Adverse Drug Reactions During Treatment of Hypertension

1 Diacetolol is the N‐acetylated metabolite of acebutolol and possesses beta‐adrenergic receptor blocking properties. 2 Its antihypertensive action was assessed in accordance with a double‐blind randomised cross‐ over scheme in 17 patients with moderate essential hypertension previously well controlled with acebutolol. 3 Significant reductions in lying mean arterial blood pressure were observed with daily doses of 200 mg (‐ 9%), 400 mg (‐ 10%) and 800 mg (‐ 14%), and were associated with significant decreases in heart rate and plasma renin activity. 4 The diacetolol mean plasma level measured 8 to 10 h after drug ingestion was proportional to the dose (207 +/‐ 27, 394 +/‐ 63 and 823 +/‐ 135 ng/ml for respectively 200, 400 and 800 mg/day).

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“…The side effects encountered are those known to occur with B3-adrenoceptor blocking agents (Kellaway, 1976) …”

Section: Discussionmentioning

confidence: 99%

Antihypertensive effect of diacetolol in essential hypertension.

Thibonnier¹,

Flabeau²,

Thouvenin³

et al. 1982

Brit J Clinical Pharma

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“…Other side effects such as fatigue and muscle weakness (Kellaway, 1976;Zacharias, 1976) may be associated with this decreased blood flow in muscle tissue.…”

Section: Discussionmentioning

confidence: 99%

Effects of propranolol and metoprolol on haemodynamic and respiratory indices and on perceived exertion during exercise in hypertensive patients.

Herwaarden¹,

Binkhorst²,

Fennis³

et al. 1979

Heart

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SUMMARY A double blind cross-over trial of the non-selective beta-blocker propranolol and the betalselective blocker metoprolol was carried out in 8 hypertensive patients. At the end of each 4-week period of treatment haemodynamic and respiratory indices and perceived exertion were studied during moderate exercise. Both beta-blockers resulted in reduced heart rate, cardiac output, and blood pressure, whereas the stroke volume increased. Total peripheral resistance did not change. During exercise the expiratory peak flow rate equally increased in every period. However, the peak flow rate at rest, as well as during exercise, was reduced by propranolol, while metoprolol had no such influence. Neither of the beta-blockers changed 02 consumption, CO2 production, tidal volume, or respiratory rate. Moreover, they did not influence perceived exertion. These results suggest that the arteriolar and bronchiolar beta2-receptors do not play a major role in the alteration of circulation and ventilation during exercise. As far as their practical use as antihypertensive agents is concerned, this study shows no advantage in the use of either of these beta-blockers.

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“…fatigue, cough, sexual dysfunction) affect quality of life and reduce compliance. [86][87][88][89] Adherence to published guidelines for the treatment of HTN is poor, mitigating many of the benefits of these medications. 90 Studies suggest that only 50% of patients adhere to their antihypertensive medication regimen and that only 33% are well controlled.…”

Section: Renal Artery Stenosis: Management Optionsmentioning

confidence: 99%

The role of percutaneous revascularization for renal artery stenosis

Dubel

Murphy

2008

Vasc Med

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Renal artery stenosis (RAS) is usually caused by atherosclerosis or fibromuscular dysplasia. RAS leads to activation of the renin-angiotensin-aldosterone system and may result in hypertension, ischemic nephropathy, left ventricular hypertrophy and congestive heart failure. Management options include medical therapy and revascularization procedures. Recent studies have shown angiotensin receptor blockers (ARB) and angiotensin converting enzyme inhibitors (ACE-I) to be highly effective in treating the hypertension associated with RAS and in reducing cardiovascular events; however, they do not correct the underlying RAS and loss of renal mass may continue. Renal artery angioplasty was first performed by Gruntzig in 1978. The routine use of stents has increased technical success rates compared with angioplasty, and surgery is now only rarely performed. Although numerous case series claimed benefit in terms of blood pressure control, no adequately powered randomized, controlled, prospective study of renal artery interventions has reported their effect on cardiovascular morbidity or mortality. The CORAL trial, an ongoing study of renal artery stent placement and optimal medical therapy (OMT) funded by the National Institutes of Health, is the first study to attempt to do so. Until the CORAL trial results are in, physicians will continue to be faced with difficult choices when determining the optimal management for RAS patients and deciding which, if any, patients should be offered revascularization.

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Adverse Drug Reactions During Treatment of Hypertension

Cited by 18 publications

References 3 publications

Antihypertensive effect of diacetolol in essential hypertension.

Antihypertensive effect of diacetolol in essential hypertension.

Effects of propranolol and metoprolol on haemodynamic and respiratory indices and on perceived exertion during exercise in hypertensive patients.

The role of percutaneous revascularization for renal artery stenosis

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