scholarly journals Effectively Prescribing Oral Magnesium Therapy for Hypertension: A Categorized Systematic Review of 49 Clinical Trials

Nutrients ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 195
Author(s):  
Andrea Rosanoff ◽  
Rebecca B. Costello ◽  
Guy H. Johnson
Keyword(s):  
Risk Factors ◽  
Antihypertensive Medication ◽  
Antihypertensive Medications ◽  
Hypertensive Patients ◽  
Medication Side Effects ◽  
Medication Side ◽  
Normotensive Subjects ◽  
Meta Analyses ◽  
Magnesium Therapy ◽  
Oral Magnesium

Trials and meta-analyses of oral magnesium for hypertension show promising but conflicting results. An inclusive collection of 49 oral magnesium for blood pressure (BP) trials were categorized into four groups: (1) Untreated Hypertensives; (2) Uncontrolled Hypertensives; (3) Controlled Hypertensives; (4) Normotensive subjects. Each group was tabulated by ascending magnesium dose. Studies reporting statistically significant (p < 0.05) decreases in both systolic BP (SBP) and diastolic BP (DBP) from both baseline and placebo (if reported) were labeled “Decrease”; all others were deemed “No Change.” Results: Studies of Untreated Hypertensives (20 studies) showed BP “Decrease” only when Mg dose was >600 mg/day; <50% of the studies at 120–486 mg Mg/day showed SBP or DBP decreases but not both while others at this Mg dosage showed no change in either BP measure. In contrast, all magnesium doses (240–607 mg/day) showed “Decrease” in 10 studies on Uncontrolled Hypertensives. Controlled Hypertensives, Normotensives and “magnesium-replete” studies showed “No Change” even at high magnesium doses (>600 mg/day). Where magnesium did not lower BP, other cardiovascular risk factors showed improvement. Conclusion: Controlled Hypertensives and Normotensives do not show a BP-lowering effect with oral Mg therapy, but oral magnesium (≥240 mg/day) safely lowers BP in Uncontrolled Hypertensive patients taking antihypertensive medications, while >600 mg/day magnesium is required to safely lower BP in Untreated Hypertensives; <600 mg/day for non-medicated hypertensives may not lower both SBP and DBP but may safely achieve other risk factor improvements without antihypertensive medication side effects.

1415Dose antihypertensive medication improve accelerated age-dependent decline of GFR in hypertension?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Ohno ◽  
H Takase ◽  
M Machii ◽  
D Nonaka ◽  
T Sugiura ◽  
...  
Keyword(s):  
Renal Disease ◽  
Kidney Function ◽  
Antihypertensive Medication ◽  
Statistical Significance ◽  
Antihypertensive Medications ◽  
Hypertensive Patients ◽  
Beneficial Effects ◽  
Age Dependent ◽  
Normotensive Subjects ◽  
Disease Study

Abstract Background/Introduction An impairment of kidney function is a risk not only for end stage renal disease but also for cardiovascular events. Hypertension is known to accelerate an age-dependent decline in glomerular filtration rate (GFR). Purpose Effects of antihypertensive medications on yearly changes of estimate GFR (eGFR) in hypertensive patients were investigated. Methods Consecutive 5110 subjects (male=3196, 52.3±11.3 year-old) who participated in our physical check-up program during 2010 and 2012 were enrolled and followed up for 5 years. The average and the yearly change of eGFR during the 5 years were calculated in each individual and the both values were compared in hypertensive and normotensive subjects. Effect of antihypertensive medication on eGFR was also investigated. The modified Modification of Diet in Renal Disease study formula for the Japanese population was used for calculating eGFR. Results In hypertensive subjects (n=1408), the baseline and the average of eGFR were smaller (74.8±14.6 vs. 80.4±13.6, p<0.001 and 72.1±13.2 vs. 77.9±11.9 mL/min per 1.73 m2, p<0.001, respectively) and the yearly decline of eGFR was greater (0.96±1.41 vs. 0.84±1.19 mL/min per 1.73 m2 per year, p<0.01) than in normotensive subjects (n=3702). The baseline and the average of eGFR were smaller in hypertensive patients with (n=1234) than without (n=174) antihypertensive medication (74.3±14.6 vs. 78.3±13.8, p<0.001 and 71.7±13.2 vs. 74.9±12.7 mL/min per 1.73 m2, p<0.01, respectively). Although the yearly decline of eGFR in hypertensive patients with medication tended to be smaller than the decline in those without medication (0.94±1.41 vs. 1.09±1.42 mL/min per 1.73 m2 per year), this did not reach a statistical significance (p=0.213). Neither the number, classes of antihypertensive medications nor systolic blood pressure during the follow-up period did affect the average or yearly decline of eGFR in hypertensive patients. Conclusions As compared to normotensive subjects, eGFR was reduced and a yearly decrease in eGFR during the 5 years was accelerated in hypertensive patients. Although antihypertensive medication may reduce an accelerated age-dependent decline of kidney function in hypertension, observational period in this study was too short to clarify such beneficial effects of antihypertensive medications.

