Side Effects Of Antihypertensive Drugs Research Articles

The Incidence of Antihypertensive Drug-induced Side Effects in Patients with Diabetes Mellitus Type 2 and Hypertension.

Objective:To determine types and frequency of side effects of antihypertensive drugs in patients with diabetes mellitus (DM) type 2 and hypertension.Subjects and Methods:We performed a prospective study of 79 patients with DM type 2 and hypertension, randomly selected by systematic sampling, who were followed over a period of six months. Patients were assessed at baseline and once a month measuring following parameters: types of used antihypertensive drugs and frequency of side effects, the values (mmHg) of systolic (SBP) and diastolic blood pressure (DBP).Results:Out of 79 patients, 48/79 (60.8%) were males and 31/79 (39.2%) were females. The median age in males was 53 years (IQR=48 to 55 years), in females was 53 years (IQR=49 to 56 years). There was no statistically significant difference in median age between males and females (P=0.368). There is a statistically significant difference in the values of SBP [χ2(5)=312.296, P<0.001] and DBP [χ2(5)=216.051, P<0.001] over a period of six months follow-up. The drug side effects were noted in 9/79 (11.4%) patients between 1-2 months, in 6/79 (7.6%) between 2-3 months, in 1/79 (1,3%) between 3-4 months. The most common side effect was cough (11/79 or 13.9%) associated with the combination of ACE inhibitor and thiazide diuretics. In 5/79 (6.3%) patients there were reports of: flushing, palpitations, headache, dizziness and leg edema associated with Ca blockers.Conclusion:The most common side effect of antihypertensive treatment was cough (13.9%) associated with the combination of ACE inhibitor and thiazide diuretic.

EVALUASI PENGGUNAAN OBAT ANTI HIPERTENSI PADA PASIEN GAGAL GINJAL KRONIK YANG MENJALANI HEMODIALISIS

The intervention led to various complications in dialysis patients include hypertension intradialitik as a result of hemodynamic changes.The phenomenon of the paradox of which caused activation of endogenous vasopresor due to changes in volume status and antihypertensive medication terdialisisnya factor. This study aims to determine patterns of use of antihypertensive drugs, evaluating the rationality and side effects of antihypertensive drugs based on literarur. This study was performed with the patient’s condition based on the observation of patients to see medical records drug data, laboratory data of patients and patient’s condition.Retrospective study of hemodialysis patients in the hospital PKU Muhammadiyah Yogyakarta year period from 2009 to 2010. Patients according to inclusion criteria, anti-hypertensive drug receipts and complete medical record data. Evaluation of rationality involves the use of antihypertensive drugs right dose, right patient and side effects based on the Drug Information Hand Book 2005, Handbook of Clinical Drug Data, 2002. The study found 60 patients who fit the inclusion criteria. Based on the research patterns of use of antihypertensive drugs in patients with hemodialysis is captoril, furosemide, nifedipine, lisinopril, amlodipine, valsatran and clonidin. Evaluation rationality inappropriate use of drugs dose use of captopril 11 patients of 34 patients and furosemide 18 patients from 52 patients, inappropriate use of captopril patients was 9 patients of 34 patients.Side effects that occur in patients with hypokalemia due to the use of furosemide is 40 patients, cough due to captopril was 13 patients, side effects of nifedipine gastrointestinal disorders cough and 11 patients, 5 patients cough lisinopril. Conclusion:he use of antihypertensive medications in hemodialysis patientsat RSU PKU Muhammadiyah Yogyakarta is rational.

Side-effects of antihypertensive drugs

Each antihypertensive drug has different major side-effects. and practice guidelines describe the absolute and relative contraindications of antihypertensive drugs. Sometimes patients taking antihypertensive drugs complain of minor side- effects, resulting in the obstacle to the adequate control of blood pressure. and poor compliance. Although old drugs such as diuretics or beta-blockers have unavoidable. dose-related side-eflects，new drugs such as calcium antagonists，angiotensin-converting enzyme inhibitors，or angiotensin receptor blockers are relatively well-tolerated. Not only short-term side-effects ，but tong-term safety of antihypertensive drug must be considered in individual prescription. Low-dose combination therapy is a recommended strategy to minimize the side-effects of anti-hypertensive drugs. Short-term and long-term side-effects of diuretics ，beta-blockers ，calcium antagonists，angiotensin converting enzyme inhibitors ，and angiotensin receptor blockers with be reviewed.

