High Blood Pressure Homeopathic Cure

Hypertension Exercise Program

The exercises in Three Easy Exercises to Drop Blood Pressure Below 120/80 take about 30 minutes a day, and you can do them while you're doing routine household chores. Christian Goodman is the researcher behind the Blue Heron Health High Blood Pressure Exercise Program. If this pressure is too high, it puts a strain on your arteries and your heart making you more likely suffer a heart attack, a stroke or kidney disease. All of your risk will be stopped instantly in less than 30 minutes a day to practice exercises. These exercises used in Natural Blood Pressure are focused on mind and body ones in the system called Focused Break. You will start experiencing the calming effects of the exercises within minutes. Best of all, you won't need to rely on medication or implement any major dietary changes. They're safe, easy and effective. More here...

Hypertension Exercise Program Summary


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Antihypertensive Drugs

Drugs that are used for treating hypertonic diseases as well as symptomatic hypertensions are called antihypertensive drugs. Hypertension is a syndrome characterized by elevated arterial blood pressure that depends on a number of factors. Some of the main factors that determine arterial blood pressure are parameters of heart rate, volume, viscosity, and electrolytic contents of circulating blood. Normal range of blood pressure varies depending on sex and age. Moreover, various medical schools themselves determine what an acceptable value is. The etiology of 90-95 of cases of this disease are unknown, and these cases are referred to as primary or essential hypertension treatment is of a palliative nature that is directed to lowering systolic and diastolic blood pressure, and in general, effectively permitting control of a patient's arterial blood pressure over a long period of time. During such treatment, antihy-pertensive agents can be directed at various sections of physiological...

Role of Endocannabinergic System in Hypertension

As early as in the 1970s, the potential use of cannabinoid ligands as antihypertensive agents had been considered (Archer 1974 Crawford and Merritt 1979 Varma et al. 1975 Zaugg and Kyncl 1983), in the hope that their neurobehavioral and cardiovascular effects could be separated. Although an early study in normotensive rats indicated rapidly developing tolerance to the hypotensive and bradycardic effects of THC (Adams et al. 1976), a subsequent study in spontaneously hypertensive rats (SHR) found no evidence for tolerance for the same effects during a similar, 10-day treatment period (Kosersky 1978). Following the introduction of selective CB receptor antagonists in the mid 1990s, the finding that treatment of normotensive rats or mice with CB1 antagonists alone does not affect blood pressure (Lake et al. 1997a Varga et al. 1995), and that baseline blood pressure is similar in CB1 knockout mice and their wild-type littermates (Jarai et al. 1999 Ledent et al. 1999), indicated the...

R The role of endothelin receptor antagonists in hypertension

It is disappointing that mechanistically novel antihypertensive drugs have not emerged during the last decade or two. The only real novelty of the last decade was the addition of angiotensin II receptor antagonists as a refinement of the approach introduced with ACE inhibitors. The expectations for direct renin antagonists have not been realized. Some of the cornerstone classes of antihypertensive drugs, such as the diuretics, beta-adrenoceptor antagonists, calcium channel blockers, and direct vasodilators, have been around for several decades. Advances have predominantly been made in the pharmacokinetic properties and pharmacodynamic specificities of compounds in existing antihypertensive drug classes. With the emergence of knowledge about en-dothelial factors such as nitric oxide and en-dothelin, there was much expectation that en-dothelin antagonists would become useful in the management of hypertension. Endothelin was discovered in 1988 (1R) and is the most potent vasoconstrictor...

TABLE 422 Examples of Selected Antihypertensive Combinations

High Blood Pressure Anatomy Diaphragm

ANTIHYPERTENSIVE may find it necessary to prescribe a different antihyper-tensive drug when the patient experiences no response to therapy. Some antihypertensive drugs are used only in severe cases of hypertension and when other less potent drugs have failed to lower the blood pressure. At times, two antihypertensive drugs may be given together to achieve a better response (see Fig. 42-1). Diazoxide (Hyperstat IV) and nitroprusside (Nitropress) are examples of intravenous (IV) drugs that may be used to treat hypertensive emergencies. A hypertensive emergency is a case of extremely high blood pressure that does not respond to conventional antihypertensive drug therapy.

Arterial hypertension and pregnancy

Different kinds of arterial hypertension should be distinguished from one another as follows (for pulmonary hypertension, see section 2.8.14) m Chronic hypertension (with or without proteinuria) which was diagnosed before, during or after pregnancy Pre eclampsia, eclampsia that is proteinuria ( 300mg d), and newly diagnosed hypertension (edemas are no longer necessary symptoms) Pre-eclampsia in a pregnant woman with pre-existing chronic hypertension, which occurs in 20-25 percent of all pregnancies with chronic hypertension Pregnancy-induced hypertension (PIH) that occurs beyond 20 weeks without proteinuria and returns to normal 12 weeks after delivery approximately half of these pregnant women develop pre-eclampsia. Blood pressure of 140 90 mmHg is the threshold for hypertension in pregnancy. Treatment should only be initiated at levels higher than 160 110 mmHg, because below that there are no advantages in treatment for the outcome of mother and child. If a patient has no...


Hypotension and tachycardia are well-recognised effects of cannabis and cannabinoid use in man (Benowitz and Jones, 1981). The antihypertensive effects of the cannabinoids appear to be independent of their psychotropic effects for example CBD, a non-psychotropic derivative, is active (Adams et al., 1977). There is no clinical trial evidence that cannabis or any of its derivatives would be satisfactory alternatives to established agents in the long-term control of elevated blood pressure. While these agents have a hypotensive effect, the pharmacology of this process remains unclear and is complex, possibly involving stimulation of vasodilatory prostaglandins (Burstein and Hunter, 1984). Interestingly, CBD appears to have a bradycardic effect in animal models where THC produces tachycardia (Smiley et al., 1976) therefore if cannabinoid analogues are to be developed as antihypertensive agents, it may be more useful to explore derivatives based on the structure of the former rather than...


Erectile dysfunction is claimed to be a frequent side effect of antihypertensive treatment. Also patients themselves are convinced that their impotence is caused by antihypertensive drugs they take, and many physicians support this opinion however, as early as 1978 Bauer et al. stated that the extent of sexual function impairment is age-related as compared with that observed in men not taking antihypertensives. Ten year later, Bansal (1988) quoted that the reported studies did not clearly indicate whether the impairment is due to the drugs, the influence of the disease, or both. Again 10 years later, other authors concluded Scientific evidence that links antihypertensive drugs to sexual dysfunction in placebo-controlled trials is limited (Grimm et al. 1997). Nevertheless, patients with hypertension are at greater risk to suffer from erectile dysfunction, irrespective of the treatment, than are healthy men. The OR was found to be significantly greater than 1 in large case-control...

Organs and Systems Cardiovascular

Particularly when androgens anabolics are misused to promote extreme muscular development, there is a risk of cardiomegaly and ultimate cardiac failure. Androgen-induced hypertension may be due to a hypertensive shift in the pressure-natriuresis relation, either by an increase in proximal tubular reabsorption or by activation of the renin-angiotensin system (15). This effect is not related to higher doses or longer treatment and can develop after a few months but can also be delayed for many years.

General adverse effects

The frequencies and the profile of adverse effects of five major classes of antihypertensive agents have been assessed in an unselected group of 2586 chronically drug-treated hypertensive patients (19). This was accompanied by a questionnaire-based survey among patients visiting a general practitioner. The percentages of patients who reported adverse effects spontaneously, on general inquiry, and on specific questioning were 16,24, and 62 respectively. With ACE inhibitors the figures were 15, 22, and 55 . The percentage of patients in whom discontinuation was due to adverse effects was 8.1 with ACE inhibitors (significantly higher than diuretics). Compared with beta-blockers, ACE inhibitors were associated with less fatigue (RR 0.57 95 CI 0.38, 0.85), cold extremities (RR 0.11 CI 0.07, 0.18), sexual urge (RR 0.52 CI 0.33, 0.82), insomnia (RR 0.10 CI 0.04, 0.26), dyspnea (RR 0.38 CI 0.17, 0.85), and more coughing (RR 13 CI 5.6, 30). The authors did not find a significant effect of age...

