Hypertension treatment side effects
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Hypertension Treatment Side Effects
Angiogenesis Inhibitors and Hypertension
Angiogenesis Inhibitors: Common Side Effects
Hypertension is a prevalent side effect of treatments involving angiogenesis inhibitors, such as bevacizumab and small molecule tyrosine kinase inhibitors targeting VEGF . These drugs can cause significant increases in blood pressure, necessitating careful monitoring and management during and after treatment. The incidence and severity of hypertension depend on the type, dose, and schedule of the angiogenesis inhibitors used.
Management Strategies
Proactive management, including the use of antihypertensive drugs, is crucial to maintain therapy despite the onset of hypertension. Lifestyle modifications, although beneficial, may not always be suitable for patients with metastatic cancer, making early drug intervention necessary. However, there is no clear consensus on the best antihypertensive agent for managing this side effect due to a lack of controlled studies.
Erythropoietin and Blood Pressure
Erythropoietin-Induced Hypertension
Recombinant human erythropoietin (rHuEPO) used to treat anemia in chronic renal failure patients often leads to increased blood pressure in about one-third of patients. This increase is not related to the dose of rHuEPO or the final hematocrit level achieved but is more common during the first four months of therapy. The mechanism behind this hypertension is not fully understood but may involve increased systemic vascular resistance and abnormal cardiovascular autoregulation.
Severe Complications
In some cases, rHuEPO-induced hypertension can lead to severe complications such as hypertensive encephalopathy and seizures, which are associated with rapid increases in blood pressure. Conventional antihypertensive therapy is recommended to control this hypertension, and if it persists, reducing the rHuEPO dose or temporarily discontinuing therapy may be necessary.
Hypertension in Older Adults
Intensive Blood Pressure Treatment Risks
In adults aged 60 years or older, intensive blood pressure treatment can lead to adverse effects such as falls, fractures, and cognitive impairment. While lowering systolic blood pressure (SBP) to less than 150 mm Hg is generally recommended, more aggressive targets can increase the risk of these side effects.
Balancing Benefits and Harms
A systematic review indicated that while intensive blood pressure lowering can reduce the risk of stroke and cardiac events, it also increases the likelihood of adverse effects, necessitating a careful balance between benefits and harms.
Antihypertensive Drug Side Effects
Common Adverse Effects
Antihypertensive drugs, including beta-blockers, diuretics, ACE inhibitors, and calcium channel blockers, can cause various side effects such as depression, sexual dysfunction, nightmares, and gastrointestinal symptoms . Diuretics, for example, can lead to hypokalemia, which is particularly dangerous when combined with digitalis, potentially causing serious arrhythmias.
Drug-Specific Side Effects
Different classes of antihypertensive drugs have specific side effects. For instance, orlistat, used for weight reduction in hypertensive patients, commonly causes gastrointestinal issues, while sibutramine can increase diastolic blood pressure. Phentermine/topiramate has been shown to reduce blood pressure but is associated with side effects like dry mouth and paresthesia.
Conclusion
Hypertension treatment, while essential for managing cardiovascular risks, comes with a range of side effects that vary depending on the specific medication and patient population. Careful monitoring, individualized treatment plans, and proactive management strategies are crucial to mitigate these adverse effects and ensure effective hypertension control.
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