Evaluation of Factors Affecting the Efficacy of Nitroglycerin Infusion in Patients with Hypertensive Crisis Effects of nitroglycerin in hypertensive crisis
Iranian Journal of Pharmaceutical Sciences,
Vol. 17 No. 2 (2021),
1 April 2021
,
Page 105-116
https://doi.org/10.22037/ijps.v17.40289
Abstract
Hypertensive crisis is a severe elevation in blood pressure (BP) that requires urgent reduction in BP to prevent or reduce target organ damage. The antihypertensive effects of nitroglycerin have been proven, but there are limited reports on the effects of various factors on the effectiveness of nitroglycerin in the treatment of hypertensive crisis. The purpose of this study was to evaluate the effects of diabetes, history of hypertension and age as well as gender differences in the effectiveness of nitroglycerin in patients with hypertensive crisis. This study included 76 patients with hypertensive crisis. For management, nitroglycerin initially started at 5 μg/min by intravenous infusion and, if needed, every 3 to 5 min, 5 μg/min was added to the above dose to a maximum of 20 μg/min as long as the blood pressure level reaches to the desired level. The results showed that the mean time of reduction of BP to the desired level in patients with history of hypertension and diabetes alone or both diseases, increased significantly in comparison to patients without these underlying diseases (P<0.01, P<0.01 and P<0.05 respectively). The results also demonstrated that there is a significant difference between patients younger than 45 and over 65 years with patients aged 45-65 (P<0.05). There is no difference between two genders in each group (P>0.05). In conclusion, patients with diabetes and/or history of hypertension are more resistant to pressure lowering effect of nitroglycerin in hypertensive crisis. Patients under 45 years of age as well as the elderly are also resistant. Therefore, it is advisable for physicians to choose the appropriate treatment for the desired outcome, considering the patient's condition.
Keywords:
- Blood pressure
- Diabetes
- History of hypertension
- Hypertensive crisis
- Nitroglycerin
How to Cite
Khademvatan, K., Gerami, F. ., Abbaszadeh, S. ., & Soraya, H. . (2021). Evaluation of Factors Affecting the Efficacy of Nitroglycerin Infusion in Patients with Hypertensive Crisis: Effects of nitroglycerin in hypertensive crisis. Iranian Journal of Pharmaceutical Sciences, 17(2), 105–116. https://doi.org/10.22037/ijps.v17.40289
References
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[34] Dudenbostel T, Glasser SP. Effects of antihypertensive drugs on arterial stiffness. Cardiol. Rev. (2012) 20: 259-63.
[35] Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin. Pharmacokinet. (2009) 48: 143-57.
[36] Jochmann N, Stangl K, Garbe E, Baumann G, Stangl V. Female-specific aspects in the pharmacotherapy of chronic cardiovascular diseases. Eur. Heart J. (2005) 26: 1585-95.
[37] Huxley VH. Sex and the cardiovascular system: the intriguing tale of how women and men regulate cardiovascular function differently. Adv. Physiol. Educ. (2007) 31: 17-22.
[38] Ong KL, Tso AW, Lam KS, Cheung BM. Gender difference in blood pressure control and cardiovascular risk factors in Americans with diagnosed hypertension. Hypertension. (2008) 51: 1142-8.
[39] Ahimastos AA, Formosa M, Dart AM, Kingwell BA. Gender differences in large artery stiffness pre- and post puberty. J. Clin. Endocrinol. Metab. (2003) 88: 5375-80.
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[2] Varon J, Marik PE. Clinical review: the management of hypertensive crises. Crit. Care. (2003) 7: 374-84.
[3] Sadeghi E, Behnood-Rod A, Aerab-Sheibani H, Shobeiri E, Pourzargar P, Ormoz E, Sadigh N, Moharamzad Y. Controlled blood pressure in Iranian patients: a multi-center report. Glob. J. Health Sci. (2015) 8: 188-95.
