The treatment of hypertension

Chalmers, John

doi:10.1046/j.1365-2125.1996.03686.x

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…There is considerable suspicion that some of the drugs used may have adverse eVects which partly counteract the benefits of the blood pressure reduction. 8 Nonpharmacological blood pressure reductionfor instance, by regular exercise-therefore seems an attractive alternative. However, no prospective randomised trials have been performed to show that exercise training reduces cardiovascular morbidity and mortality in hypertensive patients.…”

Section: Marleen a Van Baakmentioning

confidence: 99%

Exercise and hypertension: facts and uncertainties.

Baak

1998

Br J Sports Med

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Section: Marleen a Van Baakmentioning

confidence: 99%

Exercise and hypertension: facts and uncertainties.

Baak

1998

Br J Sports Med

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“…Currently available calcium channels blockers are divided into two categories based upon their effect: the dihydropyridines, which cause arterial vasodilation but do not influence heart contractility and conduction, and the nondihydropyridines, which do not cause vasodilation but have negative effect upon heart conduction and contractility [1, 2]. The most commonly reported adverse events noted with dihydropyridines are peripheral oedema and flushing that occur in 10–20% of the patients, both children and adults.…”

mentioning

confidence: 99%

Cyclosporin enhances the tendency towards oedema and flushing noted on dihydropyridine calcium channel blockers

Vigier

Fossali

Edefonti

et al. 2002

Brit J Clinical Pharma

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Wenzel and colleagues recently concluded that an endothelin-A (ET-A) receptor antagonist attenuates the skin vasoconstriction produced by angiotensin II (Ang II) and noradrenaline (NA) [1]. The postulate that the selective ET-A antagonist, BQ123, blocks Ang II and NA mediated vasoconstriction challenges well-established physiological and pharmacological concepts, in particular, the notion of specific receptors for these peptidergic and nonpeptidergic substances. We believe that the double injection technique (DIT) used to assess blood flow of the skin microcirculation in this study has some drawbacks that might have affected the data generated from it.In this study [1], skin blood flow was assessed immediately after injection of the study substance, which can give rise to confounding results as injection trauma can produce significant vasodilation [2]. Studies using microdialysis probes to visualize the changes in skin blood flow by laser-Doppler perfusion imaging demonstrate that a blood flow equilibrium period of about 60 min is required for the effects of trauma to dissipate [2]. The vasodilatory effects of local histamine released from injection trauma can last up to 40 min [2]. Hence, the effects of injection trauma cannot be distinguished from the effects of the study drug. It can be assumed that, in this study, the dilator effects of the control drug (i.e. saline or the antagonist) were subtracted from the vasodilation or vasoconstriction induced by the study drug. Regardless, subtracting the value does not ensure that the effects of histamine or other vasodilatory substances released by injection trauma will not be present during the study period of 30 min For example, BQ123 could have induced a nonspecific vasodilatory effect unrelated to blockade of ET-A receptors. Similarly, trauma could have affected the vasoconstrictor effects of Ang II and NA by release of local vasodilatory substances.The combination of microdialysis and laser-Doppler flowmetry (Figure 1), with an equilibrium period of 2 h after insertion of the microdialysis probes, allows similar studies without the confounding effects of trauma. This technique allows for the study of vasodilatory and vasoconstrictor substances on skin blood flow even at the already low baseline flows found during normothermia and after resolution of trauma [3]. Using this technique, we have shown that the ET-B receptor antagonist (BQ788) at a dose of 1.5 × 10 − 7 mol l − 1 produced cutaneous vasodilation in healthy men and vasoconstriction in healthy females. Therefore, we concluded that the contribution of ET-B receptors to resting vascular tone differs between males and females in the human cutaneous vasculature [4]. In contrast, the authors' in the present study [1] demonstrated a mild vasoconstriction with BQ788 in men at doses ranging from 10 -8 -10

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