Risks versus benefits of withdrawing antihypertensive therapy.
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Antihypertensive Agents↗
Biomedical subjects
F H Messerli
Publications and source records attributed to F H Messerli.
Diuretic therapy and the risk for renal cell carcinoma.
Diuretics are important drugs in the treatment of arterial hypertension, congestive heart failure, the nephrotic syndrome, and other clinical conditions. With diuretic treatment, reduction of both morbidity and mortality has been clearly shown in those conditions. However, a recent meta-analysis showed an increased risk for renal cell carcinoma in patients treated with diuretics. We summarize and critically review data from studies examining the association between diuretic use and renal cell carcinoma. In general, in many clinical conditions, the reduction of mortality with diuretic therapy outweighs a potential risk of renal cell carcinoma. However, in certain conditions, alternative medical treatment should be considered.
Carcinoma, Renal Cell↗
Low-dose bisoprolol/hydrochlorothiazide: an option in first-line, antihypertensive treatment.
Two recent, multicenter, double-blind, placebo-controlled studies established the efficacy and safety of low-dose bisoprolol/hydrochlorothiazide (HCTZ) in patients with mild to moderate essential hypertension. Bisoprolol, a cardioselective beta-blocker, was used in a dose of 2.5 mg, 5 mg, or 10 mg. HCTZ was used at a dose of 6.25 mg. This low-dose compound was developed to minimize dose-related adverse effects. The addition of HCTZ to each of the doses of bisoprolol was compared with monotherapy and placebo. Results of both studies demonstrated that this once-a-day, low-dose option effectively reduced sitting diastolic and systolic blood pressure measured at the end of the 24-hour dosing period. Drug-related adverse effects, including those generally associated with traditional beta-blocker therapy, were infrequent in individuals who received the low-dose bisoprolol/HCTZ regimen. Dose-related side effects were minimized because of the low doses of the two agents used together. There were no significant changes in mean total cholesterol, triglycerides, or serum glucose with bisoprolol/HCTZ 6.25 mg therapy versus placebo (analysis of variance statistical methods). The incidence of treatment-induced hypokalemia with bisoprolol/HCTZ 6.25 mg was not significant; uric acid elevations were minimized, and the incidence of hyperuricemia was significantly (P < 0.01) less with bisoprolol/HCTZ 6.25 mg than with 25 mg of HCTZ. Once-a-day dosing with the low-dose agent controlled (defined as a sitting diastolic blood pressure < or = 90 mmHg and/or a decrease from baseline > or = 10 mmHg) blood pressure in up to 80% of patients for a full 24 hours after dosing.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies?
Over the past 2 decades, nifedipine in the form of capsules has become widely popular in the treatment of hypertensive emergencies. Unlike other agents, such as sodium nitroprusside, nicardipine hydrochloride, diazoxide, and nitroglycerin--which require intravenous administration and monitoring of blood pressure--nifedipine can be given orally, and close monitoring is said not to be necessary. Although administration of nifedipine capsules has been reported to be expedient and safe, it has not been approved by the Food and Drug Administration for labeling for treatment of hypertensive emergencies or of any other form of hypertension because of lack of outcome data. A review of the literature revealed reports of serious adverse effects such as cerebrovascular ischemia, stroke, numerous instances of severe hypotension, acute myocardial infarction, conduction disturbances, fetal distress, and death. Sublingual absorption of nifedipine has been found to be poor; most of the drug is absorbed by the intestinal mucosa. Given the seriousness of the reported adverse events and the lack of any clinical documentation attesting to a benefit, the use of nifedipine capsules for hypertensive emergencies and pseudoemergencies should be abandoned.
Administration, Sublingual↗