Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Calcium antagonists represent a diverse group of therapeutic agents with heterogenous pharmacologic, pharmacokinetic, and pharmacodynamic properties. It seems clear that the role of these agents in the management of patients with ischemic heart disease and hypertension is, in part, predicated on the subclass of calcium antagonists (dihydropyridine versus nondihydropyridine [heart rate-lowering]) that are used. The reports by Psaty and Furberg are important in that they remind clinicians of the fact that use of short-acting dihydropyridine agents may be associated with increased cardiac event rates in patients with ischemic heart disease and hypertension. It is our opinion, however, that there are no data that support the extrapolation of these untoward effects to the more contemporary, long-acting dihydropyridines (eg, amlodipine) or, especially, to the non-dihydropyridine (heart rate-lowering) calcium antagonists, such as diltiazem or verapamil. On the contrary, data pooled from homogeneous populations of post-MI patients from DRS, MDPIT, DAVIT-I, and DAVIT-II indicate that clinical outcomes are favorably influenced in patients recovering from non-Q wave MI, and in hypertensive post-MI patients with preserved left ventricular function. These findings support the belief that the deleterious effects observed in certain studies with short-acting dihydropyridine calcium antagonists represent a "selective" rather than a "class action" effect of these agents. Psaty and Furberg have assailed the absence of "evidence-based medicine" regarding, the utility of calcium antagonists as the most compelling argument to call for a moratorium on this broad class of therapy, pending the completion of several prospective, randomized, controlled clinical trials that are presently underway or planned. However, a large body of scientific evidence provides no sound basis for physicians to discontinue therapy in patients who are being treated with long acting calcium antagonists, particularly those that lower heart rate. Moreover, the available data support the use of heart rate lowering calcium antagonists in selected patients, such as those recovering from acute non-Q wave MI, who may experience long-term benefit from diltiazem or verapamil. Until the results of controlled trials are completed, these data suggest that a generic moratorium of all calcium antagonists is ill-advised.
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PMID:Calcium channel antagonists: friend or foe in postinfarction patients? 896 29

Older individuals (subjects aged >65 years) largely contribute to the percentage deaths due to myocardial infarction (MI) and stroke. The incidence of venous thromboembolism (VTE) is also higher >65 years old patients. However, the risk of bleeding complications in patients on antithrombotic drugs increases with age and with clinical conditions, as cognitive/psychiatric diseases, traumas, hypertension, poor compliance with medications, common in the elderly. Thus the risk-benefit ratio of antithrombotics should be carefully evaluated in older individuals. To prevent the risk and the recurrence of ischemic stroke and MI in the older patients with stable/ unstable angina, MI, TIA/stroke or peripheral arterial disease, antiplatelet drugs are of choice. Aspirin is the most widely used antiplatelet drug. Clopidogrel is safer and more effective than aspirin in this respect. The combination of heparin and aspirin is the treatment of choice for unstable angina and non-Q wave MI, also in the elderly. Low molecular weight heparins (LMWHs) proved to be as effective as standard heparin in this indication. In the absence of contraindications, thrombolysis for treatment of acute MI may be considered in the elderly. For the treatment of acute venous thromboembolism (VTE), intravenous standard heparin, subcutaneous standard heparin or LMWHs are effective. Because of the limited risk/benefit ratio, thrombolytic agents are not recommended for treating deep vein thrombosis (DVT) in the elderly. They should be limited to young patients and to patients with massive pulmonary embolism (PE). For chronic treatment of VTE, warfarin is the treatment of choice (INR 2.0-3.0), also in the elderly. Because of hypersensitivity to oral anticoagulants, lower dosages of warfarin are needed in the old patient. As to prophylaxis of VTE in surgery, in subjects at low-moderate risk, or in medical patients, low-dose heparin or low-dose LMWHs are effective. As to prophylaxis of VTE in surgery in subjects at high risk, adjusted-dose heparin or high-dose LMWHs are recommended. Finally, as to prevention of stroke in patients older than 75 with atrial fibrillation (AF), warfarin is of choice.
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PMID:The use of antithrombotic drugs in older people. 1185 Jun 11

This study assessed the pharmacokinetics, safety and efficacy of intravenous enoxaparin in patients undergoing percutaneous coronary intervention (PCI). Sixty consecutive patients [(age, 62 11 years; female, 16%; diabetes, 18%; hypertension, 53%; prior myocardial infarction (MI), 43%] undergoing PCI (stable angina, 89%; stent, 92%; two-vessel disease, 23%; B2/C lesions, 45%) were administered intravenous enoxaparin 1 mg/kg for procedural anticoagulation. Blood samples for anti-Xa level and activated partial thromboplastin time (aPTT) were assayed from the first 20 patients before and after enoxaparin administration at the following intervals: 5, 30, 60, 90, 120, 150, 180, 210, 240, 360 and 480 minutes. Activated clotting time was assessed 5 minutes after enoxaparin administration. Bleeding complications were classified according to Thrombolysis In Myocardial Infarction (TIMI) criteria. All patients were monitored for adverse clinical events at clinic visit 4 8 weeks after hospital discharge. No TIMI major or minor bleedings occurred during hospitalization for the PCI (median stay post-PCI = 1 day). One patient (2%) developed a non-Q wave MI after the PCI and before hospital discharge. There was no death or urgent revascularization up to clinical follow-up. The peak anti-Xa level was 1.30 0.18 IU/ml (range, 1.03 1.69 IU/ml). The minimum anti-Xa level was 0.55 IU/ml 4 hours after enoxaparin. Thus, the use of intravenous enoxaparin in patients undergoing PCI is associated with a low incidence of ischemic and bleeding complications. A stable therapeutic anticoagulant effect is provided without the need for monitoring within 4 hours of enoxaparin administration.
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PMID:Stable and optimal anticoagulation is achieved with a single dose of intravenous enoxaparin in patients undergoing percutaneous coronary intervention. 1214 72