Fluid Matters in Choosing Antihypertensive Therapy: A Hypothesis That the Data Speak Volumes

Blankfield, Robert P.

doi:10.3122/jabfm.18.2.113

Cited by 6 publications

(3 citation statements)

References 114 publications

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“…High-dose diuretics reduce the incidence of stroke and heart failure, but do not protect against myocardial infarction and can predispose to diabetes [71]. Antihypertensive regimes that lead to fluid retention predispose to heart failure [72]. No hypertensive therapy has slowed the progression of atherosclerosis back to a normotensive baseline [70].…”

Section: Pharmacological Antihypertensive Treatment and Inflammationmentioning

confidence: 99%

The potential anti-inflammatory benefits of improving physical fitness in hypertension

Edwards¹,

Mills²

2007

Journal of Hypertension

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Hypertension is associated with an increased risk of stroke and atherosclerosis. In addition to elevated blood pressure, hypertension is characterized by neuroendocrine and immune activation, including elevated levels of C-reactive protein, inflammatory cytokines, and soluble adhesion molecules, which are predictive of morbidity and mortality outcomes. Pharmacological treatment for hypertension reduces blood pressure, but has limited effectiveness in reducing the accompanying inflammation and its associated morbidity and mortality. Exercise and diet interventions regularly show reductions in blood pressure in hypertensive individuals. Similar interventions in other populations show reductions in many inflammatory markers, but these effects have not been routinely examined in hypertensive individuals. The mechanisms through which exercise might exert an anti-inflammatory action include the sympathetic nervous system, the hypothalamic-pituitary-adrenal axis, as well as direct effects of blood pressure. Here, exercise is promoted as a potentially effective treatment for both the elevated blood pressure and chronic inflammation found in hypertension.

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Section: Pharmacological Antihypertensive Treatment and Inflammationmentioning

confidence: 99%

The potential anti-inflammatory benefits of improving physical fitness in hypertension

Edwards¹,

Mills²

2007

Journal of Hypertension

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“…[35,36] Overall incidence of edema with S-amlodipine has been reported to be 1.39% as against the reported incidence ranging from 1.7 to 32% with racemic amlodipine. [36,37] This indicates that R-amlodipine component of amlodipine is mainly responsible for blunting of precapillary postural vasoconstrictor reflex and for other local changes responsible for peripheral edema due to amlodipine. Plasma half-life of S amlodipine is also reported to be longer than that of racemic amlodipine.…”

Section: S-amlodipine: the Safer And Longeracting Amlodipinementioning

confidence: 99%

Development of safer molecules through chirality

Patil¹,

Kothekar²

2006

Indian J Med Sci

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Many of the drugs currently used in medical practice are mixtures of enantiomers (racemates). Many a times, the two enantiomers differ in their pharmacokinetic and pharmacodynamic properties. Replacing existing racemates with single isomers has resulted in improved safety and/or efficacy profile of various racemates. In this review, pharmacokinetic and pharmacodynamic implications of chirality are discussed in brief, followed by an overview of some important chiral switches that have yielded safer alternatives. These include levosalbutamol, S-ketamine, levobupivacaine, S-zopiclone, levocetirizine, S-amlodipine, S-atenolol, S-metoprolol, S-omeprazole, S-pantoprazole and R-ondansetron. Few potential chiral switches under evaluation and some chiral switches that have not been successful are also discussed.

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“…35 Thiazide diuretics are more effective than ACEIs, CCBs, and ␣-blockers at preventing heart failure, and thiazide diuretics are more effective than ACEs and ␣-blockers at preventing strokes. 36 -40 When compared with ␤-adrenergic receptor blockers and ACEIs, CCBs are less effective at reducing myocardial infarctions and heart failure.…”

Section: Antihypertensive Medicationsmentioning

confidence: 99%

Can Natriuretic Peptide Levels Predict the Cardiovascular Complications of COX-2 Inhibitors and Nonsteroidal Anti-inflammatory Drugs?

Blankfield

2006

The Journal of the American Board of Family Medicine

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There is evidence that fluid retention, whether due to a disease process or due to a medication, is associated with a number of cardiovascular diseases, including heart failure, strokes, coronary artery disease, and cardiovascular death. There is additional evidence that fluid retention that manifests as increased intravascular volume adversely affects cardiovascular outcomes. Because natriuretic peptide levels reflect intravascular volume and pressure, it is hypothesized that when patients are prescribed medications that promote fluid retention-such as non-selective nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors-monitoring natriuretic peptide levels before and after initiating the medication may allow these medications to be used more safely. ( Several diseases that are associated with fluid retention are also associated with cardiovascular diseases. Likewise, some medications that promote fluid retention are associated with, and in some instances contribute to, cardiovascular morbidity and mortality. Because natriuretic peptide levels reflect intravascular volume, and because elevated natriuretic peptide levels are a risk factor for a number of adverse cardiovascular outcomes, there is a scientifically based rationale for the hypothesis of this paper that monitoring natriuretic peptide levels before and after starting medications that cause fluid retention-such as non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors-might allow these medications to be used more safely. Natriuretic Peptides and Cardiovascular DiseaseData involving natriuretic peptides provides the primary evidence that fluid retention in the form of increased intravascular volume is a cardiovascular risk factor. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are secreted by the myocytes of the atria and ventricles in response to stretch and pressure. Serum levels of ANP and BNP reflect intravascular volume or pressure, with higher levels of ANP and BNP indicating increased intravascular volume or pressure.While abnormally elevated levels of natriuretic peptides imply a diagnosis of heart failure, even when natriuretic peptide levels fall within the normal range, higher than average levels of BNP and ANP predict a number of adverse cardiovascular events: death from any cause, first major cardiovascular event, heart failure, atrial fibrillation, and stroke or transient ischemic attack, but not coronary heart disease.

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Fluid Matters in Choosing Antihypertensive Therapy: A Hypothesis That the Data Speak Volumes

Cited by 6 publications

References 114 publications

The potential anti-inflammatory benefits of improving physical fitness in hypertension

The potential anti-inflammatory benefits of improving physical fitness in hypertension

Development of safer molecules through chirality

Can Natriuretic Peptide Levels Predict the Cardiovascular Complications of COX-2 Inhibitors and Nonsteroidal Anti-inflammatory Drugs?

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