101
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Affiliation(s)
- Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Michel Burnier
- Service of Nephrology and Hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hypertension Research Foundation, St-Légier, Switzerland
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102
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Zhang P, Jin MY, Song XY, Wang Z, Jiang YH, Yang CH. Comparison of the antihypertensive efficacy of morning and bedtime dosing on reducing morning blood pressure surge: A protocol for systemic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24127. [PMID: 33592863 PMCID: PMC7870267 DOI: 10.1097/md.0000000000024127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It is well known that morning blood pressure surge increases the risk of myocardial events in the first several hours post-awakening. This meta-analysis was performed to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge. METHODS Articles in 4 databases about clinical trials of ingestion time of antihypertensive drugs were searched and performed a meta-analysis to evaluate the different effects on morning blood pressure and absolute blood pressure (BP) reduction from baseline of between bedtime administration (experimental group) and morning awaking administration (control group). RESULTS The aim of this study is to compare the antihypertensive efficacy of morning and bedtime dosing on decreasing morning blood pressure surge. CONCLUSIONS The bedtime will provide evidence support for clinicians and patients for reducing morning blood pressure surge. ETHICS AND DISSEMINATION This study does not require ethical approval.
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Affiliation(s)
- Peng Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250355
| | - Mei-Ying Jin
- Yanzhou District Hospital of Traditional Chinese Medicine, Jining 272100
| | - Xu-Yu Song
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250355
| | - Zhao Wang
- Shandong College of Traditional Chinese Medicine
| | - Yue-Hua Jiang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
| | - Chuan-Hua Yang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China
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103
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Dzudie A, Fomo MF, Teuwafeu DG, Nkoke C, Kenfack A, Bonghaseh DT, Ekaney D, Tantchou A, Tantchou C, Ngoa LSE, Kengne AP, Choukem SP. Prescription of pharmacotherapy and blood pressure control among hypertensive outpatients in two semi-urban hospitals in Cameroon: a cross-sectional study. Pan Afr Med J 2021; 37:122. [PMID: 33425155 PMCID: PMC7755361 DOI: 10.11604/pamj.2020.37.122.21156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/02/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction several international guidelines are available on drug treatment for hypertension, but the control of hypertension remains very poor in sub-Saharan Africa (SSA). We investigated the commonly prescribed antihypertensive drugs and their association with blood pressure (BP) control in adult Cameroonians. Methods we consecutively recruited hypertensive outpatients attending the Buea and Limbe Regional Hospitals (southwest region of Cameroon). Controlled BP was defined as BP < 140/90mmHg in hypertensive patients aged 60 years or younger, diabetics or patients with chronic kidney disease or a BP < 150/90mmHg in non-diabetic hypertensive patients older than 60 years of age (JNC8). Results of the 408 participants included (mean age 61.1 years), 67% were female. The median duration of hypertension was 6 years and the median duration of the current treatment was 22 weeks. Commonly prescribed antihypertensives were calcium channel blockers (CCB, 35.1%), thiazide/thiazide-like diuretics (TD/TLD, 26.1%) and angiotensin-converting enzyme inhibitors (ACEI, 19.5%). The median monthly cost of antihypertensive was 10279.6 CFA (approximately equal to US$ 172). Seventy percent (70%) of participants were receiving at least 2 drugs, with ACEI+TD/TLD, CCB+TD/TLD, and ACEI+CCB+TD/TLD being the most frequent combination. The rate of BP control was 52% overall, and 60% in participants on monotherapy. Conclusion CCBs were the most prescribed single antihypertensive drugs in this setting while ACEI+TD/TLD was the most common combination. About half of patients were at target BP control levels Improving availability and affordability of these medications may improve hypertension management and control.
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Affiliation(s)
- Anastase Dzudie
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala, Cameroon
| | - Messaline Fodom Fomo
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon
| | | | - Clovis Nkoke
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine, Buea Regional Hospital, Buea, Cameroon
| | - Azabji Kenfack
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Divine Tim Bonghaseh
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Baptist Hospital Mutengene, Mutengene, Cameroon
| | - Domin Ekaney
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Sub-divisional Hospital Batoke, Limbe, Cameroon
| | | | | | - Laurent Serges Etoundi Ngoa
- Department of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Andre Pascal Kengne
- Clinical Research Education Networking and Consultancy (CRENC), Douala, Cameroon.,Non-communicable Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simeon Pierre Choukem
- Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala, Cameroon.,Health and Human Development (2HD) Research Network, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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104
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Soška V. Early and concurrent therapy of dyslipidemia and hypertension: when to start it and how to maintain patient´s good and long-term adherence? Vnitr Lek 2021; 67:37-40. [PMID: 33752389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Treatment of dyslipidemia and hypertension is a key step for reducing the risk of atherosclerotic cardiovascular disease. Dyslipidemia and hypertension often occur in one patient at the same time, so both of these risk factors need to be addressed at the same time. It is better to start therapy before the patient is at high risk of a fatal cardiovascular event. To improve the patients prognosis, it is important not only to achieve the target LDL-cholesterol value and the optimal blood pressure value, but it is also very important (and often more difficult) to maintain the patients good and long-term adherence to established combination pharmacotherapy. For better adherence to long-term therapy also contributes reduction the number of tablets, which can be achieved through the use of a fixed combination of statins and antihypertensive agents.
