Current Pharmaceutical Design - Volume 21, Issue 6, 2015

Blood pressure (BP) is traditionally assessed, for centuries, at the brachial artery by cuff-based sphygmomanometric techniques. Technological and methodological innovations as well as emerging new findings from clinical studies and trials now provoke a re-consideration of traditional strategies for BP management. The existing knowledge regarding the occurring changes of BP over time (temporal variability) and the evident diff Read More

The profound observations of William Harvey (1578-1657), in blood circulation and the progress of physical science laid the foundation for the development of the Iatrophysical School that contributed to the evolution of clinical sphygmomanometry. The pioneer work of Reverend Stephen Hales (1677-1761) demonstrated the dynamics of the vascular system. One century later the French physician Jean-Léonard-Marie Poise Read More

Hypertension provoked since the beginning of the 19th century a medical debate between physicians. The early antihypertensive agents were poorly tolerated. Progress towards more effective drugs, appeared after the 2nd World War. Thiocyanates, dehydrogenated alkaloids of ergot, barbiturates, bismuth and bromides, were soon replaced by phenoxbenzamine, hexamethonium, pentolinium, and mecamylamine. Thia Read More

While for years clinicians have used cuff pressure to assess patients’ cardiovascular risk, recent evidences has shown that aortic pressure, or more specifically aortic systolic and aortic pulse pressures, have a better prognostic value to predict cardiovascular events and mortality. This led to the emergence of multiple methods and devices to assess aortic pressure non-invasively. Some use scaled waveforms measured at the car Read More

Although the clinical relevance of brachial blood pressure (BP) measurement for cardiovascular (CV) risk stratification is nowadays widely accepted, this approach can nevertheless present several limitations. Pulse pressure (PP) amplification accounts for the notable increase in PP from central to peripheral arterial sites. Target organs are more greatly exposed to central hemodynamic changes than peripheral organs. The pathoph Read More

Reduction strategies of blood pressure, as a modifiable cardiovascular risk, are currently based on office assessment of brachial artery blood pressure. However, antihypertensive treatment based on brachial BP values reduces cardiovascular risk but cannot completely reverse the hypertension-induced risk of morbidity events. As is well known, BP varies in different arterial systems and invasive and non-invasive stu Read More

Differences in blood pressure measurements between arms are commonly encountered in clinical practice. If such differences are not excluded they can delay the diagnosis of hypertension and can lead to poorer control of blood pressure levels. Differences in blood pressure measurements between arms are associated cross sectionally with other signs of vascular disease such as peripheral arterial disease or cerebrovascula Read More

Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Clinical evidences support that short-term and long-term BPV independently contribute to target organ damage, cardiovascular events and mortality in patients with hypertension or diabetes. Attenuation of excessive fluctuations of systolic and diastolic BPV has been suggested as an additional therapeutic target in ca Read More

Elevated nighttime blood pressure (BP) and a reduced day-night BP fall ("nondipping" condition) are strong predictors of cardiovascular complications, both in hypertension and in the general population. A reduced or inverted nocturnal BP fall might also be theoretically used to define the most appropriate timing for drug administration. In a systematic review of the available evidence, we show that bedtime dosing of a Read More

Recent findings indicate cardiovascular disease (CVD) risk is best predicted by asleep systolic blood pressure (SBP), and lowering it by scheduling ≥1 conventional long-acting hypertension medications, alone or in combination, at bedtime significantly lessens vascular-associated risks. Some 20 years ago, four controlled-onset extended-release drug-delivery systems incorporating a calcium channel or β-blocker, with the treatme Read More

Clinical medicine faces many challenges, e.g. applying personalized medicine and genomics in daily practice; utilizing highly specialized diagnostic technologies; prescribing costly therapeutics. Today’s population is aging and patients are diagnosed with more co-morbid conditions than in the past. Co-morbidity makes management of the elderly difficult also in terms of pharmacotherapy. The high prevalence of hypertension a Read More

Drug discovery and development is a high-risk enterprise that requires significant investments in capital, time and scientific expertise. The studies of xenobiotic metabolism remain as one of the main topics in the research and development of drugs, cosmetics and nutritional supplements. Antihypertensive drugs are used for the treatment of high blood pressure, which is one the most frequent symptoms of the patients that Read More

High blood pressure (BP) is an important risk factor for stroke and ischaemic heart disease. Yet, despite the availability of effective drugs, it is generally poorly controlled. Partly this is because some patients do not adhere to treatment regimens and partly because clinicians either measure BP insufficiently frequently or are not rigorous in applying treatment guidelines. Additionally individual surgery measurements of BP prov Read More