Antihypertensive activity of Salvia elegans Vahl. (Lamiaceae): ACE inhibition and angiotensin II antagonism

Ethnopharmacological relevance Salvia elegans Vahl. (Lamiaceae), recognized with the popular name of “mirto” is widely used in Mexico for healing purposes, and also them as antihypertensive treatment. Aim of the study The high prevalence of this illness and the side effects of antihypertensive drugs conducted us to the evaluation of the Salvia elegans extract on angiotensin II action. Materials and methods The acute response of blood pressure to angiotensin II administration was measured in mice. We also tested in vitro the inhibitory effect on angiotensin convertase enzyme. Additionally, characterization of the pharmacological effect of the extract fraction was obtained. Results We obtained dose–response curve for the administration of complete extract and extract fractions. Due to the hydroalcoholic extract (SeHA) treatment blood pressure decreased significantly from systolic dose of 0.75 mg kg −1 ( p < 0.05) and even had an antihypertensive effect that was greater than that treatment with losartan. SeHA extract decreased the E max of the AG II hypertensive effect by about 20% in both systolic and diastolic pressures, treatment with losartan also decreased the same parameter between 6% and 8% for systolic and diastolic pressures, respectively. Fractions SeF8 and SeF8-8 showed similar levels of AG II ED 50 for both pressures compared with losartan, these fractions showed major compounds with maximum absorbance peaks at 221, 289 and 330 nm typical of flavonoids. In the inhibition assay the activity of angiotensin converting enzyme (ACE), the extract SeHA showed percentage inhibition (%IACE) of 50.27 ± 5.09% ( n = 5). SeBuOH fraction is found to have greater inhibitory capacity of achieving a IACE 78.40 ± 2.24% ( n = 5), which was similar to the values obtained in the presence of the SeF8-22 fraction (82.61 ± 1.74%) and lisinopril (87.18 ± 1.16%). The changes in the value of K M suggest that components of the extracts and fractions were recognized by the enzyme's active site. The main compounds of the fractions SeBuOH, SeF8-22 were by flavonoid and phenyl propanoid types, according to UV absorption spectra of the fractions. Conclusions The experimental results demonstrated the antihypertensive effect of Salvia elegans and it was due to the AG II antagonism and inhibition of angiotensin converting enzyme.

Hypertension Finds Its Way into Psychiatric Practice

Hypertension Finds Its Way into Psychiatric Practice

Metabolic Syndrome and Cardiovascular Risk in Primary Hypertension

The metabolic syndrome can be found in approximately one third of patients who do not have diabetes but have primary hypertension. Its presence has been associated with a wide range of traditional and nontraditional cardiovascular risk factors and early signs of cardiovascular and renal damage. Moreover, it was emphasized recently that the metabolic syndrome predicts an increased probability of sustaining a cardiovascular event or dying. In the clinical setting of insulin resistance, attention should be paid to the metabolic side effects of antihypertensive drugs; therefore, preference should be given to renin-angiotensin system inhibitors and calcium channel blockers rather than to beta blockers and diuretics.

Self-reported Side-effects of Antihypertensive Drugs: An Epidemiological Study on Prevalence and Impact on Health-state Utility

The aim in this study was to assess the frequency and type of self-reported side-effects among hypertensives in a general population, and to estimate the relationship between drug use and side-effects and health utility using the Rating Scale (RS) method. The study is based on a postal questionnaire that was sent to a random sample of 8000 inhabitants aged 20-84 years (response rate 68%) in Uppsala County, Sweden, in 1995. The results showed that nearly 20% of the users of antihypertensive drugs reported side-effects. Men and women reported side-effects to nearly the same extent. In the linear regression analyses, those with hypertension, with or without medication, rated lower health utilities (-6.0 and-7.1 respectively) than did normotensives after controlling for age and sex. The lowest value, -8.7, was found among drug users who experienced side-effects. Side-effects causing impotence and emotional distress, i.e. insomnia, tiredness and depression had the strongest negative impact on health utility. To conclude, the study showed that side-effects among hypertensives are common. Both the disease and the drug treatment adversely affect the patient's well-being. However, drug treatment was of less importance than that found in prior studies. The findings here stress that side-effects should be taken into greater consideration when evaluating drug treatment. Key

Requirements for antihypertensive therapy in diabetic patients: metabolic aspects.

