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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Both the Joint National Committee and the British Hypertension Society recommend b-blockers and diuretics as first-line therapy in the treatment of uncomplicated hypertension. As a result, many clinicians will also prescribe these drugs in the treatment of patients with hypertension and coexistent disease (unless they are specifically contraindicated), even though they may not always be the most beneficial choice. This review aims to examine factors that should be taken into consideration when choosing appropriate antihypertensive therapy. Particular attention is given to treatment options in two special patient groups, the elderly and patients with co-morbid diabetes, as these groups have an increased risk of developing cardiovascular complications. In response to the increasing evidence base from large-scale trials, the article concludes that cardiovascular risk factors, coexisting disease, concomitant medication and age should all be taken into account when choosing antihypertensive therapy.
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PMID:Considerations for drug therapy in hypertension. 1121 16

Angiotensin receptor antagonists (ARB) are equally effective but better tolerated than all the other blood pressure lowering agents. The reason, why they are not subscribed as first line drugs for uncomplicated hypertension, is the higher price for these products. What the real difference in costs is, remains unclear because calculations are missing to what extent lesser controls of therapy would shift the balance in favour of the ARBs. For other indications than hypertension, but often associated with that condition, be it per se or as a consequence of it, the effects of the ARBs are studied in large trials these days. For some of them the benefit, which has been proven for ACE inhibitors, is not yet established for the ARBs, but evidence emerges that they are also useful in the treatment of cardiac failure, left ventricular hypertrophy and diabetic and other kinds of nephropathy. A large percentage of hypertensive patients can be treated effectively with ARBs without considerable side effects, thus increasing adherence and minimizing the necessity of safety controls.
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PMID:[Angiotensin receptor blockers--significance for the therapy of hypertension]. 1145 Jan 62

A cost-effectiveness model was designed to explore the effect of adding a new angiotensin-II inhibitor, telmisartan, to the therapeutic options for treating mild-to-moderate uncomplicated hypertension. Incorporating the cost of drugs, physician visits, and adverse-event treatments, the model concluded that availability of telmisartan on formulary may shorten the mean time and costs to control. The stability of the initial findings over a range of sensitivity analyses lends credence to the model conclusions that availability of telmisartan on formulary improves the therapeutic options of care for hypertension.
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PMID:Mild-to-moderate uncomplicated hypertension: further analysis of a cost-effectiveness study of five drugs. 1148 19

To study the prevalence of pre-eclampsia (PE) and other obstetric outcomes (growth restriction and fetal mortality) in pregnancies of normotensive and hypertensive women attending an antenatal hypertension clinic, we studied a cohort of 372 pregnancies from 267 women. The prevalence of PE in the groups of pregnancies of normotensive and chronic hypertensive women was 11.9% (19/159 cases) and 16.0% (34/213 cases) respectively (chi 2 = 1.2, p = 0.27). There were no significant differences in respect of ethnicity, being primi- or multigravida and smoking status or age. Treatment with antihypertensive drugs during pregnancy did not decrease the prevalence of PE. In pregnancies with hypertensive complications (with or without PE) there was a trend towards higher rates of pre-term delivery (< 37 weeks), caesarean section, small for gestational age babies, stillbirth and lower baby birth weight and ponderal index values. Pregnancies in women with uncomplicated hypertension had an increased risk for emergency caesarean section, pre-term delivery (< 37 weeks), birth weight < 2500 g and stillbirth (relative risks [with confidence intervals] 2.5 [1.9-3.2], 2.3 [1.8-2.9], 3.1 [2.5-3.7] and 5.5 [2.6-11.9] respectively) compared with the general hospital obstetric population. After classification according to the type of hypertensive syndrome, a progressively higher risk for fetal growth restriction and adverse perinatal outcome was shown in the hypertensive and pre-eclamptic groups. In chronic hypertension, this was irrespective of superimposed pre-eclampsia or antihypertensive therapy. The high prevalence of PE in chronic hypertensive women (16.0%) was not statistically significant to that of normotensive women (11.9%), reflecting the referral selection of 'high risk' normotensive women to our clinic.
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PMID:The prevalence of pre-eclampsia and obstetric outcome in pregnancies of normotensive and hypertensive women attending a hospital specialist clinic. 1150 Dec 23