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105
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Cinar FI, Mumcu Ş, Kiliç B, Polat Ü, Bal Özkaptan B. Assessment of Medication Adherence and Related Factors in Hypertensive Patients: The Role of Beliefs About Medicines. Clin Nurs Res 2020; 30:985-993. [PMID: 33327775 DOI: 10.1177/1054773820981381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Low medication adherence is one of the leading causes that affect the achievement of target levels for hypertension. Identifying modifiable factors associated with low adherence is crucial. This study aims to assess medication adherence and the role of beliefs about medicines on medication adherence among hypertensive patients.This cross-sectional study was conducted with 200 hypertension patients.Data were collected using the Morisky-Green-Levine Medication Adherence Scale, and the Beliefs about Medicines Questionnaire [BMQ-Turkish Translation (BMQ-T)]. It was found that the BMQ-T subscales of Specific Concern (β = 0.358, p = .027) and General Overuse (β = 0.552, p = .011) had an independent predictor effect on medication adherence scores. In this study, the patients who thought that drugs were overused and had concerns about this were seen to be less adherent with the medication. With regard to patients who use antihypertensive drugs but have uncontrolled blood pressure, their beliefs about drugs should not be ignored when evaluating adherence with drug therapy.
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Affiliation(s)
- Fatma Ilknur Cinar
- University of Health Sciences Turkey, Gülhane Faculty of Nursing, Ankara, Turkey
| | - Şule Mumcu
- Bingol University, Faculty of Health Sciences, Bingol, Turkey
| | - Betülay Kiliç
- University of Health Sciences Turkey, Gülhane Faculty of Nursing, Ankara, Turkey
| | - Ülkü Polat
- Gazi University, Faculty of Health Sciences, Department of Nursing, Ankara, Turkey
| | - Bilge Bal Özkaptan
- Sinop University, Faculty of Health Sciences, Department of Nursing, Sinop, Turkey
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106
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Qadi O, Lufumpa N, Adderley N, Bem D, Marshall T, Kokab F. Patients' and health professionals' attitudes and perceptions towards the initiation of preventive drugs for primary prevention of cardiovascular disease: a systematic review of qualitative studies. BJGP Open 2020; 4:bjgpopen20X101087. [PMID: 33082157 DOI: 10.3399/bjgpopen20X101087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/06/2020] [Indexed: 01/13/2023] Open
Abstract
Background Statins and antihypertensive agents are recommended for primary prevention of cardiovascular disease (CVD), but they are not always prescribed to eligible patients. Design & setting A systematic review of qualitative studies. Aim To explore health professionals’ and patients’ attitudes towards cardiovascular preventive drugs. Method MEDLINE, Embase, PsychINFO, CINAHL, ASSIA, HMIC, Conference Proceedings Citation Index, and Open Grey were searched for studies of qualitative design without restrictions on date or language. Two reviewers performed study selection, data extraction, quality assessment, and thematic synthesis. Results In total, 2585 titles and abstracts were screened, yielding 27 studies, of which five met eligibility criteria on full text assessment. These included 62 patients and 47 health professionals. Five themes emerged about patient attitudes: questioning preventive drugs; perceived benefit and risks, such as improving quality of life; patient preferences; trust in health professional judgement; and family, friends, and media influences. Five themes emerged about health professional attitudes: addressing patient concerns and information; duty as a health professional to prescribe; uncertainty about preventive drug prescribing; recognising consequences of prescribing, such as unnecessary medicalisation; and personalised treatment. Conclusion The attitudes of patients and health professionals regarding drug initiation for primary prevention reflect the complexity of the patient–health professional encounter in primary practice. For prescribing to be more adherent to guidelines, research should further investigate the patient–health professional relationship and the appropriate communication methods required when discussing drug initiation, specifically for primary prevention.
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107
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Borowicz-Reutt KK, Czuczwar SJ, Rusek M. Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy. Expert Rev Clin Pharmacol 2020; 13:1329-1345. [PMID: 33305639 DOI: 10.1080/17512433.2020.1850258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Comorbidities of epilepsy may significantly interfere with its treatment as diseases in the general population are also encountered in epilepsy patients and some of them even more frequently (for instance, depression, anxiety, or heart disease). Obviously, some drugs approved for other than epilepsy indications can modify the anticonvulsant activity of antiepileptics. Areas covered: This review highlights the drug-drug interactions between antiepileptics and aminophylline, some antidepressant, antiarrhythmic (class I-IV), selected antihypertensive drugs and non-barbiturate injectable anesthetics (ketamine, propofol, etomidate, and alphaxalone). The data were reviewed mainly from experimental models of seizures. Whenever possible, clinical data were provided. PUBMED data base was the main search source.Expert opinion: Aminophylline generally reduced the protective activity of antiepileptics, which, to a certain degree, was consistent with scarce clinical data on methylxanthine derivatives and worse seizure control. The only antiarrhythmic with this profile of action was mexiletine when co-administered with VPA. Among antidepressants and non-barbiturate injectable anesthetics, trazodone, mianserin and etomidate or alphaxalone, respectively, negatively affected the anticonvulsant action of some antiepileptic drugs. Clinical data indicate that only amoxapine, bupropion, clomipramine and maprotiline should be used with caution. Possibly, drugs reducing the anticonvulsant potential of antiepileptics should be avoided in epilepsy patients.
