Dose-response relationships with antihypertensive drugs

Johnston, G. D.

doi:10.1016/0163-7258(92)90029-y

Cited by 22 publications

(12 citation statements)

References 213 publications

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“…Our data agree with previous studies demonstrating the unpredictable response of intravenous hydralazine that may be associated with highly variable pharmacodynamics (7–9). We did identify certain clinical factors that predicted a greater response to intravenous hydralazine including history of arrhythmia and concurrent use of blockers of the renin-angiotensin system.…”

Section: Discussionsupporting

confidence: 93%

“…Intravenous hydralazine, is a potent vasodilator with a rapid onset of action that has an unpredictable effect on BP and unpredictable dose response (7–9). The approved indication for intravenous hydralazine is the management of severe hypertension when medication cannot be given orally and when there is need to urgently reduce blood pressure (10).…”

Section: Introductionmentioning

confidence: 99%

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Intravenous hydralazine for blood pressure management in the hospitalized patient: its use is often unjustified

Campbell

Baker

Bendel

et al. 2011

Journal of the American Society of Hypertension

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Background Intravenous hydralazine is approved for the treatment of hypertensive emergency and widely used for hypertension associated with toxemia of pregnancy. As we had observed increased off-label use of this agent in area hospitals, we studied its use in a University teaching hospital. Methods Patients were identified prospectively between April and October 2010 from all hospitalized patients who had an order for intravenous hydralazine entered into the computerized physician order entry system. Clinician prescribers were unaware that this study was being conducted. Demographic and clinical information, including pre-treatment blood pressure (BP), change in BP and heart rate (HR) within 2 hours post-administration of hydralazine, concurrent and follow-up antihypertensive medications, and adverse events were obtained. Results There were 94 patients (mean age, 69 ± 18 years, 48% women, 89% with chronic hypertension) who received 201 intravenous hydralazine doses (mean dose of 11.4 ± 4.3 mg). Only 4 (2%) of patients had evidence of an urgent hypertensive condition (e.g., symptoms, target organ injury). Baseline BP was 175/82 ± 25/16 mmHg and following hydralazine was reduced by 24/9 ± 29/15 mmHg while HR increased by 4 ± 13 beats/min. Changes from baseline in BP were related to baseline BP: change in BP in the lower baseline range was −3 ± 20 mmHg while change observed in those with the highest range of baseline blood pressure was −35 ± 25 mmHg. Seventeen patients experienced an adverse event, the most common being hypotension (n=11). Conclusions Intravenous hydralazine is commonly prescribed for non-urgent cases of hypertension in the hospitalized patient. Changes in systolic BP, while related to baseline BP values, are nevertheless, highly variable. There is risk of hypotension associated with its use. There is evidence that this agent is not useful for many patients with hypertension in the hospital setting and may cause harm if used inappropriately.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Intravenous hydralazine for blood pressure management in the hospitalized patient: its use is often unjustified

Campbell

Baker

Bendel

et al. 2011

Journal of the American Society of Hypertension

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“…12 Unfortunately, failure to properly define the lower end of the dose-response relationship and hence, the lowest effective dose, has been responsible for the introduction of many antihypertensive drugs into clinical practice at excessively high doses. Because efficacy data are often incomplete due to failure to adequately explore the lower or upper extreme of the dose, E max analysis of receptor-blocking drugs has only occasionally been used in phase II and phase III clinical trials.…”

mentioning

confidence: 99%

Dose-Related Efficacy of Irbesartan for Hypertension

et al. 1998

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Abstract-Results of eight multicenter, randomized, placebo-controlled, double-blind, parallel-group studies were pooled to assess the efficacy of the angiotensin II-receptor blocker irbesartan over the dose range of 1 to 900 mg. A total of 2955 adults with a seated diastolic blood pressure of 95 to 110 mm Hg were randomized to treatment with oral irbesartan once daily or placebo for 6 to 8 weeks. Office blood pressure was measured at trough (24Ϯ3 hours after the last dose) and peak (3Ϯ1 hours after the last dose) by mercury sphygmomanometry. Demographic characteristics (mean blood pressure; 151/101 mm Hg; mean age, 54 years; 63% male; and 82% white) were similar across all dose groups. After the groups were pooled, antihypertensive efficacy was assessed by therapeutic response (trough seated diastolic blood pressure Ͻ90 mm Hg or a reduction from baseline of Ն10 mm Hg) and by modeling of the maximum reductions in trough and peak seated diastolic and systolic blood pressure. Antihypertensive effects increased with increasing doses and reached a plateau at Ն300 mg. Irbesartan 150 mg provided placebo-subtracted reductions in trough seated systolic and diastolic blood pressure of Ϸ8 and Ϸ5 mm Hg, respectively, with 56% of patients displaying a favorable response.In conclusion, irbesartan provides clinically significant blood pressure lowering, with a clear relationship between (log) dose and antihypertensive effect. (Hypertension. 1998;31:1311-1316.)

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“…1 Esse fármaco pode causar efeitos colaterais maternos em função do seu efeito farmacológico incluindo taquicardia, cefaleia, hipotensão, náusea, palpitação, tonteira e retenção de sal (A,B). 19,20 A nifedipina é bloqueador dos canais de cálcio tipo 2. Essa ação leva primariamente ao relaxamento do músculo liso, atuando principalmente sobre a musculatura vascular, uterina e vesical.…”

Section: Resultsunclassified

Quando introduzir o tratamento farmacológico na pré-eclâmpsia

Silva¹,

Louback²,

Monteiro³

et al. 2015

Revista Hospital Universitário Pedro Ernesto

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Artigo de revisão Resumo Sabe-se que cerca de 10% das gestações cursam com hipertensão arterial, o que representa a primeira causa de mortalidade materna no Brasil. A pré-eclâmpsia é condição sistêmica que se manifesta clinicamente com o aparecimento de hipertensão arterial após a 20ª semana de gestação, em mulheres previamente normotensas, associada à proteinúria. Não há consenso na literatura sobre a conduta farmacológica mais adequada e tampouco se há vantagens em usar fármacos anti-hipertensivos nos casos de pré-eclâmpsia. Sendo assim, este artigo busca reunir informações de pesquisa em bancos de dados, como Cochrane Library, Medline (por meio do PubMed), Google Acadêmico e SciELO, a fim de revisar a conduta proposta atualmente para o tratamento antihipertensivo de manutenção da pré-eclâmpsia. As mais usadas são aquelas que não trazem riscos ao binômio maternofetal ou seus riscos são mínimos, como a hidralazina, nifedipina, alfametildopa e labetalol. Contudo, concluímos que não há conduta-padrão e, sendo assim, a escolha do medicamento vai depender da experiência de cada obstetra e da rotina adotada para aquele serviço.

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Dose-response relationships with antihypertensive drugs

Cited by 22 publications

References 213 publications

Intravenous hydralazine for blood pressure management in the hospitalized patient: its use is often unjustified

Intravenous hydralazine for blood pressure management in the hospitalized patient: its use is often unjustified

Dose-Related Efficacy of Irbesartan for Hypertension

Quando introduzir o tratamento farmacológico na pré-eclâmpsia

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