Hypertension is a major cause of cardiovascular disease and mortality worldwide. In India, about 33% of urban and 25% of rural populations have hypertension, though only a fraction are aware of and successfully controlling their condition. Azilsartan is a new angiotensin II receptor blocker that has been shown to more effectively lower blood pressure than other ARBs. As the eighth approved drug in its class, Azilsartan may help improve blood pressure control for Indian patients with hypertension when it becomes available.
The document discusses a clinical update on hypertension and summarizes key findings from phase 3 clinical trials of the drug EDARBI. It provides details on 6 phase 3 trials involving over 3,600 patients that evaluated the efficacy and safety of EDARBI for treating hypertension. The trials showed that EDARBI 80 mg was superior to Diovan and Benicar in reducing blood pressure over 24 hours and provided additional reductions when combined with other drugs. EDARBI was generally well tolerated with diarrhea being the most common side effect.
1. Resistant Hypertension, complications, Target organ damage2. newly diagnosed stage-1 hypertension, rationale of use of ARB and comparison of Azilsartan with other ARBs3. Hypertension with bronchial asthma 4. Hypertension with Diabetes Mellitus with proteinuria5. Hypertension , Diabetes and IHD6. Gestational Hypertension , rationale of use of drugs7. Hypertension , Diabetes , ACS8. Hypertension, Diabetes and Syndrome X9. Hypertension and special situations
This document summarizes guidelines for the treatment of hypertension from various medical organizations. It finds that reducing blood pressure reduces cardiovascular risks, and regimens based on ACE inhibitors such as perindopril have been shown to significantly improve survival in clinical trials. The guidelines recommend treating hypertension when systolic is over 150/90 for those over age 60, or over 140/90 for those under 60 with kidney disease or diabetes. Initial treatment should include ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. The goal of treatment is to lower blood pressure to under 140/90 mmHg for most patients.
This document provides information about the drug irbesartan, including its trade names, dosage forms, pharmacological mechanisms, pharmacokinetics, indications and usage, interactions, side effects, contraindications, and storage. Irbesartan is an angiotensin II receptor antagonist used to treat hypertension. It is well absorbed orally and highly protein bound. Common side effects include diarrhea, heartburn, dizziness and fatigue. Irbesartan has few drug interactions and may be taken with or without food.
ONTARGET trial - Summary & Results with Ramipril Global Endpointtheheart.org
The ONTARGET trial compared the angiotensin receptor blocker (ARB) telmisartan to the angiotensin converting enzyme (ACE) inhibitor ramipril and their combination in 25,620 patients with cardiovascular disease or diabetes. The trial found that telmisartan was noninferior to ramipril for the primary outcome of cardiovascular death, heart attack, stroke or hospitalization for heart failure. The combination of telmisartan and ramipril showed no additional benefit compared to ramipril alone and was associated with more side effects such as renal impairment.
1. Heart failure is a major public health problem, affecting over 5 million Americans. It is primarily a condition of the elderly and costs Medicare billions of dollars annually.
2. The VALIANT trial compared the ARB valsartan to the ACE inhibitor captopril and their combination in over 14,000 patients with heart failure or left ventricular dysfunction following a myocardial infarction. It found valsartan to be noninferior to captopril in reducing cardiovascular mortality and morbidity.
3. The presentation discusses the role of the renin-angiotensin system in cardiovascular disease and how ARBs like valsartan can provide beneficial blockade of this system in heart failure and post-myocardial infarction
1. The document discusses hypertension and the need for combination therapy to control blood pressure as most patients require two or more medications.
2. It highlights that the combination of telmisartan and amlodipine is preferred in Pakistan due to their complementary mechanisms that minimize side effects and provide synergistic blood pressure lowering effects.
3. Telmisartan has advantages over other ARBs like a longer half-life and higher tissue distribution that provide sustained blood pressure control, especially during early morning hours when cardiovascular events are more common.
1. The document discusses guidelines and strategies for the prevention, treatment, and control of hypertension.
2. It outlines 4 stages of intervention for hypertension: preventive, primary, secondary, and resistant hypertension. Treatment approaches differ depending on the stage.
3. The challenges of controlling hypertension include special patient populations, factors influencing drug choice, and issues related to resistant hypertension when blood pressure remains high despite treatment with 3 drug classes.
The document discusses a clinical update on hypertension and summarizes key findings from phase 3 clinical trials of the drug EDARBI. It provides details on 6 phase 3 trials involving over 3,600 patients that evaluated the efficacy and safety of EDARBI for treating hypertension. The trials showed that EDARBI 80 mg was superior to Diovan and Benicar in reducing blood pressure over 24 hours and provided additional reductions when combined with other drugs. EDARBI was generally well tolerated with diarrhea being the most common side effect.
1. Resistant Hypertension, complications, Target organ damage2. newly diagnosed stage-1 hypertension, rationale of use of ARB and comparison of Azilsartan with other ARBs3. Hypertension with bronchial asthma 4. Hypertension with Diabetes Mellitus with proteinuria5. Hypertension , Diabetes and IHD6. Gestational Hypertension , rationale of use of drugs7. Hypertension , Diabetes , ACS8. Hypertension, Diabetes and Syndrome X9. Hypertension and special situations
This document summarizes guidelines for the treatment of hypertension from various medical organizations. It finds that reducing blood pressure reduces cardiovascular risks, and regimens based on ACE inhibitors such as perindopril have been shown to significantly improve survival in clinical trials. The guidelines recommend treating hypertension when systolic is over 150/90 for those over age 60, or over 140/90 for those under 60 with kidney disease or diabetes. Initial treatment should include ACE inhibitors, ARBs, calcium channel blockers, or thiazide diuretics. The goal of treatment is to lower blood pressure to under 140/90 mmHg for most patients.