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Affiliation(s)
- Kinga K Borowicz-Reutt
- Independent Unit of Experimental Neuropathophysiology, Department of Pathophysiology, Medical University of Lublin , Lublin, Poland
| | | | - Marta Rusek
- Department of Pathophysiology, Medical University of Lublin , Lublin, Poland.,Department of Dermatology, Venereology and Pediatric Dermatology, Laboratory for Immunology of Skin Diseases, Medical University of Lublin , Lublin, Poland
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108
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Alfian SD, van Boven JFM, Abdulah R, Sukandar H, Denig P, Hak E. Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: A cluster randomised controlled trial. Br J Clin Pharmacol 2020; 87:2032-2042. [PMID: 33085801 PMCID: PMC8056734 DOI: 10.1111/bcp.14610] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 01/31/2023] Open
Abstract
Aim To assess the effects of a targeted and tailored pharmacist‐led intervention among patients with type 2 diabetes (T2DM) who are nonadherent to antihypertensive drugs. Methods A cluster‐randomised controlled trial was conducted in 10 community health centres (CHCs) in Indonesia among T2DM patients aged ≥18 years who reported nonadherence to antihypertensive drugs according to the Medication Adherence Report Scale (MARS‐5). Patients in CHCs randomised to the intervention group received a tailored intervention based on their adherence barriers (eg, forgetfulness, lack of knowledge, lack of motivation and/or other drug‐related problems) using a simple question‐based flowchart at baseline and 1‐month follow‐up. Patients in control CHCs received usual care. Primary outcome was the between‐group difference in change in MARS‐5 score from baseline to 3‐month follow‐up. Secondary outcomes included changes in patients' blood pressure and their medication beliefs. Differences in difference in primary and secondary outcomes between groups were assessed using general linear models. Results In total, 201 patients were screened for eligibility, 113 met the inclusion criteria and participated, and 89 (79%) patients had complete follow‐up. Forgetfulness (42%) and lack of knowledge (18%) were the most common adherence barriers identified at baseline. The intervention improved medication adherence by 4.62 points on the MARS‐5 scale (95% CI 0.93 to 8.34, P value = 0.008). There were no significant changes in blood pressure levels and beliefs about antihypertensive drugs. Conclusion A tailored low‐cost pharmacist‐led intervention aimed at nonadherent T2DM patients resulted in an improvement in medication adherence to antihypertensive drugs. There were no significant changes in secondary outcomes.
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Affiliation(s)
- Sofa D Alfian
- University of Groningen, Groningen Research Institute of Pharmacy, Unit Pharmaco-Therapy, -Epidemiology & -Economics, Groningen, the Netherlands.,Universitas Padjadjaran, Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Jatinangor, Indonesia.,Universitas Padjadjaran, Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Jatinangor, Indonesia
| | - Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
| | - Rizky Abdulah
- Universitas Padjadjaran, Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Jatinangor, Indonesia.,Universitas Padjadjaran, Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Jatinangor, Indonesia
| | - Hadyana Sukandar
- Universitas Padjadjaran, Faculty of Medicine, Department of Public Health, Bandung, Indonesia
| | - Petra Denig
- University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, Unit Pharmaco-Therapy, -Epidemiology & -Economics, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
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109
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Signorini L, Zaza G, Gambaro G. The challenge of early glomerular filtration rate decline in response to antihypertensive treatment and chronic kidney disease outcomes. Nephrol Dial Transplant 2020; 37:222-229. [PMID: 33155053 DOI: 10.1093/ndt/gfaa171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Indexed: 11/14/2022] Open
Abstract
Hypertension and chronic kidney disease (CKD) are closely linked pathological processes. Combating high blood pressure (BP) is an essential part of preventing CKD progression and reducing cardiovascular (CV) risk. Data from recent randomized controlled trials on patients at high CV risk showed the beneficial effects of intensive action to meet BP targets on mortality related to CV disease. The impact of meeting such targets on renal function is still unclear, however, particularly for patients with CKD. This issue has been the object of several post hoc analyses because lowering BP definitely has a nephroprotective role, but the early decline in glomerular filtration rate (GFR) associated with antihypertensive therapies and strict BP targets is still a concern in nephrology clinical practice. The present review discusses the results of studies on this topic, focusing specifically on the clinical significance of early GFR decline in response to treatment with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, or to different BP targets, in terms of renal and CV outcomes, and how this tips the balance towards continuing or discontinuing antihypertensive therapy.
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Affiliation(s)
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italia
| | - Giovanni Gambaro
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italia
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110
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Ssentongo AE, Ssentongo P, Heilbrunn ES, Lekoubou A, Du P, Liao D, Oh JS, Chinchilli VM. Renin-angiotensin-aldosterone system inhibitors and the risk of mortality in patients with hypertension hospitalised for COVID-19: systematic review and meta-analysis. Open Heart 2020; 7:e001353. [PMID: 33154144 PMCID: PMC7646321 DOI: 10.1136/openhrt-2020-001353] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/05/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear. We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension. METHODS PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and medrxiv.org were searched from 1 January 2020 to 1 September 2020. Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified. RESULTS Fourteen studies were included in the systematic review (n=73,073 patients with COVID-19; mean age 61 years; 53% male). Overall, the between-study heterogeneity was high (I2=80%, p<0.01). Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0.65, 95% CI 0.45 to 0.94). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as 'moderate' quality. CONCLUSIONS In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension. Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension. PROSPERO REGISTRATION NUMBER The present study has been registered with PROSPERO (registration ID: CRD 42020187963).
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Affiliation(s)
- Anna E Ssentongo
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Center for Neural Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Emily S Heilbrunn
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Alain Lekoubou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - John S Oh
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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111
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Affiliation(s)
- Genevieve Gabb
- Acute and Urgent Care, Royal Adelaide Hospital.,Division of Medicine, Cardiac and Critical Care, Flinders Medical Centre, Bedford Park, SA.,Discipline of Medicine, School of Medicine, Faculty of Health Science, University of Adelaide.,College of Medicine and Public Health, Flinders University, Bedford Park, SA
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112
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Hu YY, Fang QQ, Wang XF, Zhao WY, Zheng B, Zhang DD, Tan WQ. Angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor blocker: Potential agents to reduce post-surgical scar formation in humans. Basic Clin Pharmacol Toxicol 2020; 127:488-494. [PMID: 32564469 DOI: 10.1111/bcpt.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/01/2022]
Abstract
Studies on the effectiveness and mechanisms of reducing scar formation by interfering with the renin-angiotensin-aldosterone-system (RAAS) have been demonstrated in animals, but not in humans due to the lack of clinical support. Our aim was to investigate whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II type 1 receptor blocker (ARB) could inhibit scar formation in humans. Thus, an observational and hypothesis-generating study using a designed questionnaire was carried out. A total of 347 patients with postoperative scars secondary to thyroid tumours were enrolled. They were divided into four groups: ACEI group, ARB group, other antihypertensive drugs control group and blank control group according to the administration of antihypertensive drugs. The width of scar was measured, and the Scar Cosmesis Assessment and Rating (SCAR) Scale was filled out. Results showed that patients of ACEI group (mean scar width 1.60 mm) and ARB group (mean scar width 1.57 mm) formed smaller scars than those of other antihypertensive drugs control group (mean scar width 2.09 mm) and blank control group (mean scar width 2.0 mm). Oral administration of ACEI and ARB may be associated with better post-surgical scar formation in humans. These two kinds of antihypertensive drugs may be active components of anti-scar medicine.
