antihypertensive agent
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Introduction
Agents used in the control of blood pressure.
Classification
Benefit/risk
- no benefit to anti-hypertensive agents for treatment of mild hypertension[2]
- 1 in 12 patients experience adverse drug effects from anti-hypertensive agents
- antihypertensive use reduces incident dementia or cognitive impairment 7.0 vs 7.5% & cognitive decline: 20 vs 21%[5]
- antihypertensive use does not change scores on the Mini-Mental State Examination, Trail Making Test, or Cognitive Abilities Screening Instrument[5]
- RAAS inhibitors that cross the blood-brain barrier* may be linked to less memory decline[9] (see RAAS inhibitor)
- number needed to treat (NNT) with anti-hypertensive agent(s) for systolic blood pressure of 170 mm Hg, non-smoking, without diabetes mellitus[3]
- 238 men 50 years old to prevent 1 MI
- 227 men 50 years old to prevent 1 stroke
- 569 women 50 years old to prevent 1 MI
- 310 women 50 years old to prevent 1 stroke
- 101 men 65 years old to prevent 1 MI
- 88 men 65 years old to prevent 1 stroke
- 294 women 65 years old to prevent 1 MI
- 120 women 65 years old to prevent 1 stroke
- antihypertensive treatment associated with lower risk for cardiovascular events (9-11%) regardless of baseline blood pressure or cardiovascular disease, even at systolic blood pressures of < 120 mm Hg[7]*
* apparently this would not apply to patients with HFpEF [[8]
Dosage
- bedtime dosing may benefit patients who do not become hypotensive at night or have nocturnal falls due to orthostatic hypotension
- ACE inhibitors, ARBs & calcium channel blockers with most evidence for benefit of bedtime dosing[1]
- bedtime antihypertensive dosing may diminish cardiovascular risk[4]
- morning vs night dosing with similar rates of cardiovascular outcomes[11]
- Cochrane review unable to determine whether morning or evening dosing superior with respect to cardiovascular outcomes or adverse effects[13]
Adverse effects
- no association of antihypertensives & falls in the elderly[6]
- acute kidney injury (RR=1.2)*
- hyperkalemia (RR=1.9)*
- hypotension (RR=2.0)
- syncope (RR=1.3)[6]
- antihypertensives associated with increased MRI white matter hyperintensities[10]
* risks magnified with medications affecting the renin-angiotensin-aldosterone system
Notes
- substantial heterogeneity in blood pressure response to antihypertensives[12]
- personalized therapy with potential to lower systolic blood pressure an additional 4.4 mm Hg[12]
More general terms
More specific terms
- angiotensin II type 2 & 4 inhibiting agent
- angiotensin II type 2 & 4 stimilating agent
- diuretic
- sympatholytic; alpha & beta blockers; adrenergic neuron inhibitors; adrenolytic
- vasodilator agent
Additional terms
- antihypertensive agents & diabetes risk
- chronic hypertension
- hypertension (HTN, high blood pressure, HBP)
Component of
References
- ↑ 1.0 1.1 Prescriber's Letter 19(1): 2012 Timing of Antihypertensive Medications Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280109&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 The NNT: Anti-Hypertensive Treatment for the Primary Prevention of Cardiovascular Events In Mild Hypertension. http://www.thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/
- ↑ 3.0 3.1 The NNT: Blood Pressure Medicines for Five Years to Prevent Death, Heart Attacks, and Strokes. http://www.thennt.com/nnt/anti-hypertensives-to-prevent-death-heart-attacks-and-strokes/
- ↑ 4.0 4.1 Hermida RC, Crespo JJ, Dominguez-Sardina M et al. Bedtime hypertension treatment improves cardiovascular risk reduction: The Hygia Chronotherapy Trial. Eur Heart J 2019 Oct 22; ehz754 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31641769 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478
Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol. 2011 Dec;22(12):2313-21. Epub 2011 Oct 24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22025630 Free PMC Article - ↑ 5.0 5.1 5.2 Hughes D, Judge C, Murphy R et al Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment. A Systematic Review and Meta-analysis. JAMA. 2020;323(19):1934-1944 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32427305 https://jamanetwork.com/journals/jama/fullarticle/2766163
- ↑ 6.0 6.1 6.2 Albasri A, Hattle M, Koshiaris C et al. Association between antihypertensive treatment and adverse events: Systematic review and meta-analysis. BMJ 2021 Feb 10; 372:n189. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33568342 PMCID: PMC7873715 Free PMC article https://www.bmj.com/content/372/bmj.n189
- ↑ 7.0 7.1 The Blood Pressure Lowering Treatment Trialists' Collaboration Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021. May 1. Volume 397, ISSUE 10285, P1625-1636 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33933205 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00590-0/fulltext
- ↑ Faselis C, Lam PH, Zile MR et al. Systolic blood pressure and outcomes in older patients with HFpEF and hypertension. Am J Med 2021 Apr 1; 134:e252. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33010225 https://www.amjmed.com/article/S0002-9343(20)30812-3/fulltext
- ↑ 9.0 9.1 Pass W Memory benefit seen with antihypertensives crossing blood-brain barrier. Internal Medicine News. 2021. June 21. https://www.mdedge.com/internalmedicine/article/241878/neurology/memory-benefit-seen-antihypertensives-crossing-blood-brain
- ↑ 10.0 10.1 Messerli FH, Bavishi C, Messerli AW, Siontis GCM On Cerebrotoxicity of Antihypertensive Therapy and Risk Factor Cosmetics. Eur Heart J. 2021;42(7):758-760. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33369623 https://www.medscape.com/viewarticle/948862
- ↑ 11.0 11.1 Mackenzie IS et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): A prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022 Oct 22; 400:1417. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36240838 Free article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01786-X/fulltext
- ↑ 12.0 12.1 12.2 Sundstrom J et al. Heterogeneity in blood pressure response to 4 antihypertensive drugs: A randomized clinical trial. JAMA 2023 Apr 11; 329:1160. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37039792 PMCID: PMC10091169 (available on 2023-10-11) https://jamanetwork.com/journals/jama/fullarticle/2803518
- ↑ 13.0 13.1 Wu C, Zhao P, Xu P et al Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev. 2024 Feb 14;2(2):CD004184. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38353289 Review.