Abstract 3783: Antihypertensive Medications in the Department of Veterans Affairs (VA) 1999–2006

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Julio R Lopez ◽  
Sonya Wong ◽  
Joy L Meier ◽  
Fran Cunningham ◽  
David Siegel
Keyword(s):  
Antihypertensive Medication ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Medication Use ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Steady Increase ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors

Objective: To evaluate national antihypertensive medication use we collected data from 2003–2006 and compared it to previously collected data from 1999 –2002. We examine the cost implications of shifts in antihypertensive medications prescribed. Methods: National VA pharmacy data were used to determine the use of beta blockers (BB), calcium channel blockers (CCB), thiazide diuretics (TD) alone or with K sparing diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and combinations of the aforementioned classes for 2003–2006. Total number of treatment days, determined from days supply of the prescription, was used to determine patterns of use over time. Results: Antihypertensive medication use in the VA represented more than 1.5 billion days in 2006 and increased 2.5 fold from the 577 million estimated for 1999. ACEI were most commonly used, representing 31.8% and 31.7% of treatment days in 1999 and 2006, respectively. In the ACEI class lisinopril is the most commonly used drug. Increases in use from 1999 to 2006 were 21.2% to 25.2% for BB, 14.4% to 17.8% for TD, and 1.2% to 5.2% for ARB. Decreases in use from 1999 to 2006 were 26.7% to 17.6% for CCB. The decline in CCB was inversely correlated to the increase in BB or TD (p<0.001). Shifts in medication use are estimated to save the VA $33 million annually. Conclusions: ACEI remain the most prescribed antihypertensive drug class in the VA, followed by BB, TD, CCB, and ARBs. TD use shows a slow steady increase while CCB use continues to decline. These findings suggest that VA has increasing adherence to JNC7 and VA HTN guidelines.

scholarly journals Antihypertensive Drugs and the Risk of Cancer: A Nationwide Cohort Study

2021 ◽  
Vol 10 (4) ◽  
pp. 771
Author(s):  
In-Jeong Cho ◽  
Jeong-Hun Shin ◽  
Mi-Hyang Jung ◽  
Chae Young Kang ◽  
Jinseub Hwang ◽  
...  
Keyword(s):  
Antihypertensive Drugs ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Incident Cancer ◽  
Increased Risk ◽  
Risk Of Cancer

We sought to assess the association between common antihypertensive drugs and the risk of incident cancer in treated hypertensive patients. Using the Korean National Health Insurance Service database, the risk of cancer incidence was analyzed in patients with hypertension who were initially free of cancer and used the following antihypertensive drug classes: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs); beta blockers (BBs); calcium channel blockers (CCBs); and diuretics. During a median follow-up of 8.6 years, there were 4513 (6.4%) overall cancer incidences from an initial 70,549 individuals taking antihypertensive drugs. ARB use was associated with a decreased risk for overall cancer in a crude model (hazard ratio (HR): 0.744, 95% confidence interval (CI): 0.696–0.794) and a fully adjusted model (HR: 0.833, 95% CI: 0.775–0.896) compared with individuals not taking ARBs. Other antihypertensive drugs, including ACEIs, CCBs, BBs, and diuretics, did not show significant associations with incident cancer overall. The long-term use of ARBs was significantly associated with a reduced risk of incident cancer over time. The users of common antihypertensive medications were not associated with an increased risk of cancer overall compared to users of other classes of antihypertensive drugs. ARB use was independently associated with a decreased risk of cancer overall compared to other antihypertensive drugs.

Risk of Cerebral Hypoperfusion with Antihypertensive Therapy

DICP ◽  
1989 ◽  
Vol 23 (12) ◽  
pp. 957-962 ◽  
Author(s):  
Susan C. Eagan ◽  
Lance W. Payne ◽  
Susan C. Houtekier
Keyword(s):  
Antihypertensive Therapy ◽  
Antihypertensive Medication ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cerebral Hypoperfusion ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Populations At Risk ◽  
Treatment Of Hypertension

The effective treatment of hypertension is a major factor in the declining incidence of stroke in North America. There are subsets of patients, however, in which antihypertensive therapy may actually cause cerebral ischemia and infarction. Elderly patients and those with malignant hypertension, acute stroke, and occlusive cerebrovascular disease appear to be the populations at greatest risk of iatrogenic stroke. This article reviews the effect of beta-blockers, angiotensin-converting enzyme inhibitors, direct vasodilators, and calcium-channel blockers on cerebral blood flow in various populations. Although many investigations have been performed, it remains difficult to predict the risk of cerebral hypoperfusion due to antihypertensive medication in an individual patient. It is best for practitioners to be aware of the patient populations at risk and treat high blood pressure cautiously in these patients.

