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PloS One 2022To compare maternal and infant outcomes with different antihypertensive medications in pregnancy.
OBJECTIVE
To compare maternal and infant outcomes with different antihypertensive medications in pregnancy.
DESIGN
Retrospective cohort study.
SETTING
Kaiser Permanente, a large healthcare system in the United States.
POPULATION
Women aged 15-49 years with a singleton birth from 2005-2014 treated for hypertension.
METHODS
We identified medication exposure from automated pharmacy data based on the earliest dispensing after the first prenatal visit. Using logistic regression, we calculated weighted outcome prevalences, adjusted odds ratios (aORs) and 95% confidence intervals, with inverse probability of treatment weighting to address confounding.
MAIN OUTCOME MEASURES
Small for gestational age, preterm delivery, neonatal and maternal intensive care unit (ICU) admission, preeclampsia, and stillbirth or termination at > 20 weeks.
RESULTS
Among 6346 deliveries, 87% with chronic hypertension, the risk of the infant being small for gestational age (birthweight < 10th percentile) was lower with methyldopa than labetalol (prevalence 13.6% vs. 16.6%; aOR 0.77, 95% CI 0.63 to 0.92). For birthweight < 3rd percentile the aOR was 0.57 (0.39 to 0.80). Compared with labetalol (26.0%), risk of preterm delivery was similar for methyldopa (26.5%; aOR 1.10 [0.95 to 1.27]) and slightly higher for nifedipine (28.5%; aOR 1.25 [1.06 to 1.46]) and other β-blockers (31.2%; aOR 1.58 [1.07 to 2.23]). Neonatal ICU admission was more common with nifedipine than labetalol (25.9% vs. 23.3%, aOR 1.21 [1.02 to 1.43]) but not elevated with methyldopa. Risks of other outcomes did not differ by medication.
CONCLUSIONS
Risk of most outcomes was similar comparing labetalol, methyldopa and nifedipine. Risk of the infant being small for gestational age was substantially lower for methyldopa, suggesting this medication may warrant further consideration.
Topics: Antihypertensive Agents; Birth Weight; Female; Humans; Hypertension, Pregnancy-Induced; Infant; Infant, Newborn; Infant, Newborn, Diseases; Labetalol; Methyldopa; Nifedipine; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies
PubMed: 35576217
DOI: 10.1371/journal.pone.0268284 -
British Journal of Clinical Pharmacology 19791 Twenty patients with essential hypertension completed a double-blind, dose-tritrated, cross-over comparison of methyldopa and labetalol. 2 Average lying BPs... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
1 Twenty patients with essential hypertension completed a double-blind, dose-tritrated, cross-over comparison of methyldopa and labetalol. 2 Average lying BPs (systolic/diastolic) were reduced by 28/15 mmHg with methyldopa and by 23/15 mmHg with labetalol. 3 Average standing BPs (systolic/diastolic) were reduced by 29/14 mmHg with methyldopa and by 29/15 mmHg with labetalol. 4 Both lying and standing heart rates were reduced with labetalol. 5 It is concluded that the antihypertensive properties of labetalol and methyldopa are similar but that larger patient populations are needed to study the relative incidence of subjective adverse effects.
Topics: Blood Cell Count; Blood Pressure; Clinical Trials as Topic; Double-Blind Method; Ethanolamines; Female; Heart Rate; Humans; Hypertension; Labetalol; Male; Methyldopa; Middle Aged; Patient Compliance; Time Factors
PubMed: 393286
DOI: No ID Found -
The Journal of the Royal College of... Oct 1976The distribution of blood pressure levels in elderly patients is described and the evidence that higher levels are associated with morbidity at this age is reviewed. In... (Review)
Review
The distribution of blood pressure levels in elderly patients is described and the evidence that higher levels are associated with morbidity at this age is reviewed. In the absence of definitive evidence about the results of treating hypertension in the elderly, the physiological factors that have to be taken into account are surveyed with particular reference to aggravating cerebral ischaemia.More potent hypotensive agents should be avoided in older patients and in practice the decision on whether to treat may depend more on the clinical context than on the level of the blood pressure itself.
