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      Management of Hypertension in Patients with Concomitant Diseases


      S. Karger AG

      Heart failure, Diabetes, Pulmonary disease, Renal insufficiency, Hypertension

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          The treatment of hypertension in patients with diabetes, obstructive airway disease, impaired renal function, or congestive heart failure (CHF) is discussed. Specifically, the value of α<sub>1</sub>-adrenoceptor blocking agents in such patients is reviewed. An individualized approach to therapy is required, with careful consideration of the effects of different drugs on the existing metabolic and hemodynamic situation. In diabetic individuals, commonly used step-1 agents may impair glucose tolerance; β-adrenergic blockade may increase blood glucose levels and significantly change response to insulin-induced hypoglycemia. Diabetic patients may also be especially sensitive to side effects of some centrally acting antihypertensive agents. In patients with obstructive airway disease, β-blockade and α-stimulation worsen bronchospasm; although β-stimulants produce bronchodilatation, they often are contraindicated in hypertensive patients due to their stimulatory effects on the heart. In patients with impaired renal function, therapy for hypertension may include problems such as an increased half-life of antihypertensive agents and retention of active metabolites. In patients with CHF, if blood pressure is not normalized with diuretics, more aggressive therapy may be required. According to results of several studies discussed, the α<sub>1</sub>-adrenoceptor blocking agent prazosin appears to be a safe and effective therapy, causing a minimum of side effects, for treatment of hypertension in patients with these conditions.

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          Author and article information

          S. Karger AG
          11 November 2008
          : 74
          : 1
          : 71-81
          Department of Clinical Pharmacology, Cedars-Sinai Medical Center, Los Angeles, Calif., USA
          174178 Cardiology 1987;74:71–81
          © 1987 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 11
          Special Article


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