scholarly journals Role of antihypertensive drugs in the treatment of migraine

2015 ◽  
Vol 156 (5) ◽  
pp. 179-185 ◽  
Author(s):  
Gergely Fehér ◽  
Gabriella Pusch
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Migraine Prevention ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

The treatment of migraine depends on the frequency, severity and concomitant diseases. There are several specific drugs developed for migraine prevention in addition to the additive antimigraine effects of some other non-specific drugs. The aim of this literature-based review is to summarize the possible antimigraine properties of different antihypertensive agents (beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, etc.) focusing on the possible side effects (avoidance of beta blockers in the absence of heart disease, possible antiparkinson effect of calcium channel blockers, additive effect of drugs modifying the renin-angiotensin system activity, etc.). Current evidence supports the use of angiotensin converting enzyme inhibitors (mainly lisinopril) and angiotensin receptor blockers (mainly candesartan) for long-term migraine prevention and blood pressure control. Long-term beta-blocker treatment should be avoided in the absence of ischemic heart disease due to possible unfavourable cardiovascular effects. Orv. Hetil., 2015, 156(5), 179–185.

Abstract 15213: Association of Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers Use and Covid-19 Infection Among Patients With Hypertension

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jaejin An ◽  
Rong Wei ◽  
hui zhou ◽  
Tiffany Luong ◽  
Ran Liu ◽  
...  
Keyword(s):  
Antihypertensive Medication ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Age Groups ◽  
Medication Use ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Increased Risk ◽  
Receptor Blockers

Introduction: Given the limited evidence, we investigated the association between use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and risk of Covid-19 infection within a large diverse hypertension population. Methods: We identified patients with hypertension as of March 1, 2020 (index date) from Kaiser Permanente Southern California, a large US integrated healthcare system. Patient demographics, antihypertensive medication use, neighborhood income and education, and comorbidities were identified from electronic health records within 1-year pre-index date. The study outcome was a positive RT-PCR test for Covid-19 between March 1 - May 6, 2020. We used multivariable logistic regression models to examine the association between ACEI/ARB use and Covid-19 infection. Results: Among 824,650 patients with hypertension, 16,898 (2.0%) were tested for Covid-19. Of those tested, 1,794 (10.6%) had a positive result and 547 (30.5% of positive cases) were hospitalized within 14-days of testing positive. Of those tested, 4,878 (28.9%) were on ACEIs, 3,473 (20.6%) were on ARBs, and 4,177 (24.7%) were on other antihypertensive medication classes. Risk of covid-19 infection associated with ACEI use decreased with increasing age (P-interaction = 0.01). In age-stratified analyses, ACEI use was not statistically associated with increased risk of Covid-19 infection among the age groups of 18-39, 40-64, and 65-84 years but was associated with lower risk of Covid-19 among those aged ≥85 years ( Table ). Across all age groups, ARB use was not associated with increased risk of Covid-19, but non-white race, lower neighborhood income and education, and no antihypertensive medication use were associated with increased risk of Covid-19. Conclusions: ACEI nor ARB use was not associated with increased risk of Covid-19 infection. The decreased risk of Covid-19 infection among older adults using ACEIs warrants further investigation.

Cardioprotective drugs

2017 ◽  
Author(s):  
Johan De Sutter ◽  
Miguel Mendes ◽  
Oscar H. Franco
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Black People ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Stable Coronary Artery Disease ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors

Cardioprotective drugs are important in the treatment of patients at risk for or with documented cardiovascular disease. Beta-blockers are indicated after acute coronary syndromes, stable coronary artery disease, heart failure, and arrhythmias. Angiotensin-converting enzyme inhibitors (ACEi) are important in congestive heart failure, stable angina, post-acute myocardial infarction, and secondary prevention after any event or revascularization. Angiotensin receptor blockers are mainly alternative drugs for the same indications in case of intolerance to ACEi. Calcium channel blockers are first line medication for patients with isolated systolic hypertension, black people, and during pregnancy, in the presence of intermittent claudication, asymptomatic atherosclerosis, or metabolic syndrome. A polypill is a combination pill in which multiple medications effective in the prevention of cardiovascular disease (for example statins, antihypertensives, and aspirin) are put together in a single pill.