This document provides information about the drug irbesartan, including its trade names, dosage forms, pharmacological mechanisms, pharmacokinetics, indications and usage, interactions, side effects, contraindications, and storage. Irbesartan is an angiotensin II receptor antagonist used to treat hypertension. It is well absorbed orally and highly protein bound. Common side effects include diarrhea, heartburn, dizziness and fatigue. Irbesartan has few drug interactions and may be taken with or without food.
ONTARGET trial - Summary & Results with Ramipril Global Endpointtheheart.org
The ONTARGET trial compared the angiotensin receptor blocker (ARB) telmisartan to the angiotensin converting enzyme (ACE) inhibitor ramipril and their combination in 25,620 patients with cardiovascular disease or diabetes. The trial found that telmisartan was noninferior to ramipril for the primary outcome of cardiovascular death, heart attack, stroke or hospitalization for heart failure. The combination of telmisartan and ramipril showed no additional benefit compared to ramipril alone and was associated with more side effects such as renal impairment.
1. Heart failure is a major public health problem, affecting over 5 million Americans. It is primarily a condition of the elderly and costs Medicare billions of dollars annually.
2. The VALIANT trial compared the ARB valsartan to the ACE inhibitor captopril and their combination in over 14,000 patients with heart failure or left ventricular dysfunction following a myocardial infarction. It found valsartan to be noninferior to captopril in reducing cardiovascular mortality and morbidity.
3. The presentation discusses the role of the renin-angiotensin system in cardiovascular disease and how ARBs like valsartan can provide beneficial blockade of this system in heart failure and post-myocardial infarction
1. The document discusses hypertension and the need for combination therapy to control blood pressure as most patients require two or more medications.
2. It highlights that the combination of telmisartan and amlodipine is preferred in Pakistan due to their complementary mechanisms that minimize side effects and provide synergistic blood pressure lowering effects.
3. Telmisartan has advantages over other ARBs like a longer half-life and higher tissue distribution that provide sustained blood pressure control, especially during early morning hours when cardiovascular events are more common.
1. The document discusses guidelines and strategies for the prevention, treatment, and control of hypertension.
2. It outlines 4 stages of intervention for hypertension: preventive, primary, secondary, and resistant hypertension. Treatment approaches differ depending on the stage.
3. The challenges of controlling hypertension include special patient populations, factors influencing drug choice, and issues related to resistant hypertension when blood pressure remains high despite treatment with 3 drug classes.
Effect of Nifedipine Versus Telmisartan on Prevention of Atrial Fibrillation ...طالبه جامعيه
This study compared the effects of nifedipine-based versus telmisartan-based antihypertensive treatment on the prevention of atrial fibrillation recurrence in 149 hypertensive patients with paroxysmal atrial fibrillation. Both treatments successfully lowered blood pressure to the target level. However, telmisartan was more effective at preventing progression to persistent atrial fibrillation, likely by reducing left ventricular hypertrophy and left atrial remodeling to a greater extent than nifedipine. Overall rates of atrial fibrillation recurrence were similar between the groups. The study provides evidence that telmisartan may be superior to nifedipine for preventing the worsening of
The document discusses hypertension and the benefits of combination therapy using amlodipine and valsartan. It summarizes that:
1) Amlodipine/valsartan provides powerful blood pressure reductions of up to 43 mmHg in systolic blood pressure across different hypertension severities and patient types, including the elderly, those with isolated systolic hypertension, obesity, and diabetes.
2) In patients uncontrolled on monotherapy, amlodipine/valsartan reduces blood pressure by around 21 mmHg on average.
3) Fewer patients experience peripheral edema with amlodipine/valsartan compared to amlodipine monotherapy.
Although many are still concerned with an ARB–MI paradox, our study of close to 60 000 patients with MI should serve as reassurance that ARBs are not associated with adverse outcomes compared with ACEIs. Potential benefits of ARBs as compared with ACEIs in older women with MI should be further evaluated.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
1) Telmisartan has the longest half-life, largest volume of distribution, highest lipophilicity, and lowest renal excretion of clinically available ARBs, resulting in the longest duration of action.
2) Telmisartan binds insurmountably to the AT1 receptor and has a much longer dissociation half-life compared to losartan, providing tighter, more sustained blockade of the RAS.
3) Telmisartan is the preferred ARB for patients with renal impairment due to its renal excretion profile and superior blood pressure lowering in renal disease compared to other ARBs like losartan.
The document discusses the renin-angiotensin-aldosterone system (RAAS) and its role in cardiovascular diseases. It describes how inappropriate activation of RAAS can lead to hypertension, diabetes, obesity, heart failure and kidney diseases. RAAS modulators like angiotensin converting enzyme inhibitors and angiotensin receptor blockers are effective in managing these conditions by inhibiting RAAS. Clinical trials have shown that drugs like losartan, valsartan and candesartan reduce blood pressure and cardiovascular events.
