Multiple drug-intolerant hypertension: a case series utilising a novel-treatment algorithm

Saxena, Manish; Antoniou, Sotiris; Hamedi, N; Robinson, Paul; Singh, Harjit; Mukhtar, Omar; Kapil, Vikas; Lobo, Melvin D.

doi:10.3399/bjgp16x684709

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…We have previously reported a case series to illustrate how the different steps of our novel treatment algorithm have been successfully deployed 10. In terms of the clinical efficacy of transdermal clonidine in BP control in this patient group, we have demonstrated in a 36-patient trial a reduction in clinic SBP of 23±33 mm Hg (p<0.001) and a reduction in clinic DBP of 10±18 mm Hg (p=0.002) over a duration 11 weeks with a good tolerability profile.…”

Section: Discussionmentioning

confidence: 99%

Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances

et al. 2018

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A 61-year-old man with a 30-year history of uncontrolled hypertension was unable to tolerate conventional antihypertensive medications from all classes. At the time of referral to our centre he had discontinued all antihypertensive drugs and felt well. However, his average home blood pressure (HBP) reading was 179/125 mm Hg and echocardiography demonstrated moderate concentric left ventricular hypertrophy. A novel stratified medicines algorithm was used to guide treatment entailing transdermal clonidine patch therapy instead of tablet formulations. Sixteen months later, his average HBP was 147/106 mm Hg with no side effects and the left ventricular hypertrophy had completely regressed. Our experience has taught us that multiple drug intolerance is a common, often overlooked, cause of non-adherence to antihypertensive medication. This case demonstrates the benefit of a novel approach to optimise blood pressure control and emphasises the important role of hypertension specialists in managing complex, high-risk patients unable to tolerate guideline-based therapy.

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Section: Discussionmentioning

confidence: 99%

Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances

et al. 2018

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“…The implementation in the clinical practice of this new therapeutic algorithm lead to a significant increase in terms of drug tolerability and BP control [55] and such effects may be due to the reduction of dose-dependent ADRs by drugs’ dosage-reduction; the higher and synergic antihypertensive effect of a low-dose combination therapy versus a high-dose mono-therapy; and the avoidance of lactose-or silica-based excipients that account for the 90% of the weight of the solid formulations and that may be responsible of pharmacological interactions and gastrointestinal irritability leading to ADRs [56]. Despite these results, no evidence is available on the persistence of these favorable effects over time as well as on the adherence to the prescribed medications by direct TDM techniques.…”

Section: Mdi-htn Therapeutic Strategiesmentioning

confidence: 99%

Multiple drug intolerance in antihypertensive patients: what is known and what is missing

Palermiti,

Pappaccogli,

Rabbia

et al. 2024

Journal of Hypertension

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Drug allergy and intolerance are increasingly recognized as significant public health concerns, leading to adverse reactions in patients undergoing pharmacological treatments. Multiple drug intolerance syndrome (MDIS), characterized by adverse reactions to at least three different drug classes without a clear immunological mechanism, poses a substantial challenge, particularly in hypertensive patients. Despite its link to suboptimal adherence and uncontrolled blood pressure, MDIS in the context of hypertension remains insufficiently explored. This review synthesizes existing literature on MDIS, emphasizing clinical characteristics, pathogenesis, and psychiatric comorbidity. Furthermore, it delves into MDIS in the context of hypertension, highlighting the importance of a multidisciplinary approach in diagnosis and management, including innovative therapeutic strategies such as novel therapeutic algorithms or renal denervation. The review concludes by emphasizing the necessity for further research and clinical trials to enhance our understanding and address MDIS, especially in hypertensive patients.

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“…Hypertension treatment is challenging, particularly for people over 60. Because the pharmacological effects of initial conventional doses of antihypertensive drugs are sensitive to these patients [1,2]. Chemically known as ((2S)-1[(2S)-S-2-methyl-3-sulfanylpropanoyl]pyrrolidine-2carboxylic acid), captopril (CAP) is a frequently used anti-hypertensive drug that is also used to treat different diseases such as rheumatoid arthritis, diabetic nephropathy, and vascular diseases.…”

Section: Introductionmentioning

confidence: 99%

Green Procedure Index Assessment of the Novel Stability-Indicating Rp-HPLC Method for the Determination of Captopril From Pharmaceutical Dosage Form

Erkmen

Uslu

2023

Ankara Ecz. Fak. Derg.

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Objective: In this study, it was aimed to develop a novel reverse-phase liquid chromatography method for the ultra-sensitive determination of the antihypertensive drug captopril, using paracetamol, which is the common pain killer, as the internal standard. Optimization of all experimental conditions including composition of mobile phase, flow rate, and column temperature was carried out step by step, and the method validity of the developed method was examined according to international validation guidelines. Calibration range, linearity, the limit of determination, the limit of quantification, robustness, accuracy from commercial tablet samples, and method stability were examined in detail. In addition, the greenness profile for the developed method was assessed with the Green Analytical Procedure Index and Analytical Greenness Calculator techniques, which are frequently used in the literature. Material and Method: The chromatographic method was conducted with an XBridge C18 column (25 cm x 4.6 mm ID; 5 µm) packed with fully porous silica materials. All analyses were performed isocratically with a mobile phase containing acetonitrile:5 mM, pH 7.0 ammonium acetate solution (50:50, v/v) at a flow rate of 1.5 ml min-1. The injection volume was 5 μl, and the column was kept at 25°C in a column oven. The column eluate was monitored at 220 nm. Under optimized conditions, retention times of captopril, and paracetamol were approximately 1.59, and 2.0 min, respectively. Result and Discussion: This study described a fully validated, simple, sensitive, accurate, linear, precise, and reproducible reversed-phase liquid chromatography method for the determination of captopril in tablet samples. Under optimal experimental conditions, the linear range was found in the range of 0.5-200 µg ml-1 and the correlation coefficient was greater than 0.99. Method precision was acceptable, with coefficients of variation between 0.05% and 0.61%. In addition, as a result of the recovery studies carried out on the tablet samples, the accuracy was found to be within satisfactory limits between 99.45% and 102.55%. Moreover, the greenness profile of the developed method also showed that the method is environmentally friendly.

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Multiple drug-intolerant hypertension: a case series utilising a novel-treatment algorithm

Cited by 6 publications

References 8 publications

Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances

Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances

Multiple drug intolerance in antihypertensive patients: what is known and what is missing

Green Procedure Index Assessment of the Novel Stability-Indicating Rp-HPLC Method for the Determination of Captopril From Pharmaceutical Dosage Form

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