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Koracevic G, Stojanovic M, Lovic D, Kostic T, Tomasevic M, Martinovic SS, Zdravkovic SC, Koracevic M, Stojanovic V. Blood pressure cut-offs to diagnose impending hypertensive emergency depend on previous hypertension-mediated organ damage and comorbid conditions. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 36:257-262. [PMID: 38692626 DOI: 10.25259/nmji_160_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Background Hypertensive emergencies (HTN-E) are important due to a high risk of mortality. However, a sudden increase in blood pressure (BP) can damage target organs before the BP reaches cut-offs to diagnose HTN-E. We (i) analyse HTN guidelines for recommendations of treatment individualization, such as adjusting BP cut-offs for hypertensive urgency or impending HTN-E according to patient's susceptibility to complications (because of previous hypertension-mediated organ damage [HMOD], cardiovascular events and comorbid conditions), and (ii) provide a rationale for the inclusion of patient's susceptibility in protocols for treatment of acute HTN-E. Methods We searched PubMed, SCOPUS, Science Direct, Springer, Oxford Press, Wiley, SAGE and Google Scholar for the following terms: arterial hypertension, impending, emergency, target organ damage, hypertension-mediated organ damage, and comorbidity. Results The available guidelines do not recommend that when we estimate the probability of HTN-E in a patient with very high BP, we take into account not only the 'aggressive factor' (i.e. history of HTN, absolute BP values and rate of its increase), but also the 'vulnerability of the patient' due to previous major adverse cardio-vascular events, HMOD and comorbid conditions. Conclusion The risk does not depend only on the aggressiveness of the health threat but also on the strength of the host's defence. It is, therefore, surprising that one side of the natural interaction (i.e. susceptibility of a patient) is overlooked in almost all available guidelines on HTN.
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, University Clinical Center Nis, Serbia
| | | | - Dragan Lovic
- Clinic for Internal Diseases Inter Medica, Nis, Serbia
| | - Tomislav Kostic
- Department for Cardiovascular Diseases, University Clinical Center Nis, Serbia
| | - Miloje Tomasevic
- Faculty of Medicine and Department for Cardiovascular Diseases, University of Kragujevac and University Clinical Center of Serbia, Belgrade, Serbia
| | | | | | | | - Vladimir Stojanovic
- Department for Cardiovascular Diseases, University Clinical Center Nis, Serbia
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Magidson PD. The Aged Heart. Emerg Med Clin North Am 2022; 40:637-649. [DOI: 10.1016/j.emc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Li P, Wu H, Zhao Z, Du P, Xu H, Liu H, Zhou Y, Yu W, Li H, Liu L. Simultaneous Quantitation of Clevidipine and Its Active Metabolite H152/81 in Human Whole Blood by LC-MS/MS: Application to Bioequivalence Study. Front Chem 2022; 10:861952. [PMID: 35464212 PMCID: PMC9021437 DOI: 10.3389/fchem.2022.861952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Clevidipine is an ultrashort-acting dihydropyridine calcium antagonist, which can control blood pressure accurately. It is necessary to develop a liquid chromatography–tandem mass spectrometry (LC-MS/MS) method to quantitate clevidipine and its active metabolite H152/81 for clinical pharmacokinetic study and therapeutic drug monitoring. Liquid–liquid extraction was used for sample preparation, and clevidipine-d7 and H152/81-13C-d3 were chosen as the isotope internal standard. The chromatographic separation was performed on an ACE Excel 2 Phenyl column (50 × 2.1 mm). Mass quantification was carried out on the multiple reaction monitoring of the transitions of m/z 473.1→338.1, 480.1→338.1, 356.0→324.0, and 362.2→326.2 for clevidipine, clevidipine-d7, H152/81, and H152/81-13C-d3. The validated method gave an excellent linearity over a concentration range of 0.1–30 ng/ml for clevidipine and 2–600 ng/ml for H152/81. Other fully validated content such as accuracy, precision, extraction recovery, matrix effect, and stability were also investigated and showed satisfactory results. It was strongly recommended that whole blood is the first choice for clinical bioanalysis. Using whole blood for sample analysis can reduce the whole blood collection volume (1 ml vs. 4 ml) and shorten the time from sample collection to storage to 5 min, and there is no centrifugation process and precooling in the ice water bath, which can further reduce the instability caused by exposure. The method was successfully applied to a bioequivalence study of clevidipine butyrate-injectable emulsion.
