Exercise training combined with antihypertensive drug therapy: effects on lipids, blood pressure, and left ventricular mass

Article Abstract:

Patients with mild high blood pressure (hypertension) are often treated with drugs and are advised to partake in therapeutic exercise for this condition. The interaction between two therapies is not fully understood. There is some evidence that antihypertensive drugs have an adverse effect on blood lipid levels, increasing the risk of coronary heart disease. Also, circuit weight training, which has increased in popularity in recent years, may have a negative effect on left ventricular mass and actually increase blood pressure. To further investigate the relationship between exercise and drug therapy in mildly hypertensive individuals, the effects of two drugs, diltiazem hydrochloride and propranolol hydrochloride, were assessed in conjunction with aerobic exercise and circuit weight training. Blood lipid levels, blood pressure, and left ventricular mass measurements were obtained from 52 men with hypertension at baseline, and after a 10-week training period. The subjects exercised three times a week and were randomly assigned to receive either one of the drugs or a placebo. Both the average systolic and diastolic blood pressure of all subjects were lower after the exercise training period when compared against baseline measurements. A more rapid reduction of blood pressure was observed after four weeks in the group that received drug therapy than the group that took a placebo, but at 10 weeks no significant differences in blood pressure were evident. It was concluded that drug therapy provided no benefits other than those that were obtained from exercise by these patients. All subjects experienced a drop in low-density lipoproteins and total cholesterol levels. However, the group that took the propranolol had a decrease in high-density lipoproteins; the placebo and diltiazem groups experienced an increase in high-density lipoproteins. Left ventricular mass measurements were higher after exercise, but diastolic function remained the same among all subjects. No apparent adverse effects of exercise on left ventricle function were observed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Exercise therapy, Lipoproteins, Heart ventricle, Left, Left heart ventricle, Propranolol hydrochloride, Propranolol, Blood lipoproteins, Diltiazem

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Severe angioedema related to ACE inhibitors in patients with a history of idiopathic angioedema

Article Abstract:

Hypertension is a serious condition, characterized by a chronic increase in blood pressure; if left untreated, it may result in a stroke or other life-threatening event. In the past, treatment for hypertension involved the use of diuretics (which promote water excretion) and beta blockers (B-blockers). Several new classes of drugs have been developed for the treatment of hypertension and have caused a major change in treatment strategies. One such drug, ACE inhibitors (angiotensin converting enzyme inhibitors), is generally considered to be as effective as diuretics and B-blockers in lowering blood pressure. ACE inhibitors are not associated with some of the side effects caused by the older antihypertensive drugs, such as heart failure, asthma, and changes in blood fat levels. However, the present report documents that angioedema can be a serious side effect of ACE therapy. Angioedema is characterized by the development of urticaria, or hives, and edematous areas in the skin, mucous membranes and abdominal organs. This condition may result from an allergic reaction to foods, drugs, bee stings, molds, or from a physical reaction of the skin to cold temperature, exercise, light, or pressure. The four case reports presented provide evidence that the development of angioedema of the airway and pharynx can result in an immediate life-threatening emergency. The fact that all of the patients in these cases had a prior history of angioedema lends support to the conclusion that ACE inhibitors should be used cautiously in patients with a history of angioedema. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention

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Recurrent angiotensin-converting enzyme inhibitor-associated angioedema

Article Abstract:

Patients on ACE inhibitors who develop angioedema may develop it again if they continue to take the drug. Angioedema is a swelling of the face, lips, hands and feet and other organs. Researchers followed 82 patients on ACE inhibitors who had angioedema between 1986 and 1992 through June of 1993. In that time, 13 patients had another episode of angioedema. The risk of recurrent angioedema was about 10 times higher in those who continued to take the drug compared to those who discontinued it. Many of the physicians treating these patients did not realize that the ACE inhibitor was responsible for this condition.

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