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The initial hemodynamic response to newer antihypertensive agents at rest and during exercise: Review of visacor, doxazosin, nisoldipine, tiapamil, perindoprilat, pinacidil, dilevalol, and carvedilol

  • Hypertension
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Summary

Antihypertensive drugs may lower blood pressure through very different mechanisms, initially as well as during chronic use. This article is a review of theimmediate hemodynamic changes induced by a beta blocker (visacor), an alpha-receptor blocker (doxazosin), two calcium antagonists (tiapamil and nisoldipine), an angiotensin-converting enzyme inhibitor (perindoprilat), two double-acting compounds (dilevalol and carvedilol), and placebo studied in 126 patients with mild to moderately severe essential hypertension. The patient populations of the different treatment groups were comparable. The invasive hemodynamic technique, including intraarterial blood pressure (BP) recording and measurements of cardiac output by cardiogreen, was the same in all studies. All antihypertensive compounds examined induced a rapid reduction in blood pressure both at rest and during exercise, while no significant changes occurred in the placebo group. This review shows the scope of hemodynamic responses, ranging from peripheral vasodilatation to a reduction of heart rate and blood flow. Furthermore, different counterregulatory effects blunting the immediate BP reduction are demonstrated.

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References

  1. Lund-Johansen P. Hemodynamics in early essential hypertension.Acta Med Scand 1967;181(Suppl 482):1–101.

    PubMed  Google Scholar 

  2. Lund-Johansen P, Omvik P, Haugland H. The first dose hemodynamic responses to visacor (ICI 141-292) in essential hypertension.Acta Med Scand 1985;693(Suppl):121–125.

    Google Scholar 

  3. Lund-Johansen P, Omvik P, Haugland H. Acute and chronic haemodynamic effects of doxazosin in hypertension at rest and during exercise.Br J Clin Pharmacol 1986:21(Suppl 1):45s-54s.

    PubMed  Google Scholar 

  4. Omvik P, Lund-Johansen P, Haugland H. Nisoldipine: Central hemodynamic effects at rest and during exercise in essential hypertension. Acute and chronic studies.J Hypertens 1988;6:95–103.

    PubMed  Google Scholar 

  5. Omvik P, Lund-Johansen P. Acute and long-term hemodynamic effects of tiapamil at rest and during exercise in essential hypertension.Cardiovasc Drugs Ther 1989;3:517–523.

    PubMed  Google Scholar 

  6. Omvik P, Lund-Johansen P. Acute hemodynamic effects of perindoprilat in essential hypertension at rest and during exercise.J Hypertens 1989;7:633–638.

    PubMed  Google Scholar 

  7. Omvik P, Lund-Johansen P. Acute hemodynamic effects of carvedilol in essential hypertension at rest and during exercise. Submitted for publication.

  8. Lund-Johansen P, Omvik P. Acute and chronic hemodynamic effects of dilevalol in essential hypertension at rest and during exercise.Am J Med, in press.

  9. Aoki K, Sato K, Kawaguchi Y. Increased cardiovascular responses to calcium antagonists in essential hypertension compared with normotension in humans.J Cardiovasc Pharmacol 1985;7(Suppl 6):S182–S186.

    PubMed  Google Scholar 

  10. Tarazi RC, Dustan H. Beta-adrenergic blockade in hypertension: Practical and theoretical implications of long-term hemodynamic variation.Am J Cardiol 1972;29:633–640.

    PubMed  Google Scholar 

  11. Simon G, Franciosa JA, Gimenez HJ, Cohn J. Short-term systemic hemodynamic adaptation to beta-adrenergic inhibition with atenolol in hypertensive patients.Hypertension 1981;3:262–268.

    PubMed  Google Scholar 

  12. Pickering TG. Mechanisms of beta-blockade in hypertension. In: Laragh JH, Buhler FR, Seldin DW eds.Frontiers in hypertension research. New York: Springer Verlag, 1981:459–461.

    Google Scholar 

  13. Frohlich ED, Tarazi RC, Dustan HP, Page IH. The paradox of beta-adrenergic blockade in hypertension.Circulation 1968;37:417–423.

    PubMed  Google Scholar 

  14. Trap-Jensen J, Clausen JP, Noer I, et al. The effects of beta-adrenoceptor blockers on cardiac output, liver blood flow and skeletal muscle blood flow in hypertensive patients.Acta Physiol Scand 1976;440(Suppl):30.

    Google Scholar 

  15. Lund-Johansen P The effect of beta-blocker therapy on chronic hemodynamics.Prim Cardiol 1980;6(Suppl 1):20–28.

    Google Scholar 

  16. Franciosa JA, Johnson SM, Tobian LJ. Exercise performance in mildly hypertensive patients. Impairment by propranolol but not oxprenolol.Chest 1980;78:291–299.

    PubMed  Google Scholar 

  17. Kaiser P. Physical performance and muscle metabolism during beta-adrenergic blockade in man.Acta Physiol Scand 1984;536(Suppl):1–53.