General Information

Anorectic drugs, which are structurally related to the amphetamines, act mainly on the satiety centre in the hypothalamus and also increase general physical activity (1). All of them, except fenfluramine, stimulate the central nervous system and can cause restlessness, nervousness, irritability, and insomnia. Adverse effects also occur through sympathetic stimulation and gastrointestinal irritation. Drug interactions can occur with monoamine oxidase inhibitors. Dexamfetamine, phenmetrazine, and benzfetamine can cause dependence. Some of them have been associated with cardiac valvulopathy and primary pulmonary hypertension (2).

Contraindications Precautions And Interactions

This drug is contraindicated in individuals who have had previous hypersensitivity reactions to pentamidine isethionate. Pentamidine isethionate is used cautiously in patients with hypertension, hypotension, hyper-glycemia, renal impairment, diabetes mellitus, liver impairment, bone marrow depression, pregnancy (Category C), or lactation.

John A Henry MD and Joseph G Rella MD

Adverse drug reactions to MDMA were first reported in the mid-1980s. Consistently reported findings include rapid heart rate, high blood pressure, teeth grinding, tense muscles, nausea, sweating, difficulty urinating, and headache (Buchanan 1985 Greer and Tolbert 1986 Hayner and McKinney 1986 Bryden et al. 1995). These effects, which may result in part from increased adrenaline (alpha-adrenergic activity), can last from hours to days after MDMA use and occur even after a single dose. Other reported effects of MDMA use have included psychosis, panic, and depression. See Mental Health Problems Associated with MDMA Use for further information on psychiatric complications. Not surprisingly, people whose only complications from using MDMA are teeth grinding or sweating almost never have to go to the hospital. One report indicates, however, that a large proportion of people who do go to emergency departments are first-time users who are experiencing what might be considered typical adverse...

Pregnancy Category None

The Amanita muscaria mushroom has been used to treat alcohol overdose and to relieve nervousness, fever, and pain of sore throat, nerves, and joints. The natural product contains muscimol, a chemical that initially acts as a stimulant but that can later produce temporary loss of muscular control as the drug action proceeds. Muscarine chloride can be prepared from amanita. In various animal species muscarine chloride can cause spasms and constrictions and lower blood pressure. The relevance of those studies to humans is unclear for example, a dose that would poison a human leaves a monkey unfazed. Bufotenine has been reported in amanita, but the report is disputed. The ibotenic acid in amanita can produce hallucinations a case report mentions visual hallucinations lasting for days after ingesting the mushroom. The mushroom is said to produce euphoria and to cause changes in sensory perceptions. Some persons consume the fungus for spiritual purpose, a practice that some authorities date...

Cardiac Complications

Cardiac complications include hypertension (increases of 40 mm Hg in systolic blood pressure), tachycardia (increases of 30 beats minute) (Mas et al. 1999), cardiac arrhythmias (irregular heart rhythms), and contraction band necrosis (cell death of a specific part of the heart muscle), as seen in catecholamine-induced myocardial injury (such as cocaine-related heart attacks) (Milroy et al. 1996). A case of QT-interval prolongation (an electrocardiogram abnormality) has been reported (Drake and Broadhurst 1996). Ecstasy has been known to induce fatal cardiac arrhythmias (Dowling et al. 1987).

Long Term Effects Drug withdrawal

A retrospective cohort study in 5052 elderly subjects, of whom 451 were taking verapamil, diltiazem, or nifedipine, showed that these drugs were associated with a cancer risk of 1.72 (95 CI 1.27, 2.34), and there was a significant dose-response relation (8). A small risk of cancer (RR 1.27 95 CI 0.98, 1.63) with calcium channel blockers was reported in a nested case-control retrospective study involving 446 cases of cancers in hypertensive patients (128). However, the authors concluded that this


Adrenergic drugs are contraindicated in patients with known hypersensitivity. Isoproterenol is contraindicated in patients with tachyarrhythmias, tachycardia or heart block caused by digitalis toxicity, ventricular arrhythmias, and angina pectoris. Dopamine is contraindicated in those with pheochromocytoma (tumor of adrenal gland), unmanaged arrhythmias, and ventricular fibrillation. Epinephrine is contraindicated in patients with narrow-angle glaucoma, cerebral arteriosclerosis, and cardiac insufficiency. Norepinephrine and ephedrine are contraindicated in patients who are hypotensive from blood volume deficits. Midodrine is contraindicated in those with severe organic heart disease, acute renal disease, pheochromocytoma, and supine hypertension.

General Management of MDMA Toxicity

Treatment of the symptomatic patient is mainly supportive. Gastric lavage (pumping the stomach) is not necessary, but it is advisable to give oral activated charcoal if the drug was taken within the previous hour. Monitoring of the blood pressure, electrocardiogram, and body temperature for a minimum of twelve hours is recommended. Diazepam may be given to control anxiety and agitation. Chlorpromazine (Thorazine) and haloperidol (Haldol), antipsychotic medications, should be avoided, since they are likely to reduce the threshold for seizures and exacerbate hypotension (low blood pressure). Symptomatic narrow complex tachycardia in adults should be treated with beta-blockers (for example, 5-10 mg metoprolol given intravenously, only if there is certainty that cocaine was not ingested), and hypertension should be treated with calcium channel blockers (for example, 5-10 mg nifedipine taken orally) or alpha-adrenergic antagonists (for example, 2-5 mg phentolamine intravenously, only if...

Comparative studies

In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), over 40 000 participants aged 55 years or older with hypertension and at least one other risk factor for coronary heart disease were randomized to chlortalidone, amlodipine, doxazosin, or lisinopril (1,2). Doxazosin was discontinued prematurely because chlortalidone was clearly superior in preventing cardiovascular events, particularly heart failure (2). Otherwise, mean follow-up was 4.9 years. There were no differences between chlortalidone, amlodipine, and lisinopril in the primary combined outcome or all-cause mortality. Compared with chlortalidone, heart failure was more common with amlodipine and lisinopril, and chlortalidone was better than lisinopril at preventing stroke.

Second Generation Effects Pregnancy

Maternal azathioprine treatment during pregnancy is clearly teratogenic in animals, but the mechanisms are not known. A large number of reports have described the outcome of pregnancies following the use of immuno-suppressant drugs, in particular in renal transplant patients, and hundreds of pregnancies have been analysed (199). The largest experience is that derived from the National Transplantation Pregnancy Registry which has been built up in the USA since 1991 (200). This registry has accumulated data on more than 900 pregnancies, of which 83 followed kidney transplantation and in this and other studies there was no difference in the rate of malformations when comparing ciclosporin with other immunosuppressive regimens (197,198,201). Ectopic pregnancies and miscarriages seemed to occur at a similar rate as in the general population. The most common complications were frequent prematurity and more frequent intrauterine growth retardation with low birth-weight. Risk factors...

Monitoring and Managing Adverse Drug Reactions

When use of the CNS stimulants causes insomnia, the nurse administers the drug early in the day (when possible) to diminish sleep disturbances. The patient is encouraged not to nap during the day. Other stimulants, such as coffee, tea, or cola drinks, are avoided. In some patients, nervousness, restlessness, and palpitations may occur. The vital signs are checked every 6 to 8 hours or more often if tachycardia, hypertension, or palpitations occur. Many times these adverse reactions will diminish with continued use as tolerance develops. If tolerance develops, the dosage is not increased.

Drug Administration Drug formulations

Transdermal clonidine (clonidine TTS) has been used with some success for the treatment of mild hypertension. Systemic adverse effects are similar to those seen after oral administration, but are less frequent and milder. They include dry mouth, drowsiness, headache, sexual disturbance, cold extremities, obstipation, and fatigue (31-33). These adverse effects rarely necessitate withdrawal of clonidine TTS. A high percentage of patients who take clonidine (up to 38 ) (34) develop contact allergic reactions, usually due to the active ingredient, at the patch application site (35). This has been reported with a frequency of 15 in 357 African-American hypertensive patients. It can lead to drug discontinuation in 4.2 of patients.

Syndromes of Depression and Their Treatment

Some antihypertensive medications and recreational drugs can also contribute to depression. Coordinate the treatment for your medical problems with your primary care doctor and psychiatrist if you take medication that can cause depression. Try to stop recreational drugs that can worsen your mood.

DLIS Concentrations Healthy Individuals versus Disease 231 Healthy Individuals

Volume expansion is a major cause of elevated DLIS in blood. Elevated concentrations of DLIS have been reported in uremia, essential hypertension, hypertension of water volume expansion, liver disease, preeclampsia, liver and kidney transplant, congestive heart failure, premature babies, and other conditions (19-24).