scholarly journals Reasons for antihypertensive medication nonadherence influence physician preferences for hypertension management

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R E Schmieder ◽  
D E Kandzari ◽  
T.-D Wang ◽  
Y.-H Lee ◽  
C Haro ◽  
...  
Keyword(s):  
Side Effects ◽  
Renal Denervation ◽  
The United States ◽  
Patient Specific ◽  
Hypertension Management ◽  
Medication Nonadherence ◽  
Antihypertensive Medications ◽  
Medication Side Effects ◽  
Medication Side ◽  
Patient Nonadherence

Abstract Background/Introduction Patient nonadherence to prescribed antihypertensive medications is a major contributor to low global hypertension control rates. Attitudes toward renal denervation vary between physicians and patients, with recent data showing that side effects from medications is a key factor influencing both patient nonadherence to prescribed medications and preferences for interventional treatment. The influence of patient nonadherence on physician recommendations for renal denervation is not well understood. Purpose To examine whether specific reasons for patient nonadherence influence physician preferences for renal denervation as a treatment option for hypertension. Methods Online surveys were fielded to general and interventional cardiologists in Europe and the United States. Physicians were asked to position their willingness to recommend renal denervation in the hypertension management pathway based on three factors of nonadherence: patients' preference not to take antihypertensive medications, medication side effects, and nonspecific nonadherence to medication. The surveys followed the highest industry standards ISO 20252. Results were compared using two-tailed Z tests. Results Over two-thirds of 501 physicians surveyed stated that they would recommend renal denervation for uncontrolled hypertension irrespective of the reason for nonadherence. This recommendation was significantly more common in the scenario of patient reported medication side effects as compared with desire not to take medications or other nonspecific reasons for nonadherence (p&lt;0.001 for both; Figure) Conclusions Surveyed physicians were more likely to recommend renal denervation to patients reporting side effects with their antihypertensive medications than for other reasons of nonadherence. These findings underscore the influence of patient-specific reasons for medication nonadherence on provider recommendations as part of a shared decision-making process when evaluating different options for hypertension management. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic

Factors associated with re-presentation to emergency departments in elderly people with pain

2014 ◽  
Vol 38 (4) ◽  
pp. 461 ◽  
Author(s):  
Rebecca Howard ◽  
Andrew Hannaford ◽  
Tracey Weiland
Keyword(s):  
Risk Factors ◽  
Elderly People ◽  
Opioid Analgesics ◽  
Complex Care ◽  
Care Needs ◽  
Factors Associated ◽  
Medication Side Effects ◽  
Medication Side ◽  
Complex Care Needs