[4] Salkic S, Batic-Mujanovic O, Ljuca F, Brkic S. Clinical presentation of hypertensive crises in emergency medical services. Mater. Sociomed. (2014) 26: 12-6.
[5] Aggarwal M, Khan IA. Hypertensive crisis: hypertensive emergencies and urgencies. Cardiol. Clin. (2006) 24: 135-46.
[6] Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA Sr, Williamson JD, Wright JT Jr. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. (2018) 71: 1269-324.
[7] Angelate EG, Baur EB. Hypertension, hypertensive crisis, and hypertensive emergency: approaches to emergency department care. Emergencias. (2010) 22: 209-19.
[8] Salkic S, Brkic S, Batic-Mujanovic O, Ljuca F, Karabasic A, Mustafic S. Emergency room treatment of hypertensive crises. Med. Arch. (2015) 69: 302-6.
[9] Vilela-Martin JF, Vaz-de-Melo RO, Kuniyoshi CH, Abdo AN, Yugar-Toledo JC. Hypertensive crisis: clinical-epidemiological profile. Hypertens. Res. (2011) 34: 367-71.
[10] Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL. Jr, Jones DW, Materson BJ, Oparil S, Wright JT. Jr, Roccella EJ. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. (2003) 289: 2560-72.
[11] Varon J, Marik PE. Perioperative hypertension management. Vasc. Health Risk Manag. (2008) 4: 615-27.
[12] Aronow WS. Treatment of hypertensive emergencies. Ann. Transl. Med. (2017) 5(Suppl 1): S5-S.
[13] Carter BL, Frohlich ED, Elliott WJ, Moore MA, Mann RJ, RW R. Selected factors that influence responses to antihypertensives. Choosing therapy for the uncomplicated patient. Arch. Fam. Med. (1994) 3: 528-36.
[14] Rosano GM, Lewis B, Agewall S, Wassmann S, Vitale C, Schmidt H, Drexel H, Patak A, Torp-Pedersen C, Kjeldsen KP, Tamargo J. Gender differences in the effect of cardiovascular drugs: a position document of the working group on pharmacology and drug therapy of the ESC. Eur. Heart J. (2015) 36: 2677-80.
[15] Freis ED. Age and antihypertensive drugs (hydrochlorothiazide, bendroflumethiazide, nadolol and captopril). Am. J. Cardiol. (1988) 61: 117-21.
[16] Gu Q, Burt VL, Paulose-Ram R, Dillon CF. Gender differences in hypertension treatment, drug utilization patterns, and blood pressure control among US adults with hypertension: data from the National Health and Nutrition Examination Survey 1999-2004. Am. J. Hypertens. (2008) 21: 789-98.
[17] Maleki A, Sadeghi M, Zaman M, Tarrahi MJ, Nabatchi B. Nifedipine, Captopril or Sublingual Nitroglycerin, Which can Reduce Blood Pressure the Most? ARYA Atheroscler. (2011) 7: 102-5.
[18] Prasanna N, Dissanayake HA, Constantine GR. Sublingual nitroglycerin for early blood pressure control in hypertensive emergencies: observations from an emergency department clinical audit in Sri Lanka. BMC. Res. Notes. (2018) 11: 355.
[19]. Cao H. Adipocytokines in obesity and metabolic disease. J. Endocrinol. (2014) 220: 47-59.
[20] Grossman E, Messerli FH. Management of blood pressure in patients with diabetes. Am. J. Hypertens. (2011) 24: 863-75.
[21]. Lithovius R, Harjutsalo V, Forsblom C, Saraheimo M, Groop PH. Antihypertensive treatment and resistant hypertension in patients with type 1 diabetes by stages of diabetic nephropathy. Diabetes Care. (2014) 37: 709-17.
[22] Winer N, Sowers JR. Diabetes and arterial stiffening. Adv. Cardiol. (2007) 44: 245-51.
[23] El Husseny MW, Mamdouh M, Shaban S, Ibrahim Abushouk A, Zaki MM, Ahmed OM, Abdel-Daim MM. Adipokines: potential therapeutic targets for vascular dysfunction in type II diabetes mellitus and obesity. J. Diabetes Res. (2017) 2017: 8095926.