This document summarizes the OSCAR study which compared high-dose olmesartan to standard-dose olmesartan plus a calcium channel blocker in 1164 elderly Japanese patients with uncontrolled hypertension. The study found that blood pressure was better controlled with the combination therapy, with a 2.4 mmHg lower systolic and 1.7 mmHg lower diastolic blood pressure. There was no significant difference in the primary outcome of cardiovascular events and death between the two groups. However, subgroup analysis found that patients with preexisting cardiovascular disease benefited more from the combination therapy, with significantly fewer cardiovascular events and deaths.
1) The study compared outcomes of 5,139 patients with heart failure treated with candesartan or losartan.
2) One-year survival was 90% for candesartan vs 83% for losartan, and 5-year survival was 61% vs 44%.
3) After adjusting for potential confounding factors, treatment with losartan was associated with a 43% higher risk of all-cause mortality compared to candesartan.
This document summarizes several studies on the use of ACE inhibitors and angiotensin receptor blockers (ARBs) in treating heart failure and reducing cardiovascular risk. The HOPE trial showed that the ACE inhibitor ramipril reduced cardiovascular events in high-risk patients. The CHARM trial found that the ARB candesartan reduced cardiovascular outcomes in heart failure patients, both alone and in combination with ACE inhibitors. The ONTARGET trial aimed to compare the ARB telmisartan to ramipril, and their combination, to determine if telmisartan was non-inferior to ramipril and if their combination provided additional benefit.
Comparative effectives of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers added to standard medical therapy for treating patients with stable ischemic heart disease and preserved left ventricular systolic function.
Hypertension, or high blood pressure, refers to blood pressure above 140/90 mmHg. It is regulated by the renin-angiotensin-aldosterone system and can be caused by age, family history, weight, and other factors. There are several classes of anti-hypertensive drugs used to treat it. The most common are ACE inhibitors, ARBs, thiazide diuretics, and calcium channel blockers, which work by inhibiting renin, blocking angiotensin receptors, increasing sodium excretion, and reducing calcium influx respectively. Other options include beta blockers, loop diuretics, potassium-sparing diuretics, and alpha blockers. Proper control of blood
This document discusses the rational for using the combination of amlodipine and valsartan to treat hypertensive diabetic patients. It notes that hypertension is present in 20-60% of diabetic patients and substantially increases their risk of complications. While guidelines recommend tight control of both blood pressure and blood glucose, many patients require multiple medications to achieve targets. The combination of amlodipine, a calcium channel blocker, and valsartan, an angiotensin receptor blocker, provides complementary mechanisms of action that allow for more effective blood pressure control with fewer side effects compared to monotherapies. Clinical trials demonstrate the amlodipine/valsartan combination is well-tolerated and effective at reducing blood pressure
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
This document summarizes guidelines for managing chronic heart failure. It discusses evaluating patients, lifestyle modifications including diet and exercise, and pharmacological treatments. Key drugs discussed are ACE inhibitors, ARBs, beta blockers, aldosterone antagonists, and digoxin. Several clinical trials are summarized that demonstrate the mortality benefits of these drug classes in heart failure.
This document summarizes clinical studies comparing the effects of carvedilol and metoprolol in patients with myocardial infarction (MI) and heart failure (HF). Several studies found that carvedilol improved outcomes more than metoprolol, reducing mortality, improving quality of life, and decreasing hospital readmissions in post-MI and HF patients. Carvedilol's multi-receptor blocking properties allow it to provide better sympatholytic effects than metoprolol. The document concludes that carvedilol is a better choice than metoprolol for treating patients with MI or HF.
The success of neurohormonal blockade: looking back – looking forward: Beta-b...drucsamal
- The document summarizes the history of beta-blocker treatment for heart failure, from early studies in the 1970s showing potential benefits to large randomized controlled trials in the 1990s and 2000s firmly establishing mortality reduction.
- Key trials included MDC (1993) showing reduced mortality and heart transplantation, CIBIS-II (1999) showing reduced mortality with bisoprolol, MERIT-HF (1999) showing reduced mortality with metoprolol CR/XL, and COPERNICUS (2001) showing reduced mortality, hospitalizations, and worsening heart failure with carvedilol.
- Meta-analyses demonstrated a consistent mortality reduction of approximately 35% associated with beta-blocker use in
Recent Developments in the Treatment of Hypertension Recent Developments in...MedicineAndFamily
This document summarizes recent evidence from clinical trials on the treatment of hypertension, with a focus on patients with type 2 diabetes. It discusses trials comparing different classes of antihypertensive drugs and levels of blood pressure control. The evidence suggests that ACE inhibitors may provide greater benefits for diabetic patients compared to other drugs, reducing cardiovascular events and slowing kidney and eye disease progression. Intensive blood pressure control is also supported, though some calcium channel blockers may increase cardiovascular risk in diabetes. Ongoing long-term safety documentation is still needed for many antihypertensive agents.
This document discusses the management of resistant hypertension. It defines resistant hypertension as BP that remains above goal despite treatment with three or more antihypertensive drugs, including a diuretic. It provides characteristics of true resistant hypertension and outlines a management algorithm. Device-based treatments for resistant hypertension discussed include carotid baroreceptor stimulation and arteriovenous anastomosis. Drug classes are identified where abrupt withdrawal can cause complications due to effects like sympathetic overactivity, fluid retention, or risk of angina.