Objectives To identify medical, social and demographic factors associated with increased risk of 30-day re-presentation to the emergency department (ED) in elderly people presenting with pain. Methods We undertook a single site, prospective observational study of all patients aged >65 years discharged from the ED with pain. Data were collected on possible medical, social and demographic predictors of ED readmission. Participants were a subset of all elderly patients presenting to the ED with pain, and received follow-up case management as part of the hospital’s rapid response, assessment and care planning program for elderly people. Results Over 8 months, 356 people were eligible for inclusion in the study; of these, 189 consented to case management and to participate in the study. Three factors statistically increased odds of re-presentation to ED within 30 days: (1) prescription of opioids (P = 0.003); (2) the presence of Home and Community Care Services (P = 0.03); and (3) the absence of a gait aid (P = 0.019). Nineteen per cent of eligible patients re-presented to ED within 30 days of initial presentation. Conclusion These findings contribute to current debate about opioid prescription and effective pain management in the elderly. The study highlights the need for routine follow-up care of older people discharged from the ED with pain, particularly those discharged home with opioids or with complex care needs. What is known about the topic? Re-presentation rates within 28 days for all-comers to the emergency department (ED) are collected and reported as part of routine service monitoring and evaluation. Presentation rates for elderly people to EDs have been escalating over the past decade; however, the risk factors that lead to re-presentations for elderly people have not been documented. Similarly, increasing concern about the prescription of opioids in elderly people is documented; however, its impact on ED re-presentations has not been reported. Innovative models of care are emerging to stem the rise in ED demand; however, their role and impact on re-presentation rates are not documented for this subgroup of ED presenters. What does this paper add? This research has demonstrated that ED re-presentation rates for elderly people with pain are higher than overall ED re-presentation rates. This article has identified three risk factors that significantly increase the risk of re-presentation in this population, including the prescription of opioid analgesics. Qualitative data have identified that elderly people prescribed opioids require extensive education and support to manage the medication side effects. What are the implications for practitioners? Practitioners should be aware that elderly people with pain are a higher risk group for ED re-presentation, particularly those prescribed opioid analgesics or with complex care needs. Discharge planning and assessment of supports should be routinely instigated to manage medication side effects, and follow-up services put in place where inadequate. Improved provision of written information in multiple languages for patients who cannot read English should also be initiated.

scholarly journals Variations of Lung Function Status in Hypertension and Antihypertensive Medication

2016 ◽  
Vol 12 (1) ◽  
pp. 28-32
Author(s):  
Mst Nasrin Nahar ◽  
Shelina Begum ◽  
Sultana Ferdousi ◽  
Sharmeen Sultana ◽  
Zinia Parveen ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Lung Function ◽  
Antihypertensive Medication ◽  
Antihypertensive Drugs ◽  
Armed Forces ◽  
Forced Expiratory Volume ◽  
Control Group ◽  
Newly Diagnosed ◽  
Hypertensive Patients ◽  
Normotensive Subjects

Introduction: Essential hypertension is associated with altered pulmonary function. Antihypertensive medication and lung function are also associated. Amlodipine (calcium channel blocker) and Atenolol (beta blocker) are commonly used antihypertensive drugs. Objective: To evaluate the effects of antihypertensive drugs on lung function status in patients with essential hypertension. Materials and Methods: This prospective observational study was carried out in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, from July 2012 to June 2013 on 100 newly diagnosed essential hypertensive patients. Based on prescribed treatment, these study subjects were divided into two groups - B1 and B2. B1 included 50 patients who received amlodipine 5mg daily and B2 included 50 patients who received atenolol 50mg daily. Lung function tests were done in both B1 and B2 groups before taking medication, after 3 months of medication and after 6 months of medication. For assessing lung function status, Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st second (FEV1) and Peak Expiratory Flow Rate (PEFR) were measured with a computer based Spirometer. Age, sex and BMI matched 50 apparently healthy normotensive subjects were also studied as control (group A). Data were compared among subjects of different groups. For statistical analysis independent sample‘t’ test and paired sample‘t’ test were performed. Results: Mean FVC, FEV1 and PEFR were significantly lower in newly diagnosed hypertensive patients in comparison with that of healthy normotensive subjects. Mean FVC, FEV1 and PEFR were found significantly higher in the group taking amlodipine for 6 months when compared to newly diagnosed hypertensive patients but lower than those of controls. In addition mean FVC and FEV1 were found significantly lower in the group taking atenolol for 6 months when compared to newly diagnosed hypertensive patients and those of controls. Conclusion: Reduced lung function occurs in newly diagnosed essential hypertensive patients which improve by treatment with amlodipine but decreases after treatment with atenolol. Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 28-32

Sign in / Sign up

Export Citation Format

Share Document