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Affiliation(s)
- Yan-Yan Hu
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing-Qing Fang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Feng Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wan-Yi Zhao
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Zheng
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ding-Ding Zhang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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113
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Jorge-Galarza E, Martínez-Sánchez FD, Javier-Montiel CI, Medina-Urrutia AX, Posadas-Romero C, González-Salazar MC, Osorio-Alonso H, Arellano-Buendía AS, Juárez-Rojas JG. Control of blood pressure levels in patients with premature coronary artery disease: Results from the Genetics of Atherosclerotic Disease study. J Clin Hypertens (Greenwich) 2020; 22:1253-1262. [PMID: 32644257 DOI: 10.1111/jch.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/11/2020] [Accepted: 05/29/2020] [Indexed: 01/19/2023]
Abstract
High blood pressure (BP) is the major cardiovascular-risk factor for coronary artery disease (CAD), principally in young patients who have an important and increasing socioeconomic burden. Despite the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), recommended BP target <140/90 mm Hg for patients with stable CAD, in 2017 the American College of Cardiology and the American Heart Association (ACC/AHA) updated BP target to <130/80 mm Hg. We aimed to analyze the prevalence of BP control in patients with premature CAD using both criteria. In addition, antihypertensive therapy, lifestyle, clinical, and sociodemographic characteristics of the patients were evaluated in order to identify factors associated with the achievement of BP targets. The present study included 1206 patients with CAD diagnosed before 55 and 65 years old in men and women, respectively. Sociodemographic, clinical, and biochemical data were collected. The results indicate that 85.6% and 77.5% of subjects with premature CAD achieved JNC-7 non-strict and ACC/AHA strict BP target, respectively. Consistently, number of antihypertensive drugs and hypertension duration >10 years were inversely associated with BP targets, whereas total physical activity and smoking were directly associated with BP targets, regardless of BP criteria. Considering that age, gender, and hypertension duration are non-modifiable cardiovascular-risk factors, our results highlight the need for more effective strategies focused on increase physical activity and smoking cessation in young patients with CAD. These healthier lifestyles changes should favor the BP target achievement and reduce the socioeconomic and clinical burden of premature CAD.
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Affiliation(s)
- Esteban Jorge-Galarza
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Cesar I Javier-Montiel
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Aida X Medina-Urrutia
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Carlos Posadas-Romero
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - María C González-Salazar
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Horacio Osorio-Alonso
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Abraham S Arellano-Buendía
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan G Juárez-Rojas
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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114
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Zaccara G, Lattanzi S, Cincotta M, Russo E. Drug treatments in patients with cardiac diseases and epilepsy. Acta Neurol Scand 2020; 142:37-49. [PMID: 32259277 DOI: 10.1111/ane.13249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/06/2020] [Accepted: 03/29/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Comorbidity between epilepsy and heart diseases is frequent. METHODS All drugs classified within the group of drugs for cardiovascular system according to the Anatomical Therapeutic Chemical (ATC) classification system were reviewed for their effects on seizures or epilepsy. RESULTS Several agents showed antiseizure properties in animal models of seizures and/or in patients with epilepsy and only few were proconvulsant. Drugs with anticonvulsant effects include mecamylamine and guanfacine (antihypertensive drugs), indapamide, amiloride, furosemide and bumetanide (diuretics), fasudil (peripheral vasodilator), bioflavonoids (vasoprotective drug), propranolol (beta blocking agent), isradipine, nimodipine, verapamil and diltiazem (calcium channel blockers: CCBs), fosinopril and zofenopril (agents acting on the renin-angiotensin system), several statins, and fenofibrate (lipid-modifying agents). Drugs with proconvulsant properties in experimental models or in patients include reserpine, buflomedil, naftidrofuryl, and clonidine and propranolol at high doses. Drug-drug interactions (DDI) between antiseizure medications (ASMs) and drugs for cardiovascular system were also searched in two leading publicly accessible drug compendia. The most important DDIs occur between enzyme-inducing (EI) ASMs and ivabradine, ranolazine, macitenan and between EI-ASMs and the CCBs felodipine, nicardipine, nisoldipine, and verapamil. Simvastatin and atorvastatin are the lipid-modifying agents with more DDIs with EI-ASMs. Several pharmacodynamic interactions have been also documented. DISCUSSION AND CONCLUSIONS Available data show that the treatment of patients with epilepsy and vascular comorbidities is challenging and requires the appropriate knowledge of pharmacological properties of drugs and drug interactions.