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Affiliation(s)
- Pengfei Li
- Pharmacy Department of Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Haitang Wu
- Shanghai Xihua Scientific Co., Ltd, Shanghai, China
| | - Zhixia Zhao
- Pharmacy Department of Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Ping Du
- Pharmacy Department of Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Haitong Xu
- Shanghai Xihua Scientific Co., Ltd, Shanghai, China
| | - Hongchuan Liu
- Pharmacy Department of Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yu Zhou
- Shanghai Xihua Scientific Co., Ltd, Shanghai, China
| | - Weiyue Yu
- Pharmacy Department of Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Shanghai Xihua Scientific Co., Ltd, Shanghai, China
- *Correspondence: Hao Li, ; Lihong Liu,
| | - Lihong Liu
- Pharmacy Department of Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Hao Li, ; Lihong Liu,
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Fragoulis C, Dimitriadis K, Siafi E, Iliakis P, Kasiakogias A, Kalos T, Leontsinis I, Andrikou I, Konstantinidis D, Nihoyannopoulos P, Tsivgoulis G, Thomopoulos C, Tousoulis D, Muiesan ML, Tsioufis KP. Profile and management of hypertensive urgencies and emergencies in the emergency cardiology department of a tertiary hospital: a 12-month registry. Eur J Prev Cardiol 2021; 29:194-201. [PMID: 34718521 DOI: 10.1093/eurjpc/zwab159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 12/11/2022]
Abstract
AIMS Currently there are scarce epidemiological data regarding prevalence, clinical phenotype, and therapy of hypertensive urgencies (HU) and emergencies (HE). The aim of this article was to record the prevalence, clinical characteristics, and management of patients with HU and HE assessed in an emergency department (ED) of a tertiary hospital. METHODS AND RESULTS The population consisted of patients presenting with HE and HU in the ED (acute increase in systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥120 mmHg with and without acute target organ damage, respectively). Of the 38 589 patients assessed in the ED during a 12-month period, 353 (0.91%) had HU and HE. There were 256 (72.5%) cases presented as HU and 97 (27.5%) as HE. Primary causes for both HU and HE were stress/anxiety (44.9%), increased salt intake (33.9%), and non-adherence to medication (16.2%). Patients with HU reported mainly dizziness/headache (46.8%) and chest pain (27.4%), whereas those with HE presented dyspnoea (67%), chest pain (30.2%), dizziness/headache (10.3%), and neurological disorders (8.2%). In HE, the underlying associated conditions were pulmonary oedema (58%), acute coronary syndrome (22.6%), and neurological disorders/stroke (7.2%). All HE cases were hospitalized and received intensive healthcare, including dialysis. CONCLUSION This 1-year single-centre registry demonstrates a reasonable prevalence of HU and HE contributing to the high volume of visits to the ED. Stress, increased salt intake and non-adherence were main triggers of HE and HU. Dizziness and headache were the prevalent symptoms of HU patients while heart failure was the most common underlying disease in patients with HE.