Increased intraocular pressure and glaucoma

Ocular hypertension and open-angle glaucoma are well-known adverse effects of ophthalmic administration of glucocorticoids (SEDA-17, 449). A large case-control study, in which 9793 elderly patients with ocular hypertension or open-angle glaucoma were compared with 38 325 controls, has shown an increased risk of these complications with oral glucocor-ticoids (SEDA-22, 446) (54). The risk of ocular hypertension or open-angle glaucoma increased with increasing dose and duration of use of the oral glucocorticoid. There was no significant increase in the risk of ocular hypertension or open-angle glaucoma in patients who had stopped taking oral glucocorticoids 15-45 days before. The authors estimated that the excess risk of ocular hypertension or open-angle glaucoma with current oral glucocorticoid use is 43 additional cases per 10 000 patients per year. However, in patients taking over 80 mg day of hydrocortisone equivalents, the excess risk is 93 additional cases per 10 000 patients per...

Pituitaryadrenal axis

Syndrome, the predominant symptoms are in part determined by hyperandrogenicity and tend to comprise hypertension, acne, impaired sight, disorders of sexual function, hirsutism or virilism, striae of the skin, and plethora, Cushing's syndrome due to glucocorticoid therapy is likely to cause benign intracranial hypertension, glaucoma, subcapsular cataract, pancreatitis, aseptic necrosis of the bones, and panniculitis. Obesity, facial rounding, psychiatric symptoms, edema, and delayed wound healing are common to these different forms of Cushing's syndrome.

Drugs stimulating predominantly aadrenoreceptors

Clonidine raises systemic blood pressure and heart rate by stimulating a2-adrenorecep-tors in certain parts of the CNS, and it is used mainly as an antihypertensive agent. Clonidine is used in various forms of hypertonic illnesses and for stopping hypertensive attacks. It is also used in ophthalmological practice for open-angle glaucoma. Synonyms of clonidine are hemiton, catapres, and clofelin.

Electrolyte balance

Two major surveys have reviewed the features of diuretic-induced hyponatremia (93,94). Thiazide-like diuretics alone or in combination with potassium-sparing diuretics are responsible for more than 90 of cases. Hyponatremia occurs mainly in elderly women, although the relation with age probably merely reflects the widespread use of diuretics in older subjects. In most cases, the interval between starting thiazide and clinical presentation is less than 2 weeks serum sodium may fall by 5mmol l or more in 24 hours or less in patients who develop severe hyponatremia. In contrast, when loop diuretics cause hyponatremia, the lag period is usually several months. Hypertension is the indication for diuretics in over 80 of cases. The patient is clinically euvo-lumic, but in the majority excess antidiuretic hormone (ADH) activity, hypokalemia, excess water intake, and increased free water clearance singly or together appear to contribute to the development of hyponatremia. The urine is...

Calcineurin inhibitors

Serious side effects related to CsA treatment are concentration-dependent and include nephrotoxicity, neurotoxicity, hepatotoxicity, hirsutism, hypertrichosis, gingival hypertrophy, glucose intolerance, hypertension, hyperlipidemia, hypomag-nesemia, hyperuricemia, and hypokalemia. In general, over-suppression leads to an increased risk for viral infections and lymphoproliferative disease, especially in children (52).

Pregnancy Category X

Tests with normal persons find that flurazepam has equal or less appeal compared to placebo. Medical authorities examining the drug in the 1970s concluded that it probably had little potential for abuse. Despite the drug's apparent low appeal, it can create a physical dependence with a person's body. Withdrawal symptoms can include peevishness, fidgeting, anxiety, sweating, tremors, high blood pressure, and intolerance to light and sounds. One longtime user of flurazepam and diazepam developed such a strong dependence with them that a severe withdrawal syndrome occurred when she suddenly halted dosage cramps, stomach discomfort, nervous unease, sleep difficulty, and nightmares. Milder versions of such symptoms are reported if the original level of dependence is lighter. Symptoms can be avoided if flur-azepam usage is tapered off rather than stopped suddenly. Volunteers who received flurazepam in a long-term experiment consistently detected the difference between the...

Ongoing Assessment

During the ongoing assessment the nurse takes the vital signs daily more frequent monitoring may be needed if the patient is moderately to acutely ill or if the patient is taking epoetin alfa (because of the increased risk of hypertension). The nurse monitors the patient for adverse reactions and reports any occurrence of adverse reactions to the primary health care provider before the next dose is due. However, the nurse immediately reports severe adverse reactions.

Potassium Sparing Diuretics

When the potassium-sparing diuretics are administered to patients taking angiotensin-converting enzyme (ACE) inhibitors (see Chap. 42), there is an increased risk for hyper-kalemia. When the potassium-sparing diuretics are administered with potassium preparations, severe hyperkalemia may occur, possibly with cardiac arrhythmias or cardiac arrest. When spironolactone is administered with anticoagulant drugs or the NSAIDs, there is a decreased effectiveness of the anticoagulant or NSAID. When spironolactone or triamterene is administered with the ACE inhibitors, significant hyper-kalemia may occur.

Hawthorn Leaves and Flowers in CHF

Yet, in that RCT Walker et al. 61 examined a different hawthorn extract than the one they have analysed in the pilot study. 79 hypertensive patients with type 2 diabetes (70 under hypotensive treatment) were treated (daily dosis 1200 mg extract duration 16 weeks). The study showed a small but significant decrease in diastolic blood pressure in the hawthorn group vs. placebo (-2.6mmHg p 0.035).

Carbonic Anhydrase Activity Suppressing Diuretics

Symptoms for using carbonic anhydrase inhibitors are edema in cardiopulmonary insufficiency, glaucoma (wide angle, secondary, and preoperational narrow-angle glaucoma), minor epileptic attacks, premenstrual high blood pressure, and severe altitude sickness. It is believed that in glaucoma, the effect of drugs is possibly linked to suppression of carbonic anhydrase in ciliary bodies, which can result in decreased secretion of cerebrospinal fluid. Of the drugs that suppress carbonic anhydrase activity, acetazolamide, methazo-lamide, and dichlorphenamide are used in medical practice.

DA Receptors as Targets for Cocaine Pharmacotherapies

The close association of the D3 receptor with the striatal reward pathways and its selective distribution in the mesolimbic dopamine system suggest that drugs that target the D3 receptor subtype may decrease the reinforcing effects of cocaine. Because D3 receptors' densities elevate as cocaine dependence develops, this upregulation of D3 receptors may contribute to the reinforcing effects of cocaine.105 From this perspective, the development of drugs that block D3 receptor function may be useful for the treatment of cocaine dependence. In keeping with this hypothesis, the D3-selective antagonists (-)DS 121125 and SB-277011A132 attenuate cocaine self-administration in rats and block cocaine reinstatement.133,134 Alternatively, agents that act as D3 agonists or partial agonists may be used as substitutes to treat cocaine dependence.135 The compound BP 897, a highly selective D3 agonist, reduced cocaine seeking behavior in rats 136 however, BP 897 also demonstrates antagonist properties...

Pregnancy Category C

Levorphanol can cause dangerous and even fatal breathing difficulty. For that reason medical personnel are supposed to carefully adjust dosage to a patient's individual needs rather than depend upon customary amounts of the drug being safe. It is supposed to be used with special caution in patients with asthma, low thyroid function, urinary difficulty, or an enlarged prostate. Wariness is also prudent when using the substance to reduce heart pain, because the drug's influence on cardiac function has not been confirmed. The substance can lower blood pressure and may produce nausea, vomiting, and constipation. Levorphanol can make users woozy and harm skills needed for operating a car or other dangerous machinery. Although levorphanol is a depressant in humans, it increases leg activity in ponies an effect that may not have escaped notice by persons seeking ways to improve the animals' performance in races.

Adverse Reactions

Adverse reactions may occur if the dosage is too high or prolonged, or if withdrawal is too rapid. Administration of fludrocortisone may cause edema, hypertension, congestive heart failure, enlargement of the heart, increased sweating, or allergic skin rash. Additional adverse reactions include hypokalemia, muscular weakness, headache, and hypersensitivity reactions. Because this drug has glucocorticoid and mineralocorticoid activity and is often given with the glucocorticoids, adverse reactions of the glucocorticoids must be closely monitored as well (see Display 50-2).

