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Biomedical subjects

C V Ram

Publications and source records attributed to C V Ram.

At least 73 records · Page 4Linked to original sources
PubMed1982

Diuretics in the management of hypertension.

Diuretics-especially the thiazide type-are the cornerstone of antihypertensive therapy. Practitioners need to be familiar with one or two of each type to use them effectively with full knowledge of possible side effects. Chronic use demands periodic monitoring of electrolyte levels.

Benzothiadiazines↗
PubMed1982

Captopril.

Explore the source record for details and available documents.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1981

Alpha adrenergic blockade by prazosin in therapy of essential hypertension.

To elucidate the mechanism of action of prazosin in lowering the blood pressure, we studied the vascular pressor responsiveness to the infusion of norepinephrine and angiotensin II before and after prazosin in patients with essential hypertension. After prazosin, the pressor response to the alpha agonist norepinephrine was markedly attenuated, but the vascular reactivity to angiotensin II was unchanged. There was a threefold increment in the dose of norepinephrine required to elicit a 20 mm Hg rise in diastolic blood pressure after prazosin therapy. These results confirm that prazosin induces significant alpha adrenergic blockade during the treatment of essential hypertension.

Adrenergic alpha-Antagonists↗
PubMed1981

Moderate sodium restriction and various diuretics in the treatment of hypertension.

Changes in total body potassium level and blood pressure (BP) were determined in multiple studies on 12 hypertensive subjects ingesting a diet either moderately restricted or higher in sodium. On both diets, the following diuretics were randomly given for four-week intervals: chlorthalidone, hydrochlorothiazide, or furosemide. Total body exchangeable potassium level fell 225 mEq with lower sodium intake and 455 mEq with higher intake, combining all diuretics. Chlorthalidone caused more potassium wastage than the other diuretics. The average falls in mean BP were 13.9 mm Hg with the lower sodium diet and 9.1 with the higher sodium diet, combinging all diuretics. Combining both diets, chlorthalidone produced the greatest fall and furosemide produced the slightest. These data suggest that if a diuretic is used to treat hypertension, a diet moderately restricted in sodium and a single morning dose of a diuretic of intermediate duration of action offer the best balance of efficacy and safety for most patient.

Adult↗
PubMed1979

Abrupt discontinuation of clonidine therapy.

Clonidine therapy was discontinued abruptly in seven patients. Blood pressure was recorded every hour or two hours throughout the study. Clonidine therapy was reinstituted 48 hours after its discontinuation in all except two patients, in whom it was reinstituted at 36 hours. During the withdrawal phase, blood pressure tended to return rapidly to nontreatment levels, but there was no "overshoot" in blood pressure. Apprehension, insomnia, palpitations, and sweating were experienced by two patients. These symptoms were relieved promptly by reinstituting clonidine therapy. In this prospective study, no blood pressure overshoot was noted with abrupt discontinuation of clonidine.

Adult↗
PubMed1979

Individual titration of diazoxide dosage in the treatment of severe hypertension.

Diazoxide, 300 mg as a single bolus injection, is widely used to treat severe hypertension. Although usually effective, this standard dosage may decrease the blood pressure too much, inducing hypotensive problems. In this study 32 patients with a diastolic blood pressure above 125 mm Hg were treated with smaller bolus injections, 105 or 150 mg, which were repeated every 5 minutes as needed to reduce the diastolic pressure to 110 mm Hg or less. Seven patients of the 32 patients needed only one injection of 150 mg; only one patient needed more than three injections. This individual titration with mini-bolus injections of diazoxide was effective and did not induce hypotension or other side effects.

Adult↗
PubMed1979

Pheochromocytoma--recognition and management.

Pheochromocytoma is an infrequent cause of hypertension. In spite of its rarity, pheochromocytoma has assumed notorious importance because or a wide variety of clinical features associated with this syndrome. Hypertension remains the most important clinical lead. The presence of other features, such as severe headache, perspiration, palpitations or orthostatic hypotension, makes the diagnosis of pheochromocytoma likely. The diagnosis of this condition can be made with greater certainty than that of any other form of secondary hypertension. Pharmacologic tests are no longer used for evaluation purposes. Biochemical tests are the most important aids to diagnosis, provided highly specific methods are used to determine the levels of urinary catecholamines or their metabolites. Interference by various drugs should be avoided. Most of the pheochromocytomas are found in the abdomen, predominantly in the adrenals. Successful outcome of surgery depends critically on adequate preoperative preparation of the patient with adrenergic blocking drugs and proper intraoperative care. Surgery should only be performed in an institution with experience in treating these tumors. Invasive localizing procedures could be dangerous in patients with pheochromocytoma and are best avoided. Medical therapy proves to be quite successful for those patients who are unable or unwilling to undergo surgery and for those with demonstrated malignant tumor. The postoperative course in most instances is uneventful. The physician should be aware of familial forms of pheochromocytomas and screen all the hypertensive members of the patient's family for the presence of this condition. Pheochromocytoma, with its multiple facets, presents a challenge to the clinician; however, with prompt diagnosis and proper treatment, pheochromocytoma can often be cured. The improved management of patients with this potentially lethal condition is the result of better knowledge of biochemical pharmacology, improved preoperative, surgical and postoperative care.

