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

A 40-year-old housewife was observed with chief complaints of syncope and palpitation. The electrocardiogram indicated premature ventricular ectopic complexes of the torsade de pointes. Serum potassium level was low because of thiazide-induced hypokalemia for the treatment of transient hypertension. Even after the disappearance of threatening ventricular arrhythmias and normalization of serum potassium level, prolongation of QT interval was continuously persisted. Thiazide induced hypokalemia might have some roles on producing ventricular ectopic activity in prolonged QT syndrome as shown in our case.
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PMID:Multifocal ventricular ectopic complexes possibly related to diuretic induced hypokalemia in a woman with the long QT syndrome. 243 47

The major risk factors for coronary disease are blood pressure, blood lipids and cigarette smoking. Major advances have been made over the past 20 years in altering these factors and this has been accompanied by a dramatic reduction in new incidence myocardial infarction (MI) and stroke. Several questions remain however, concerning the best treatment approaches for 'mild' hypertension (DBP = 90-104 mmHg). One major question is the potential ability of different classes of antihypertensive drugs to prevent fatal and non-fatal coronary heart disease. Underscoring this question is the recognition that drug classes differ in their lipid effects. Thiazide diuretics tend to increase total and low density lipoprotein (LDL)-cholesterol, increase triglycerides and slightly lower high density lipoprotein (HDL)-cholesterol. On the other hand alpha 1-antagonists have been shown to influence lipids favourably by lowering total cholesterol, LDL-cholesterol and increasing HDL-cholesterol. Other agents such as calcium channel blockers and ACE inhibitors appear to be lipid neutral. The cost effectiveness of various treatments for hypertension depends not only on direct drug costs but also on the less well-defined indirect costs associated with possible differences in disease rates between treatments. Estimates of disease occurrence with various lipid changes can be modelled after the results of the Coronary Primary Prevention Trial (CPPT) and cost estimates of various diseases (i.e. acute MI) can be estimated from diagnosis-related group data, insurance data and physician survey data.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidemiological and cost implications of antihypertensive treatment for the prevention of cardiovascular disease. 251 65

Thiazide diuretics have frequently been recommended as initial therapy in patients with mild to moderate hypertension. However, their undesirable metabolic consequences have been suspected of contributing to increases in cardiovascular morbidity and mortality. Even at low doses, there is a definite decrease in both potassium and magnesium levels. The degree of decrease in potassium and magnesium levels has been shown to be directly related to the hydrochlorothiazide dosage. Many investigators have now reported an increase in ventricular ectopy associated with diuretic-induced hypokalemia. Whereas there is no single study that conclusively proves that thiazide therapy results in malignant arrhythmias and an increased risk of sudden death, the circumstantial evidence is strong. Although sodium restriction is critical to potassium restoration, it rarely works alone. Potassium chloride supplementation can be effective in restoring potassium but not magnesium. Potassium-sparing diuretic combinations can both prevent and treat hypokalemia and hypomagnesemia, possibly reducing the risk of potentially lethal arrhythmias and sudden death.
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PMID:Electrolyte disarray and cardiovascular disease. 264 89

When a patient with chronic obstructive pulmonary disease (COPD) requires medical therapy for systemic hypertension, a number of special considerations may affect the choice of antihypertensive drug and subsequent management. Thiazide diuretics have no adverse effect on airway function and are the agents of choice for initial therapy. beta-Antagonists are usually considered first-line agents in antihypertensive therapy, but even relatively cardioselective ones may increase airway resistance in patients with obstructive lung diseases, and they should be used with caution, if at all, in such patients. Although potassium-wasting diuretics are the preferred agents for treating hypertension in patients with COPD, they may worsen carbon dioxide retention in hypoventilating patients and potentiate hypokalemia in those receiving corticosteroids. In addition, beta-agonists may substantially lower serum potassium levels in patients already rendered hypokalemic by diuretics. Patients with COPD receiving potassium-wasting diuretics who have chronic respiratory acidosis or are receiving corticosteroids or beta-agonists should undergo close monitoring of electrolyte levels and be considered for therapy with potassium supplements or, preferably, potassium-sparing agents.
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PMID:Fluid and electrolyte considerations in diuretic therapy for hypertensive patients with chronic obstructive pulmonary disease. 286 47

