Pathophysiologically based antihypertensive pharmacotherapeutics rationality, efficacy and safety in Sub Saharan African Nations – A review

Ajayi, A. A.; Ajayi, Olufemi E.

doi:10.1016/j.ijcrp.2021.200111

Cited by 2 publications

(2 citation statements)

References 86 publications

(173 reference statements)

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“…Unfortunately, methyldopa is still recommended as a first-line antihypertensive agent in some practices, but, from our findings, we would recommend avoiding methyldopa use in pregnancy if alternative agents are available. [9][10][11] Clinicians should be aware that pregnancy-related abnormal liver tests may be attributable to medications started within the prior 3 months and can initially occur postpartum such as seen in autoimmune hepatitis. Clinicians should consult a liver specialist, exclude other common causes of pregnancy-related abnormal liver tests, use the National Institutes of Health's LiverTox website (https://ncbi.nlm.nih.gov/books/ NBK547852/) to identify the most likely causative medications, and discontinue likely causative medications promptly.…”

Section: Discussionmentioning

confidence: 99%

Drug-Induced Liver Injury in Pregnancy

Masood,

Venturini,

Nicoletti

et al. 2024

Obstetrics &Amp; Gynecology

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There are limited data on the causative agents and characteristics of drug-induced liver injury in pregnant individuals. Data from patients with drug-induced liver injury enrolled in the ongoing multicenter Drug-Induced Liver Injury Network between 2004 and 2022 and occurring during pregnancy or 6 months postpartum were reviewed and compared with cases of drug-induced liver injury in nonpregnant women of childbearing age. Among 325 individuals of childbearing age in the Drug-Induced Liver Injury Network, 16 cases of drug-induced liver injury (5%) occurred during pregnancy or postpartum. Compared with drug-induced liver injury in nonpregnant women, pregnancy-related drug-induced liver injury was more severe (P<.05). One elective termination and three miscarriages were documented; there were no maternal deaths. We recommend that isoniazid for latent tuberculosis be deferred to the postpartum period whenever feasible and that β-blockers or calcium channel blockers rather than methyldopa be used for hypertension management during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Drug-Induced Liver Injury in Pregnancy

Masood,

Venturini,

Nicoletti

et al. 2024

Obstetrics &Amp; Gynecology

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“…In the sub-Saharan setting, single-pill combinations are established as first-line treatment for tuberculosis [ 18 ], HIV [ 19 ], malaria [ 20 ], and hepatitis C [ 21 ]. However, antihypertensive single-pill combinations are still rather uncommon [ 22 ]. Their implementation into national essential medicines lists and national hypertension guidelines as well as availability on the market would represent key facilitators to promote this treatment strategy [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Single-Pill, Triple Antihypertensive Therapy in Rural Sub-Saharan Africa: Preliminary Experience

Stroppa,

Hunjan,

Umulisa

et al. 2024

Cardiol Ther

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Introduction Worldwide, arterial hypertension is the foremost preventable and modifiable cardiovascular risk factor. In addition to lifestyle changes, recent international guidelines recommend single-pill, low-dose combinations as initial treatment strategy. We investigated whether this approach is feasible in a rural sub-Saharan Africa setting. Methods Diagnosis of hypertension was established over three sets of blood pressure measurements, performed according to the European Society of Hypertension recommendations by trained personnel, using a validated, automated, oscillometric device OMRON M7 IT-HEM-7322-E. In 98 individuals with arterial hypertension, a once-daily, single-pill combination of olmesartan, amlodipine, and hydrochlorothiazide was prescribed at an appropriate dose. Patients were instructed on its administration and potential side effects and encouraged towards lifestyle modifications. The treatment regimen was adjusted, if needed, at each outpatient clinic scheduled after 4, 8, 12, and 16 weeks. Results Seventy-nine patients (aged 61 [53–70] years; median and interquartile range) strictly adhered to the treatment schedule, while 19 individuals (70 [65–80] years) dropped out. Blood pressure was < 140/90 mmHg after 4 weeks in 44 (56%), after 8 weeks in 62 (78%), after 12 weeks in 69 (87%), and after 16 weeks in 74 (94%) participants. Excellent tolerance was reported. Conclusions These results provide real-life evidence that hypertension management with a once-daily, single-pill combination of olmesartan, amlodipine, and hydrochlorothiazide as initial treatment is feasible and effective also in a rural sub-Saharan setting. Single-pill combinations should be made available also in rural and remote areas in low- and middle-income countries as a reliable first-line treatment strategy.

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Pathophysiologically based antihypertensive pharmacotherapeutics rationality, efficacy and safety in Sub Saharan African Nations – A review

Cited by 2 publications

References 86 publications

Drug-Induced Liver Injury in Pregnancy

Drug-Induced Liver Injury in Pregnancy

Single-Pill, Triple Antihypertensive Therapy in Rural Sub-Saharan Africa: Preliminary Experience

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