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Affiliation(s)
- Christos Fragoulis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Eirini Siafi
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Panagiotis Iliakis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Alexandros Kasiakogias
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Theodoros Kalos
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Leontsinis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Andrikou
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitrios Konstantinidis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Petros Nihoyannopoulos
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Georgios Tsivgoulis
- Second Neurologic Department (Clinic), Medical School, University of Athens, Attikon Hospital, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Maria L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Konstantinos P Tsioufis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
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Zhang Y, Zhao S, Zhou H, Ding L. Development and validation of samples stabilization strategy and LC-MS/MS method for simultaneous determination of clevidipine and its primary metabolite in human plasma: Application to clinical pharmacokinetic study in Chinese healthy volunteers. J Chromatogr B Analyt Technol Biomed Life Sci 2020; 1161:122448. [DOI: 10.1016/j.jchromb.2020.122448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/20/2020] [Accepted: 10/26/2020] [Indexed: 11/15/2022]
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6
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Tkacheva ON, Kotovskaya YV, Eruslanova KA. [Hypertensive Crisis in the Elderly Patients]. ACTA ACUST UNITED AC 2020; 60:1121. [PMID: 32515714 DOI: 10.18087/cardio.2020.5.n1121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022]
Abstract
A hypertensive crisis is a sudden increase in blood pressure (BP) to an individually high level associated with clinical symptoms and target organ damage, in which BP must be reduced immediately. Since 2018 in Europe and since 2020 in Russia, an uncomplicated hypertensive crisis is recommended to be considered as a part of malignant (uncontrolled) arterial hypertension. The clinical picture of increased BP in elderly patients is characterized by nonspecific symptoms even in target organ damage. Management of this group of patients requires a physician to know the patient's comorbidities and the drugs taken on a regular basis to minimize development of side effects of the administered drugs and their undesirable interaction with the chronic therapy.
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Affiliation(s)
- O N Tkacheva
- Russian Clinical and Research Center of Gerontology, N. I. Pirogov Russian National Medical University, Moscow, Russia
| | - Yu V Kotovskaya
- Russian Clinical and Research Center of Gerontology, N. I. Pirogov Russian National Medical University, Moscow, Russia
| | - K A Eruslanova
- Russian Clinical and Research Center of Gerontology, N. I. Pirogov Russian National Medical University, Moscow, Russia
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Alshami A, Romero C, Avila A, Varon J. Management of hypertensive crises in the elderly. J Geriatr Cardiol 2018; 15:504-512. [PMID: 30364798 PMCID: PMC6198269 DOI: 10.11909/j.issn.1671-5411.2018.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 11/21/2022] Open
Abstract
Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.
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Affiliation(s)
- Abbas Alshami
- Dorrington Medical Associates, Houston, Texas, USA
- University of Baghdad/College of Medicine, Baghdad, Iraq
| | - Carlos Romero
- Dorrington Medical Associates, Houston, Texas, USA
- Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - America Avila
- Dorrington Medical Associates, Houston, Texas, USA
- Universidad Durango Santander, Hermosillo, Sonora, México
| | - Joseph Varon
- The University of Texas Health Science Center at Houston, USA
- The University of Texas Medical Branch at Galveston, USA
- Critical Care Services, United Memorial Medical Center / United General Hospital, Houston, Texas, USA
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9
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Rabbia F, D'Avolio A, Bernini G, Fulcheri C, De Nicolò A, Berra E, Bruno RM, Mulatero P, Taddei S, Veglio F. Antihypertensive Bridge Therapy by Continuous Drug Infusion With an Elastomeric Pump in Device-Resistant Hypertension. Hypertension 2016; 67:e3-4. [PMID: 26781280 DOI: 10.1161/hypertensionaha.115.06978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Franco Rabbia
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.).
| | - Antonio D'Avolio
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - GiamPaolo Bernini
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - Chiara Fulcheri
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - Amedeo De Nicolò
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - Elena Berra
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - Rosa Maria Bruno
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - Paolo Mulatero
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - Stefano Taddei
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
| | - Franco Veglio
- From the Internal Medicine and Hypertension Division, AOU Città della Salute e della Scienza, Department of Medical Sciences (F.R., C.F., E.B., P.M., F.V.) and Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital (A.D.A., A.D.N.), University of Turin, Turin, Italy; and Hypertension Unit, Department of Internal Medicine, University of Pisa, Pisa, Italy (G.P.B., R.M.B., S.T.)
