Antihypertensive therapy: special focus on drug interactions

Abstract

Today, the lifetime risk of patients aged 55-65 years to receive antihypertensive drugs approaches 60%. Yet, recent trials suggest that hypertension is not adequately controlled in the majority of patients. The prevalence of hypertension increases with advancing age, as does the prevalence of comorbid conditions and the total number of medications taken. Multi-drug therapy, advancing age and comorbid conditions are also key risk factors for adverse drug reactions and drug interactions. In this review, the authors evaluate the most frequently used antihypertensive drugs (diuretics, beta-adrenergic blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin II receptor Type 1 blockers and alpha-adrenergic blockers) with special reference to pharmacodynamic and pharmacokinetic drug interactions. As the spectrum of drugs prescribed is constantly changing, safety yesterday does not imply safety today and safety today does not imply safety tomorrow. Furthermore, therapeutic efficacy should not be neglected over concerns regarding drug interactions. Many patients are at risk of clinically relevant drug interactions involving antihypertensive drugs but, presently, even more patients may be at risk of suffering from the consequences of their inadequately treated hypertension. In this respect, the authors discuss controversial viewpoints on the overall clinical relevance of drug interactions occurring at the level of cytochrome P450 metabolism.

Concomitant drugs with low risks of drug–drug interactions for use in oncology clinical trials

“…Most reported interactions with ACEIs were related to their effects on renal function, electrolyte balance, or blood sugar [66]. Moreover, all loop and thiazide diuretics are associated with risks of arrhythmia when co-prescribed with arrhythmogenic drugs or drugs that can cause potassium depletion.…”

“…Moreover, all loop and thiazide diuretics are associated with risks of arrhythmia when co-prescribed with arrhythmogenic drugs or drugs that can cause potassium depletion. The potassiumsparing diuretics, such as spironolactone, can be involved in significant DDIs leading to arrhythmia or fatal hyperkalemia [66]. Diuretics were recently reported as one of the main causes of drug interaction in cancer patients [4].…”

“…They are also suspected to be CYP inhibitors [39,66]. Atenolol is mainly not metabolized in the liver and has not been involved in CYP-related DDIs [39].…”

“…Among angiotensin II receptor blockers (ARBs), losartan and irbesartan are metabolized by CYP1A2, CYP2C9, and CYP3A4; while, candesartan and valsartan are predominantly metabolized by CYP2C9 [66]. Several studies showed a low potential for clinical DDIs of candesartan, eprosartan, olmesartan, and telmisartan [66].…”

Anxiety and depression symptoms in arterial hypertension: the influence of antihypertensive treatment. The HUNT study, Norway

“…Overall, the number of medications increase with advancing age and with severity of the CVD and comorbid conditions [47]. Multi-drug therapy, older age and comorbid conditions are recognized as important risk factors for adverse drug reactions and drug interactions [48,49].…”