Topics: Aged; Aging; Alprenolol; Cardiovascular Diseases; Humans; Hypertension; Methyldopa; United Kingdom
PubMed: 794464
DOI: No ID Found -
Biomedicine & Pharmacotherapy =... Nov 2022Parkinson's disease is the second most prevalent neurodegenerative disease after Alzheimer's disease, mostly happened in the elder population and the prevalence... (Review)
Review
Parkinson's disease is the second most prevalent neurodegenerative disease after Alzheimer's disease, mostly happened in the elder population and the prevalence gradually increased with age. Parkinson's disease is a movement disorder that severely affects patients' daily life. The mechanism of Parkinson's disease still remains unknown, however, studies already proved that the damage or absence of dopaminergic neurons located in the substantia nigra and the decreased dopamine in the striatum are significantly related to Parkinson's disease. To date, the mainstream treatment of Parkinson's disease has been achieved by alleviating its associated morbid symptoms, such as the use of levodopa, carbidopa, dopamine receptor agonists, monoamine oxidase type B inhibitors, anticholinergic drugs, etc. However, strong side effects, even toxicity, have been reported after using these drugs, with reduced effectiveness over time. Plant compounds have shown good therapeutic effects in neurodegenerative diseases as a less toxic treatment. In this review, we have compiled several natural plant compounds and classified the currently reported compounds for therapeutic use based on their structural parent nuclei and constituent elements. We wish to inspire new ideas for the treatment of Parkinson's disease by summarizing their mechanisms.
Topics: Humans; Aged; Parkinson Disease; Levodopa; Carbidopa; Dopamine; Dopamine Agonists; Biological Products; Neurodegenerative Diseases; Monoamine Oxidase; Cholinergic Antagonists
PubMed: 36152409
DOI: 10.1016/j.biopha.2022.113718 -
Ideggyogyaszati Szemle Nov 2022In advanced Parkinson's disease, oral medication can often no longer achieve sufficient therapeutic success. As one of the device aided therapies, the intrajejunal... (Review)
Review
In advanced Parkinson's disease, oral medication can often no longer achieve sufficient therapeutic success. As one of the device aided therapies, the intrajejunal levo-dopa administration has been established as valuable treatment option. A modern form of the well-known intestinal levodopa pump offers the opportunity to continue the oral triple combination of levodopa, carbidopa and entacapone that many patients already use. Since February 2021 this modern option is available in Austria and Germany which also contains entacapone, whereby levo-dopa can be saved. In many other countries, including Hungary, approval is expected in the near future. The pump and cartridge are significantly smaller and lighter than in the LCIG pump which should improve the accep-tance of the therapy. The higher acceptance of the smaller pump and the improved user-friendliness has already been reported in an observational study from Sweden. The unwanted effects of entacapone have to be considered.
Topics: Humans; Carbidopa; Levodopa; Parkinson Disease; Antiparkinson Agents; Drug Combinations; Gels; Observational Studies as Topic
PubMed: 36541150
DOI: 10.18071/isz.75.0365 -
British Journal of Pharmacology and... Feb 1964alpha-Methyldopa in high concentrations impaired the responses of rabbit isolated ileum and guinea-pig isolated vas deferens to stimulation of the sympathetic nerves and...