This document discusses the rationale for a single pill combination of bisoprolol and telmisartan for the treatment of hypertension. It notes that bisoprolol is a cardioselective beta-blocker that provides beta-1 receptor blockade, while telmisartan is an angiotensin receptor blocker that acts on the renin-angiotensin system. The combination provides comprehensive neuroendocrine blockade for hypertension through their complementary mechanisms of action. Clinical trials have shown that single pill combinations improve medication adherence, persistence and blood pressure control compared to free combinations. Guidelines increasingly recommend single pill combinations as first-line treatment for hypertension.
Effect of Nifedipine Versus Telmisartan on Prevention of Atrial Fibrillation ...طالبه جامعيه
This study compared the effects of nifedipine-based versus telmisartan-based antihypertensive treatment on the prevention of atrial fibrillation recurrence in 149 hypertensive patients with paroxysmal atrial fibrillation. Both treatments successfully lowered blood pressure to the target level. However, telmisartan was more effective at preventing progression to persistent atrial fibrillation, likely by reducing left ventricular hypertrophy and left atrial remodeling to a greater extent than nifedipine. Overall rates of atrial fibrillation recurrence were similar between the groups. The study provides evidence that telmisartan may be superior to nifedipine for preventing the worsening of
The document discusses hypertension and the benefits of combination therapy using amlodipine and valsartan. It summarizes that:
1) Amlodipine/valsartan provides powerful blood pressure reductions of up to 43 mmHg in systolic blood pressure across different hypertension severities and patient types, including the elderly, those with isolated systolic hypertension, obesity, and diabetes.
2) In patients uncontrolled on monotherapy, amlodipine/valsartan reduces blood pressure by around 21 mmHg on average.
3) Fewer patients experience peripheral edema with amlodipine/valsartan compared to amlodipine monotherapy.
Although many are still concerned with an ARB–MI paradox, our study of close to 60 000 patients with MI should serve as reassurance that ARBs are not associated with adverse outcomes compared with ACEIs. Potential benefits of ARBs as compared with ACEIs in older women with MI should be further evaluated.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
1) Telmisartan has the longest half-life, largest volume of distribution, highest lipophilicity, and lowest renal excretion of clinically available ARBs, resulting in the longest duration of action.
2) Telmisartan binds insurmountably to the AT1 receptor and has a much longer dissociation half-life compared to losartan, providing tighter, more sustained blockade of the RAS.
3) Telmisartan is the preferred ARB for patients with renal impairment due to its renal excretion profile and superior blood pressure lowering in renal disease compared to other ARBs like losartan.
The document discusses the renin-angiotensin-aldosterone system (RAAS) and its role in cardiovascular diseases. It describes how inappropriate activation of RAAS can lead to hypertension, diabetes, obesity, heart failure and kidney diseases. RAAS modulators like angiotensin converting enzyme inhibitors and angiotensin receptor blockers are effective in managing these conditions by inhibiting RAAS. Clinical trials have shown that drugs like losartan, valsartan and candesartan reduce blood pressure and cardiovascular events.
This document summarizes the OSCAR study which compared high-dose olmesartan to standard-dose olmesartan plus a calcium channel blocker in 1164 elderly Japanese patients with uncontrolled hypertension. The study found that blood pressure was better controlled with the combination therapy, with a 2.4 mmHg lower systolic and 1.7 mmHg lower diastolic blood pressure. There was no significant difference in the primary outcome of cardiovascular events and death between the two groups. However, subgroup analysis found that patients with preexisting cardiovascular disease benefited more from the combination therapy, with significantly fewer cardiovascular events and deaths.
1) The study compared outcomes of 5,139 patients with heart failure treated with candesartan or losartan.
2) One-year survival was 90% for candesartan vs 83% for losartan, and 5-year survival was 61% vs 44%.
3) After adjusting for potential confounding factors, treatment with losartan was associated with a 43% higher risk of all-cause mortality compared to candesartan.
This document summarizes several studies on the use of ACE inhibitors and angiotensin receptor blockers (ARBs) in treating heart failure and reducing cardiovascular risk. The HOPE trial showed that the ACE inhibitor ramipril reduced cardiovascular events in high-risk patients. The CHARM trial found that the ARB candesartan reduced cardiovascular outcomes in heart failure patients, both alone and in combination with ACE inhibitors. The ONTARGET trial aimed to compare the ARB telmisartan to ramipril, and their combination, to determine if telmisartan was non-inferior to ramipril and if their combination provided additional benefit.
Comparative effectives of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers added to standard medical therapy for treating patients with stable ischemic heart disease and preserved left ventricular systolic function.
