 to animal and predict the advisability of its taking to human in dose of 20 mg per reception. In the course of studying the literature sources we came to the conclusion that drugs for the treatment of hypertension are used for a long time. Most drugs for the treatment of cardiovascular diseases are used in tablet form. Based on the foregoing, it is urgent to develop technology of tablets based on "Hypertril" containing 20 mg of active ingredient. Thus, the aim of our work is the development of technology of "Hypertril" tablets with 20 mg of active ingredient. Materials and Methods The studies of rational choice of excipients to create "Hypertril" tablets by direct pressing were undertaked. We studied six excipients groups having different physical and technological properties. We studied 30 excipients, most of which appeared on the market in recent years and have no examples in pharmaceutical technology for tablet drugs creating. One tablet contained 0.02g of hypertril, 0.082 g samples of MCC (microcrystalline cellulose) (factor A), 0.040g of sugar sample (factor B), 0.010g of disintegrant (factor C), 0.040g of crystalline substances (factor D), 0,006g of glidants (factor E) and 0.002g lubricants (factor F). In the study of six qualitative factors we used one of the plans of analysis of variance – six-factor experiment based on Hyper-Greco-Latin square. Based on this carried out analysis we concluded the impact of studied factors on pharmaco-technological properties of the hypertril powder masses. Research results The results of analysis of variance showed that all six studied factors as follows: D> A> C> F> E> B affect hypertril’s free bulk of powder blend; after shrinkage - A> D> C> E > B> F affect hypertril’s tapped bulk density, also all the factors affect flow powder blend: D> E> B> A> C> F, angle of natural repose of hypertril’s powders - D> C> E> A> B> F. In the study of powder masses on indicants of free bulk of powder blend, tapped bulk density, fluidity and angle of natural repose, we found that in most series of experiments powder masses have technological properties that indicate the possibility of tablets’ creating by direct pressing. The studies have shown that studied six groups of excipients manifest "leaders" in effect on one or another pharmaco-technological powder masses index. Conclusions The effect of six excipients groups on technological characteristics of hypertril’s powder masses is studied. In most series of experiments, powder masses have technological properties that indicate the possibility of tablets’ creating by direct pressing.

Treatment of Hypertension in Patients with Coronary Artery Disease

Hypertension is among the leading causes of mortality worldwide, both in the developed and developing world. Most deaths occur due to cardiovascular complications such as myocardial infarction (MI) and stroke. In the Asia Pacific Region, hypertension alone contributes to 66% of all cardiovascular deaths, more than it does worldwide. The most recent meta-analysis on the benefits of treating hypertension showed that tighter control of blood pressure (133/76 mmHg) leads to a significant 14% reduction in myocardial infraction. In patients with concurrent Coronary Artery Disease (CAD) the two issues which need to be addressed are: 1) to determine the target of blood pressure (BP), and; 2) to determine the drug of choice in hypertensive patients with concurrent CAD. Up to five years ago, most Clinical Practice Guidelines suggested that target BP to be achieved was <130/80 mmHg. This however was revised recently to <140/90 mmHg. The new cut-off was mainly due to lack of evidence from randomized controlled trials on the lower BP of <130/80 mmHg and the persistence concern about the J curve. This article reviewed recommendations made by the latest Hypertension Guidelines across major hypertension societies in North America, Europe and the Asia Pacific Region published over the last 3 years in the English language. These were than compared with major clinical outcome studies investigating phenotype of patients with hypertension and CAD. The treatment of choice for patients with CAD depends on clinical circumstances. In patients with underlying CAD, calcium channel blockers (verapamil) and beta blockers (atenolol) are indicated based on the INVEST trial. Besides, ACE I should also be the treatment of choice as indicated by the EUROPA trial especially in patients with minimal symptomatic angina. Beta blockers and dihydropyridine calcium channel blockers are indicated for symptomatic angina although there is no evidence of their impact on prognosis. For patients with previous myocardial infarction and normal left ventricular ejection fraction , ACE I and beta blockers are the drugs of choice to improve prognosis and clinical outcome although doubt has been raised on the benefits of beta blockers especially for mortality reduction. As for post-MI patients with reduced left ventricular ejection fraction, ACE I (or ARB), beta blockers and aldosterone antagonist are indicated.

To study the preferred antihypertensive drugs in patients suffering from diabetes mellitus at a tertiary care hospital of Uttarakhand with an emphasis on compelling indications

Background: People with diabetes are more likely to also have high blood pressure. Hypertension can increase the risk of diabetes complications and is a powerful risk factor for development of a wide variety of cardiovascular, cerebrovascular and renal diseases. The treatment of hypertension in patients with diabetes thus becomes all the more important and may effectively prevent cardiovascular events. This study was thus planned with the aim to study the preferred antihypertensive drugs in patients suffering from diabetes mellitus and to teach UG students about the clinical importance of compelling indications in the treatment of hypertension.Methods: A total of 100 prescriptions of patients suffering from hypertension and diabetes mellitus were collected from diabetic hypertensive visiting the department of Medicine. Data was analysed in terms of percentage to find out the most and least preferred antihypertensive drugs in diabetes mellitus.Results: ACE inhibitors (30.95%) and ARBs (30.16%) were the most preferred, diuretics (19.84%), and CCBs (11.9%), and beta blockers (7.14%) were the least preferred antihypertensive drugs in diabetes patients. Three patients were on non-pharmacological treatment and among the remaining 97 prescriptions, monotherapy was the most common mode (70.1%) of therapy for hypertension, and drugs in combination were prescribed to 29.89% patients.Conclusions: ACE-I and ARBs were the preferred antihypertensive drugs prescribed in diabetic hypertensive. Treatment of hypertension should be individualized depending upon the compelling indications. This should be taught to undergraduate students in a practical way in collaboration with Medicine department.