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Salkic S, Brkic S, Batic-Mujanovic O, Ljuca F, Karabasic A, Mustafic S. Emergency Room Treatment of Hypertensive Crises. Med Arch 2015; 69:302-6. [PMID: 26622081 PMCID: PMC4639340 DOI: 10.5455/medarh.2015.69.302-306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/05/2015] [Indexed: 11/03/2022] Open
Abstract
AIM The aim of the study was to evaluate efficiency of hypertensive urgency treatment using inhibitors of α1-adrenergic receptors and angiotensin converting enzyme inhibitors-ACE inhibitors in the Emergency Room of Outpatient Hospital and Polyclinic "dr Mustafa Šehovic" Tuzla in relation to age, duration and severity of hypertension. METHODS The study was conducted from June 2011 to May 2012 and included 120 patients of both sexes diagnosed with arterial hypertension, aged 40 to 80 with verified hypertensive urgency. The patients were divided into two groups: the control group treated with sublingual captopril and the experimental group treated intravenously with urapidil. RESULTS The results show that the largest number of patients belonged to age group from 60 to 69 years (34,16%), and the average age was 58 (11). The largest number of patients (38,0%) had verified hypertension for 11 to 20 years. The average systolic/diastolic artery blood pressure at reception was 213 (19) / 130 (4) mmHg. The average systolic/diastolic artery blood pressure after the first dose of 12,5 mg captopril in the control group was 177,42 (10,91) / 112,33 (3,50) mmHg, while after the first dose of 12,5 mg urapidil it was 179,25 (16,62) / 110,33 (8,78) mmHg. The average systolic/diastolic artery blood pressure after the second dose of 12,5 mg of captopril in the control group was 152,00 (6,32) / 95,50 (3,76) mmHg, while after the second dose of 12,5 mg of urapidil it was 152,55 (7,17) / 95,29 (5,04) mmHg. CONCLUSION Urapidil is more efficient in hypertensive urgency treatment, since the decrease of middle artery pressure (MAP) in the group treated with urapidil was statistically significant (p<0,001). No statistical significance was found between the efficiency of urapidil and the patient's age, while captopril was more efficient in older patients (p=0,02). Also, no statistically significant difference was found between the efficiency of captopril and urapidil in relation to duration of hypertension.
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Affiliation(s)
- Sabina Salkic
- Emergency Medical Service Department, Community Health Care Center Tuzla
| | - Selmira Brkic
- Department of Pathophysiology, Faculty of Medicine, University of Tuzla
| | | | - Farid Ljuca
- Department of Physiology, Faculty of Medicine, University of Tuzla
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Keating GM. Clevidipine: a review of its use for managing blood pressure in perioperative and intensive care settings. Drugs 2015; 74:1947-1960. [PMID: 25312594 DOI: 10.1007/s40265-014-0313-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The ultrashort-acting dihydropyridine calcium channel antagonist clevidipine (Cleviprex(®)) has a rapid onset and offset of effect and reduces blood pressure (BP) by decreasing arteriolar resistance without affecting venous capacitance vessels. This article reviews the clinical efficacy and tolerability of intravenous clevidipine when used to manage BP in perioperative and intensive care settings, as well as summarizing its pharmacological properties. Intravenous clevidipine effectively treated preoperative and postoperative hypertension in patients undergoing cardiac surgery, according to the results of the randomized, multicentre, double-blind, phase III ESCAPE-1 and ESCAPE-2 trials. The randomized, open-label, multicentre, phase III ECLIPSE trials indicated that in terms of keeping systolic BP within the target range, clevidipine was more effective than nitroglycerin or sodium nitroprusside perioperatively and had similar efficacy to nicardipine postoperatively in cardiac surgery patients. In small, double-blind trials in patients undergoing coronary artery bypass graft surgery, perioperative clevidipine was noninferior to nitroglycerin, and postoperative clevidipine had similar efficacy to sodium nitroprusside. Noncomparative studies demonstrated that clevidipine provided rapid BP control in patients with acute neurological injuries (including intracerebral haemorrhage, subarachnoid haemorrhage and acute ischaemic stroke), and was not associated with 'overshoot' in the vast majority of patients. Intravenous clevidipine was generally well tolerated and was usually associated with no reflex tachycardia or only very modest increases in heart rate. In conclusion, intravenous clevidipine is a valuable agent for the management of BP in perioperative and intensive care settings.
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Affiliation(s)
- Gillian M Keating
- Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand.