Acalypha wilkesiana M A

Uses In Malaysia, a beverage consisting of about 60 g of the leaves boiled in goat's milk is drunk to lower blood pressure, treat fever, relieve cough and heal pimples. It is said that about 10 g of the leaves boiled with sugar is used to treat trombocytopenic purpurea and allergic purpurea.

Ergonovine and Methylergonovine

Ergonovine is contraindicated in those with known hypersensitivity to the drug, hypertension, and before the delivery of the placenta. Ergonovine is used cautiously in patients with heart disease, obliterative vascular disease, renal or hepatic disease, and during lactation. Methylergonovine is contraindicated in patients with a known hypersensitivity to the drug, hypertension, and preeclampsia and should not be used to induce labor (Pregnancy Category C). Methylergonovine is used cautiously in patients with renal or hepatic impairment. When methylergonovine is administered concurrently with vasopressors or to patients who are heavy cigarette smokers, excessive vasoconstriction may occur.

See also Prostaglandins General Information

Latanoprost is an analogue of PGF2a, used to treat glaucoma. The use of latanoprost and unoprostone in the treatment of open-angle glaucoma and ocular hypertension has been reviewed (1). More data on safety are needed to calculate its benefit-to-harm balance. Latanoprost caused reduced intraocular pressure by 20-40 in adults with open-angle glaucoma or ocular hypertension, but its efficacy and safety in children have not been widely reported. Most children reported so far gained little benefit on intraocular pressure from latano-prost, but older children and those with juvenile-onset open-angle glaucoma do gain a significant ocular hypo-tensive effect. Systemic and ocular adverse effects in children using latanoprost are infrequent (2).

Herbal Alert Green

Green tea and black teas come from the same plant. The difference is in the processing. Green tea is simply dried tea leaves, whereas black tea is fermented, giving it the dark color, the stronger flavor, and the lowest amount of tannins and polyphenols. The beneficial effects of green tea lie in the polyphenols, or flavonoids, that have antioxidant properties. Antioxidants are thought to play a major role in preventing disease (eg, colon cancer) and reducing the effects of aging. Green tea polyphenols are powerful antioxidants. The polyphenols are thought to act by inhibiting the reactions of free radicals within the body that are thought to play a role in aging. The benefits of green tea include an overall sense of well-being, cancer prevention, dental health, and maintenance of heart and liver health. Green tea taken as directed is safe and well tolerated. It contains as much as 50 mg of caffeine per cup. Decaffeinated green tea retains all of the polyphenol content. The...

Sympathomimetic Drugs

These drugs may cause transient local reactions such as burning and stinging, eye pain, brow ache, headache, allergic lip reactions, and ocular irritation. With prolonged use adrenochrome (a red pigment contained in epinephrine) deposits may occur in the conjunctiva and cornea. Although rare, systemic reactions may occur such as headache, palpitations, tachycardia, extrasystoles, cardiac arrhythmia, hypertension, and faintness. Dipivefrin appears to be better tolerated and has fewer adverse reactions than the other sympathomimetic drugs used to lower IOP.

Alpha2Adrenergic Drugs

The drug is contraindicated in patients with hypersen-sitivity to the drug or any component of the drug and in patients taking the monoamine oxidase inhibitors (MAOIs). Patients should wait at least 15 minutes after instilling brimonidine before inserting soft contact lenses because the preservative in the drug may be absorbed by soft contact lenses. The drug is used cautiously during pregnancy (Pregnancy Category B) and lactation and in patients with cardiovascular disease, depression, cerebral or coronary insufficiency, orthosta-tic hypotension, or Raynaud's phenomenon. When bri-monidine is used with central nervous system (CNS) depressants such as alcohol, barbiturates, opiates, sedatives, or anesthetics, there is a risk for an additive CNS depressant effect. Use the drug cautiously in combination with the beta blockers, antihypertensive drugs, and cardiac glycosides because a synergistic effect may occur.

Vasoconstrictors Mydriatics

These drugs are contraindicated in individuals with hypersensitivity to the drug or any component of the drug and in patients with narrow angle glaucoma or anatomically narrow angle and no glaucoma and in patients with a sulfite sensitivity (some of these products contain sulfite). The drugs are used cautiously in patients with hypertension, diabetes, hyperthyroidism, cardiovascular disease, and arteriosclerosis. Local anesthetics can increase absorption of topical drugs. Systemic adverse reactions may occur more frequently when these drugs are administered with the p-adrenergic blocking drugs. When the mydriatics (drugs that dilate the pupil) are administered with the MAOIs or as long as 21 days after MAOI administration, exaggerated adrenergic effects may occur.

Second Generation Effects Teratogenicity

In the study of 14 522 patients mentioned in the introduction to this monograph (2) three mothers were exposed to losartan during the first trimester of pregnancy. One pregnancy terminated in a spontaneous abortion. The two others were both complicated by hypertension. One baby died with extreme prematurity and growth retardation, and the second survived after having been born prematurely. A woman who took losartan from 17 to 31 weeks of gestation developed oligohydramnios and delivered a stillborn fetus with deformities of the extremities and face (23).

Drug Drug Interactions Erythromycin

Because losartan is metabolized by CYP2C9 and CYP3A4 to an active metabolite, E3174, which has greater antihypertensive activity than the parent compound, the effects of co-administration of losartan 50 mg day and erythromycin, a moderate inhibitor of CYP3A4, have been investigated in a well-designed study in healthy volunteers. There was no significant effect of erythromycin. Indometacin 50 mg bd for one week did not interfere with the antihypertensive efficacy of losartan 50-100 mg day in patients with essential hypertension, despite the fact that indometacin caused significant increases in weight and extracellular fluid volume (28). Glomerular filtration rate remained unchanged. Indometacin did not adversely influence peripheral hemodynamics. This is in contrast to the reported effects of indometacin during ACE inhibition, leading to an increase in blood pressure. It suggests that prosta-glandins in part mediate vasodilatation during ACE inhibition, a mechanism that is not shared...

Organs and Systems Nervous system

Rebound intracranial hypertension can develop as a result of mannitol administration in neurological patients and is associated with an increase in CSF mannitol and osmolality after intravenous administration (3,4). The reported incidence of rebound intracranial hypertension with mannitol varies widely. There is no agreement that osmotic gradients and their reversal are the respective mechanisms of intracranial pressure reduction and rebound after manni-tol. Another explanation is that mannitol reduces intracra-nial pressure by reducing viscosity and compensatory vasoconstriction, thus reducing cerebral blood volume and thereby reducing intracranial pressure. Rebound can then be explained by the delayed increase in viscosity after mannitol-induced diuresis and elimination of mannitol. It is unlikely that this provides a comprehensive explanation for the effects of mannitol. It may be that passage of mannitol across the blood-brain barrier is significantly influenced by the presence...

Contraindications adverse effects precautions

- Do not administer to patients with hypersensitivity to ergot derivatives (cabergoline, bromocriptine, ergotamine, etc.), severe hypertension, pre-eclampsia, eclampsia, septicaemia. - May cause gastrointestinal disturbances, headache, paraesthesia, confusion, dizziness, tinnitus, hypertension, peripheral vasoconstriction, chest pain.

Herbal Alert Ginseng

Adverse reactions are rare, but sleeplessness, nervousness, and diarrhea have been reported in individuals taking large amounts of the herb. The herb should not be taken in combination with stimulants including those containing caffeine. Dosage is 200 to 500 mg day of the standardized extract or 1 to 4 g of powdered root a day. Ginseng is contraindicated in individuals with high blood pressure and during pregnancy.

See also Diuretics General Information

Metolazone occupies an intermediate position between the thiazide diuretics and the more potent loop diuretics (1). It is more effective than the thiazides in moderate to advanced renal insufficiency (SED-8, 488) (SED-9, 355). In patients with normal renal function its antihypertensive effect compares favorably with that of bendroflumethia-zide. When severe heart failure is refractory to conventional triple therapy (high-dose loop diuretic, digoxin, and angiotensin-converting enzyme inhibitor) metolazone can restore diuresis, with weight loss and clinical improvement.