    Google Scholar 

  18. Man in't Veld AJ, Wenting GJ, Boomsma F, et al. Sympathetic and parasympathetic components of reflex cardiostimulation during vasodilator treatment of hypertension.Br J Clin Pharmacol 1980;9:547–551.

    PubMed  Google Scholar 

  19. Langer SZ. Presynaptic regulation of the release of catecholamines.Pharmacol Rev 1981;32:337–362.

    Google Scholar 

  20. Graham RM, Thornell IR, Gain JW, et al. Prazosin: The first-dose phenomenon.Br Med J 1976;2:1293–1294.

    PubMed  Google Scholar 

  21. Lund-Johansen P. Hemodynamic effects of verapamil in essential hypertension at rest and during exercise.Acta Med Scand 1984;681(Suppl):109–115.

    Google Scholar 

  22. Fagard R, Bulpitt C, Lijnen P, Amery A. Response of the systemic and pulmonary circulation to converting-enzyme inhibition (captopril) at rest and during exercise in hypertensive patients.Circulation 1982;65:33–39.

    PubMed  Google Scholar 

  23. Garavaglia GE, Messerli FH, Nunez BD, et al. Immediate and short-term cardiovascular effects of a new converting enzyme inhibitor (lisinopril) in essential hypertension.Am J Cardiol 1988;62:912–916.

    PubMed  Google Scholar 

  24. Sullivan JM, Ginsburg BA, Ratts TE, et al. Hemodynamic and antihypertensive effects of captopril, an orally active angiotensin converting enzyme inhibitor.Hypertension 1979;1:397–401.

    PubMed  Google Scholar 

  25. Tarazi RC, Bravo EL, Fouad FM, et al. Hemodynamic and volume changes associated with captopril.Hypertension 1980;2:576–585.

    PubMed  Google Scholar 

  26. Gavras H, Brunner HR, Turini GA, et al. Antihypertensive effect of oral angiotensin converting enzyme inhibitor SQ 14225 in man.N Engl J Med 1978;298:991–995.

    PubMed  Google Scholar 

  27. Cohen ML, Kurz KD. Pinacidil-induced vascula relaxation: Comparison to other vasodilators and to classical mechanisms of vasodilation.J Cardiovasc Pharmacol 1988; 12(Suppl 2):S5–S9.

    PubMed  Google Scholar 

  28. Carlsen JE, Kardel T, Lund JO, et al., Acute hemodynamic effects of pinacidil and hydralazine in essential hypertension.Clin Pharmacol Ther 1985;37:253–259.

    PubMed  Google Scholar 

  29. Goldberg MR. Clinical pharmacology of pinacidil, a prototype for drugs that affect potassium channels.J Cardiovasc Pharmacol 1988;12(Suppl 2):S41–S47.

    Google Scholar 

  30. Koch-Weser J. Hydralazine.N Eng J Med 1976;295:320–323.

    Google Scholar 

  31. Eggertsen R, Sivertsson R, Andren L, Hansson L. Acute and long-term hemodynamic effects of carvedilol, a combined beta-adrenoceptor blocking and precapillary vasodilating agent, in hypertensive patients.J Cardiovasc Pharmacol 1987;10(Suppl 11):S97–S100.

    Google Scholar 

  32. Guyton AC, Coleman TG, Granger HJ. Circulation: Overall regulation.Ann Rev Physiol 1972;34:13–46.

    Google Scholar 

  33. Page IH. The mosaic theory. In Page IH,Hypertension mechanisms, Orlando, FL: Grune and Stratton, 1987:910–916

    Google Scholar 

  34. Lund-Johansen P, Omvik P. Hemodynamic patterns of untreated hypertensive disease. In: Laragh JH, Brenner BM, eds.Hypertension. Pathophysiology, diagnosis, and management. New York: Raven Press, 1990:305–327.

    Google Scholar 

  35. 1988 Joint National Committee. The 1988 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.Arch Intern Med 1988;148:1023–1038.

    Google Scholar 

  36. Man in't Veld AJ, van den Meiracker AH. Effects of antihypertensive drugs on cardiovascular hemodynamics. In: Laragh JH, Brenner BM, eds.Hypertension.Pathophysiology, diagnosis, and management. New York: Raven Press, 1990:2117–2130.

    Google Scholar 

  37. Menard J, Bellet M, Brunner HR. Clinical development of antihypertensive drugs. In: Laragh JH, Brenner BM, eds.Hypertension. Pathophysiology, diagnosis, and management. New York: Raven Press, 1990:2331–2342.

    Google Scholar 

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  1. Cardiology Section, Medical Department, 5021 Haukeland Hospital, Bergen, Norway

    Per Omvik MD & Per Lund-Johansen

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  1. Per Omvik MD
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  2. Per Lund-Johansen
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Omvik, P., Lund-Johansen, P. The initial hemodynamic response to newer antihypertensive agents at rest and during exercise: Review of visacor, doxazosin, nisoldipine, tiapamil, perindoprilat, pinacidil, dilevalol, and carvedilol. Cardiovasc Drug Ther 4, 1135–1143 (1990). https://doi.org/10.1007/BF01856510

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