Remarkable progress has been made during the past 30 years in the management of hypertension, a disease that affects approximately one out of every four adults in the United States. In the 1960s, at least half of the individuals with hypertension were unaware of their disease, and the blood pressures of fewer than 20 percent were controlled at normotensive levels. In contrast, in the 1980s, only a small percentage, perhaps as few as 10 or 15 percent of hypertensive patients, are unaware of their disease and, in many parts of the country, more than 60 percent are being treated to goal blood pressure levels. More effective treatment of hypertension is probably a major reason for the 45 percent decrease in stroke mortality rates in the last 12 years alone and for the dramatic decrease in the number of hypertensive patients in whom renal failure or congestive heart failure develops. In addition, at least a portion of the 25 to 30 percent decrease in coronary mortality rates can probably be attributed to better management of patients with hypertension. The availability of antihypertensive drugs in the 1950s (rauwolfia preparations, veratrum derivatives, thiocyanates, hydralazine, and the ganglion blockers) and the discovery of more effective agents in the period from the 1960s to the present have dramatically improved the prognosis of hypertensive patients. Thiazide diuretics, centrally acting sympatholytic agents, beta-adrenergic inhibitors, and, more recently, selective alpha-adrenergic inhibitors, converting-enzyme inhibitors, and calcium entry blockers are examples of these medications. All of these agents have some side effects, with varying patient acceptability. The search continues for newer drugs that are well tolerated, that lower blood pressure by reducing peripheral resistance, and that produce few metabolic changes. A detailed review of the physiologic effects of antihypertensive medications, as well as a critique of the clinical trials and some of the problems noted in the pharmacologic management of hypertension, is presented.
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PMID:Historical perspective on the management of hypertension. 287 99

The results of several important clinical trials have confirmed the benefits of pharmacologic treatment in patients with hypertension. However, some issues concerning this type of treatment have yet to be resolved. For example, it has not been determined whether there are differences among antihypertensive agents with respect to their effects on mortality and morbidity or whether such effects are independent of the alterations in blood pressure resulting from the use of such agents. Thiazide diuretics, the most commonly prescribed antihypertensive drugs, were the first agents proven to be effective and practical for the widespread treatment of hypertension. Alpha blockers, also commonly prescribed antihypertensive drugs, provide equally effective blood pressure control to that of the thiazides, but with a very different metabolic profile. In this article, these drugs are compared for efficacy, side-effect profiles, metabolic effects, and potential for reducing the risk of coronary heart disease.
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PMID:Thiazide diuretics and selective alpha blockers: comparison of use in antihypertensive therapy, including possible differences in coronary heart disease risk reduction. 287 60

The treatment of high blood pressure with beta-blocking and other antihypertensive agents has been associated with a decrease in the incidence of stroke, progression of hypertension, heart failure, left ventricular hypertrophy, retinopathy and renal failure. Although hypertension increases the risk for developing coronary disease, the risk is heightened markedly if coexistent hyperlipidemia, smoking or glucose tolerance is present. Thiazide diuretics, primarily used as antihypertensive agents, compromise glucose tolerance and are associated with increases in plasma cholesterol, triglycerides and low density lipoprotein levels. Nonselective and beta 1-selective beta blockers have also been associated with increases in plasma triglycerides and very low density lipoproteins, as well as with decreases in high density lipoprotein levels. The effects of various antihypertensive agents on lipid levels, lipid metabolism, carbohydrate metabolism, left ventricular size and atherogenesis are discussed.
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PMID:Effects of beta blockers and other antihypertensive drugs on cardiovascular risk. 288 79

