Effects of a Mononitrate, a β1-Blocker and a Dihydropyridine Calcium Channel Blocker on Cardiovascular Responsiveness to Passive Orthostasis

Ylitalo, Ritva; Kähönen, Mika; Nieminen, Tuomo; Kööbi, Tiit; Ylitalo, Pauli; Turjanmaa, Väinö

doi:10.1055/s-0031-1296838

Cited by 8 publications

(10 citation statements)

References 11 publications

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“…In another study in hypertensive patients, the peripheral CCB Cilnidipine showed significant decreases in blood pressure without adverse OH effects [50]. Furthermore, a study comparing the influences of anti-anginal drugs on cardiovascular responsiveness to orthostasis found that a dihydropyridine CCB influenced the latter less than a mononitrate or a beta-blocker [51]. …”

Section: Discussionmentioning

confidence: 99%

Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

et al. 2013

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BackgroundOur previously proposed morphological classification of orthostatic hypotension (MOH) is an approach to the definition of three typical orthostatic hemodynamic patterns using non-invasive beat-to-beat monitoring. In particular, the MOH pattern of large drop/non-recovery (MOH-3) resembles the syndrome of supine hypertension–orthostatic hypotension (SH-OH), which is a treatment challenge for clinicians. The aim of this study was to characterise MOH-3 in the first wave of The Irish Longitudinal Study of Ageing (TILDA), with particular attention to concurrent symptoms of orthostatic intolerance (OI), prescribed medications and association with history of faints and blackouts.MethodsThe study included all TILDA wave 1 participants who had a Finometer® active stand. Automatic data signal checks were carried out to ensure that active stand data were of sufficient quality. Characterisation variables included demographics, cardiovascular and neurological medications (WHO-ATC), and self-reported information on comorbidities and disability. Multivariable statistics consisted of logistic regression models.ResultsOf the 4,467 cases, 1,456 (33%) were assigned to MOH-1 (small drop, overshoot), 2,230 (50%) to MOH-2 (medium drop, slower but full recovery), and 781 (18%) to MOH-3 (large drop, non-recovery). In the logistic regression model to predict MOH-3, statistically significant factors included being on antidepressants (OR = 1.99, 95% CI: 1.50 – 2.64, P < 0.001) and beta blockers (OR = 1.60, 95% CI: 1.26 – 2.04, P < 0.001). MOH-3 was an independent predictor of OI after full adjustment (OR = 1.47, 95% CI: 1.25 – 1.73, P < 0.001), together with being on hypnotics or sedatives (OR = 1.83, 95% CI: 1.31 – 2.54, P < 0.001). In addition, OI was an independent predictor of history of falls/blackouts after full adjustment (OR = 1.27, 95% CI: 1.09 – 1.48, P = 0.003).ConclusionsAntidepressants and beta blockers were independently associated with MOH-3, and should be used judiciously in older patients with SH-OH. Hypnotics and sedatives may add to the OI effect of MOH-3. Several trials have demonstrated the benefits of treating older hypertensive patients with cardiovascular medications that were not associated with adverse outcomes in our study. Therefore, the evidence of benefit does not necessarily have to conflict with the evidence of potential harm.

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Section: Discussionmentioning

confidence: 99%

Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

et al. 2013

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“…Of the 27 placebo-controlled trials, 11 had a cross-over design (table 1 ) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ] and 16 had a parallel-group comparison design (table 2 ) [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Regardless of the design, these placebo-controlled studies had a sample size of tens and a follow-up time of weeks.…”

Section: Arterial Effects Of Antihypertensive Drugs In Placebo-contromentioning

confidence: 99%

“…Of the 16 placebo-controlled parallel-group comparison trials, 12 and 4 had single [ 15 , 17 , 18 , 19 , 20 , 21 , 22 , 24 , 25 , 27 , 28 , 29 ] and multiple comparisons with placebo [ 14 , 16 , 23 , 26 ], respectively, and 8, 3, and 5 studied pulse wave velocity [ 14 , 16 , 19 , 24 , 25 , 26 , 27 , 28 ], augmentation index alone [ 15 , 18 , 23 ], and both [ 17 , 20 , 21 , 22 , 29 ], respectively (table 2 ). The results of these parallel-group comparison trials were confirmatory for pulse wave velocity.…”

