Incidence Of Postural Hypotension Research Articles

Relation Between Labetalol and Methyldopa in Treatment of Pregnancy Induced Hypertension

Background: Hypertensive disorder is the most common medical problem encountered in pregnancy with a high perinatal and maternal mortality & morbidity. Worldwide about 76,000 pregnant women die each year from preeclampsia and related hypertensive disorders. Objective: To assess the relation between labetalol and methyldopa in treatment of pregnancy induced hypertension. Methods: This study was hospital based comparative prospective study was conducted at Dept. of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh from January to June 2021. The study consisted of 100 patients with pregnancy induced hypertension attending outpatient department and admitted in ANW, or who directly came to labour room. These patients were randomly selected on lottery basis after they fulfilled the inclusion criteria. Total patients were taken for the study and divided into 2 groups of 50 patients in each group. Results: A total 100 patients were included. The mean age in Group I was 24.4±4.55 years and in Group-II, 23.95±4.28 years. Maximum number of patients was between 19- 24 years in both the groups. In Group-I, 26 (52%) patients and in Group-II, 25 (50%) patients were in this age group. The maximum age in the Group I was 34 years and 35 years in the Group-II. The minimum age was 17 years in both the groups. The inter group difference was not statistically significant (p>0.05) thus the two groups were comparable by age. At baseline no significant difference was seen in SBP in both treatment groups. However after 8 days post testament SBP of women was significantly lower in Group-I patients as that of Group-II patients. i.e. Group-I: 123.41 vs. Group-II: 126.62, p- value=0.009. At baseline no significant difference was seen in DBP in both treatment groups. However at 8th day post treatment DBP of patients was significantly lower in Group-I patients. i.e. 77.18 vs. Group-II 79.64, p-value=0.005. For SBP more effective control was seen in women whose parity was 3-4 and for DBP notable difference was seen in women whose parity was 1-2. The control of systolic blood pressure was more effective in patients with normal body mass index and for Diastolic blood pressure (DBP) more effective control was seen in patients who were obese. On comparison methyldopa significantly causes more drowsiness, headache and nasal congestion and the incidence of Postural hypotension and dysponea in both groups were not significantly different. The patient who required additional drugs to control the uncontrolled hypertension. In Group I, 2 (4%) patients and in Group II, 3 (6%) patients did not respond with starting drug. The inter group difference was not statistically significant (p>0.05). Conclusion: Labetalol had less maternal adverse effect compared to methyldopa but fetal outcome was not observed in this study. Labetalol and methyldopa are equally efficacious in controlling blood pressure in new onset hypertension in pregnancy. This study is just a step in this long way. Therefore, labetalol can be considered positively in the treatment of pregnancy induced hypertension.

Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis.

ABSTRACTIntroduction:The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alpha-blockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones.Materials and Methods:For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706).Results:In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from “very low” to “moderate” according to the CINeMA approach.Conclusion:Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.

A cross-sectional study of gender differences in cardiovascular responses to orthostatic tolerance test in adolescents

Background: Clinical data show higher incidence of postural hypotension in women than men. Clinicians make use of orthostatic tolerance test (OTT) to investigate such a situation and also in other varieties of clinical disorders ranging from most common disorders such as diabetes, hypertension leading to autonomic neuropathy to very rare disorders such as Shy-Drager syndrome and dysautonomias. This study will help to assess gender differences in cardiovascular response to orthostatic challenge. Aims and Objectives: The objective of the study was to evaluate the gender differences in cardiovascular responses such as change in systolic blood pressure (BP), diastolic BP, heart rate (HR), and mean arterial pressure (MAP) during OTT in 16–20 years of age group. Materials and Methods: The present cross-sectional study was conducted in 34 males and 36 female students of the age group of 16–20 years. The autonomic test used to assess orthostatic tolerance was OTT which is widely used for routine clinical evaluation of autonomic dysfunction. HR and BP changes during the orthostatic challenge were recorded, and 30:15 ratio was calculated from R-R interval of electrocardiogram ECG recording during the challenge. Results: Among the baseline parameters of males and females only HR, diastolic BP, and MAP were comparable. BP response during orthostatic challenge showed that MAP was significantly lower for females than males (P < 0.05). HR response was not statistically significant. Conclusion: The values being significantly lower for females than males this study helped to support the fact that women have less responsiveness to BP regulation during an orthostatic challenge in adolescents.

A PROSPECTIVE STUDY TO ANALYSE THE SIDE EFFECTS OF OLMESARTAN MEDOXOMIL AND ENALAPRIL IN HYPERTENSIVE SUBJECTS

Objective: The present study was aimed to analyze the side effects of olmesartan medoxomil and enalapril in hypertensive subjects.Methods: The study consisted of newly diagnosed hypertension categorized according to 7th report of Joint National Commission on prevention, detection, evaluation, and treatment of high blood pressure. The subjects were divided into two groups. The Group A subjects received olmesartan, and Group B subjects received enalapril. Pressure was recorded both in supine and sitting positions. The appearance of side effects was observed in the follow-up, i.e., dry cough, headache, postural hypotension, angioedema, dizziness, skin rashes, taste alterations, and urticaria. A statistical data were prepared on the basis of information obtained and analyzed thoroughly for antihypertensive effects and side effects of olmesartan and enalapril. SPSS software was used for analysis.Results: There was observed an increase in the incidence of taste alteration with drug therapy in Group B (Enalapril). There was observed an increase in the incidence of postural hypotension with drug therapy in both groups. In Group A (Olmesartan), the incidence of postural hypotension at the beginning of trial, 4 weeks, and 8 weeks was 0%, 2%, and 2%, respectively. In Group A (Olmesartan), there was no incidence of a headache at the beginning of trial, at 4 weeks and 8 weeks.Conclusion: From the study, it can be concluded that both olmesartan and enalapril are effective in Stage I and Stage II hypertension, but olmesartan is tolerated well with lesser side effects.