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Affiliation(s)
| | - Simona Lattanzi
- Neurological Clinic Department of Experimental and Clinical Medicine Marche Polytechnic University Ancona Italy
| | - Massimo Cincotta
- Unit of Neurology of Florence Central Tuscany Local Health Authority Firenze Italy
| | - Emilio Russo
- Science of Health Department School of Medicine University “Magna Graecia” of Catanzaro Catanzaro Italy
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115
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Ibrahim AE, Elmansi H, Belal F. Solvent-free mixed micellar mobile phases: An advanced green chemistry approach for reversed-phase HPLC determination of some antihypertensive drugs. J Sep Sci 2020; 43:3224-3232. [PMID: 32510825 DOI: 10.1002/jssc.202000429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 12/23/2022]
Abstract
Minimizing the amount of organic solvents without loss in chromatographic performance has been an important step toward greening analytical methodologies. Mobile-phase composition is the key for maintaining separation efficiency in liquid chromatography while decreasing the procedure hazardousness. If sodium dodecyl sulfate is mixed with Brij-35 in the mobile phase, they could be used as a green alternative for using organic modifiers. In this research, the effect of changing the relative amounts of both surfactants was studied on the chromatographic performance and separation efficiency of ten antihypertensive drugs belonging to different categories. The use of surfactants has many advantages including low cost and toxicity, safe environmental disposal, unique selectivity besides high solubilization capabilities. The optimum separation was maintained using a mobile phase (0.01 M Brij-35, 0.08 M sodium dodecyl sulfate and 0.01 M sodium dihydrogen phosphate/pH 5) on reversed-phase C18 core-shell column at flow rate 1.5 mL/min and temperature 30°C. The method was successfully applied for the determination of the drugs in various marketed dosage forms. International Conference of Harmonization guidelines were followed to validate the developed method. Additionally, the method was verified on the Green Analytical Procedure Index in regards to the greenness and found to be an excellent green alternative method.
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Affiliation(s)
- Adel Ehab Ibrahim
- Faculty of Pharmacy, Pharmaceutical Analytical Chemistry Department, Port-Said University, Port Fouad City, Egypt
| | - Heba Elmansi
- Faculty of Pharmacy, Pharmaceutical Analytical Chemistry Department, Mansoura University, Dakahlia Governorate, Egypt
| | - Fathalla Belal
- Faculty of Pharmacy, Pharmaceutical Analytical Chemistry Department, Mansoura University, Dakahlia Governorate, Egypt
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116
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Tokareva AS, Borovkova NY. [Blood pressure variability in hemodialysis patients: prognostic significance and treatment possibilities]. TERAPEVT ARKH 2020; 92:91-97. [PMID: 32598705 DOI: 10.26442/00403660.2020.04.000534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/22/2022]
Abstract
A present review is devoted to the current state of the problem of blood pressure variability (BPV) in hemodialysis patients. The BPV classification and clinical significance of BPV metrics are discussed. The results of cohort and randomized studies on the high BPV influence on outcomes in hemodialysis patients, as well as on the possibilities of antihypertensive drugs in the treatment of high BPV in dialysis patients, are presented.
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117
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Peeters LEJ, Feyz L, Boersma E, Daemen J, van Gelder T, Koch BCP, Versmissen J. Clinical Applicability of Monitoring Antihypertensive Drug Levels in Blood. Hypertension 2020; 76:80-86. [PMID: 32418497 DOI: 10.1161/hypertensionaha.120.15038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dried blood spot (DBS) analysis is a novel analytical method for therapeutic drug monitoring to identify nonadherence to antihypertensive drugs. This study was conducted to evaluate the clinical applicability of measuring drug concentrations of 8 antihypertensive drugs, using DBS and venipuncture. Furthermore, this study aimed to provide more insight into the between-patient variability in drug concentrations. False-negative values from DBS compared with a venipuncture were determined to assess drug adherence. A generalized estimating equation was used to estimate the model parameters, including sex, dose, age, weight, and the time interval, between drug intake and sampling, on the Cplasma (drug concentration in plasma). No false-negative values were found when measuring nonadherence using DBS compared with venipuncture. A high variability in Cplasma between patients was observed, especially at peak concentrations with a fold change reaching from 2.3 to 35.2. The time of intake was significantly related to the height of the Cplasma in 7 of the 8 measured drugs with a P<0.05, but the influence of dose, weight, age, and sex on drug levels differed largely between the measured drugs. DBS is a reliable and convenient method to assess nonadherence to antihypertensive drugs in clinical practice. The Cplasma of the 8 antihypertensive drugs in this study show a large interindividual difference, and therefore, low plasma concentrations do not necessarily mean nonadherence. Nonadherence can only be confirmed if drug levels are undetectable, that is, values below the lower limit of detection.
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Affiliation(s)
- Laura E J Peeters
- From the Department of Hospital Pharmacy (L.E.J.P., T.v.G., B.C.P.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Internal Medicine (L.E.J.P., T.v.G., J.V.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Lida Feyz
- Department of Cardiology (L.F., E.B., J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology (L.F., E.B., J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology (L.F., E.B., J.D.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Teun van Gelder
- From the Department of Hospital Pharmacy (L.E.J.P., T.v.G., B.C.P.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Internal Medicine (L.E.J.P., T.v.G., J.V.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Birgit C P Koch
- From the Department of Hospital Pharmacy (L.E.J.P., T.v.G., B.C.P.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jorie Versmissen
- Department of Internal Medicine (L.E.J.P., T.v.G., J.V.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
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118
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Aronow WS. Treatment of resistant hypertension. Future Cardiol 2020; 16:353-356. [PMID: 32316771 DOI: 10.2217/fca-2020-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Wilbert S Aronow
- Departments of Cardiology and Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, USA
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119
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Hammoudi-Bendib N, Manamani L, Ouabdesselam S, Ouamer DS, Ghemri S, Courouve L, Cherif A, Mahi L, Benkhedda S. Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Arterial Hypertension in Current Medical Practice in Algeria. Curr Hypertens Rev 2020; 17:75-82. [PMID: 32208121 DOI: 10.2174/1573402116666200324144223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There are limited data on the management of hypertension (HT) in Algeria. The aim of this study was to assess, in current medical practice, the use and benefits of ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of HT. METHODS A prospective, observational, multicenter study was performed in 2017. Patients aged ≥ 18 years with suspected or treated HT were included. A 24-hour ABPM was performed at baseline in all patients. Therapeutic decision was taken by the physician according to ABPM results and patients were then followed up to 6 weeks. RESULTS The analysis included 1027 patients (mean age, 51.0 years; women, 61.6%) with treated HT (37.3%) or suspected HT (62.7%). Major cardiovascular risk factors were diabetes (15.7%) and lipid disorders (7.2%). ABPM was pathological in 55.1% of patients on antihypertensive treatment and in 60.8% of patients with suspected HT. A therapeutic adjustment or a treatment switch was performed after pathological ABPM in 37.4% of patients already on antihypertensive treatment and an antihypertensive therapy was initiated in 54.9% of patients with initially suspected HT. CONCLUSION This study is the first evaluation of the usefulness of ABPM for the management of HT in Algeria. Our results emphasize that ABPM is a highly valuable method for avoiding the whitecoat effect and for detecting patients who are insufficiently treated with antihypertensive drugs.
