Older Blood Pressure Medications—Do They Still Have a Place?

Slim, Hanna B.; Black, Henry R.; Thompson, Paul D.

doi:10.1016/j.amjcard.2011.03.041

Cited by 30 publications

(14 citation statements)

References 90 publications

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“…Reserpine is characterized by a slow onset of action and sustained effects. Reserpine has been employed in several of the early hypertension trials and was effective as mono and more so as add-on therapy [ 52 ]. Given as monotherapy, reserpine in general reduces systolic BP by 3-4 mmHg, a level of BP reduction that is considerably enhanced when it is coadministered with a diuretic.…”

Section: Reserpinementioning

confidence: 99%

Centrally Acting Antihypertensive Agents in the Treatment of Hypertension

Sica

2015

Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Centrally acting antihypertensive agents stimulate α 2 -adrenergic receptors and/or imidazoline receptors on adrenergic neurons situated within the rostral ventrolateral medulla and in so doing variably reduce sympathetic outfl ow. Centrally acting agents also stimulate peripheral α 2 -receptors, which for the most part is of marginal clinical signifi cance with the medication doses used in clinical practice. Central α-agonists have an extended usage history, starting with α-methyldopa, which has seen its use dramatically decline, in part, because of signifi cant dose-dependent side effects as well as the arrival of more mechanistically attractive classes of antihypertensive medications. Patients with resistant hypertension requiring multidrug therapy, such as those with chronic kidney disease, are commonly responsive to these drugs as are patients with sympathetically mediated forms of hypertension. Perioperative hypertension is typically responsive to clonidine -a clinical circumstance where the anestheticand analgesia-sparing properties of this compound may offer further clinical benefi ts. Clonidine can be used adjunctively with other more traditional therapies in systolic forms of heart failure, particularly when hypertension exists. Sustained-release moxonidine, however, is associated with early mortality and morbidity when used in the patient with heart failure. Escalating doses of drugs in this class often give rise to salt and water retention in which case diuretic therapy becomes a needed adjunctive therapy.

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Section: Reserpinementioning

confidence: 99%

Centrally Acting Antihypertensive Agents in the Treatment of Hypertension

Sica

2015

Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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“…Spironolactone can legitimately be viewed as an "older" BP medication [35]; however, it is now used with increasing regularity in patients with resistant hypertension, with or without primary aldosteronism, who are receiving multidrug regimens that include a diuretic and any of several other drug classes (eg, an ACE inhibitor, an ARB, and/or a calcium channel blocker) [31,[36][37][38][39]. Spironolactone also has a greater incremental antihypertensive effect when added to single-agent renin-angiotensin axis blockade than is the case if a second renin-angiotensin axis blocker is given [3].…”

Section: Essential Hypertension/resistant Hypertensionmentioning

confidence: 99%

What is the Role of Aldosterone Excess in Resistant Hypertension and How Should It Be Investigated and Treated?

Sica

2011

Curr Cardiol Rep

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Resistant hypertension has evolved as an important global health care problem. Primary aldosteronism is one of several potentially reversible causes of resistant hypertension. Primary aldosteronism can be effectively treated, when recognized, with a mineralocorticoid receptor antagonist, such as spironolactone and eplerenone. Each of these compounds can reduce blood pressure as monotherapy or when given with a range of other antihypertensive drug classes. These compounds have distinctive pharmacokinetic and pharmacodynamic patterns that require some forethought in their use before they are prescribed. However, as the use of mineralocorticoid-blocking agents has gradually increased, the hazards inherent to use of such drugs has become more apparent. Whereas the endocrine side effects of spironolactone are in most cases little more than a cosmetic annoyance, the potassium-sparing effects of both spironolactone and eplerenone can prove fatal if sufficient degrees of hyperkalemia develop. However, for most patients the risk of developing hyperkalemia in and of itself should not discourage the prudent clinician from bringing these compounds into play. Hyperkalemia should always be considered as a likelihood in any patient receiving one or the other of these medications. As such, steps should be taken to lessen the likelihood of it occurring if therapy is being contemplated with agents in this class.

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“…23 However, the harm from bloodletting shows that not all techniques or agents that reduce blood pressure also reduce cardiovascular risk. Similarly, α blockers, 24 immediate release calcium channel blockers, 25 guanethidine, 26 and renal denervation and its sham 27 …”

Section: Rationale For Changementioning

confidence: 99%

Mild hypertension in people at low risk

Martin

Boucher

Wright

et al. 2014

BMJ

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Antihypertensive drugs have an important role in the treatment of malignant hypertension, secondary prevention of cardiovascular disease, and primary prevention for people at high risk: those with moderate to severe hypertension (≥160/100 mm Hg), diabetes, or chronic kidney disease. Debate continues, however, about the level at which treatment should begin and the appropriate targets for treatment. The greatest uncertainty surrounds mild hypertension (140-159/90-99 mm Hg), which accounts for over 60% of those with hypertension or 22% of the global adult population. Evidence suggests no net benefit from drug treatment of mild hypertension in people without the higher risks of diabetes or chronic kidney disease. Nevertheless, most people with mild hypertension are treated with drugs. In this article, we examine the overdiagnosis and overtreatment of mild hypertension

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Older Blood Pressure Medications—Do They Still Have a Place?

Cited by 30 publications

References 90 publications

Centrally Acting Antihypertensive Agents in the Treatment of Hypertension

Centrally Acting Antihypertensive Agents in the Treatment of Hypertension

What is the Role of Aldosterone Excess in Resistant Hypertension and How Should It Be Investigated and Treated?

Mild hypertension in people at low risk

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