Drug Drug Interactions Clonidine and methyldopa

Mianserin lacks potential for peripheral adrenergic interactions, but since it has a-adrenoceptor activity, it might interact with the centrally acting a-adrenoceptor agonists clonidine and methyldopa. In healthy volunteers, pre-treatment with mianserin 60 mg day for 3 days did not modify the hypotensive effects of a single 300 mg dose of clonidine, and in 11 patients with essential hypertension, the addition of mianserin 60 mg day (in divided doses) for 2 weeks did not reduce the hypotensive effects of cloni-dine or methyldopa (16). In patients taking methyldopa, there were additive hypotensive effects after the first dose of mianserin, but these were not significant after 1 or 2 weeks of combined treatment. The results of this study appear to have justified the authors' conclusion that combining mianserin with centrally-acting hypotensive agents will not result in loss of blood pressure control.

Hemoglobinbased oxygen carriers

Hemoglobin-based oxygen carriers have benefits, such as the lack of pathogen transmission, no need for cross-matching, and increased stability and storage time. However, they bind endogenous nitric oxide, thereby causing transient hypertension, esophageal dysfunction, and abdominal discomfort. Compared with erythro-cyte transfusions, these products have a short half-life. In a phase II study using O-raffinose cross-linked hemoglobin (Hemolink ) in patients undergoing coronary artery bypass grafting surgery raised blood pressure, probably caused by binding of O-raffinose cross-linked hemoglobin to nitric oxide, and jaundice were

Drug Administration Drug overdose

The minimum fatal dose of non-selective MAO inhibitors is about 5-10 times the maximum daily dose, although individuals have been reported to survive such amounts. Symptoms of overdosage can be initially mild and deceptive, but can progress over 24 hours to include agitation, tremor, alternating low and high blood pressure, severe muscle spasms, hyperpyrexia, and convulsions. Symptomatic treatment has included the beta-blocker practolol (10 mg intravenously, repeated after 2 hours) and muscle relaxants with assisted respiration (42), which may help reduce pyrexia by abolishing excessive muscle activity. Active elimination techniques are unhelpful, according to a comprehensive review of anti-depressant overdosage (43).

Promoting an Optimal Response to Therapy

Decongestants are used only occasionally in the clinical setting. Because some of these products are available without a prescription, their use may be discovered during a patient history for other medical disorders. Nonprescription nasal decongestants should not be used by those with hypertension or heart disease unless such use is approved by the primary health care provider. After administering a topical nasal decongestant, some patients may experience a mild, transient stinging sensation. This usually disappears with continued use. To minimize the occurrence of rebound nasal congestion, the drug therapy should be discontinued gradually by initially discontinuing the medication in one nostril, followed by withdrawal from the other nostril.

Pregnancy Category D

In some circumstances midazolam can lower blood pressure drastically and cause seizures administering the drug with fentanyl or other opiates can increase the likelihood of such severe actions. Rat experiments unexpectedly found that the stimulant caffeine boosts difficulties in movement caused by midazolam, and cocaine also worsened that performance. Opiates or alcohol can deepen some midazolam effects in humans,

Self Change Approaches

A nontraditional way of facilitating self-change with regard to excessive drinking has been through the use of very brief interventions by physicians in primary care health settings. These interventions usually consist of a short inquiry followed by brief advice and feedback when warranted. An important characteristic of these interventions is that although typically the patients' reasons for visiting their physician have nothing to do with their alcohol use, as part of the visit doctors can ask an individual about their alcohol use and determine if a patient's drinking exceeds recommended guidelines (Dawson, Grant, & Li, 2005 National Institute on Alcohol Abuse and Alcoholism, 1995, 2007). At this point, physicians can then raise concerns (e.g., cutting back on your alcohol use might be helpful in lowering your hypertension levels ) and suggest that patients reduce their drinking to recommended l evels. Such interventions have produced significant decreases in drinking, and they can...

Susceptibility Factors

Treatment of hypertensive emergencies has been the object of a randomized comparison of isosorbide dinitrate aerosol and nifedipine in 60 adults (46). Two patients taking nifedipine had myocardial ischemia early after administration and four patients had rebound hypertension during the follow-up period. Authors who reviewed the role of nifedipine in hypertensive emergencies reached the conclusion that the use of short-acting sublingual or oral nifedipine is no longer recommended for the treatment of these urgencies because it can precipitate serious adverse reactions (47).

Medications that affect lactation

Medications with an antidopamine effect, such as phenothiazine, haloperidol, and other neuroleptics, such as sulpiride and risperidone, as well as the antihypertensive a-methyldopa, and medications used to stimulate intestinal peristalsis, domperidone and metoclopramide, can, as a result of increasing the secretion of prolactin, stimulate milk production. The sympatholytic action of reserpine can have the same effect. Growth hormone and thyrotrophin-releasing hormone can also enhance milk production. Domperidone and metoclopramide are occasionally used for this purpose - for example. 10 mg metoclopramid three times a day (for a maximum of 7-10 days) and then tapering off the dosage for 2-5 days is sometimes recommended. Domperidone (not available in the USA) is less capable of crossing the blood-brain barrier, and therefore the risk of extrapyramidal symptoms is remote. Due to a molecular mass of 426, protein binding 90 , and poor oral bioavailability, the relative dose for a fully...

Therapeutic studies

The role of nitric oxide therapy in infants with severe acute hypoxemic respiratory failure has been reviewed (2). Inhaled nitric oxide was extremely well tolerated. Inhalation of 80 ppm rapidly improved oxygenation in patients with persistent pulmonary hypertension of the newborn (3). In three randomized, multicenter clinical trials there was a reduction in requirement for extracor-poreal membrane oxygenation, with no significant adverse effects. There was no methemoglobinemia, high nitrogen dioxide, or increased rates of intracranial hemorrhage. In the NINOS trial in 235 term neonates (4), the

Duration depending on duration of the operation Contraindications adverse effects precautions

- Do not administer to patients with intraocular hypertension, pre-eclampsia. - Administer with caution to patients with arterial or intracranial hypertension, coronary insufficiency, psychiatric disorders. - May cause hypertension, hypersalivation, hallucinations during recovery (less frequent in children or when injected IM), apnoea following rapid IV injection.

Drug Drug Interactions General interactions with NSAIDs

Widespread use of NSAIDs, particularly in the elderly, who often take other drugs at the same time, leads to a high risk of clinically significant drug interactions, both pharma-cokinetic and pharmacodynamic. The inhibitory effects of azapropazone, oxyphenbutazone, and phenylbutazone on the metabolism of other drugs, such as oral anticoagulants, oral hypoglycemic drugs, and phenytoin, is an example of a pharmacokinetic mechanism. Other NSAIDs inhibit the renal excretion of lithium (although toxicity is less likely with aspirin, ibuprofen, and sulindac) and methotrexate. Pharmacodynamic mechanisms are exemplified by the interactions between indometacin and other NSAIDs (except perhaps sulindac) and with antihypertensive agents (including beta-blockers, diuretics, and ACE inhibitors). Interactions of NSAIDs with other drugs (230) are summarized in Tables 2 and 3.

Calcium Channel Blockers

Calcium channel blockers are primarily used to prevent anginal pain associated with certain forms of angina, such as vasospastic (Prinzmetal's variant) angina and chronic stable angina. They are not used to abort (stop) anginal pain once it has occurred. When angina is caused by coronary artery spasm, these drugs are recommended when the patient cannot tolerate therapy with the beta (p)-adrenergic blocking drugs (see Chap. 23) or the nitrates. Calcium channel blockers used as antianginals are listed in the Summary Drug Table Antianginal Drugs. Some calcium channel blocking drugs have additional uses. Verapamil affects the conduction system of the heart and may be used to treat cardiac arrhythmias. Diltiazem, nicardipine, nifedipine, and verapamil also are used in the treatment of essential hypertension (see Chap. 42).

Herbal Alert Larginine

L-arginine is commonly sold in health food specialty shops as a supplement capable of improving vascular health and sexual function in men. The herb may be beneficial in improving health in individuals with congestive heart failure, peripheral artery disease, angina, hypertension, hyperlipidemia, and type 2 diabetes. The herb appears to increase nitric oxide concentrations. Abnormalities of the vascular endothelial cells may cause vasoconstriction, inflammation, and thrombolytic activity. These abnormalities are partially attributable to degradation of nitric oxide. L-arginine's ability to increase nitric oxide is the basis for its effectiveness in improving some vascular disease states. Oral doses of 9 to 30 g per day are well tolerated. No adverse reactions were reported in those taking 9 g d. Higher doses may cause nausea and mild diarrhea. L-arginine may exacerbate sickle cell crisis and should be used with caution in those with sickle cell anemia.