AIM OF ANTIHYPERTENSIVE TREATMENT IN DIABETICS: Prevention or treatment of hypertensive in diabetic patients reduces the incidence and progression of diabetic complications of retinopathy and nephropathy, cerebro- and cardio-vascular disease, and widespread macroangiopathy. Therefore, in patients with diabetes and hypertension beside good glucose control, the basic and probably major intervention steps is to normalize blood pressure. Antihypertensive treatment usually means life-long use of antihypertensive drugs. METABOLIC EFFECTS OF DIFFERENT DRUG CLASSES: Given the known diabetogenic properties of several antihypertensive drugs and their high rate of use, in probably a substantial proportion of patients with diabetes or prone to develop diabetes, treating arterial hypertension with conventional diuretics and/or beta-blockers might, in the long term, offset the beneficial effects of lowering blood pressure. Furthermore, there are conflicting reports of increased mortality in patients treated with diuretics, beta-blockers or calcium antagonists. Consequently, metabolic aspects and side effects of antihypertensive drugs are key elements in determining the preference for a specific antihypertensive regimen. Although the impact of hyperinsulinemia/insulin resistance on morbidity and mortality is an open question, it is preferable that antihypertensive treatment does not increase insulin resistance and/or hyperinsulinemia. Chronic beta-blocker treatment can be accompanied by an increase in insulin resistance. Calcium antagonists and angiotensin converting enzyme (ACE) inhibitors and alpha(1)-blockers are neutral or might even improve insulin resistance and lipid profile. Thiazides impair glucose tolerance, increase low-density lipoprotein cholesterol and decrease potassium, although these side effects are dose-dependent. Unless diuretics are needed for reasons other than hypertension, treatment of diabetics with thiazides should be avoided until the influence of these agents on prognosis is clarified. If the addition of a diuretic is needed, the metabolically neutral indapamide would seem a reasonable choice. PREFERRED FIRST-LINE TREATMENT: On the basis of favorable pharmacological profiles, ACE inhibitors and certain calcium antagonists have emerged as the preferred first-line drugs in the treatment of the hypertensive diabetic patient. In diabetics with nephropathy, therapy is usually initiated with an ACE inhibitor. Moreover, the combination of an ACE inhibitor and a calcium antagonist that lowers the heart rate (such as verapamil) might offer even greater advantages than either class of drug alone, since they combine metabolic neutrality with added antihypertensive and renal protective efficacy.

Vascular effects of systemic hypertension

Hypertension is a major risk factor for cardiovascular diseases, including coronary artery disease (CAD), stroke, left ventricular hypertrophy (LVH), congestive heart failure, peripheral vascular disease, renal failure, and aortic aneurysms. It is also a potent promoter of atherosclerosis. Observational studies have shown a linear relationship between a wide range of blood pressures and the risk for CAD and stroke. Clinical trials have indicated that hypertension reduction leads to the predicted reduction in stroke incidence, but that CAD incidence is affected to a lesser extent than predicted. The modest effect of traditional antihypertensive drugs on CAD may be due to several factors, including failure to reverse well-established coronary atherosclerosis, particularly if multiple risk factors are not reduced as well. Metabolic side effects of antihypertensive drugs or excessive lowering of blood pressure leading to inadequate myocardial perfusion, especially in patients with increased left ventricular (LV) mass, also may play important roles. Hypertension is a major cause of renal failure, particularly in black males, but control of the hypertension does not necessarily prevent deterioration of renal function. Increased glomerular pressure is thought to play a causative role in the development of renal failure in hypertensive and diabetic patients. Antihypertensive drugs may have a direct effect on the arterial wall, which may be independent of their antihypertensive action. Beta-adrenergic blockers, calcium antagonists, and angiotensin-converting enzyme (ACE) inhibitors inhibit the development of vascular lesions in response to hypercholesterolemia or to iatrogenic balloon injury, but the clinical importance of these observations remains to be determined.

Diurétiques, inhibiteurs de l'enzyme de conversion et anomalies électrolytiques chez les personnes âgées. Étude multicentrique lors de l'entrée à l'hôpital de 631 patients âgés de 70 ans et plus

Electrolytic side effect of antihypertensive drugs were studied in 631 elderly patients. 4% of 337 patients without these drugs had a natremia lower than 130 mmol/l (HN) and 12% a kaliemia lower than 3.5 mmol/l (HK). With thiazides, HN and HK were more frequent (12% and 20% respectively), especially in women.

Antihypertensive drug side effects in the Hypertension Detection and Follow-up Program.