alpha-Methyldopa in high concentrations impaired the responses of rabbit isolated ileum and guinea-pig isolated vas deferens to stimulation of the sympathetic nerves and to noradrenaline, but these preparations taken from animals previously treated with alpha-methyldopa showed no sign of impairment. Contractions of the cat nictitating membrane were reduced but not abolished by alpha-methyldopa. In cats, dogs and rats, pressor responses to noradrenaline were usually slightly increased by alpha-methyldopa. Pressor responses to tyramine were not affected consistently. alpha-Methyldopa, alpha-methyldopamine and alpha-methylnoradrenaline behaved like dopa, dopamine and noradrenaline respectively in restoring the responses of tissues from reserpine-treated animals to stimulation of the sympathetic nerves to the rabbit ileum, the guinea-pig vas deferens and the cat nictitating membrane and in restoring responses to tyramine of the cat blood pressure and nictitating membrane, and the rat blood pressure. The potency of alpha-methylnoradrenaline relative to noradrenaline ranged from one-half to one-ninth on various preparations. The results are discussed in relation to the antihypertensive action of alpha-methyldopa.
Topics: Animals; Antihypertensive Agents; Blood Pressure; Carotid Sinus; Cats; Deoxyepinephrine; Dihydroxyphenylalanine; Dogs; Dopamine; Guinea Pigs; Humans; Ileum; Lagomorpha; Male; Methyldopa; Nictitating Membrane; Nordefrin; Norepinephrine; Pharmacology; Pressoreceptors; Rabbits; Rats; Research; Reserpine; Spleen; Sympathetic Nervous System; Tyramine; Vas Deferens
PubMed: 14126060
DOI: 10.1111/j.1476-5381.1964.tb01545.x -
International Journal of Molecular... Oct 2023Antihypertensive therapy is an essential part of management of patients with preeclampsia (PE). Methyldopa (Dopegyt) and nifedipine (Cordaflex) are basic medications of...
Features and Comparative Characteristics of Fucosylated Glycans Expression in Endothelial Glycocalyx of Placental Terminal Villi in Patients with Preeclampsia Treated with Different Antihypertensive Regimens.
Antihypertensive therapy is an essential part of management of patients with preeclampsia (PE). Methyldopa (Dopegyt) and nifedipine (Cordaflex) are basic medications of therapy since they stabilize blood pressure without affecting the fetus. Their effect on the endothelium of placental vessels has not yet been studied. In this study, we analyzed the effect of antihypertensive therapy on the expression of fucosylated glycans in fetal capillaries of placental terminal villi in patients with early-onset PE (EOPE) and late-onset PE (LOPE), and determined correlation between their expression and mother's hemodynamic parameters, fetoplacental system, factors reflecting inflammatory response, and destructive processes in the endothelial glycocalyx (eGC). A total of 76 women were enrolled in the study: the comparison group consisted of 15 women with healthy pregnancy, and the main group comprised 61 women with early-onset and late-onset PE, who received one-component or two-component antihypertensive therapy. Hemodynamic status was assessed by daily blood pressure monitoring, dopplerometry of maternal placental and fetoplacental blood flows, and the levels of IL-18, IL-6, TNFα, galectin-3, endocan-1, syndecan-1, and hyaluronan in the blood of the mother. Expression of fucosylated glycans was assessed by staining placental sections with AAL, UEA-I, LTL lectins, and anti-Le MAbs. It was found that (i) expression patterns of fucosylated glycans in eGC capillaries of placental terminal villi in EOPE and LOPE are characterized by predominant expression of structures with a type 2 core and have a similar pattern of quantitative changes, which seems to be due to the impact of one-component and two-component antihypertensive therapy on their expression; (ii) correlation patterns indicate interrelated changes in the molecular composition of eGC fucoglycans and indicators reflecting changes in maternal hemodynamics, fetoplacental hemodynamics, and humoral factors associated with eGC damage. The presented study is the first to demonstrate the features of placental eGC in women with PE treated with antihypertensive therapy. This study also considers placental fucoglycans as a functional part of the eGC, which affects hemodynamics in the mother-placenta-fetus system.
