DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

to rapidly treat patients merely on the basis of increased
blood pressure should be resisted. Appropriate therapeutic
decisions need to encompass how well the
patients’ major organs are reacting to the very high
blood pressures. While many drugs have been used parenterally
to rapidly decrease blood pressure in emergencies
(including nitroprusside, enalaprilat, esmolol,
fenoldapam, labetalol, clevidipine and nicardipine,
hydralazine, and phentolamine), the clinical significance
of differing actions of many of these drugs in this
setting is largely unknown (Perez et al., 2008).
RESISTANT HYPERTENSION
Some patients with hypertension do not appear to
respond to recommended treatments. There are many
potential explanations. To achieve stringent control of
hypertension, many patients require two, three, or four
appropriately selected drugs used at optimal doses.
Clinicians may be reluctant to prescribe sufficient
numbers of medications that exploit the full dose
response curve (therapeutic inertia), or patients may not
adhere to the recommended pharmacological regimen.
Sometimes multiple drugs in the same therapeutic class
are chosen. Excess salt intake and the tendency of some
antihypertensive drugs (especially vasodilators) to promote
salt retention may mitigate falls in blood pressure;
consequently, inadequate diuretic treatment commonly
is found in patients with resistant hypertension. Patients
may take prescription drugs, over-the-counter drugs, or
herbal preparations that oppose the actions of antihypertensive
drugs: for example, NSAIDs, sympathomimetic
decongestants, cyclosporine, erythropoietin,
ephedra (ma huang) or licorice. Illicit drugs such as
cocaine and amphetamines may raise blood pressure.
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CHAPTER 27
TREATMENT OF MYOCARDIAL ISCHEMIA AND HYPERTENSION