Despite dramatic improvements in the management of hypertensive cardiovascular disease, much remains to be accomplished. Arterial stiffness, through its effects on central aortic pressure, is a key determinant of increased cardiovascular risk. Increased pulse pressure is a late manifestation of increased arterial stiffness. What is needed is a simple, reliable, non-invasive method of detecting early disturbances in central artery stiffness at a time when therapeutic intervention can be most beneficial. Currently, intervention studies support initiating antihypertensive therapy in uncomplicated hypertension when systolic blood pressure > or = 160 mmHg, whereas the benefit of treating systolic blood pressure of 140-159 mmHg, the largest subset of persons with hypertension, has yet to be tested in controlled trials. Further studies are needed to determine the optimal target goal for blood pressure reduction in both uncomplicated hypertension and in hypertension complicated by diabetes, coronary heart disease, or renal disease. Angiotensin converting enzyme inhibitors may provide selective cardiac and renal protection beyond their blood pressure-lowering effect in the presence of specific cardiovascular disease and/or diabetes. In contrast, there is as yet no definitive answer as to the relative benefit of blood pressure lowering versus specific drug effects in minimizing cardiovascular events in uncomplicated hypertension. Although there has been a recent increase in hypertension awareness and treatment, only a small percentage of affected individuals are being treated to goal. Hypertensive cardiovascular disease represents a world-wide public health challenge that can be solved only by new innovative measures aimed at both prevention and treatment.
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PMID:Blood pressure and cardiovascular disease: what remains to be achieved? 1171 48

The spectrum of disorders associated with an elevated blood pressure (BP) encompasses chronic uncomplicated hypertension and the hypertensive crises, including hypertensive urgencies and emergencies. Although these syndromes vary widely in their presentations, clinical courses, and outcomes they share pathophysiologic mechanisms and, consequently, therapeutic responses to specifically targeted antihypertensive drug types. Nevertheless, hypertensive crises are often treated with drugs which, in that setting are either unsafe or are of unsubstantiated efficacy. The purpose of this review is to examine the pathophysiology of commonly encountered hypertensive crises, including stroke, hypertensive encephalopathy, aortic dissection, acute pulmonary edema, and preeclampsia-eclampsia and to provide a rational approach to their treatment based upon relevant pathophysiologic and pharmacologic principles. Measurement of plasma renin activity (PRA) level often provides insight regarding pathophysiology and predicts efficacy of antihypertensive treatments in the individual patient. However, in hypertensive crises, drug therapy is initiated before the PRA level is known. Nevertheless, the renin-angiotensin dependence (R-type) or volume dependence (V-type) of hypertension can often be deduced by the BP response to drugs that interrupt the renin system (R-drugs) or that decrease body volume (V-drugs). Based upon these considerations, a treatment algorithm is provided to guide drug selection in patients presenting with a hypertensive crisis.
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PMID:Management of hypertensive crises: the scientific basis for treatment decisions. 1172 16

Current guidelines in the treatment of arterial hypertension do not recommend differential treatment of obesity-associated hypertension. Since optimal blood pressure control in most obese hypertensives requires a combination of blood pressure-lowering substances, careful consideration of the choice of treatment is of particular importance. On the basis of their favorable metabolic properties, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, and low-dose diuretics, should be preferentially employed in the obese. Beta-blockers should not be given to young obese patients with uncomplicated hypertension. Before definitive pronouncements on what constitutes optimal treatment of obese patients can be made, the results of studies looking at hard end points must be available.
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PMID:[Lowering blood pressure in obese hypertensive patients. Which antihypertensive drugs are suitable]. 1177 Mar 73