The 5485 participants in the Hypertension Detection and Follow-up Program, Stepped-Care group form one of the largest groups to date on which detailed surveillance of long-term antihypertensive therapy and drug side effects has been reported. During a 5-year period, among all hypertensive persons (mild, moderate, and severe combined) who were not taking antihypertensive medications at the beginning of the study and who attended the clinic at least once during the 5-year trial, a total of 9.3% had definite or probable side effects severe enough to cause discontinuation of the drug treatment in question. Less than 1% of active participants required hospitalization for side effects. No death that could be attributed to side effects was detected. Thus, the Hypertension Detection and Follow-up Program data, which have previously demonstrated the beneficial effects of antihypertensive therapy, confirm the relative safety of such therapy.

Should the Elderly Hypertensive Be Treated?

Clinical trials for over 15 years have addressed the therapeutic utility of treating elderly hypertensives. Many early trials showed no treatment effects. Because of the recent publication of new information, a review of available evidence concerning this issue was undertaken. Eight randomized clinical trials were assessed regarding trial design. The studies varied according to generalizability, diagnostic criteria, choice of therapy, outcome measures assessed, evaluation of compliance, methods of analysis, duration of follow-up, determination of side effects, and ability to exclude a type 2 error. While many of the earlier studies found no treatment effects, they lacked methodologic rigor; more recent studies demonstrated positive treatment effects. Pooling of results from similar trials supports a notable treatment effect in the prevention of stroke. There is also evidence that the elderly are not more susceptible to side effects of antihypertensive drugs, as is generally believed. The best evidence suggests the hypertensive elderly should be treated.

Adverse effects of antihypertensive medications in the Hypertension Detection and Follow-up Program

T HE BENEFICIAL effects of drug treatment have been demonstrated in individuals with hypertension.‘-* The adverse effects of antihypertensive medications also have been well documented.9-‘4 While in most individuals high BP can be treated safely, side effects of drugs are relatively frequent and may have notable effects on quality of life and compliance with the prescribed regimens. Although the Hypertension Detection and Follow-up Program (HDFP) was not designed to study the side effects of drugs in comparison with placebo, its Stepped Care (SC) category does constitute the largest cohort (N = 5,485) from which detailed antihypertensive drug surveillance data are available in the United States. The data presented herein represent a description of the experience of the HDFP with antihypertensive drug side effects.

Sexual side effects of antihypertensive drugs. Treatment strategies and strictures.

Although not all sexual dysfunctions in patients receiving an antihypertensive medication are attributable to the drug, many are. The author advocates accepting a patient's report of such dysfunction without challenge, and assuming, at least initially, that the drug is at fault. He has found that systematic modification of the drug regimen eliminates the side effect or reduces its severity in most cases.

A method for evaluating postural hypotension in conscious rabbits as a model to predict effects of drugs in man

Because of the importance of postural hypotension as a side effect of antihypertensive drugs in man, an experimental model has been developed that permits the investigation of blood pressure response to tilting. Conscious rabbits were placed on a tilting table and tilted rapidly from horizontal to vertical position. Blood pressure was recorded continuously throughout the whole period. The individual orthostatic reaction was expressed as an orthostatic index. The experimental data obtained with guancydine, clonidine, guanethidine, prazosin and dihydralazine were compared with clinical observations with regard to the impairment of orthostatic reaction; dihydralazine did not agree, but there was a good agreement for guancydine, clonidine, guanethidine, and prazosin. Although complete agreement between the experimental data and clinical observations does not exist, the model seems to be sufficient to differentiate between drugs with low or high potential for postural hypotension.

Managing hypertension: the postgraduate medicine lecture.

Managing hypertension effectively requires careful evaluation of the patient, in particular for the presence of target-organ damage and of other risk factors for atherosclerosis. Dietary management has proved to be unsatisfactory in most hypertensive patients, as patients resist dietary restrictions or any other changes in life-style. Drug treatment has been shown to significantly reduce morbidity and mortality in patients with diastolic blood pressures above 104 mm Hg. Evidence suggests that drug treatment is also effective in those with diastolic pressures between 90 and 104 mm Hg. Selection of drugs is still an empirical decision--treatment with an oral diuretic usually is effective for mild hypertension (diastolic pressures 90 to 115 mm Hg). A sympathetic depressant, often propranolol, may be added to the regimen next, and if this is ineffective, a vasodilator (usually hydralazine) is included. Common side effects of antihypertensive drugs are seldom serious but can be annoying. Patients should be forewarned about them, and about the effects of untreated hypertension in an effort to improve compliance.