Hypertension, or high blood pressure, refers to blood pressure above 140/90 mmHg. It is regulated by the renin-angiotensin-aldosterone system and can be caused by age, family history, weight, and other factors. There are several classes of anti-hypertensive drugs used to treat it. The most common are ACE inhibitors, ARBs, thiazide diuretics, and calcium channel blockers, which work by inhibiting renin, blocking angiotensin receptors, increasing sodium excretion, and reducing calcium influx respectively. Other options include beta blockers, loop diuretics, potassium-sparing diuretics, and alpha blockers. Proper control of blood
This document discusses the rational for using the combination of amlodipine and valsartan to treat hypertensive diabetic patients. It notes that hypertension is present in 20-60% of diabetic patients and substantially increases their risk of complications. While guidelines recommend tight control of both blood pressure and blood glucose, many patients require multiple medications to achieve targets. The combination of amlodipine, a calcium channel blocker, and valsartan, an angiotensin receptor blocker, provides complementary mechanisms of action that allow for more effective blood pressure control with fewer side effects compared to monotherapies. Clinical trials demonstrate the amlodipine/valsartan combination is well-tolerated and effective at reducing blood pressure
Beta Blockers in current cardiovascular practice Praveen Nagula
betablockers are the drug of choice for prevention of progression of heart failure with mortality benefit, after the evolution of neurohormonal regulation as pathogenesis of heart failure
This document summarizes guidelines for managing chronic heart failure. It discusses evaluating patients, lifestyle modifications including diet and exercise, and pharmacological treatments. Key drugs discussed are ACE inhibitors, ARBs, beta blockers, aldosterone antagonists, and digoxin. Several clinical trials are summarized that demonstrate the mortality benefits of these drug classes in heart failure.
This document summarizes clinical studies comparing the effects of carvedilol and metoprolol in patients with myocardial infarction (MI) and heart failure (HF). Several studies found that carvedilol improved outcomes more than metoprolol, reducing mortality, improving quality of life, and decreasing hospital readmissions in post-MI and HF patients. Carvedilol's multi-receptor blocking properties allow it to provide better sympatholytic effects than metoprolol. The document concludes that carvedilol is a better choice than metoprolol for treating patients with MI or HF.
The success of neurohormonal blockade: looking back – looking forward: Beta-b...drucsamal
- The document summarizes the history of beta-blocker treatment for heart failure, from early studies in the 1970s showing potential benefits to large randomized controlled trials in the 1990s and 2000s firmly establishing mortality reduction.
- Key trials included MDC (1993) showing reduced mortality and heart transplantation, CIBIS-II (1999) showing reduced mortality with bisoprolol, MERIT-HF (1999) showing reduced mortality with metoprolol CR/XL, and COPERNICUS (2001) showing reduced mortality, hospitalizations, and worsening heart failure with carvedilol.
- Meta-analyses demonstrated a consistent mortality reduction of approximately 35% associated with beta-blocker use in
Recent Developments in the Treatment of Hypertension Recent Developments in...MedicineAndFamily
This document summarizes recent evidence from clinical trials on the treatment of hypertension, with a focus on patients with type 2 diabetes. It discusses trials comparing different classes of antihypertensive drugs and levels of blood pressure control. The evidence suggests that ACE inhibitors may provide greater benefits for diabetic patients compared to other drugs, reducing cardiovascular events and slowing kidney and eye disease progression. Intensive blood pressure control is also supported, though some calcium channel blockers may increase cardiovascular risk in diabetes. Ongoing long-term safety documentation is still needed for many antihypertensive agents.
This document discusses the management of resistant hypertension. It defines resistant hypertension as BP that remains above goal despite treatment with three or more antihypertensive drugs, including a diuretic. It provides characteristics of true resistant hypertension and outlines a management algorithm. Device-based treatments for resistant hypertension discussed include carotid baroreceptor stimulation and arteriovenous anastomosis. Drug classes are identified where abrupt withdrawal can cause complications due to effects like sympathetic overactivity, fluid retention, or risk of angina.
This document discusses the rationale for a single pill combination of bisoprolol and telmisartan for the treatment of hypertension. It notes that bisoprolol is a cardioselective beta-blocker that provides beta-1 receptor blockade, while telmisartan is an angiotensin receptor blocker that acts on the renin-angiotensin system. The combination provides comprehensive neuroendocrine blockade for hypertension through their complementary mechanisms of action. Clinical trials have shown that single pill combinations improve medication adherence, persistence and blood pressure control compared to free combinations. Guidelines increasingly recommend single pill combinations as first-line treatment for hypertension.
Approach to Hypertension - Combination therapy.pptxdrsbansal2000
1) Combination therapy with two or more antihypertensive drugs from different classes is more effective at lowering blood pressure and helping more patients achieve target blood pressure goals than initiating treatment with a single drug alone (monotherapy).
2) Several major clinical trials have demonstrated that initiating treatment for hypertension with combination therapy results in greater reductions in both systolic and diastolic blood pressure compared to traditional stepped-care approaches starting with monotherapy.
3) Combination therapy may also help improve patient adherence and reduce withdrawals from therapy due to adverse effects compared to multiple medication changes involved in stepped-care approaches.
Addressing hypertension to reduce the burden of stroke 19 feb2018 (1)Sudhir Kumar
Hypertension is a leading risk factor for stroke. Treating hypertension reduces the risk of stroke through several mechanisms. All classes of antihypertensive drugs lower stroke risk, though some are preferred for primary and secondary stroke prevention. Maintaining controlled blood pressure reduces first and recurrent strokes, highlighting the importance of adherence to antihypertensive regimens. Guidelines recommend targeting a blood pressure of less than 130/80 mmHg to minimize stroke risk, especially for those with additional risk factors.