The decision to treat, or not treat, uncomplicated mild hypertension should be based on a formal estimate of absolute cardiovascular risk and not on an arbitrary blood pressure threshold. The decision to initiate pharmacologic treatment requires consideration of the degree of blood pressure elevation, the presence of target organ damage, and the presence of clinical cardiovascular disease or other risk factors. Special considerations include demographic characteristics, concomitant diseases that may be beneficially or adversely affected by the antihypertensive agent chosen, quality of life, cost, and use of other drugs that may lead to drug interactions. Diuretics, beta-blockers or ACE inhibitors may be used as first-step drug therapies for the treatment of uncomplicated hypertension. Genetic factors may contribute to interindividual differences in responses to antihypertensive drug therapy. Knowledge of polymorphic variation in these genes will help to predict individual patients' blood pressure responses to antihypertensive drug therapy and may also provide new insights into molecular mechanisms responsible for elevation of blood pressure.
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PMID:[Pharmacologic treatment of patients with arterial hypertension. Parameters to be considered when choosing a therapeutic approach]. 1200 41

Beta-blockers are the most frequently used drugs for the treatment of hypertension. Apart from concerns regarding potential adverse metabolic effects on lipids or insulin sensitivity, beta-blockers can also cause weight gain in some patients. This fact appears little known to clinical practitioners and trialists. Thus, only a minority of clinical trials with beta-blockers report weight changes during treatment. In trials that do report weight changes, beta-blockers are associated with a weight gain of 1.2 (range -0.4-3.5) kg. This may be attributable to the fact that beta blockade can decrease metabolic rate by 10%. Beta-blockers may also have other negative effects on energy metabolism. Obesity management in overweight hypertensive patients may therefore be more difficult in the presence of beta-blocker treatment. We therefore question the use of beta-blockers as first-line therapy for overweight or obese patients with uncomplicated hypertension.
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PMID:Use of beta-blockers in obesity hypertension: potential role of weight gain. 1211 98

The aim of the study was to examine whether the circulating cell adhesion molecules, von Willebrand factor (vWf) and endothelin-1, are elevated in patients with essential hypertension with no other risk factors for atherosclerosis and thus may serve as a markers of endothelial dysfunction in uncomplicated hypertension. Furthermore, the effect of treatment with the ACE inhibitor, quinapril, on levels of endothelial dysfunction markers were studied. The levels of adhesion molecules (intercellular cell adhesion molecule-1 [ICAM-1], E-selectin, P-selectin), von Willebrand factor (vWf) and endothelin-1 were measured in patients with hypertension without any other risk factors of atherosclerosis before and after treatment with quinapril (n = 22) and in normotensive controls (n = 22). Compared with normotensive subjects, the hypertensive patients had significantly higher levels of ICAM-1 (238 vs 208 ng/ml, P = 0.02), vWf (119 vs 105 IU/dl, P < 0.05) and endothelin-1 (5.76 vs 5.14 fmol/ml, P < 0.05). Three-month treatment of hypertensive patients with quinapril led to a significant decrease in the levels of endothelin-1 (5.76 vs 5.28 fmol/ml, P < 0.01). We did not observe significant changes in the levels of adhesion molecules and vWf after ACE inhibitor treatment, although a trend toward a decrease was apparent with all these parameters. Patients with uncomplicated hypertension with no other risk factors of atherosclerosis had significantly elevated levels of ICAM-1, vWf, and endothelin-1. Our data suggest that these factors may serve as markers of endothelial damage even in uncomplicated hypertension. In hypertensive patients, treatment with the ACE inhibitor quinapril resulted in a significant decrease in endothelin-1 levels. These findings indicate a beneficial effect of ACE inhibitors on endothelial dysfunction in hypertensive patients.
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PMID:Circulating intercellular cell adhesion molecule-1, endothelin-1 and von Willebrand factor-markers of endothelial dysfunction in uncomplicated essential hypertension: the effect of treatment with ACE inhibitors. 1214 57


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