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Hipertensi obat

Eritropoetin : These include the possible role of the rise of hematocrit and erythrocyte mass, changes in production or sensitivity to endogenous vasopressors, alterations in vascular smooth-muscle ionic milieu, dysregulation of production or responsiveness to endogenous vasodilatory factors, a direct vasopressor action of EPO, and finally arterial remodeling through stimulation of vascular cell growth.

Pil kb : ekspansi volume krn renin angiotensin

Cocain : NEW YORK (MedscapeWire) Mar 08 Researchers at the University of Texas Southwestern Medical Center at Dallas have identified the underlying mechanism by which cocaine triggers hypertensive crisis, the most severe form of high blood pressure and one of the most common cocaine-related, cardiovascular emergencies in the United States.

The findings, reported in the March 5 issue of Circulation, may lead to the development of new treatment strategies for cocaine-induced hypertension and related complications, including stroke and acute myocardial infarction. "The underlying mechanism of the blood-pressure-raising effect of cocaine use in humans has not been well studied," said Dr. Wanpen Vongpatanasin, senior author of the study and assistant professor of internal medicine at the University of Texas Southwestern Medical Center. Before this study, most researchers believed that the mechanism by which cocaine increases blood pressure was involved with the prevention of clearance or reuptake of noradrenaline from blood vessels into nerve endings. The high level of noradrenaline was thought to cause the blood vessels to constrict. "The textbook explanation of cocaine-related elevated blood pressure is based on evidence from previous studies in rats and mice," said Dr. Meryem Tuncel, lead author of the study and a postdoctoral fellow in hypertension. "However, anesthesia used to sedate these animals interferes with the effects of cocaine on the central nervous system, and it is very difficult to show that even a large dose of cocaine can increase blood pressure in animals. Therefore, we suspected that the results would be different in humans." Dr. Vongpatanasin concurred, We found that this mechanism [the high level of noradrenaline] plays a very small role in humans. Instead, cocaine increases blood pressure by stimulation of the heart to cause rapid heartbeat and increased cardiac output. This elevation in blood pressure, if severe or persistent, can lead to damage of multiple vital organs such as the heart, brain, and kidney." The investigators administered a small, medically approved dose of cocaine nose drops to 15 healthy cocaine-naive study participants. To directly measure the drug's effect on blood vessels without influencing the brain or heart, the researchers administered 2 different doses of cocaine into the artery of the forearm and measured blood pressure, forearm blood

flow, and forearm venous noradrenaline concentration in the same study participants on 2 different days. Microelectrodes, which are similar to acupuncture needles, were used to record sympathetic nerve activity during administration of the cocaine nose drops. The researchers found that when cocaine is given directly into the artery in the upper arm, it causes blood vessels to constrict as shown in previous animal studies. "However, when cocaine is given through the nose, it causes dilation, rather than constriction of the blood vessels," Vongpatanasin said. "Blood pressure is determined by two factors, vascular tone and cardiac output. If intranasal cocaine increases blood pressure and the blood vessels dilate instead of constrict, the cardiac output must increase. "Now that we know the mechanisms involved in how cocaine elevates blood pressure, I think we should refocus our strategy to use medications that will affect sympathetic stimulation of the heart rather than medications that have effects only on blood vessels." Approximately 25 million Americans have tried cocaine, and the drug is the most frequent cause of drug-related deaths reported by medical examiners. In 1999, cocaine use was cited in 30 percent of all drug-related emergency department visits and cocaine is the most commonly used illicit drug among people seeking care in hospital emergency departments or drug treatment centers. The study was funded by the Natiooonal Institutes of Health's National Institute on Drug Abus

Siklosporin :

The adverse effect of cyclosporine on blood pressure is well known.[45] The exact mechanism of cyclosporine-induced hypertension is uncertain, but several hypotheses have been proposed, including increased prostaglandin synthesis and decreased water, sodium, and potassium excretion.[46,47] Up to 50% of renal transplant patients receiving cyclosporine treatment have reported elevated blood pressure, and most of these cases required treatment for hypertension.[48] Because of the adverse effects of cyclosporine withdrawal in transplant patients and in patients with autoimmune disease, cyclosporine is rarely discontinued for elevated hypertension. Treatment of cyclosporine-induced hypertension may be pharmacologic, consisting possibly of calcium channel blockers, diuretics, beta-blockers, or ACE inhibitors, or nonpharmacologic, consisting of reduced sodium intake.[45] In 1999, a consensus statement was

released, stating that if systolic blood pressure rose above 140 mmHg or diastolic pressure rose above 90 mmHg on two consecutive occasions, then the cyclosporine dose should be decreased by 25%.[48] Blood pressure should be monitored every two weeks for the first three months of cyclosporine therapy in order to monitor for any changes. In patients with severe, treatment-refractory cyclosporine-induced hypertension, switching to tacrolimus may be an option. Tacrolimus, like cyclosporine, has been shown to have a significant effect on blood pressure. However, the incidence of tacrolimus-induced hypertension (35%) is less than that of cyclosporine (50%).[49] The mechanism of tacrolimus-induced hypertension is postulated to be similar to cyclosporine's, as previously discussed.[50] Modifications similar to those listed for cyclosporineinduced hypertension, whether pharmacologic or nonpharmacologic, may be required to treat the blood pressure elevations associated with tacrolimus therapy.[51] Careful blood pressure monitoring is warranted during therapy with either tacrolimus or cyclosporine.

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