Reporting of adverse drug reactions caused while using antihypertensive drugs...SriramNagarajan17
This document reviews adverse drug reactions caused by antihypertensive medications. It discusses how various classes of antihypertensive drugs like thiazides, ACE inhibitors, ARBs, beta-blockers, and calcium channel blockers can cause adverse effects like dizziness, hypotension, erectile dysfunction, hyperkalemia, dry cough, and others. The study analyzed data from journals and found that cardiovascular adverse drug reactions were most frequent, and that beta-blockers were most often associated with adverse reactions. It concludes that while antihypertensive drugs treat hypertension, they can also cause adverse effects that should be reported and treated to help physicians safely select the best therapy for patients.
1) Telmisartan is advantageous over ACE inhibitors for patients with cardiovascular risk as it provides renin-angiotensin system blockade with fewer side effects and better treatment adherence, leading to reduced cardiovascular risk.
2) Telmisartan more effectively controls blood pressure throughout the 24-hour dosing period compared to ramipril, including better control of the early morning blood pressure surge which is important for reducing cardiovascular risk.
3) High adherence to antihypertensive treatment is associated with a 10% reduced risk of coronary artery disease, so assessing and supporting adherence is important for primary prevention of CAD in hypertensive patients.
Q-1The disease process I chose for this article is the treatment.docxwoodruffeloisa
Here are 3 responses to the posts with at least 200 words each, including a scholarly reference within the last 5 years per response in APA style:
RESPONSE 1:
I agree that patient attitudes and beliefs greatly impact treatment adherence for hypertension (Ashoorkhani et al., 2018). Providing thorough education is crucial, but healthcare providers must also be sensitive to cultural beliefs that may influence a patient's perspective on medication. While homeopathic approaches alone may not sufficiently control blood pressure, incorporating some cultural practices could help patients feel more engaged in their care. For the Iranian patient mentioned, suggesting reduced salt substitutes like fresh herbs and spices in cooking may be a good compromise that respects cultural traditions while still lowering sodium intake. Taking time to
This document reviews novel antihypertensive drugs used in clinical practice. It discusses how blood pressure is controlled and the causes and types of hypertension. It also examines the mechanisms of hypertension and the renin-angiotensin system. Several classes of antihypertensive drugs are described, including diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, and vasodilators. Specific drugs within these classes like losartan, candesartan, valsartan, irbesartan, telmisartan, olmesartan are compared in terms of their pharmacokinetics, dosage, and receptor binding affinities. The extensive synthetic work on
Novel Antihypertensive Drug Used in Clinical Practice: A ReviewBRNSS Publication Hub
Introduction: Blood pressure (BP) control continues to be important in reducing cardiovascular risk, along with the modification of other cardiovascular risk factors, especially cholesterol level. Lifestyle modification to reduce BP may control Stage 1 hypertension. Drug treatment should be based on evidence of improved outcomes and individualized account for the patient age, race, and quality of life. BP varies from minute to minute and is influenced by measurement technique, time of day, emotion, pain, discomfort, hydration, temperature, exercise, posture, and drugs. Purpose of Review: In this review, we examine how synthetic novel drugs involved in the management of hypertension not only in the wider population but also within special population groups such as the elderly, pregnant women, and those with a trial fibrillation. Conclusion: The extensive synthetic work carried out shows that some molecules are very effectively managing the hypertension in all ages of patients. Summary: We have made an attempt in reviewing the literature on 1,2 pyrazoline derivatives for their medicinal uses with the help of chemical abstract, journals, and internet surfing.
This document reviews novel antihypertensive drugs used in clinical practice. It begins by discussing blood pressure control and hypertension. It then examines the mechanisms of hypertension and various types of hypertension. The document reviews the history of antihypertensive drug treatment and describes different classes of drugs used including diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists, vasodilators, and others. It provides details on specific drugs within these classes and compares the pharmacokinetics of various angiotensin II receptor antagonists. The extensive synthetic work on new molecules is said to effectively manage hypertension in patients of all ages.
This document provides guidance on the management of hypertension. It begins with educational objectives and a case study example. It then reviews the magnitude of hypertension, definitions of true hypertension versus white coat hypertension, and the role of ambulatory blood pressure monitoring. Guidelines for diagnosing and staging hypertension from ACC/AHA and JNC-8 are presented. Non-pharmacologic and pharmacologic treatment options are discussed, including diuretics, ACE inhibitors, ARBs, beta blockers, calcium channel blockers, and vasodilators. Resistant hypertension, hypertensive crises, and hypertension management in specific clinical contexts like stroke are also addressed. Recommendations are provided for evaluating and managing different patient cases.
The panel recommends the following for treatment of hypertension in adults:
- For ages 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For ages 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those under 30, or ages 60 or older with diabetes or kidney disease, treat to a goal of less than 140/90 mm Hg.
- Initial drug treatment should include a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For nonblack populations, including those with diabetes, consider a
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic).
- For non
Eighth Joint National Committee (JNC 8) - Blood Pressure in AdultsSandru Acevedo MD
The panel recommends the following for treatment of hypertension in adults:
- For patients aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For patients aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For nonblack patients, including those with diabetes, initially treat with a thiazide-type diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker.
- For black patients, including those with diabetes, initially treat with a calcium channel blocker or thiazide-type diuretic.
