Rebound Hypertension Following Abrupt Cessation of Clonidine and Metoprolol

Mehta, Jawahar L.

doi:10.1001/archinte.1987.00370020207067

Cited by 23 publications

(3 citation statements)

References 17 publications

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“…Therefore, we recommend that medical volunteers prescribe hypertension medication if possible, while informing patients that continuous medication is necessary, rather than being reluctant to prescribe, owing to difficulties in following up. Oral clonidine and beta-blockers, for which possible rebound hypertension has been known, might be avoided [21,22], and prescriptions should be made simply so as to be understandable by locals with the help of local translators, so they can be continued with later visits to local drugstores or volunteering clinics.…”

Section: Discussionmentioning

confidence: 99%

Illnesses Encountered during Medical Volunteering in Takeo Province, Cambodia

Lee

Choi²,

Rim

et al. 2020

Medicina

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Background and Objectives: Medical volunteering seeks to meet the clinical needs of underserved areas, but has been criticized for difficulties in addressing local health issues and resultant lack of sustainability. Our team has visited rural Cambodia annually since 2012. This study reports the illnesses encountered during the recent mission and share our experiences to improve the efficiency of medical volunteering. Materials and Methods: Infrastructure, such as public electricity or water, was unavailable, hence most medical care and records were hand-performed. We categorized (1) primary diagnoses (chief complaints) by duration of symptoms, and (2) primary and secondary diagnoses (illnesses that were not related to the chief complaint) by severity of illness since patients commonly reported multiple symptoms. Blood pressure and anthropometric values were also checked and analyzed. Results: We encountered 317 adult and 141 pediatric patients. Among adults, 61.3% had persistent chronic (>6 month) symptoms of their chief complaints. The commonest diagnoses of chronic symptoms were musculoarthritis (31.5%) and gastroesophageal reflux disease and/or gastritis (21.7%). Hypertension and/or cardiac problems were relatively common among males (13.6%). The most common diagnosis among the severest cases (specialized or intensive care recommended) was cardiac problems (14.8%), often with abnormalities in sonography or electrocardiogram. For children, the overwhelming majority of diagnoses were related to acute symptoms and low severity, and approximately half were cases of the common cold. Commonly prescribed drugs were antacids or mucosal protectors (31.3%), Non-steroidal anti-inflammatory drugs (NSAIDs) or other painkillers (27.6%), and antiparasites (17.7%) in adults, and NSAIDs (44.7%) and antiparasites (23.2%) in children. Among adults, 32.7% were diagnosed with hypertension, and body mass index (p = 0.003) and age (p < 0.001) were both correlated with hypertension and its grade. Conclusions: Our study offers practical help to volunteer health workers planning to visit Southeast Asia.

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Section: Discussionmentioning

confidence: 99%

Illnesses Encountered during Medical Volunteering in Takeo Province, Cambodia

Lee

Choi²,

Rim

et al. 2020

Medicina

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“…This study was the first to administer 4-PBA to a SHR at a young age and then have the treatment withdrawn after 8 wk. Human studies have shown that hypertension treatment withdrawal may be well tolerated (38); however, earlier studies suggest withdrawal of adrenergic blockers may result in hypertensive crisis (26). This may be an important characteristic in determining the tolerability of antihypertensives considering imperfect patient adherence to therapy overtime.…”

Section: Discussionmentioning

confidence: 99%

Endoplasmic reticulum stress inhibition blunts the development of essential hypertension in the spontaneously hypertensive rat

Naiel

Carlisle

Lü

et al. 2019

American Journal of Physiology-Heart and Circulatory Physiology

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Essential hypertension is the leading cause of premature death worldwide. However, hypertension’s cause remains uncertain. endoplasmic reticulum (ER) stress has recently been associated with hypertension, but it is unclear whether ER stress causes hypertension. To clarify this question, we examined if ER stress occurs in blood vessels before the development of hypertension and if ER stress inhibition would prevent hypertension development. We used the spontaneously hypertensive rat (SHR) as a model of human essential hypertension and the Wistar-Kyoto (WKY) rat as its normotensive control. Resistance arteries collected from young rats determined that ER stress was present in SHR vessels before the onset of hypertension. To assess the effect of ER stress inhibition on hypertension development, another subset of rats were treated with 4-phenylbutyric acid (4-PBA; 1 g·kg−1·day−1) for 8 wk from 5 wk of age. Blood pressure was measured via radiotelemetry and compared with untreated SHR and WKY rats. Mesenteric resistance arteries were collected and assessed for structural and functional changes associated with hypertension. Systolic and diastolic blood pressures were significantly lower in the 4-PBA-treated SHR groups than in untreated SHRs. Additionally, 4-PBA significantly decreased the media-to-lumen ratio and ER stress marker expression, improved vasodilatory response, and reduced contractile responses in resistance arteries from SHRs. Overall, ER stress inhibition blunted the development of hypertension in the SHR. These data add evidence to the hypothesis that a component of hypertension in the SHR is caused by ER stress. NEW & NOTEWORTHY In this study, 4-phenylbutyric acid’s (4-PBA’s) molecular chaperone capability was used to inhibit endoplasmic reticulum (ER) stress in the small arteries of young spontaneously hypertensive rats (SHRs) and reduce their hypertension. These effects are likely mediated through 4-PBA's effects to reduce resistant artery contractility and increase nitric oxide-mediated endothelial vasodilation through a process preventing endothelial dysfunction. Overall, ER stress inhibition blunted the development of hypertension in this young SHR model. This suggests that a component of the increase in blood pressure found in SHRs is due to ER stress. However, it is important to note that inhibition of ER stress was not able to fully restore the blood pressure to normal, suggesting that a component of hypertension may not be due to ER stress. This study points to the inhibition of ER stress as an important new physiological pathway to lower blood pressure, where other known approaches may not achieve blood pressure-lowering targets.

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“…When they are combined, they may result in severe bradycardia or heart block. Patients using these drugs together run the risk of experiencing substantial rebound hypertension if abruptly stopped 94 .…”

Section: Thiazidementioning

confidence: 99%

A Basic Review on Hypertension, its Non-Pharmacological and Pharmacological Treatment

Singh,

Vishal,

Kumar

et al. 2024

J. Drug Delivery Ther.

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Hypertension (HTN) Is Prevalent Leading Health Issue Around the World. It is significant cause for cardiovascular morbidity and mortality risk factors? The term "high blood pressure" refers to hypertension. It is long term condition in which the blood pressure in the arteries continuously increased. Distribution of HTN in developed nation, in obese, elderly, pregnancy and now a day’s teenager is also affected. The pathological mechanisms involved in HTN are genetics, sympathetic nervous system over activity, gender differences, cardiac output and peripheral vascular resistance, obstructive sleep apnoea, racial and ethnic factors, and many others. it can be prevented by reducing salt intake, weight loss, exercise, smoking cessation. There are many drugs are available for the treatment of this and its combination therapy is more effective. The pathophysiology, diagnosis, and current state of the disease's management are covered in this study. Keywords: Hypertension, cardiovascular morbidity, cardiac output, peripheral vascular resistance

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Rebound Hypertension Following Abrupt Cessation of Clonidine and Metoprolol

Cited by 23 publications

References 17 publications

Illnesses Encountered during Medical Volunteering in Takeo Province, Cambodia

Illnesses Encountered during Medical Volunteering in Takeo Province, Cambodia

Endoplasmic reticulum stress inhibition blunts the development of essential hypertension in the spontaneously hypertensive rat

A Basic Review on Hypertension, its Non-Pharmacological and Pharmacological Treatment

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