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12
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Storozhakov GI, Gendlin GE, Anisimova AV, Melekhov AV, Ostrovskaya YI. [Tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:12-19. [PMID: 26120992 DOI: 10.17116/jnevro2015115312-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine an optimal tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke. MATERIAL AND METHODS We examined 86 inpatients, 42 men and 44 women, aged 46-87 years, with hypertonic crisis complicated with hemorrhagic stroke. The severity of neurological deficit, parameters of cardiac output and Kaplan-Meier survival curve based on the level of arterial pressure (AP) were assessed. RESULTS The best survival rate of the patients with systolic blood pressure >162 mm Hg to the 20th min from the beginning of treatment with the greater rate of its increase was established. The efficacy of antihypertensive therapy did not depend on the baseline neurological deficit. The remote survival rate did not depend on such factors as sex, age, baseline AP level, AP, frequency of heart contractions, hematoma's volume.
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Affiliation(s)
- G I Storozhakov
- Pirogov Russian National Research Medical University, Moscow
| | - G E Gendlin
- Pirogov Russian National Research Medical University, Moscow
| | - A V Anisimova
- Pirogov Russian National Research Medical University, Moscow
| | - A V Melekhov
- Pirogov Russian National Research Medical University, Moscow
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13
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Baum L. A case of hypertensive urgency. J ROY ARMY MED CORPS 2015; 162:297-8. [PMID: 26002343 DOI: 10.1136/jramc-2015-000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/01/2015] [Indexed: 11/04/2022]
Abstract
A 41-year-old male Nepalese soldier presented to the primary care medical centre with a 1-week history of fatigue and muscle aches following a trip to Nepal. His BP was 164/98 but was otherwise normal. Four days later he presented with new symptoms of sweating and palpitations and a BP of 200/127 whereupon he was admitted to hospital with the diagnosis of hypertensive crisis. Appropriate investigation and initial management were undertaken, and he was discharged after 12 h on antihypertensive treatment. This case highlights the risk of hypertensive crisis in both diagnosed and silent hypertensive disease, and the review highlights the presentations, initial investigation and different management of hypertensive crisis.
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14
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Wang X, Zheng Z, He G, Mai L, Zhou Z, Zhong S, Lin Q, Shan Z, Deng C, Yang M, Yu X. Rapid determination of fenoldopam in human plasma by UPLC-MS/MS for pharmacokinetic analysis in patients. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 978-979:78-82. [PMID: 25531873 DOI: 10.1016/j.jchromb.2014.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 11/13/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
We developed and validated a rapid, selective, and sensitive ultra-performance liquid-chromatography mass-spectrometry (UPLC-MS/MS) method for quantifying fenoldopam in human plasma for pharmacokinetic studies. Fenoldopam and the internal-standard (IS), oxazepam, were isolated from human plasma by liquid-liquid extraction using ethyl acetate after alkalization, and were separated on a 2.1×100 mm Acquity UPLC HSS T3 C18 column (inside diameter, 1.8 μm) using a mobile phase of water (0.05% formic acid) and acetonitrile gradient elution. The fenoldopam and IS were eluted at 1.07 and 2.32 min, respectively. Quantification was performed using positive-ion electrospray-ionization (ESI), and the fenoldopam and IS responses were optimized at the m/z 306.16→107.10 and m/z 287.1→241.01 transitions, respectively. The assay was validated over the linear range of 0.1-40 ng/mL fenoldopam with intra- and interassay precision <13.21%. The matrix effect of normal and hemolyzed plasma was 94.9-101.6%. Fenoldopam was stable for ≥34 days at -70 °C in normal and hemolyzed plasma containing ascorbic acid as a stabilizer. This method can be successfully applied in pharmacokinetic studies of fenoldopam in hypertensive patients.