Jnc 8 guidelines for management of high blood pressure: Lets compare with JNC 7Dr. Afzal Haq Asif
This guideline from the Eighth Joint National Committee provides evidence-based recommendations for the management of high blood pressure in adults. There is strong evidence that treating hypertensive patients aged 60 years or older to a blood pressure goal of less than 150/90 mm Hg and those aged 30-59 years to a goal of less than 90 mm Hg improves health outcomes. For hypertensive patients under age 60, a goal of less than 140/90 mm Hg is recommended based on expert opinion due to insufficient evidence for specific systolic and diastolic goals. The guideline also recommends initiating drug treatment for hypertension with certain classes of medications, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium
The panel recommends the following based on its systematic review of evidence:
1) For most adults aged 60 years or older, treat SBP to a goal of less than 150 mm Hg and DBP to a goal of less than 90 mm Hg.
2) For nonblack adults younger than 60 years, treat SBP to a goal of less than 140 mm Hg and DBP to a goal of less than 90 mm Hg.
3) Initial drug treatment should include thiazide-type diuretics, calcium channel blockers, ACE inhibitors, or ARBs.
The panel recommends the following for treatment of hypertension in adults:
- For those aged 60 years and older, treat to a blood pressure goal of less than 150/90 mm Hg.
- For those aged 30-59 years, treat to a blood pressure goal of less than 140/90 mm Hg.
- For those younger than 60 years with diabetes or chronic kidney disease, treat to a blood pressure goal of less than 140/90 mm Hg.
- Initiate treatment with one of four classes of antihypertensive drugs (angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic). The most appropriate first
This document summarizes a presentation given by Prof Kyaw Soe Win on arterial health in hypertension. The presentation covered:
- Cardiovascular diseases are now major causes of mortality, with hypertension as a common risk factor.
- Lifestyle changes like urbanization have led to increased stress and sedentary lifestyles, contributing to rising hypertension rates globally.
- Treating hypertension can significantly reduce cardiovascular outcomes. More intensive control of blood pressure through 24-hour coverage can further reduce risks.
- Choosing antihypertensive drugs that improve arterial health in addition to blood pressure control may maximize cardiovascular protection. Perindopril was highlighted as having properties that protect the endothelium.
Evidence base for secondary prevention – Antihypertensive therapy in cerebrov...Apollo Hospitals
Antihypertensive therapy for preventing recurrence in survivors of stroke and transient ischemic attack patients requires much caution. Cutting the right balance between benefit and harm calls for the classical individual evidence based considerations. Current understanding to guide practices is briefly reviewed as stroke emerges as huge challenge with increasing longevity and chronic diseases.
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Volume 5 • Issue 4 • 1000189
Cardiovasc Pharm Open Access
ISSN: 2329-6607 CPO, an open access journal
Citation: Trailokya A (2016) Will Azilsartan - An Eight ARB Bring Paradigm Shift in Hypertension Management Practices in India? Cardiovasc Pharm
Open Access 5: 189. doi:10.4172/2329-6607.1000189
effectively lowers BP in patients with essential hypertension and has
shown better antihypertensive efficacy than maximum therapeutic
dosages of olmesartan medoxomil or valsartan in major trials of up
to 24 weeks’ duration. Azilsartan provide greater BP reduction than
candesartan over 24-h monitoring period as well as during specific
daytime, night-time and early morning period. Azilsartan medoxomil
is generally well tolerated and low rates of discontinuation reported
over a 24-week period, suggesting that patients are likely to persist with
long-term treatment [8,13]. Azilsartan medoxomil is therefore a useful
and attractive new option for lowering BP in Indian patients with
essential hypertension (Mild to Moderate Hypertension), particularly
for those not able to tolerate other antihypertensive drugs. Azilsartan
also improved the non-dipping pattern in nocturnal hypertension. Also
can be combine with other anti-hypertensives like Chlorthalidione and
or Amlodipine [12]. However, unlike other ARB’s, Azilsartan is not
backedupbyclinicaldatasupportingitsabilitytoaffectimprovementin
cardiovascular outcomes and is not approved for diabetic nephropathy
or heart failure till date [14]. This drug appears as a promising aspect
for the management of hypertension for Indian hypertensive patients.
References
1. Clara K, Koon K, Rangarajan S (2013) Prevalence, awareness, treatment, and
control of hypertension in rural and urban communities in high, middle, and low-
income countries. J Am Med Assoc 310: 959-968.
2. WHO (2002) The world health report 2002-Reducing risks, promoting healthy
life. World Health Report.
3. WHO (2005) Preventing chronic disease: a vital investment. Chronic diseases
and health promotion.
4. Ram CV (2015) Hypertension guidelines: Good-bye to confusion and welcome
to clarity. Indian Heart Journal 67: 18-22.
5. Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, et al. (2014) Hypertension
in India: a systematic review and meta-analysis of prevalence, awareness, and
control of hypertension. J Hypertens 32: 1170-1177.
6. Perry CM (2012) Azilsartan Medoxomil: A Review of its Use in Hypertension.
Clin Drug Investig 32: 621-639.
7. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, et al. (2002) Age-specific
relevance of usual blood pressure to vascular mortality: a meta-analysis of
individual data for one million adults in 61 prospective studies. Lancet 360:
1903-1913.