Section: Arterial Effects Of Antihypertensive Drugs In Placebo-contromentioning

confidence: 99%

“…The actively-controlled trials also included those studies involving 2 or more drug comparisons with placebo. Of the 15 trials with a cross-over design (table 3 ) [ 1 , 2 , 3 , 4 , 5 , 10 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] and 31 trials with a parallel-group comparison design (table 4 ) [ 13 , 16 , 23 , 26 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], 6 [ 1 , 2 , 3 , 4 , 5 , 10 ] and 4 [ 13 , 16 , 23 , 26 ], respectively, were part of placebo-controlled studies. These actively-controlled studies also had a small sample size and short follow-up time with the exception of the CAFE (n = 2,073) [ 61 ], EXPLORE (n = 331) [ 50 ], and REASON trials (n = 406) [ 65 ].…”

Section: Arterial Effects Of Antihypertensive Drugs In Actively-contrmentioning

confidence: 99%

“…Of the parallel group trials, 20, 4, and 7 studied pulse wave velocity [ 13 , 16 , 26 , 39 , 40 , 41 , 42 , 43 , 46 , 47 , 49 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 62 ], augmentation index alone [ 23 , 48 , 57 , 63 ], and both [ 44 , 45 , 50 , 51 , 61 , 64 , 65 ], respectively (table 4 ). These trials included 20 comparisons of ACE inhibitors with ARBs (n = 6) [ 16 , 39 , 40 , 41 , 42 , 43 ], β-blockers (n = 2) [ 13 , 44 ], CCBs (n = 8) [ 13 , 39 , 40 , 43 , 44 , 45 , 46 ], and diuretics (n = 4) [ 44 , 47 , 48 , 49 ], 13 comparisons of ARBs with β-blockers (n = 2) [ 50 , 51 ], CCBs (n = 10) [ 39 , 40 , 43 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ], or a diuretic (n = 1) [ 23 ], 5 comparisons of β-blockers with CCBs (n = 4) [ 13 , 26 , 44 , 59 ] or a diuretic (n = 1) [ 44 ...…”

Section: Arterial Effects Of Antihypertensive Drugs In Actively-contrmentioning

confidence: 99%

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Effects of Various Antihypertensive Drugs on Arterial Stiffness and Wave Reflections

Liu

et al. 2013

Pulse

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We reviewed trials that tested the efficacy of antihypertensive drugs in reducing arterial stiffness and wave reflections as assessed by pulse wave velocity and augmentation index, respectively. Regardless of cross-over or parallel-group comparison design, placebo-controlled trials demonstrated that antihypertensive drugs were effective in reducing pulse wave velocity. In actively-controlled parallel-group comparison studies, this effect on arterial stiffness was more evident for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers than other classes of antihypertensive drugs, particularly when brachial-ankle pulse wave velocity was measured. Regardless of cross-over or parallel-group comparison or placebo- or actively-controlled design, the reviewed trials showed that β-blockers were inferior to all the other classes of antihypertensive drugs in reducing augmentation index. However, these studies had a small sample size and a short follow-up time and did not link the changes in measurements of arterial function with cardiovascular events. Whether the superiority or inferiority is clinically relevant for cardiovascular protection and prevention remains to be investigated.

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Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications

et al. 2020

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Orthostatic hypotension (OH) is an abnormal blood pressure response to standing, which is associated with an increased risk of adverse outcomes such as syncope, falls, cognitive impairment, and mortality. Medical therapy is one the most common causes of OH, since numerous cardiovascular and psychoactive medications may interfere with the blood pressure response to standing, leading to drug-related OH. Additionally, hypotensive medications frequently overlap with other OH risk factors (e.g., advanced age, neurogenic autonomic dysfunction, and comorbidities), thus increasing the risk of symptoms and complications. Consequently, a medication review is recommended as a first-line approach in the diagnostic and therapeutic work-up of OH, with a view to minimizing the risk of drug-related orthostatic blood pressure impairment. If symptoms persist after the review of hypotensive medications, despite adherence to non-pharmacological interventions, specific drug treatment for OH can be considered. In this narrative review we present an overview of drugs acting on the cardiovascular and central nervous system that may potentially impair the orthostatic blood pressure response and we provide practical suggestions that may be helpful to guide medical therapy optimization in patients with OH. In addition, we summarize the available strategies for drug treatment of OH in patients with persistent symptoms despite non-pharmacological interventions.

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Effects of a Mononitrate, a β1-Blocker and a Dihydropyridine Calcium Channel Blocker on Cardiovascular Responsiveness to Passive Orthostasis

Cited by 8 publications

References 11 publications

Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

Insights into the clinical management of the syndrome of supine hypertension – orthostatic hypotension (SH-OH): The Irish Longitudinal Study on Ageing (TILDA)

Effects of Various Antihypertensive Drugs on Arterial Stiffness and Wave Reflections

Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications

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