A Prospective, Randomized, Noninferiority Trial of Steroid Dosing After Major Colorectal Surgery

To evaluate the safety of perioperative low-dose steroids (LDS) versus high-dose steroids (HDS) in steroid-treated patients with inflammatory bowel disease (IBD) undergoing major colorectal surgery. Corticosteroid-treated patients undergoing major colorectal surgery are commonly prescribed HDS to prevent perioperative adrenal insufficiency and cardiovascular collapse. There is little evidence to support this practice. We performed a single-blinded noninferiority trial to compare perioperative hemodynamic instability in 92 steroid-treated IBD patients undergoing major colorectal surgery. Patients were randomly assigned to receive perioperative high-dose corticosteroids (HDS; hydrocortisone, 100 mg, intravenously 3 times daily, followed by taper) or low-dose corticosteroids (LDS; intravenous hydrocortisone equivalent to presurgical oral dosing, followed by taper). The primary outcome was the absence of postural hypotension on postoperative day 1, defined as a decrease in systolic blood pressure by 20 mm Hg after sitting from a supine position. The primary outcome, absence of postural hypotension on postoperative day 1, occurred in 95% of those randomized to receive high doses of corticosteroids compared with 96% of those who received low doses (noninferiority 95% confidence interval=-0.08 to 0.09; P=0.007). In IBD patients undergoing abdominal surgery, the incidence of postural hypotension or adrenal insufficiency is similar among those receiving high doses or low doses of corticosteroids in the perioperative period. To reduce complications associated with unnecessarily high doses of steroids, steroid-treated IBD patients undergoing major colorectal surgery should be treated with low doses of steroids in the perioperative period. (Clinicaltrials.gov ID# NCT01559675).

The dark knight of syncope: the urologist!

I would like to congratulate Juul-Möller et al. 1 on their contributions to the SYNCOPE Symposium, reported in your Journal. The above authors stress the different aspects of this variegated syndrome and the various approaches according to specific causes. In particular, they state that the main aetiology of syncope consists of neurocardiogenic reflexes, autonomic disorders (such as orthostatic hypotension), primary cardiovascular diseases or a combination of these, identifying within the healthcare system various specialists not only involved in the management process, but also in some cases directly responsible for the onset of symptoms: from general practitioners to cardiologists to internists, there are several physicians guilty of having prescribed drugs causing syncope, a time-limited circulatory disorder resulting in loss of consciousness and spontaneous recovery. Nevertheless, none of the papers focusing on this syndrome mention the fact that a specialist may be guilty and responsible for several ‘crimes’ through drug prescriptions – a ‘dark knight’ whose responsibilities are often overshadowed: the Urologist! Evaluating male patients with common symptoms of the lower urinary tract (e.g. dysuria, nocturia, urinary frequency, etc.), urologists may diagnose prostate enlargement due to benign hypertrophy (BPH). For patients with storage and voiding symptoms, the most common first-line medical treatment is alpha-adrenoceptor antagonists: starting from the evidence of the high concentration of alpha-receptors in the prostate gland, prostatic urethra and bladder neck, alpha-antagonists are used to cause significant relaxation of prostate and bladder smooth muscle, with consequent improvement of urinary stream hesitancy and attenuation of frequency. Because of the presence of alpha-adrenergic receptors, mainly in smooth muscle and also in the walls of blood vessels, the action of alpha-blockers may have a hypotensive effect, due to the generalized relaxation of blood vessels. Although the latest alpha-adrenoceptor antagonists used to treat BPH are super-selective and directed only against alpha-1-adrenoceptors, located mainly at the level of the bladder neck/prostate and not in blood vessel walls, many patients treated with drugs such as Tamsulosin, Terazosin, Alfuzosin or Doxazosin undergo adverse events related to alpha-blockers, such as dizziness, headache, asthenia, somnolence, postural hypotension and … syncope! 2. As reported in one of the largest studies on the treatment of BPH with alpha-blockers (3047 patients), the most common adverse events that occurred more frequently in men treated with Doxazosin than in the placebo group (P < 0.005) were dizziness, postural hypotension and asthenia, with percentages of up to 5%; because of these symptoms, about 25% of patients discontinued the treatment 3. In other studies on other alpha-blockers, the similar incidence of these side effects has been reported, highlighting the severe impact of postural hypotension on patient safety 4 and on quality of life 5. As the prevalence rate of lower urinary tract symptoms has been reported to increase with age, from 2.7% among 45–49-year-old men to 24% at age 80, the incidence of postural hypotension and syncope of 2–5% (according to various reports in the literature 6) due to alpha-blockers for BPH treatment must be counted among the most frequent causes. No conflict of interest to declare. I declare that all material in this assignment is my own work and does not involve plagiarism. I have no conflicts of interest to disclose.