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Affiliation(s)
- Xipei Wang
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhijie Zheng
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Guodong He
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Liping Mai
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhiling Zhou
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shilong Zhong
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Qiuxiong Lin
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zhixin Shan
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Chunyu Deng
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Min Yang
- Department of Pharmacy, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
| | - Xiyong Yu
- Guangdong General Hospital Medical Research Center, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
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15
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[The role of clevidipine in hypertension management: clinical results]. ACTA ACUST UNITED AC 2014; 61:557-64. [PMID: 25236947 DOI: 10.1016/j.redar.2014.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 11/21/2022]
Abstract
The prevalence of hypertension in general population is from 30% to 45%(.) Anesthesiologists frequently deal with the challenge of maintaining adequate control of perioperative blood pressure. On sudden elevations, a precise control is required to prevent end-organ damage. Recently, clevidipine, an ultra-short acting calcium antagonist has been approved by the FDA (www.accessdata.fda.gov), as a strategy for the intravenous treatment of hypertension; and by the Spanish Agency of Medicines and Medical Devices (www.aemps.gob.es) for the rapid reduction of arterial blood pressure in the perioperative setting. This medication has shown to have a rapid onset, easy titratability, and to exert a precise control of blood pressure. In addition, clevidipine has shown to be highly effective as monotherapy, and to have an excellent transition to oral antihypertensive therapy. For this article, an online search of the Medline literature was conducted up to February 2014 and "clevidipine" and "hypertension" used as keywords in order to analyze pharmacokinetics and pharmacodynamics of clevidipine. There are also clinical studies that provide evidence of the rapid and effective control that clevidipine has on blood pressure, especially in acute perioperative and emergency settings.
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16
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Padilla Ramos A, Varon J. Current and Newer Agents for Hypertensive Emergencies. Curr Hypertens Rep 2014; 16:450. [DOI: 10.1007/s11906-014-0450-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Ge R, Pejo E, Cotten JF, Raines DE. Adrenocortical suppression and recovery after continuous hypnotic infusion: etomidate versus its soft analogue cyclopropyl-methoxycarbonyl metomidate. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R20. [PMID: 23363638 PMCID: PMC4057162 DOI: 10.1186/cc12494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/29/2013] [Indexed: 11/10/2022]
Abstract
Introduction Etomidate is no longer administered as a continuous infusion for anesthetic maintenance or sedation, because it results in profound and persistent suppression of adrenocortical steroid synthesis with potentially lethal consequences in critically ill patients. We hypothesized that rapidly metabolized soft analogues of etomidate could be developed that do not produce persistent adrenocortical dysfunction even after prolonged continuous infusion. We hope that such agents might also provide more rapid and predictable anesthetic emergence. We have developed the soft etomidate analogue cyclopropyl-methoxycarbonyl etomidate (CPMM). Upon termination of 120-minute continuous infusions, hypnotic and encephalographic recoveries occur in four minutes. The aims of this study were to assess adrenocortical function during and following 120-minute continuous infusion of CPMM and to compare the results with those obtained using etomidate. Methods Dexamethasone-suppressed rats were randomized into an etomidate group, CPMM group, or control group. Rats in the etomidate and CPMM groups received 120-minute continuous infusions of etomidate and CPMM, respectively. Rats in the control group received neither hypnotic. In the first study, adrenocortical function during hypnotic infusion was assessed by administering adrenocorticotropic hormone (ACTH) 90 minutes after the start of the hypnotic infusion and measuring plasma corticosterone concentrations at the end of the infusion 30 minutes later. In the second study, adrenocortical recovery following hypnotic infusion was assessed by administering ACTH every 30 minutes after infusion termination and measuring plasma corticosterone concentrations 30 minutes after each ACTH dose. Results During hypnotic infusion, ACTH-stimulated serum corticosterone concentrations were significantly lower in the CPMM and etomidate groups than in the control group (100 ± 64 ng/ml and 33 ± 32 ng/ml versus 615 ± 265 ng/ml, respectively). After hypnotic infusion, ACTH-stimulated serum corticosterone concentrations recovered to control values within 30 minutes in the CPMM group but remained suppressed relative to those in the control group for more than 3 hours in the etomidate group. Conclusions Both CPMM and etomidate suppress adrenocortical function during continuous infusion. However, recovery occurs significantly more rapidly following infusion of CPMM.
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