Diuretic drugs, when used in the treatment of hypertension, raise the blood concentrations of total cholesterol and low-density or very low-density lipoprotein cholesterol. Triglycerides often increase as well. Thiazide, phthalimidine, loop, potassium-sparing, and methylindoline drugs produce a similar effect. Only indapamide, a methylindoline agent with vasodilator activity, has been free of adverse lipid effects. It remains unclear whether it is the low dose of indapamide or some other quality that frees it of this effect. In long-term diuretic therapy, total cholesterol returns to, or below, baseline values, suggesting that the lipid elevations are transitory. However, in studies with adequate control groups, total cholesterol declines below baseline valves in control subjects such that an adverse differential in lipid values persists in long-term treatment. Selective alpha-1-adrenoceptor-blocking drugs cause no change or favorable alterations in lipid concentrations in short-term and long-term (1 year) treatment. Among all antihypertensive drugs, this class of agents, and especially prazosin, has produced the most consistently salutary lipid and metabolic effects. Although less well examined, guanabenz, clonidine, guanfacine, and diltiazem have been associated with favorable lipid changes. Captopril and nifedipine have caused no change in lipid-lipoprotein values in limited investigations. These agents are preferable to diuretics and certain beta blockers with respect to short-term effects on lipids and lipoproteins. Their ultimate superiority as monotherapy depends on whether they lower blood pressure equally well. Lowering of the probability of coronary heart disease in hypertensive patients depends as much on blood pressure control as on lipid effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The influence of non-beta-blocking drugs on the lipid profile: are diuretics outclassed as initial therapy for hypertension? 288 46

Thiazide-type diuretic drugs modify the lipoprotein profile when used in the short term treatment of hypertension. Total cholesterol increases by 6 to 7% on average because of raised concentrations of low density or very low density lipoprotein cholesterol or both. High density lipoprotein cholesterol does not change. Spironolactone has a lesser effect on lipids than do thiazides. In contrast, the methylindoline compound, indapamide, a diuretic with vasodilator activity, has produced no adverse effects on lipids or lipoproteins. Long term data on thiazide monotherapy are sparse but suggest a persistence of the lipid effect for as long as 6 years of treatment. The clinical impact of these lipid changes is unclear. Although clinical trials have proved the benefit of lowering cholesterol on the incidence of coronary heart disease, the clinical significance of these diuretic-induced increases is unknown. A clinical trial will be required to resolve the issue by comparing antihypertensive drugs with and without adverse effects on the lipid profile. Because coronary heart disease is the most common complication of mild hypertension, and as diuretic-based regimens have not succeeded in curbing it, resolution of this concern is important.
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PMID:Effects of diuretic drugs on the lipid profile. 306 4

The benefits of treating hypertension have been documented by several long-term studies that have shown a decreased incidence of morbidity and mortality associated with stroke, left ventricular failure, and renal insufficiency. With the large number of antihypertensive drugs currently available, several safety factors need to be considered when initially choosing a regimen so as not to adversely influence the potential benefits of blood pressure control. Antihypertensive agents should be chosen based on their hemodynamic profile, the absence of adverse metabolic effects and subjective side effects, and the presence of beneficial effects on the patients' quality of life. Thiazide diuretics and beta-blocking agents have often been recommended as initial therapy in patients with mild to moderate hypertension. However, thiazide diuretics may be less desirable in certain patients because of their effects on lipids, potassium, and glucose tolerance; beta-blocking agents are not ideal for some patients because of their effects on lipids, exercise tolerance, and overall quality of life. The angiotensin-converting enzyme inhibitors, selective alpha 1-blocking agents, and calcium channel blocking agents may be more appropriate for initial therapy of hypertension in many patients.
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PMID:Issues with antihypertensive therapy: safety perspectives. 328 Feb 82


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