[24] Gulcelik NE, Usman A, Gürlek A. Role of adipocytokines in predicting the development of diabetes and its late complications. Endocrine. (2009) 36: 397-403.
[25] de Luis DA, Sagrado MG, Aller R, Conde R, Izaola O. Circulating visfatin in obese non-diabetic patients in relation to cardiovascular risk factors, insulin resistance, and adipocytokines: a contradictory piece of the puzzle. Nutrition. (2010) 26: 1130-3.
[26] Li B, Yao Q, Guo S, Ma S, Dong Y, Xin H, Wang H, Liu L, Chang W, Zhang Y. Type 2 diabetes with hypertensive patients results in changes to features of adipocytokines: Leptin, Irisin, LGR4, and Sfrp5. Clin. Exp. Hypertens. (2019) 41: 645-50.
[27] Amador N, Pérez-Luque E, Malacara JM, Guízar JM, Paniagua R, Lara S. Leptin and heart sympathetic activity in normotensive obese and non-obese subjects. Ital. Heart J. (2004) 5: 29-35.
[28] Bravo PE, Morse S, Borne DM, Aguilar EA, Reisin E. Leptin and hypertension in obesity. Vasc. Health Risk Manag. (2006) 2: 163-9.
[29] McVeigh G, Brennan G, Hayes R, Johnston D. Primary nitrate tolerance in diabetes mellitus. Diabetologia. (1994) 37: 115-7.
[30] Dupuis J, Lalonde G, Lemieux R, Rouleau JL. Tolerance to intravenous nitroglycerin in patients with congestive heart failure: role of increased intravascular volume, neurohumoral activation and lack of prevention with N-acetylcysteine. J. Am. Coll. Cardiol. (1990) 16: 923-31.
[31] Knot HJ. Nitrate tolerance in hypertension: new insight into a century-old problem. Circ. Res. (2003) 93: 799-801.
[32] Mitchell GF. Arterial stiffness and hypertension. Hypertension. (2014) 64: 13-8.
[33] Safar ME, Asmar R, Benetos A, Blacher J, Boutouyrie P, Lacolley P, Laurent S, London G, Pannier B, Protogerou A, Regnault V; French study group on arterial stiffness. Interaction between hypertension and arterial stiffness. Hypertension. (2018) 72: 796-805.
[34] Dudenbostel T, Glasser SP. Effects of antihypertensive drugs on arterial stiffness. Cardiol. Rev. (2012) 20: 259-63.
[35] Soldin OP, Mattison DR. Sex differences in pharmacokinetics and pharmacodynamics. Clin. Pharmacokinet. (2009) 48: 143-57.
[36] Jochmann N, Stangl K, Garbe E, Baumann G, Stangl V. Female-specific aspects in the pharmacotherapy of chronic cardiovascular diseases. Eur. Heart J. (2005) 26: 1585-95.
[37] Huxley VH. Sex and the cardiovascular system: the intriguing tale of how women and men regulate cardiovascular function differently. Adv. Physiol. Educ. (2007) 31: 17-22.
[38] Ong KL, Tso AW, Lam KS, Cheung BM. Gender difference in blood pressure control and cardiovascular risk factors in Americans with diagnosed hypertension. Hypertension. (2008) 51: 1142-8.
[39] Ahimastos AA, Formosa M, Dart AM, Kingwell BA. Gender differences in large artery stiffness pre- and post puberty. J. Clin. Endocrinol. Metab. (2003) 88: 5375-80.
[40] Massoud L, Al Agha H, Taleb M. Pharmacokinetic and pharmacodynamic changes in elderly people. World J. Pharm. Med. Res. (2017) 3: 14-23.
[41] Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br. J. Clin. Pharmacol. (2004) 57: 6-14.
[42] Pickering TG. Why don't we use nitrates to treat older hypertensive patients? J. Clin. Hypertens. (2005) 7: 685-7.
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