Time course for blood pressure lowering of dihydropyridine calcium channel blockers

Ghamami, Niousha; Chiang, Sandy Hsiang Yu; Dormuth, Colin R.; Wright, James M

doi:10.1002/14651858.cd010052.pub2

Cited by 12 publications

(6 citation statements)

References 27 publications

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“…First, several antihypertensive agents have halflives less than 12 h [96][97][98], and thus, their effective use requires either extended-release formulations or repeated dosing to achieve 24-h BP control. However, most modern antihypertensive agents exhibit longer half-lives or duration of action, resulting in fairly stable BP-lowering effects when dosed once daily, even in the last hours before the next dose [99,100]. Second, some drugs with relatively short halflives may have long duration of action due to irreversible target (e.g.…”

Section: Antihypertensive Medication Actionmentioning

confidence: 99%

Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Stergiou

Brunström

MacDonald

et al. 2022

Journal of Hypertension

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Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.

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Section: Antihypertensive Medication Actionmentioning

confidence: 99%

Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Stergiou

Brunström

MacDonald

et al. 2022

Journal of Hypertension

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“…first-line therapy for hypertension. [56][57][58][59][60][61][62] In total, these meta-analyses included 316 RCTs. We excluded the trials and trial arms of medications and medication dosages that were not indicated in the BNF.…”

Section: Evidence Base For Medicationsmentioning

confidence: 99%

How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure

et al. 2018

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ObjectiveTo compare the effect of exercise regimens and medications on systolic blood pressure (SBP).Data sourcesMedline (via PubMed) and the Cochrane Library.Eligibility criteriaRandomised controlled trials (RCTs) of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-2 receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs) and diuretics were identified from existing Cochrane reviews. A previously published meta-analysis of exercise interventions was updated to identify recent RCTs that tested the SBP-lowering effects of endurance, dynamic resistance, isometric resistance, and combined endurance and resistance exercise interventions (up to September 2018).DesignRandom-effects network meta-analysis.OutcomeDifference in mean change from baseline SBP between comparator treatments (change from baseline in one group minus that in the other group) and its 95% credible interval (95% CrI), measured in mmHg.ResultsWe included a total of 391 RCTs, 197 of which evaluated exercise interventions (10 461 participants) and 194 evaluated antihypertensive medications (29 281 participants). No RCTs compared directly exercise against medications. While all medication trials included hypertensive populations, only 56 exercise trials included hypertensive participants (≥140 mmHg), corresponding to 3508 individuals. In a 10% random sample, risk of bias was higher in exercise RCTs, primarily due to lack of blinding and incomplete outcome data. In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference −3.96 mmHg, 95% CrI −5.02 to −2.91). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. Although there was evidence of small-study effects, this affected both medication and exercise trials.ConclusionsThe effect of exercise interventions on SBP remains under-studied, especially among hypertensive populations. Our findings confirm modest but consistent reductions in SBP in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications. Generalisability of these findings to real-world clinical settings should be further evaluated.

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“…The number of patients introduced to the formularies, the name of the formulary medication, and the average dosage were descriptively analyzed and dose equivalences of each medicine were proposed (Table 1). [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Then, the medication dosages at the time of admission and discharge were converted to the recommended equivalent doses in the formulary and compared. Dose equivalences were established based on a systematic review and were determined on the basis of the corresponding doses established in trials, wherein each medicine was found to be non-inferior.…”

Section: Discussionmentioning

confidence: 99%

Influence of Hospital Formularies on Outpatient Prescribing Practices: Analysis of the Introduction of a Local Formulary: A Single-Center, 2-Year Follow-Up, Retrospective Cohort Study of a Local Formulary in Japan

Kanai¹,

Ando²,

Shimodate³

et al. 2022

INQUIRY

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Purpose The impact of a hospital formulary was evaluated to provide a guide for the establishment of local formularies to optimize patient care and healthcare costs. Methods A formulary was introduced by formulary pharmacists of the Toda Medical Group for suggesting recommended medicines to physicians based on the medication history. Patients who were hospitalized in the rehabilitation ward of the Niiza Hospital and prescribed medicines according to the formulary introduced between April 2017 and March 2018 were included and followed-up for six months. Results Of the 183 patients screened, 154 patients were enrolled as the formulary’s introduction patients (76 males/78 females, median age 78 years); 92% of these patients received formulary-proposed prescriptions at the specified timepoints; and 19 patients re-consulted at the Niiza Hospital after discharge and continued the same formulary medicines. The proposed acceptance rate by physicians was 100%. Most changes suggested introduced generic formulations. The doses were equivalent for all pharmacological classes with the exception of medicines that interfere with the renin–angiotensin system, which fell from 10.7 to 7.2 mg ( P< .0001). Overall daily medication costs fell at discharge compared to admission (38.5 vs. 94.6 yen per patient, respectively, P< .0001). This was valid for all pharmacological classes except for calcium channel blockers. Conclusion Hospital formulary-prescribed medications continued after discharge and promoted significant decreases in costs associated with outpatient prescriptions. Introducing a hospital formulary provides a basis for the introduction of local formularies and contributes to the reduction of local healthcare costs.

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Time course for blood pressure lowering of dihydropyridine calcium channel blockers

Cited by 12 publications

References 27 publications

Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension

How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure

Influence of Hospital Formularies on Outpatient Prescribing Practices: Analysis of the Introduction of a Local Formulary: A Single-Center, 2-Year Follow-Up, Retrospective Cohort Study of a Local Formulary in Japan

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