scholarly journals Effect of Anti-Hypertensive Medication History on Arteriovenous Fistula Maturation Outcomes

2018 ◽  
Vol 48 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Ke Wang ◽  
Leila R. Zelnick ◽  
Peter B. Imrey ◽  
Ian H. deBoer ◽  
Jonathan Himmelfarb ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Lower Risk ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Medication History ◽  
Converting Enzyme Inhibitors ◽  
Fistula Maturation

Background: The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. However, approximately half of AVFs fail to mature. The use of angiotensin converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs) exerts favorable endothelial effects and may promote AVF maturation. We tested associations of ACE-I and ARBs, CCBs, beta-blockers, and diuretics with the maturation of newly created AVFs. Methods: We evaluated 602 participants from the Hemodialysis Fistula Maturation Study, a multi-center, prospective cohort study of AVF maturation. We ascertained the use of each medication class within 45 days of AVF creation surgery. We defined maturation outcomes by clinical use within 9 months of surgery or 4 weeks of initiating hemodialysis. Results: Unassisted AVF maturation failure without intervention occurred in 54.0% of participants, and overall AVF maturation failure (with or without intervention) occurred in 30.1%. After covariate adjustment, CCB use was associated with a 25% lower risk of overall AVF maturation failure (95% CI 3%–41% lower) but a non-significant 10% lower risk of unassisted maturation failure (95% CI 23% lower to 5% higher). ACE-I/ARB, beta-blocker, and diuretic use was not significantly associated with AVF maturation outcomes. None of the antihypertensive medication classes were associated with changes in AVF diameter or blood flow over 6 weeks following surgery. Conclusions: CCB use may be associated with a lower risk of overall AVF maturation failure. Further studies are needed to determine whether CCBs might play a causal role in improving AVF maturation outcomes.

scholarly journals Treatment of emergency conditions (hypertensive crisis) in children with arterial hypertension

2020 ◽  
Vol 65 (3) ◽  
pp. 147-152
Author(s):  
I. V. Leontyeva ◽  
L. A. Balykova ◽  
A. V. Kudashova
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Hypertensive Crisis ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
Modern Classification ◽  
Hypertensive Crises

The article presents a modern classification of hypertensive crises in children. The authors describe detailed tactics of emergency care of hypertensive crises in children. They consider the treatment of hypertensive crises with beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, alpha blockers. The article contains a table of the main antihypertensive medications used to treat hypertensive crises.

Cardioprotective drugs

2015 ◽  
Author(s):  
Johan De Sutter ◽  
Miguel Mendes ◽  
Oscar H. Franco
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Black People ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Stable Coronary Artery Disease ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors

Cardioprotective drugs are important in the treatment of patients at risk for or with documented cardiovascular disease. Beta-blockers are indicated after acute coronary syndromes, stable coronary artery disease, heart failure, and arrhythmias. Angiotensin-converting enzyme inhibitors (ACEi) are important in congestive heart failure, stable angina, post-acute myocardial infarction, and secondary prevention after any event or revascularization. Angiotensin receptor blockers are mainly alternative drugs for the same indications in case of intolerance to ACEi. Calcium channel blockers are first line medication for patients with isolated systolic hypertension, black people, and during pregnancy, in the presence of intermittent claudication, asymptomatic atherosclerosis, or metabolic syndrome. A polypill is a combination pill in which multiple medications effective in the prevention of cardiovascular disease (for example statins, antihypertensives, and aspirin) are put together in a single pill.

Medical management: pharmacological therapy

ESC CardioMed ◽  
2018 ◽  
pp. 1387-1393 ◽  
Author(s):  
Aviv A. Shaul ◽  
David Hasdai
Keyword(s):  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Pharmacological Therapy ◽  
Channel Blockers ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers ◽  
Symptom Status

The current armamentarium for the treatment of chronic ischaemic heart disease includes agents that are used to relieve angina or attenuate ischaemia, as well as agents that are administered regardless of symptom status to ameliorate prognosis. Beta blockers and calcium channel blockers are the mainstay treatments for angina and ischaemia relief. Adjunct therapy includes nitrates, ivabradine, ranolazine, nicorandil, and trimetazidine. Aspirin (alternatively, clopidogrel), statins (possibly with ezetimibe), and angiotensin-converting enzyme inhibitors (alternatively, angiotensin receptor blockers), are the mainstay agents to improve outcomes.

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