Adrenal Gland Neoplasms↗
PubMed1979

Alpha- and beta-receptor blocking drugs in the treatment of hypertension.

The wide variety of antihypertensive agents now available allows considerable flexibility in the pharmacologic management of hypertension. The newly available alpha- and beta-adrenergic blocking agents have added considerably to this flexibility. Their safety and efficacy insure that they will find increasing use in the treatment of hypertension. The new postsynaptic alpha-receptor blocker prazosin, is generally free of the side effects that precluded the use of alpha-blockers which affected both pre- and postsynaptic receptors. Is is moderately effective and, excepting the problem of "first-dose" hypotension, it is usually well tolerated. Labetalol, a compound possessing both alpha- and beta-receptor blocking properties, has been found to be effective both as an oral therapy for chronic hypertension and as an intravenous agent in treating hypertensive crisis. Further experience with labetolol will determine its safety and efficacy for the long-term management of hypertension. Although the usefulness of beta-adrenergic receptor blocking agents in hypertension is unquestionable, the mechanism by which they lower the blood pressure remains in question. Most of our experience has been with propranolol, but other beta-blockers, now used in England and Europe, are likely to become available in the United States. As of January, 1979 only metoprolol has been added to propranolol as approved beta-blockers for the treatment of hypertension. General guidelines for the use of propranolol are given in Table 6. Metoprolol will likely find increasing use since it seems to work as well as propranolol and probably causes fewer side effects. Nevertheless, the experiences with one beta-blocker, both good and bad, cannot be interpolated to another beta-blocker since there are obvious and subtle differences in their actions. Patients doing well on propranolol therapy should continue to receive that drug; patients being started on a beta-blocker therapy can be given the choice of metoprolol and, in the near future, other beta-blockers as well. Beyond their efficacy and freedom from side effects in about 80% of patients, beta-blockers may offer a special advantage in protecting from coronary heart disease. Such protection has been suggested in limited trials but needs further documentation. In the meantime, the known advantages of beta-blockers ensure their increasing use in the treatment of hypertension. Regardless of which alpha- or beta-blocker is chosen, a diuretic should be used concomitantly to enhance and preserve the effectiveness of the adrenergic blocker.

Adrenergic alpha-Antagonists↗
PubMed1978

Hypertensive encephalopathy: recognition and management.

Hypertensive encephalopathy is a dramatic syndrome characterized by severe elevation of blood pressure, headache, visual disturbances, altered mental status, and convulsions. Although the syndrome is uncommon, to recognize and treat it promptly is important or the condition may prove to be fatal. Hypertensive encephalopathy should be distinguished from other cerebral complications of severe hypertension by obtaining careful history and performing thorough physical examination. The only definitive criterion for the diagnosis of this syndrome is its prompt response to therapy. If the patient's condition does not improve with hypotensive therapy, the physician should immediately search for alternate diagnoses. Potent drugs are available for prompt reduction of blood pressure. There are few medical emergencies in which the objective response to therapy is so strikingly apparent as in hypertensive encephalopathy.

Brain Diseases↗
PubMedDate not supplied

Withdrawal syndrome following cessation of guanabenz therapy.

A withdrawal syndrome consisting of nervousness, palpitations, diaphoresis, and insomnia appeared in three patients within 16--48 hours following discontinuation of guanabenz, a new centrally acting antihypertensive agent. A similar syndrome of sympathetic overactivity has been described with abrupt withdrawal of clonidine. Three of four patients treated with 48 mg/day but none of 20 other patients treated with 32 mg/day or less guanabenz developed this syndrome. None of the three patients developed hypertensive crisis, though one had a modest rise in the blood pressure above baseline levels. It is concluded that guanabenz therapy should not be discontinued abruptly and that, when possible, the dosage should be limited to less than 48 mg/day.

Adult↗