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Affiliation(s)
| | | | - Souhila Ouabdesselam
- Cardiology Division, Mustapha Hospital Cardiology Oncology Collaborative Research Group (COCRG), Benyoucef Benkhedda University, Algiers, Algeria
| | - Dalila S Ouamer
- Cardiology Division, Mustapha Hospital Cardiology Oncology Collaborative Research Group (COCRG), Benyoucef Benkhedda University, Algiers, Algeria
| | | | | | | | | | - Salim Benkhedda
- Cardiology Division, Mustapha Hospital Cardiology Oncology Collaborative Research Group (COCRG), Benyoucef Benkhedda University, Algiers, Algeria
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120
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Tamargo J. Selecting emergency therapy for patients with pre-eclampsia. Expert Opin Pharmacother 2020; 21:1119-1122. [PMID: 32133877 DOI: 10.1080/14656566.2020.1727444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Instituto De Investigación Sanitaria Gregorio Marañón, Universidad Complutense , Madrid, Spain
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121
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Liu W, Yan T, Chen K, Yang L, Benet LZ, Zhai S. Predicting Interactions between Rifampin and Antihypertensive Drugs Using the Biopharmaceutics Drug Disposition Classification System. Pharmacotherapy 2020; 40:274-290. [PMID: 32100890 DOI: 10.1002/phar.2380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
STUDY OBJECTIVE Lack of blood pressure control is often seen in hypertensive patients concomitantly taking antituberculosis medications due to the complex drug-drug interactions between rifampin and antihypertensive drugs. Therefore, it is of clinical importance to understand the underlying mechanisms of these interactions to help formulate recommendations on the use of antihypertensive drugs in patients taking these medications concomitantly. Our objective was to assess the reliability of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to predict potential interactions between rifampin and antihypertensive drugs and thus provide recommendations on the choice of antihypertensive drugs in patients receiving rifampin. DESIGN Evidence-based in vitro and in vivo predictions of drug-drug interactions. MEASUREMENTS AND MAIN RESULTS We systematically evaluated interactions between rifampin and antihypertensive drugs using the theory of the BDDCS, taking into consideration the role of drug transporters and metabolic enzymes involved in these interactions. We provide recommendations on the selection of antihypertensive drugs for patients with tuberculosis. Antihypertensive drugs approved by the U.S. Food and Drug Administration and the China National Medical Products Administration were included in this study. The drugs were classified into four categories under the BDDCS classification. Detailed information on cytochrome P450 (CYP) enzymes and drug transporters for each antihypertensive drug was searched in PubMed and other electronic databases. This information was combined with the effects of rifampin on CYP enzymes and drug transporters, and the direction and relative extent of the potential interactions between rifampin and antihypertensive drugs were predicted. Recommendations were then made using the theory of BDDCS. A thorough systematic literature review was performed, and data from all published human studies and case reports were summarized for the validation of our predictions. Interventional and observational studies published in PubMed and two Chinese databases (CNKI and WanFang) through December 16, 2019, were included, and data were extracted for validation of the predictions. Using the BDDCS theory, class 3 active drugs were predicted to exhibit minimal interactions with rifampin. On reviewing case reports and pre-post studies, the predictions we made were found to be reliable. When antituberculosis medications that include rifampin are started in patients with hypertension, it is recommended that the use of calcium channel blockers and classes 1 and 2 β-blockers be avoided. Angiotensin-converting enzyme inhibitors, olmesartan, class 3 β-blockers, spironolactone, and hydrochlorothiazide would be preferable because clinically relevant interactions would not be expected. CONCLUSION Application of the BDDCS to predict interactions between rifampin and antihypertensive drugs for patients with both tuberculosis and hypertension was found to be reliable. It should be noted, however, that based on the CYP enzyme and drug transporter information we reviewed, the mechanisms of all of the interactions could not be elucidated, and the predictions are only based on theory. The real effects of rifampin on antihypertensive drugs need to be further observed. More studies in both animals and humans are needed in the future.