Other features of the patient

Pancuronium is relatively contraindicated, particularly in combination with halothane, in patients who may have raised catecholamine concentrations, or who are receiving drugs with sympathomimetic effects. Severe hypertension together with tachycardia can occur when pancuronium is given to a patient with a pheochromocytoma (34,35).

Chapter Objectives

Hypertension hypertension hypokalemia hyponatremia isolated systolic hypertension lumen malignant hypertension orthostatic hypertension vasodilatation Discuss the various types of hypertension and risk factors involved. List the various types of drugs used to treat hypertension. Discuss the general drug actions, uses, adverse reactions, contraindications, precautions, and interactions of the antihypertensive drugs. Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking an antihypertensive drug. Explain why blood pressure determinations are important during therapy with an antihypertensive drug. List some nursing diagnoses particular to a patient taking an antihypertensive drug. Discuss ways to promote an optimal response to therapy, how to manage adverse reactions, and important points to keep in mind when educating patients about the use of an antihypertensive drug. lood pressure is the force of the blood against the walls...

Display 422 Importance of the Systolic Blood Pressure

In most individuals, the systolic pressure increases sharply with age, whereas the diastolic pressure increases until about age 55 years and then declines. Older individuals with an elevated systolic pressure have a condition known as isolated systolic hypertension (ISH). When the systolic pressure is high, blood vessels become less flexible and stiffen, leading to cardiovascular disease and kidney damage. Research indicates that treating ISH saves lives and reduces illness. The treatment is the same for ISH as for other forms of hypertension. Uncomplicated Hypertension3 Isolated systolic hypertension (older persons) Continue adding agents from other classes. Consider referral to a hypertension specialist. Figure 42-1. Algorithm for the sympathomimetic activity. treatment of hypertension. 3 Based on randomized controlled trials. In addition to these antihypertensive drugs, many antihypertensive combinations are available, such as Ser-Ap-Es, Timolide 10-25, Aldoril, and Lopressor...

Herbal Therapy Alert

Various herbs and supplements, such as hawthorn extracts, garlic, onion, ginkgo biloba, vitamin E, and aspirin, may be used by herbalists for hypertension. Although these substances may lower blood pressure in some individuals, their use is not recommended because the effect is slight and usually too gentle to affect moderate to severe hypertension. However, several studies have demonstrated that hypertensive patients may benefit from daily doses of calcium (800 mg) or magnesium (300 mg). Patients should consult the primary health care provider before taking any herbal remedy. The Patient Receiving an Antihypertensive Drug

Preadministration Assessment

Before therapy with an antihypertensive drug is started, the nurse obtains the blood pressure (see Fig. 42-3) and pulse rate on both arms with the patient in standing, sitting, and lying positions. The nurse correctly identifies all readings (eg, the readings on each arm and the three positions used to obtain the readings) and records these on the patient's chart. The nurse also obtains the patient's weight, especially if a diuretic is part of therapy or if the primary care provider prescribes a weight-loss regimen.

Drug Drug Interactions Alcohol

Intravenous injection of a mixture of methylphenidate and pentazocine intended for oral use resulted in death due to granulomatosis associated with pulmonary hypertension (17). Opioids interact with monoamine oxidase inhibitors, causing CNS excitation and hypertension (18).

Educating the Patient and Family

Nurses can do much to educate others on the importance of having their blood pressure checked at periodic intervals. This includes people of all ages because hypertension is not a disease seen only in older individuals. Once hypertension is detected, patient teaching becomes an important factor in successfully returning the blood pressure to normal or near normal levels. To ensure lifetime compliance with the prescribed therapeutic regimen, the nurse emphasizes the importance of drug therapy, as well as other treatments recommended by the primary care provider. The nurse describes the adverse reactions that may be seen with a particular antihypertensive drug and advises the patient to contact the primary care provider if any should occur. The nurse includes the following points in a teaching plan for the patient receiving an antihypertensive Never discontinue use of this drug except on the advice of the primary care provider. These drugs control but do not cure hypertension. Skipping...

Highthroughput Combinatorial Process Discovery

In one example, 2000 high-throughput screening experiments were performed to discover a novel catalyst system for a homogeneous palladium-catalyzed Suzuki coupling reaction of 2-chlorobenzonitrile (1) with 4-(methylphenyl)boronic acid (2) to yield ortho-tolylbenzonitrile (OTBN) (3), an important key intermediate of Du-Pont's antihypertensive compound Losartan (6) (Scheme 31.1). All 2000 screening experiments were performed in a custom-made 96-well reactor format within 4 weeks. Multidimensional combination of archived ligands, palladium metal precursors, various bases, and solvents were screened, leading to the discovery of a lead catalyst structure. The lead was optimized into a new catalyst system that exhibited 5000 turnovers (TO) with 99.5 selectivity of the desired heterocoupling product over the undesired homocoupling impurity 13 .

Long Term Effects Drug abuse

As with several other sympathomimetics, phenylpropano-lamine is often sold illegally in special packages as a look-alike for more euphoriant alerting stimulants. Both the absolute increase in use and the changes in the type of user have been associated with many reports of overdose consequences, including hypertension, cardiac dysrhyth-mias (sEDA-9, 10, 11), cerebral hemorrhage (SEDA-11, 2) (12,13), neuropsychiatric symptoms, including agitation and acute psychosis, and seizures (SEDA-9, 4) (14).

The Reality of Relapse

In fact, because of what we learned about recovery from addiction, we can now add one more facet to our definition of addiction. Drug addiction is a chronic, relapsing disease. It shares these characteristics with other diseases such as high blood pressure, adult-onset diabetes, and atherosclerosis. Atherosclerosis, for example, typically begins with About 30 of patients being treated for hypertension regularly take the medications their doctors prescribe, and about 30 comply with dietary restrictions designed to help them. As a result, some 40 of patients with hypertension have to be treated in the emergency room for episodes of acute, extreme high blood pressure. Similarly, only about 30 of adults who suffer from asthma take their medicine as prescribed. It is not surprising that many of the rest of these patients show up in the emergency room for treatment of acute asthma attacks. About 50 of patients with diabetes comply with routine medication. Less than 30 comply with proper...

Other Anti Ischemic Effects

Although the mechanism of EGb761 is unclear, it is possible that its actions are related to mitochondria and apoptosis because earlier studies found that caspase expression was altered 46, 60 . This is potentially important since mitochondria play a pivotal role in apoptosis for both intrinsic and extrinsic pathways 61 . The intrinsic and extrinsic pathways do not occur independently in vivo but are linked at different points, one of which is the bax bcl-2 complex - an apoptotic to anti-apoptotic index 62 . Oligomerization of bax facilitates its insertion into the outer mitochondrial membrane, triggering cytochrome c release, which promotes apop-tosis. Conversely, bcl-2 forms complexes with bax in such a way that the release of cytochrome c is inhibited to prevent apoptosis. Therefore, the ratio of bax bcl-2 is crucial in determining the progress of cell apoptosis for both the intrinsic and extrinsic pathways 62 . At least two studies, by Lu et al. 63 and Loh et al. 64 , corroborate...

Noradrenergic Adrenergic Challenges

Extensive projection sites, produces fear responses resembling those when animals are threatened by a predator (e.g., Redmond 1981). Studies of no-radrenergic neurotransmission in panic disorder have principally relied on pharmacological challenge paradigms using the imidazoline derivative cloni-dine, an a2-agonist, and yohimbine, an indole alkaloid with a2-antagonist properties. The a2-autoreceptor mechanism, which regulates firing of the no-radrenergic neuron by mediating negative feedback inhibition, is interrupted by a2-antagonists, whereas a2-agonists, such as the centrally acting antihypertensive drug clonidine, enhance negative feedback. The latter, therefore, reduces noradrenergic firing and diminishes anxiety, at least on a temporary basis. Yohimbine administration, in turn, was repeatedly shown to produce panic attacks in patients with panic disorder (e.g., Charney and Heninger 1986 Abelson et al. 1992 Uhde et al. 1992). The relative prefrontal cortical blood flow was found...

Thiazides and Related Diuretics

The thiazide diuretics are used cautiously in patients with liver or kidney disease, lupus erythe-matosus (may exacerbate or activate the disease), or diabetes. Additive hypotensive effects occur when the thiazides are given with alcohol, other antihypertensive drugs, or nitrates.

