Hypertension

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Re: Hypertension

مشاركةبواسطة دكتور كمال سيد » السبت مايو 07, 2016 10:37 am

ACE inhibitors :—
Angiotensin-converting enzyme (ACE) inhibitors :
* block production of the hormone, angiotensin II, a compound in the blood that causes narrowing of blood vessels and increases blood pressure.
By reducing production of angiotensin II, ACE inhibitors
* allow blood vessels to widen, which lowers blood pressure
* and improves heart output.
The available ACE inhibitors include benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril.
Side effects :— In some patients, ACE inhibitors cause a *persistent dry hacking cough that is reversible when the medication is stopped.
Less common side effects include ‏‎kiss‎‏ رمز تعبيري dry mouth,
* nausea,
* rash,
* muscle pain,
** or occasionally, kidney dysfunction and elevated blood potassium.
***A potentially serious complication of ACE inhibitors is angioedema, which occurs in 0.1 to 0.7 percent of people. People with angioedema rapidly (minutes to hours after taking the medication) develop :@ swelling of the lips, tongue, and throat,@ which can interfere with breathing. @These symptoms are a medical emergency,@ and the ACE inhibitor should be discontinued.
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اشترك في: الخميس إبريل 04, 2013 10:28 pm

Re: Hypertension

مشاركةبواسطة دكتور كمال سيد » السبت مايو 07, 2016 10:38 am

Calcium channel blockers — Calcium channel blocker drugs reduce the amount of calcium that enters the smooth muscle in blood vessel walls and heart muscle. Muscle cells require calcium to contract. Thus, by inhibiting the flow of calcium across muscle cell membranes, calcium channel blockers cause muscle cells to relax and blood vessels to dilate, reducing blood pressure as well as reducing the force and rate of the heartbeat.

There are two major categories of calcium channel blockers:

●Dihydropyridines, including amlodipine, felodipine, isradipine, nicardipine, nifedipine, and nisoldipine
●Nondihydropyridines, including diltiazem and verapamil
Side effects — The side effects of calcium channel blockers vary with the specific agent used. Patients who take dihydropyridines may develop headache, flushing, nausea, overgrowth of the gum tissue (gingival hyperplasia), or swelling of the extremities (peripheral edema).

Nondihydropyridines can occasionally cause the heart rate to slow too much. Other side effects may include headache and nausea with diltiazem or constipation with verapamil.
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Re: Hypertension

مشاركةبواسطة دكتور كمال سيد » السبت مايو 07, 2016 10:46 am

Resistant hypertension

Resistant hypertension is defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes, one of which should be a diuretic [1].
Patients whose blood pressure is controlled with four or more medications are considered to have resistant hypertension.
Patients with resistant hypertension are at high risk for adverse cardiovascular events and are more likely than those with controlled hypertension to have a secondary cause, which is usually at least in part reversible.
The treatment and prognosis of resistant hypertension that is not due to secondary causes will be reviewed here. The definition, prevalence, risk factors, and evaluation of resistant hypertension and secondary causes of hypertension, such as renovascular disease and primary aldosteronism, are discussed elsewhere. (See "Definition, risk factors, and evaluation of resistant hypertension" and "Evaluation of secondary hypertension".)
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Re: Hypertension

مشاركةبواسطة دكتور كمال سيد » السبت مايو 07, 2016 10:47 am

Mechanisms of Cough From Angiotensin-Converting Enzyme Inhibitors

ACE inhibitors are associated with a dry, persistent cough in 5%-35% of patients who take them.
The mechanism of cough is likely multifactorial :---
1- ACE inhibitors prevent the breakdown of bradykinin and substance P, resulting in an accumulation of these protussive mediators in the respiratory tract.
2- In addition, bradykinin can stimulate the production of prostaglandin.
3- ACE inhibition increases the cough reflex. The mechanisms underlying ACE inhibitor-induced cough are probably linked to suppression of kininase II activity, which may be followed by an accumulation of kinins, substance P and prostaglandins.
4- many experts think it is related to a natural compound called nitric oxide. ACE inhibitors cause the body to increase nitric oxide production, and nitric oxide is known to irritate the lungs and possibly cause coughing.
Iron interferes with production of nitric oxide.
# This side effect is not dose-dependent and often precludes the use of all agents within the drug class.
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Re: Hypertension

مشاركةبواسطة دكتور كمال سيد » الجمعة أكتوبر 05, 2018 7:51 pm

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