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Affiliation(s)
- Wei Liu
- Pharmacy Department, Peking University Third Hospital, Beijing, China
- Peking University, Therapeutic Drug Monitoring and Clinical Toxicology Center, Beijing, China
| | - Tingting Yan
- Pharmacy Department, Peking University Third Hospital, Beijing, China
| | - Ken Chen
- Pharmacy Department, Peking University Third Hospital, Beijing, China
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Li Yang
- Pharmacy Department, Peking University Third Hospital, Beijing, China
- Peking University, Therapeutic Drug Monitoring and Clinical Toxicology Center, Beijing, China
| | - Leslie Z Benet
- Pharmacy Department, Peking University Third Hospital, Beijing, China
- University of California, San Francisco, San Francisco, California
| | - Suodi Zhai
- Pharmacy Department, Peking University Third Hospital, Beijing, China
- Peking University, Therapeutic Drug Monitoring and Clinical Toxicology Center, Beijing, China
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Abstract
INTRODUCTION Hypertension is the most common co-morbidity in patients with chronic kidney disease (CKD), with prevalence gradually increasing across CKD Stages to the extent that about 90% of end-stage renal disease (ESRD) patients are hypertensives. Several factors contribute to blood pressure (BP) elevation and guide the therapeutic interventions that should be employed in these patients. AREAS COVERED This review summarizes the existing data for the management of hypertension, regarding optimal BP targets and the use of major antihypertensive classes in patients with CKD. EXPERT OPINION Management of hypertension in CKD requires both lowering BP levels and reducing proteinuria to minimize the risk of both CKD progression and cardiovascular disease. In this respect, aggressive control of office BP to levels <130/80 mmHg has long been proposed for patients with proteinuric nephropathies. Following evidence from recent studies that confirmed significant reductions in renal and cardiovascular outcomes with strict BP control, most, but not all, of international guidelines, suggest such BP goals for all hypertensive patients, including those with CKD. Use of renin-angiotensin system (RAS) blockers is the treatment of choice for patients with proteinuric nephropathies, while, in most patients with CKD, combination treatment with two, three, or more antihypertensive agents is often required to control BP.
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Affiliation(s)
- Charalampos Loutradis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
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123
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Espeche W, Salazar MR, Sabio R, Diaz A, Leiva Sisnieguez C, Olano D, Balbin E, Renna N, Grosse P, Flores RA, Lagos AC, Ferrer P, Poppe S, Risso Patron F, Sotnieczuk Stasiuk VD, Valentini E, Cardozo JR, Romano JR, Parodi R, Carbajal H. Adherence to antihypertensive drug treatment in Argentina: A multicenter study. J Clin Hypertens (Greenwich) 2020; 22:656-662. [PMID: 32065507 DOI: 10.1111/jch.13830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
Adherence to antihypertensive medication is an important challenge that doctors often face in the treatment of hypertension. Good adherence is crucial to prevent cardiovascular complications. In consequence, the present study aimed at determining the prevalence of adherence to antihypertensive treatment and identifying associated clinical variables. A multicenter cross-sectional study was conducted in 12 cities of Argentina. A systematic sampling was performed in order to select patients with hypertension and under pharmacological treatment for at least 6 months. Physicians took three BP measurements, and the level of adherence was assessed using the self-administered Morisky questionnaire (MMAS-8). Participants were classified into three levels of adherence: high adherence-MMAS score of 8; medium adherence-MMAS scores of 6 to <8; and low adherence-MMAS scores of <6. A total of 1111 individuals (62 ± 12 years old, women 49.4%) were included in the present analysis; 159 (14.3%), 329 (29.6%) and 623 (56.1%) patients had low, medium, and high adherence, respectively. The prevalence of controlled hypertension increased only in high adherent patients: 42.8%, 42.2%, and 64.5% for low, medium, and high adherence groups, respectively. Similarly, systolic BP was lower only in the high adherence group. High educational level (OR 3.47, 95% CI 2.68-4.49) and diuretic treatment (OR 0.64, 95% CI 0.47-0.88) were independent predictors of high adherence. In conclusion, more than a half of treated hypertensive patients had a high level of adherence. These patients had lower BP values and higher control levels. A high educational level predicts high adherence.
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Affiliation(s)
- Walter Espeche
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina.,Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Martin R Salazar
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina.,Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Rodrigo Sabio
- Servicio de Medicina Interna Hospital SAMIC de Alta Complejidad, ciudad de El Calafate, Argentina
| | - Alejandro Diaz
- CCT Instituto de Investigación en Ciencias de la Salud UNICEN, CCT-CONICET, Tandil, Buenos Ires, Argentina
| | - Carlos Leiva Sisnieguez
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina.,Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
| | - Daniel Olano
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Eduardo Balbin
- Unidad de Enfermedades Cardiometabólicas, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | | | - Pedro Grosse
- Centro privado de cardiología, Tucumán, Argentina
| | - Roberto A Flores
- Cátedra de Semiología Facultad de Ciencias Médicas, Universidad Nacional de Santiago del Estero, Santiago del Estero, Argentina
| | - Ana C Lagos
- Centro de Diagnóstico Cardiovascular, Concordia, Argentina
| | - Pablo Ferrer
- Hospital Fernandez, CABA, Buenos Aires, Argentina
| | - Silvia Poppe
- Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina
| | | | | | - Elina Valentini
- Servicio de Clínica Médica, Sanatorio de La Mujer, Rosario, Argentina
| | - Jose R Cardozo
- Hospital Justo Pereyra Aristóbulo del Valle, Misiones, Argentina
| | | | - Roberto Parodi
- Primera Cátedra de Clínica Médica y Terapéutica, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Horacio Carbajal
- Cátedra D Clínica Médica, Universidad Nacional de La Plata, Buenos Aires, Argentina
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124
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Widimský J. Arterial hypertension and COVID-19 infections: A brief commentary. Vnitr Lek 2020; 66:104-106. [PMID: 32972176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The issue of hypertension/antihypertensive treatment in patients with COVID-19 infection is discussed in the commentary.