Herbal Alert Diuretics

Diuretic teas such as juniper berries and shave grass or horsetail are contraindicated. Juniper berries have been associated with renal damage, and horsetail contains severely toxic compounds. Teas with ephedrine should be avoided, especially by individuals with hypertension.

The Action Of The Heart And Blood Circulation

There are two main systems which operate to maintain arterial blood pressure. These are the sympathetic nervous system and the renin-angion-tensin-aldosterone system. One of the processes that tends to worsen hypertension is renal glomerular sclerosis. The control system fails because narrowing of the renal vessels upsets the normal relationship between renal blood flow and arterial pressure.

Drug Administration Drug administration route

Intravenous epoprostenol increases exercise tolerance, improves pulmonary hemodynamics, and improves survival in patients with primary pulmonary hypertension. However, there are limitations to intravenous administration, and a significant proportion of patients develop catheter-related problems, such as thrombosis, pump failure, and catheter-related sepsis. In an attempt to improve delivery, several trials of aerosolized prostacyclin have been undertaken, primarily in patients with primary pulmonary hypertension. There has been a sequential comparison of inhaled nitric oxide 40 ppm with aerosolized iloprost 1417 micrograms in 35 adults with primary pulmonary hypertension (125). Five of the patients had minor headache and facial flushing during inhalation of iloprost, but these symptoms were short-lived and abated a few minutes after the inhalation ended. One patient had mild jaw pain after aerosolized iloprost, but again this was shortlived. There was an unexpected increase in...

Cardiovascular Effects of Cannabinoids In Vivo

In humans, the acute effect of smoking cannabis usually manifests as an increase in heart rate with no significant change in blood pressure (Kanakis et al. 1976). However, chronic use of cannabis in man, as well as both acute and prolonged administration of THC to experimental animals, elicit a long-lasting decrease in bloodpressureandheartrate (Rosenkratz 1974 Benowitz and Jones 1975). Because of the well-known effects of cannabinoids on central nervous system function, early studies of their cardiovascular actions concentrated on the ability of these compounds to inhibit sympathetic tone as the underlying mechanism. Indeed, cross-perfusion experiments in dogs have provided some evidence for a centrally mediated sympatho-inhibitory effect of THC, although additional peripheral sites of action could not be ruled out (Vollmer et al. 1974). Already at this early stage, the potential use of these compounds as antihypertensive agents was considered (Archer 1974), in the hope that their...

Role of Central Versus Peripheral Mechanisms in the Cardiovascular Effects of Cannabinoids

Early work with THC suggested that cannabinoids lower blood pressure through a centrally mediated sympatho-inhibitory mechanism (Vollmer et al. 1974). However, the hypotension elicited by anandamide in urethane-anesthetized rats is not associated with any change in the activity of sympathetic premotor neurons in the medullary vasomotor center or in the activity of sympathetic postganglionic nerves (Varga et al. 1996), which ruled out centrally mediated sympatho-inhibition or ganglionic blockade as possible underlying mechanisms, at least for anandamide. Intra-cerebroventricular administration in rabbits of the potent synthetic cannabinoid WIN55,212-2 was found to increase rather than decrease sympathetic tone, which also argues against a central mechanism for the hypotensive effect (Niederhoffer and Szabo 2000). Yet, the pressor response triggered by electrical stimulation of the vasomotor center was reversibly inhibited by anan-damide, whereas the effect of exogenous phenylephrine...

Drug Drug Interactions Calcium channel blockers

Retrospective analysis of clinical trials has suggested that the concomitant use of antihypertensive drugs did not lead to an increase in adverse events in patients also taking sildenafil (45). Hypertensive patients taking amlodipine, in contrast to glyceryl trinitrate, had only a minor supplementary fall in blood pressure when challenged with a single dose of sildenafil, and a few had a mild to moderate headache (46).

Thyrotropinreleasing hormone TRH protirelin SED141523

The addition of TRH to glucocorticoid therapy to accelerate fetal lung maturation has been the subject of a recent meta-analysis (62M). In 1134 premature infants the serum TSH concentration was increased for the first 6 h after the last maternal dose of TRH, then suppressed for 36 h before returning to control values (63C). The largest controlled trial (in 1368 infants) reported a small delay in development at 12 months (64C ). However, developmental assessment was by questionnaire, with incomplete ascertainment, and these findings have been questioned (65r ). In the mothers, there was a three-fold increase in nausea, vomiting, or flushing and a two-fold increase in hypertension compared with glucocorticoid therapy alone.

Congestive Heart Failure

Heart failure usually results from damage to the myocardium typically from ischemic heart disease, cardiomyopathy or myocarditis. Hypertension also contributes to cardiac failure especially if it is poorly controlled or results from damage to the heart valves and fluid overload. Apart from drugs, metabolic diseases such as, for example, thyrotoxicosis also makes a contribution. The overall result is that cardiac failure results in poor perfusion of vital organs and tissues and causes congestion of the lungs. Treatment of Congestive Heart Failure is mainly carried out by The maximal hypotensive response to thiazides can be reached at relatively low doses. They are ineffective in the presence of renal impairment. At one time, thiazides were used in extremely high doses with a high incidence of adverse effects. Nowadays, thiazides are used in low doses as they are equally effective in hypertension and result in fewer problems. 2. hypertension, Typically, drugs such as probenecid and the...

Long Term Effects Tumorigenicity

Spironolactone is antiandrogenic and increases the peripheral metabolism of testosterone to estradiol (13). It often causes gynecomastia in men and breast enlargement and soreness in women. Five cases of mammary carcinoma have been reported. Potential human metabolic products of spironolactone are carcinogenic in rodents, and the UK Committee on Safety of Medicines in 1988 restricted the approved indications for the drug, removing the indications of essential hypertension and idiopathic edema (14).

Susceptibility Factors Age

It has been argued that potassium-sparing diuretics present a real risk of renal insufficiency when they are used in elderly people (15). In large-scale studies in elderly hypertensive patients there is indeed some slight increase in the incidence of renal insufficiency when combinations including potassium-sparing diuretics are used. Although the overall incidence of nephrotoxicity is quite low, elderly patients and those with prior renal dysfunction are at particular risk. Special care is necessary in these circumstances.

Combinatorial Libraries and Highthroughput Screening of Heterogeneous Polyoxometalate Catalysts

Early efforts by Symyx Technologies led to the development of an fully integrated high-throughput technology-screening platform useful for pharmaceuticals and for fine chemicals process discovery, screening, and optimization. The platform includes a proprietary software package as an essential component in the design of combinatorial libraries. It also controls all the robotic functions, gathers data from each spatially addressable reaction entity, and automatically stores the process data in a central database. The hardware also comprises a variety of 96-well reactors equipped with a liquid- and slurry-handling robot. In one example, the integrated screening platform was employed for the high-throughput synthesis and screening of metal-doped polyoxometalate (POM) libraries in 96-well format 148 . Libraries of the heterogeneous POM catalysts were screened to discover selective aerobic oxidation catalyst systems. In this case, an imidazole alcohol was catalytically oxidized to the...

ACE lD and AGTR1 Interaction In

Routine clinical practice, risk factors for disease tend to be either additive or synergistic. In general, a patient with hypertension, diabetes, and hyperlipidemia is at greater risk of suffering an acute coronary event compared with a patient with only one of these risk factors. Thus, interactions among polymorphism-may also be germane to pharmaco-genomic studies. To this end, several studies have examined the impact of both the ACE DD and AGTRl CC genotype. One study demonstrated an increased risk of myocardial infarction among patients with the DD and CC genotypes for the ACE and AGTRl genes, respectively (95). However, a recent case-control study failed to demonstrate an association between these two polymorphisms with the risk of myocardial infarction (96). Another study revealed that the risk of ventricular arrhythmias among patients with systolic heart failure was significantly increased in patients with the DD ACE genotype and the CC genotype for the ATI gene (97). Thus, once...

AngiotensinII receptor antagonists

The value of low doses of thiazide diuretics in the management of hypertension is well attested, and low doses of diuretics have synergistic actions with other antihyperten-sive drug classes, including the angiotensin-II receptor antagonists (39-41). It is still unclear what represents the optimal dose of a thiazide diuretic in combination with either an ACE inhibitor or an angiotensin-II receptor antagonist. The addition of an angiotensin-II receptor antagonist to diuretic therapy seems to blunt the associated electrolyte disturbances. In particular, hydrochlor-othiazide-induced hyperuricemia is specifically attenuated by losartan (42).

