Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.4.15.1 (ACE)
 18,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The frequency of arterial hypertension occurrence in polish population amounts to 30-40%, among diabetics is significantly higher-70%. According to the WHO/ISH Guidelines all hypertensive patients with diabetes are included into the "high risk group" independent of hypertension stage. Pharmacological treatment of hypertension is this group of patients has a particular meaning. Among hypertensive patients the degree of blood pressure lowering is more effective for cardiovascular risk reduction than choice of drug. This fact is well documented in clinical trials comparing antihypertensive efficacy of old and new antihypertensive drugs (for example UKPDS, STOP 2, INSIGHT). From the other point of view renal protection and metabolic benefits, as well as reduction of target organ damage are more advantageous for angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and calcium antagonists than for diuretics and beta-blockers. Despite fast progress in clinical research on new antihypertensive drugs (especially AT1 receptor inhibitors) ACE-I seem to still remain still the "first choice" for hypertensive diabetics. Adequate blood pressure control among diabetic hypertensives is of special importance and usually needs appropriate combined antihypertensive therapy. Our review presents detailed information about treatment advantages and disadvantages of drugs from different antihypertensive classes in light of current clinical trials and international guidelines.
 ...
PMID:[Antihypertensive treatment for patients with hypertension and diabetes type II--current clinical research]. 1293 58

The knowledge about hypertension--especially its diagnosis and therapy--among graduates of medical schools, is very important in view of hypertensive epidemics. The aim of this study was to assess the medical graduate's knowledge about recommended technique of blood pressure (BP) measurements, the factors affecting BP measurement value, the WHO/ISH--1999 hypertension diagnostic criteria, and its complications and basic therapy rules. The questionnaire investigating the respondent's knowledge was filled out by 132 medical students of the 6th year Medical College of the Jagiellonian University, in Cracow, from February till June 2000. Only 21.2% of students had good knowledge about BP measurement technique, 70% to 90% of subjects knew hypertension diagnostic criteria, about 30% gave the correct values defined as "high-normal". About 37.1% were aware of complications concerning heart, brain, kidney, eye and peripheral blood vessels. Only 11% knew all drugs recommended by WHO/ISH guidelines, as first-line medication; but 95% were only able to mention at least four of them (diuretics, beta-blockers, ACE-I, Ca-blockers). The students have unsatisfactory levels of knowledge about hypertension. This indicates poor preparation of future physicians in treatment of hypertensive problems.
 ...
PMID:[Knowledge of hypertension and blood pressure measurement procedure among students of last year of medical school in Cracow]. 1497 41

The Task Force of the National Heart, Lung and Blood institute issued the first standardized, algorithmic approach to treating hypertension in 1973. The concept of a stepped-care approach was born at that time. Their initial recommendation for antihypertensive drug therapy was diuretics. Subsequent Joint National Committee (JNC) Reports on Detection, Evaluation, and Treatment of High Blood Pressure recommended that initial drug therapy be either a diuretic or beta-adrenergic blocker, and then either of these two drugs, and then a calcium channel blocker (CCB) or an angiotensin-converting enzyme inhibitor (ACE-inhibitors). The JNC-V then recommended any of the four classes or an alpha-beta-blocker as initial therapy, but diuretics and b-blockers were preferable. That diuretics or beta-blockers should be the initial drug for noncomplicated hypertensive patient was also the recommendation of the Sixth Joint National committee report. Safety issues that arose after introduction ACE inhibitors and CCBs have since been mostly resolved. Drug treatment thresholds varied among the US, Canadian, British and WHO/ISH recommendations despite the fact that all were based on the same set of data. The concept of "the lower the blood pressure the better without causing symptoms" was the rule until the J-curve hypothesis emerged and generated a long debate. Now the current evidence supports the old concept, at least for some conditions such as hypertension in diabetic patients or in those with nephrotic-range proteinuria. Despite the repeated recommendations that thiazide-diuretics are preferred as the initial agent in hypertension treatment, many clinicians ignore these guidelines. This practice has added a signficant cost to hypertension treatment worldwide.
 ...
PMID:The need for evidence in hypertension management: historical perspective. 1627 Jul 57

Age-related arterial stiffness is more pronounced in diabetics compared to non-diabetics, which could explain the prevalence of isolated systolic hypertension (ISH, systolic blood pressure > or =140 mmHg and diastolic blood pressure <90 mmHg) being approximately twice that of the general population without diabetes. Large-scale interventional outcome trials have also shown that diabetics usually have higher pulse pressure and higher systolic blood pressure than non-diabetics. Advanced glycation end-product formation has been implicated in vascular and cardiac complications of diabetes including loss of arterial elasticity, suggesting possibilities for new therapeutic options. With increasing age, there is a shift to from diastolic to systolic blood pressure and pulse pressure as predictors of cardiovascular disease. This may affect drug treatment as different antihypertensive drugs may have differential effects on arterial stiffness that can be dissociated from their effects on blood pressure. While thiazide diuretics are associated with little or no change in arterial stiffness despite a robust antihypertensive effect, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and calcium-channel blockers have been shown to reduce arterial stiffness. However, combination therapy is nearly always necessary to obtain adequate blood pressure control in diabetics. There are no randomized controlled trials looking specifically at treatment of ISH in diabetics. Recommendations regarding treatment of ISH in diabetes mellitus type 2 are based on extrapolation from studies in non-diabetics, post-hoc analyses and prespecified subgroup analysis in large-scale studies, and metaanalysis. These analyses have clearly demonstrated that blood pressure lowering in ISH confers improved prognosis and reduced cardiovascular and renal outcomes in both diabetics and non-diabetics.
 ...
PMID:Treatment of isolated systolic hypertension in diabetes mellitus type 2. 1677 44

It is now universally accepted that antihypertensive therapy reduces cardiovascular morbidity and mortality both in young and older patients. The clinical relevance of the systolic, diastolic and pulse pressure as independent risk factors is well recognized. The reduction of cardiovascular morbidity and mortality in hypertensive patients is the main therapeutic goal. There is substantial agreement on the treatment of individual risk factors and associated clinical conditions, but the best drug therapy for systolic and diastolic hypertension and/or high pulse pressure is still controversial. The recommendations of the JNC VI are that diuretics or beta-blockers be used as first-step drug therapies. The WHO-ISH guidelines recognize calcium antagonists, ACE-inhibitors, alpha-blockers and angiotensin II receptor antagonists as first-step drug therapies together with diuretics and beta-blockers. All these drugs have a similar hypotensive potential and reduce cardiovascular risk, but with noticeable differences in tolerability and side effects. It has long been demonstrated that diuretics and beta-blockers significantly reduce the cardiovascular risk, but their side effects can be relevant. ACE-inhibitors have proved to be efficacious in hypertensive patients with chronic heart failure and diabetes. Calcium antagonists are useful in the prevention of stroke but results in patients at high risk of coronary artery disease and heart failure are controversial. Alpha-blockers have proved to be unsafe in patients with heart failure but showed beneficial effects in young patients with diastolic hypertension. Angiotensin II receptor antagonists have proved to be safe and efficient but their advantages in comparison to other drugs need to be confirmed.
 ...
PMID:[Systolic, diastolic and pulse pressure: therapeutic options]. 1939 10


<< Previous 1 2