Topics: Humans; Pregnancy; Female; Placenta; Pre-Eclampsia; Antihypertensive Agents; Glycocalyx; Methyldopa; Polysaccharides
PubMed: 37958597
DOI: 10.3390/ijms242115611 -
Functional Neurology 2012Long-term oral therapy with levodopa is associated with the development of motor fluctuations and dyskinesia in a large percentage of patients with Parkinson's disease... (Review)
Review
Long-term oral therapy with levodopa is associated with the development of motor fluctuations and dyskinesia in a large percentage of patients with Parkinson's disease (PD). Motor complications are associated with a number of non-motor symptoms and have a negative impact on disability and quality of life. There are three therapeutic options available for the management of patients at this advanced stage: high frequency deep brain stimulation, continuous subcutaneous infusion of apomorphine, and continuous intestinal infusion of levodopa/carbidopa. On the basis of published data and in consideration of the risk-benefit profile of current therapeutic strategies, we here propose an algorithm to help clinicians select the most suitable treatment option for patients with advanced PD.
Topics: Aged; Antiparkinson Agents; Carbidopa; Decision Making; Humans; Infusions, Parenteral; Intubation, Gastrointestinal; Levodopa; Parkinson Disease; Patient Selection
PubMed: 23402675
DOI: No ID Found -
CMAJ : Canadian Medical Association... Jan 1986
Topics: Aged; Bipolar Disorder; Cognition Disorders; Confusion; Drug Interactions; Female; Humans; Hypertension; Lithium; Lithium Carbonate; Methyldopa; Tremor
PubMed: 3080214
DOI: No ID Found -
Advances in Therapy Jun 2021Levodopa/carbidopa intestinal gel (LCIG; carbidopa/levodopa enteral suspension) has been widely used and studied for the treatment of motor fluctuations in... (Review)
Review
INTRODUCTION
Levodopa/carbidopa intestinal gel (LCIG; carbidopa/levodopa enteral suspension) has been widely used and studied for the treatment of motor fluctuations in levodopa-responsive patients with advanced Parkinson's disease (PD) when other treatments have not given satisfactory results. Reduction in 'off'-time is a common primary endpoint in studies of LCIG, and it is important to assess the durability of this response. This systematic literature review was conducted to qualitatively summarise the data on the long-term effects of LCIG therapy on 'off'-time.
METHODS
Studies were identified by searching PubMed, EMBASE and Ovid on 30 September 2019. Studies were included if they reported on patients with PD, had a sample size of ≥ 10, LCIG was an active intervention and 'off'-time was reported for ≥ 12 months after initiation of LCIG treatment. Randomised clinical trials, retrospective and prospective observational studies, and other interventional studies were included for selection. Data were collected on: 'off'-time (at pre-specified time periods and the end of follow-up), study characteristics, Unified Parkinson's Disease Rating Scale (UPDRS) II, III and IV total scores, dyskinesia duration, quality of life scores, non-motor symptoms and safety outcomes.
RESULTS
Twenty-seven studies were included in this review. The improvement in 'off'-time observed shortly after initiating LCIG was maintained and was statistically significant at the end of follow-up in 24 of 27 studies. 'Off'-time was reduced from baseline to end of follow-up by 38-84% and was accompanied by a clinically meaningful improvement in quality of life. Stratified analysis of 'off'-time demonstrated mean relative reductions of 47-82% at 3-6 months and up to 83% reduction at 3-5 years of follow-up. Most studies reported significant improvements in activities of daily living and motor complications. Most frequent adverse events were related to the procedure or the device.
CONCLUSION
In one of the largest qualitative syntheses of published LCIG studies, LCIG treatment was observed to provide a durable effect in reducing 'off'-time.
INFOGRAPHIC
Video Abstract.
Topics: Activities of Daily Living; Antiparkinson Agents; Carbidopa; Drug Combinations; Gels; Humans; Levodopa; Observational Studies as Topic; Parkinson Disease; Quality of Life; Retrospective Studies
PubMed: 34018146
DOI: 10.1007/s12325-021-01747-1