8. Kurtz TW, Kajiya T (2012) Differential pharmacology and benefit/risk of
Azilsartan compared to other sartans. Vascular Health and Risk Management
8: 133-143.
9. Angeloni E (2016) Azilsartan medoxomil in the management of hypertension:
an evidence-based review of its place in therapy. Core Evidence 11: 1-10.
10. https://www.medicines.org.uk/emc/medicine/26412
11. Imprialos KP, Boutari C, Stavropoulos K, Sampani E, Karagiannis A (2016)
Renin-angiotensin system inhibitors: do they have the same impact in all ages?
J ClinHypertens (Greenwich).
12. Schmieder RE, Potthoff SA, Bramlage P, Baumgart P, Mahfoud F, et al. (2015)
Patients with newly diagnosed hypertension treated with the renin angiotensin
receptor blocker Azilsartan medoxomil vs angiotensin-converting enzyme
inhibitors: the prospective EARLY registry. J Clin Hypertens (Greenwich) 17:
947-953.
13. Rakugi H, Kario K, Enya K, Igeta M, Ikeda Y (2013) Effect of Azilsartan versus
candesartan on nocturnal blood pressure variation in japanees patients with
essential hypertension. Blood Pressure 22: 22-28.
14. Ramesh RD, Jai DP, Rohit RD, Shweta K (2016) Azilsartan: Novel Angiotensin
Receptor Blocker. Journal of The Association of Physicians of India 64: 96-98.
that differs from the licensed compound in Europe and the US
(Azilsartan medoxomil), which is the prodrug formulation [6].
Azilsartan created by modifying thetetrazole ring present
in candesartan. Azilsartan less acidic and more lipophilic than
candesartan-which potentially increases its oral bioavailability [8].
Azilsartan is highly selective for AT1 receptors and has more than a
10,000-fold greater affinity for AT1 versus AT2 receptors. Ojima et
al., Azilsartan was found to be approximately twice as potent as either
olmesartan or telmisartan. Azilsartan was found to be about 5-20 times
more potent than irbesartan and valsartan, respectively. The greater
potency of Azilsartan for AT1 receptor blockade could help explain
why Azilsartan lowers BP more than maximum approved doses of
other ARBs such as olmesartan and valsartan [8].
Following oral administration, Azilsartan medoxomil is hydrolyzed
into Azilsartan in both the gastrointestinal tract and plasma. Peak
plasma concentrations of Azilsartan are reached within 1.5-3 hours
post-dose. The elimination half-life is 11 hours. Azilsartan medoxomil,
Oral prodrug of azilsartan, an AT1 receptor antagonist (blocker).
Azilsartan produces greater AT1 receptor blockade activity than
several other angiotensin II receptor antagonists, including valsartan
and olmesartan in vitro. Azilsartan dissociates from AT1 receptors
more slowly than other ARBs including olmesartan, telmisartan,
and valsartan. Demonstrates pleiotropic cardioprotective effects
in vivo and in vitro. Pharmacokinetic profile allows for once-daily
oral administration. More effective in reducing 24 h mean SBP than
maximum approved dosages of olmesartan or valsartan over 6 weeks
or valsartan over 24 weeks in randomized phase III trials. Generally
well tolerated with headache and dizziness among the most common
adverse events. Low rate of treatment discontinuation due to adverse
events in the 24 week trial. Contraindicated during pregnancy [6]. No
major drug interaction studies on Azilsartan have been reported to
date.
Azilsartan medoxomil, acts independently by lowering BP, offers
preventive and therapeutic vasculoprotection in diabetes-induced
cerebrovascular remodeling and myogenic dysfunction [9] also
Azilsartan is also said to have renoprotective effects in reducing the
proteinuria, albuminuria and nephrinuria along with reduced tubular
cast formation and glomerular injury.
The recommended starting dosage in the EU is 40 mg once daily,
increased to a maximum of 80 mg once daily for patients who do not
achieve adequate BP with the lower dose. Azilsartan medoxomil may
be consumed with or without food. After 2 weeks of treatment, a near
maximal antihypertensive effect is expected; maximal antihypertensive
effects are achieved after 4 weeks of treatment with the drug [10].
For patients with inadequate control of BP after treatment with
Azilsartan medoxomil, additional reduction of BP may be achieved
by co-administration with other antihypertensive agents, including
diuretics (e.g. chlorthalidone and hydrochlorothiazide) and calcium
channel blockers. Dosage adjustment of Azilsartan medoxomil is not
required for patients with mild or moderate renal impairment [9]. In
the EU, close monitoring of patients with mild to moderate hepatic
impairment receiving Azilsartan medoxomil is recommended and a
starting dose of 20 mg should be considered. A starting dose of 20 mg
may be considered for very elderly (aged more than 75 years) patients
who may be at risk of hypotension [9]. Treatment of hypertensive
patients using Azilsartan appears to be more effective in younger than
in older patients [11,12].
In conclusion, Azilsartan will be soon introducing in Indian market
for the treatment of Hypertension. Once-daily Azilsartan medoxomil
Citation: Trailokya A (2016) Will Azilsartan - An Eight ARB Bring Paradigm
Shift in Hypertension Management Practices in India? Cardiovasc Pharm Open
Access 5: 189. doi:10.4172/2329-6607.1000189