Drug Drug Interactions Brimonidine

The effects of topical brimonidine and timolol have been compared in two trials in 926 subjects with glaucoma or ocular hypertension already using systemic beta-blockers (5). Concurrent systemic beta-blocker therapy had no deleterious effects on ocular hypotensive efficacy and no impact on safety with topical brimonidine, but the combination of timolol and brimonidine significantly reduced systolic and diastolic blood pressures and heart rate compared with brimonidine alone. This observation suggests that ocular hypotensive agents other than beta-blockers, such as brimonidine, may be appropriate as a first-choice therapy for glaucoma in patients concurrently taking systemic beta-blockers.

Examples from the Literature

It is understandable why the pharmaceutical industry may have some trepidation of . using pharmacogenomics in the clinical trial process. The basic tenet of most of the pharmaceutical industry has been to develop drugs in a one-size-fits-all approach with the hope that they will become blockbusters, generating greater than 1 billion in annual sales. There has been some concern that pharmacogenomic data will reduce the market share of a drug by identifying the subgroups of patients who actually derive therapeutic benefit from a drug. Paradoxically though, integration of pharmacogenomics could actually increase market share for a drug. The goal for any new product is to capture 100 of the target market however, for a drug, the target market is not composed of all patients with the particular disease that the drug is indicated to treat. Consider the following example. A pharmaceutical company develops a new drug to treat hypertension. What will be the market penetration for this new...

USA Availability Prescription

The drug can promote masculine characteristics in females. Research on the drug's effects in pigs noted that testes decreased in size research on cows noted disruption of ovarian cycles. Reports exist of human users complaining about headache, high blood pressure, nosebleeds, acne, fever, loss of appetite, queasy stomach, darkened urine, and aggressive conduct while taking the substance.

Comorbidity and Organ Function

Comorbidity and organ function are important co-factors that must be taken into account when assessing the indication for radio-chemotherapy. The prevalence of comorbid disease increases with age and organ capacity (renal, pulmonary and liver function) usually decreases with age (Ogle et al. 2000). The influence of concomitant disease on acute or late radiation toxicity has not yet been studied in great detail, but some investigators report that diabetes mellitus or hypertension have a negative impact on radiation side effects (Herold et al. 1999 BoehleR et al. 1992). There is evidence that decreased pulmonary function limits the tolerated radiation dose to the lung (Mehta 2005). Concomitant disease as well as decreased organ capacity could impair the clearance of chemotherapeutic substances and consequently lead to toxic plasma- and or tissue concentrations. Furthermore, concomitant disease might be more important to the overall prognosis of the patient than the malignant disease...

History and Recent Therapeutic Uses

Direct pDNA transfer technique had been used to examine the role of a physiologically related protein transduction signal pathway toward certain endogenous disease pheno-type, such as investigating the function of the tissue kallikrein-kinin system (KKS) in the central control of blood pressure homeostasis (13). Kallikrein is a proteinase enzyme, which converts kininogen to vasodilative kinin peptides. The human tissue kallikrein gene, in the form of naked pDNA (CMV-cHK), was directly delivered by intracerebroventricular injection into hypertensive rats. The expression of human tissue kallikrein protein was identified in the cortex, cerebellum, brain stem, hippocampus, and hypothalamus of the treated rats. The expression level and its effect could lead to understanding the role of vasodilative KKS on the pathogenesis of hypertension.

Miscellaneous Antineoplastic Drugs

When asparaginase is administered to a patient with diabetes, the risk for hyperglycemia is increased a dosage adjustment of the oral antidiabetic drug may be necessary. Glucocorticoids decrease the effectiveness of aldesleukin. When aldesleukin is administered with antihypertensive drugs, there is an additive hypotensive effect. Etoposide may decrease the immune response to live viral vaccines.

Gene Delivery for Myocardial Diseases

The method of direct pDNA injection was used to explore the effect of specific pathophysiological state on cardiac gene expression, such as ischemia (44), myocardial infarction, reperfusion injury, hypertension (45, 46), etc. Ischemia is a disease state formed when tissues are starved for blood supply and nutrients because of deficient supply of blood through possibly narrowed or blocked arteries. Sporadic myocardial ischemia is commonly associated with coronary arterial diseases. To eliminate the ischemia related disease phenotype, a therapeutic gene is required, which could be selectively up-regulated by the signals related to the heightened period of ischemic activity and consequently down regulated when the activity subdues. In this context, Prentice et al. (44) introduced expression plasmids containing muscle-specific a-MHC promoters and hypoxia-respon-sive enhancer (HRE) elements linked to a reporter gene in cultured cells or into the rabbit myocardium and measured the...

Miotic Direct Acting

These drugs are contraindicated in patients with hyper-sensitivity to the drug or any component of the drug and in conditions where constriction is undesirable (eg, iritis, uveitis, and acute inflammatory disease of the anterior chamber). The drugs are used cautiously in patients with corneal abrasion, pregnancy (Pregnancy Category C), lactation, cardiac failure, bronchial asthma, peptic ulcer, hyperthyroidism, gastrointestinal spasm, urinary tract infection, Parkinson's disease, recent myocardial infarction, hypotension, or hypertension. These drugs are also used cautiously in patients with angle closure glaucoma because miotics can, occasionally, precipitate angle closure glaucoma by increasing the resistance to aqueous flow from posterior to anterior chamber. See Chapter 24 for information on interactions.

Drug Drug Interactions ACE inhibitor

The addition of low doses of verapamil to ACE inhibitor therapy reversed ACE inhibitor-induced increases in creatinine concentrations in eight elderly hypertensive patients (27). During an average of 25 weeks, ACE inhibitors significantly reduced blood pressure, but serum creatinine concentrations rose. During an average of 10 weeks, the addition of verapamil did not reduce the blood pressure further, but the serum creatinine concentrations were normalized. Verapamil appears to have a beneficial effect, through dilatation of constricted afferent and efferent arterioles and reduction of the mesangial cell contraction induced by endothelin-1, factors that have been implicated in the increase in intraglomerular pressure and proteinuria due to ACE inhibitors.

The Dogbane botanical family Apocynaceae

Genera devil's-pepper (Rauvolfia L.), periwinkle (Catharanthus G. Don), milkwood (Tabernaemontana L.), strophanthus (Strophanthus DC.), voacanga (Voacanga U.) and alstonia (Alstonia R. Br.). The species belonging to these genera contain L-tryptophan-derived alkaloids (Figure 8). Indian snake-root (Rauvolfia serpentina) (Figure 9) contains reserpine and rescinnamine, the quinine tree (Rauwolfia capra) yields quinine, and iboga milkwood (Tabernaemontana iboga) produces iboganine. Deserpine has been isolated from the roots of Rauwolfia canescens60. This alkaloid differs from reserpine only by absence of a metoxy group but shows an interesting profile of biological activity. It has been employed in clinical practice for the treatment of hypertension and

Interference of spironolactone potassium canrenoate and canrenone in digoxin assays

Spironolactone, a competitive aldosterone antagonist, has been used clinically in the therapy of hypertension and congestive heart failure for a long time. Spironolactone is rapidly and extensively metabolized, and its metabolite canrenone is also pharmacologically active. Spironolactone and canrenone have structural similarity with digoxin (Fig. 1). Although not in formulary in the USA, potassium canrenoate is used in Europe and other countries. Potassium canrenoate is also metabolized to canrenone.

Carbazochrome and carbazochrome salicylate

Adrenochrome, an oxidation product of adrenaline, is stabilized by binding to monosemicarbazone (adrenochrome monosemicarbazide). Its solubility is greatly enhanced by combination with sodium salicylate. The product, carbazochrome salicylate, can be given either by intramuscular injection or orally. The solution for intramuscular injection is hypertonic, and patients usually experience a brief stinging pain at the site of injection. Experiments in animals have shown a significant reduction in normal bleeding time when adrenochrome mono-semicarbazide is given (4). This has been attributed to a direct effect on capillaries, as increased capillary resistance has been observed in experimental animals. Despite documentation of a transient reduction in bleeding time in humans in early experiments in the 1940s, subsequent double-blind controlled trials did not identify a useful reduction in blood loss after surgery (5-8). Despite the similarity to adrenaline, it is remarkably non-toxic and...

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