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125
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Bourque G, Ilin JV, Ruzicka M, Davis AS, Hiremath S. The Prevalence of Nonadherence in Patients With Resistant Hypertension: A Systematic Review Protocol. Can J Kidney Health Dis 2019; 6:2054358119897196. [PMID: 31903192 PMCID: PMC6931137 DOI: 10.1177/2054358119897196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/03/2019] [Indexed: 01/22/2023] Open
Abstract
Background Resistant hypertension, usually defined as blood pressure remaining above goal despite the concurrent use of 3 or more antihypertensive agents of different classes, is common (about 10% prevalence) and known to be a risk factor for cardiovascular events. These patients also undergo more screening intensity for secondary hypertension. However, not all patients with apparent treatment-resistant hypertension have true resistant hypertension, with some of them being nonadherent to prescribed pharmacotherapy. The prevalence of nonadherence varies from about 5% to 80% in the published literature. However, the relative contributions of intentional and nonintentional nonadherence are not well described. Nonintentional nonadherence refers to occasional forgetfulness and/or carelessness and can sometimes be related to an inability to follow instructions, because of either cognitive or physical limitations. Intentional nonadherence refers to an active process in which a patient may choose to alter the prescribed medication regimen by discontinuing medications, skipping doses, or modifying doses or dosing intervals. Objective Our objective is to establish the overall prevalence of nonadherence in the apparent treatment-resistant hypertension population and evaluate the relative contributions of nonintentional and intentional nonadherence subtypes. Design We will conduct a systematic review and meta-analysis. Setting We will include observational studies and randomized controlled trials where adherence to antihypertensive medications is measured using a test of adherence, either direct or indirect. Patients We will include adult human participants aged 18 years or older with a diagnosis of resistant hypertension. Measurements Data extracted from individual studies will include title, first author, design, country, publication year, funding body, method of assessing adherence to antihypertensive medication, prevalence of medication nonadherence, definition of resistant hypertension, sample size, sex, mean age, and coexistent comorbidities. Methods A librarian will search the databases Medline, EMBASE, Cochrane, CINAHL, and Web of Science for studies meeting criteria for inclusion. Two reviewers will independently screen the titles and abstracts retrieved and assess the methodological quality of eligible full-text articles using the Cochrane Risk of Bias tool for clinical trials and the Newcastle-Ottawa Scale for observational studies. Summary estimates of prevalence will be generated using pooled analysis using the random-effects method. Subgroup analyses, sensitivity analyses, and evaluation of publication bias will also be performed. Results The outcomes of interest are the pooled prevalence of nonadherence to antihypertensive medication in apparent treatment-resistant hypertension and the prevalence of nonadherence based on different methods of assessing nonadherence (indirect vs direct), which will allow us to estimate the relative proportion of unintentional and intentional nonadherence subtypes in the overall phenomenon of medication nonadherence. Limitations Possible limitations of this study include the finding of severe heterogeneity, the limitations of the literature search, publication bias, and the lack of granular data in the published studies for a study-level meta-analysis. Conclusions This systematic review will provide a synthesis of current evidence on the prevalence of medication nonadherence in apparent treatment-resistant hypertension and on the relative contributions of nonintentional and intentional nonadherence subtypes. These findings will provide clinicians with a better understanding of the factors underlying treatment-resistant hypertension and will serve as a strong research base to guide future research on interventions to address medication nonadherence as well as the nonintentional and intentional subtypes. Trial registration This protocol has been registered with PROSPERO. We will add registration details once available.
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126
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Melin EO, Hillman M, Landin-Olsson M. Midnight salivary cortisol secretion associated with high systolic blood pressure in type 1 diabetes. Endocr Connect 2019; 8:1520-1528. [PMID: 31671407 PMCID: PMC6893315 DOI: 10.1530/ec-19-0407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To explore associations between high midnight salivary cortisol (MSC) secretion and high blood pressure (BP) in type 1 diabetes (T1D). METHODS Cross-sectional study of 196 adult patients with T1D (54% men). Associations between high MSC (≥9.3 nmol/L) and high systolic BP (>130 mmHg), and high diastolic BP (>80 mmHg) were explored for all patients, users and non-users of antihypertensive drugs (AHD). Adjustments were performed for age, sex, diabetes-related variables, p-creatinine, smoking, physical inactivity, depression and medication. RESULTS The prevalence of high MSC differed between patients with high and low systolic BP in all 196 patients: 39 vs 13% (P = 0.001); in 60 users of AHD: 37 vs 12% (P = 0.039), and in 136 non-users of AHD: 43 vs 13% (P = 0.012). Significant associations with high systolic BP were for all patients: physical inactivity (adjusted odds ratio (AOR) 6.5), high MSC (AOR 3.9), abdominal obesity (AOR 3.7), AHD (AOR 2.9), age (per year) (AOR 1.07), and p-creatinine (per µmol/L) (AOR 1.03); for 60 users of AHD: high MSC (AOR 4.1) and age (per year) (AOR 1.11); for 136 non-users of AHD: abdominal obesity (AOR 27.4), physical inactivity (AOR 14.7), male sex (AOR 9.0), smoking (AOR 7.9), and age (per year) (AOR 1.08). High MSC was not associated with high DBP. CONCLUSIONS In adult patients with T1D, high systolic BP was associated with physical inactivity, high MSC secretion, abdominal obesity, p-creatinine, age, and AHD, the latter indicating treatment failure.
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Affiliation(s)
- Eva Olga Melin
- Diabetes Research Laboratory, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Correspondence should be addressed to E O Melin:
| | - Magnus Hillman
- Diabetes Research Laboratory, Lund University, Lund, Sweden
| | - Mona Landin-Olsson
- Diabetes Research Laboratory, Lund University, Lund, Sweden
- Department of Endocrinology, Skane University Hospital, Lund, Sweden
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127
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Fernández-Garcés M, Haro G, Micó ML. Predisposing factors to nonfatal cardiovascular events in women with systemic lupus erythematosus. An observational, cross-sectional, multicenter study in Spain from the risk/systemic lupus erythematosus thematic network. Medicine (Baltimore) 2019; 98:e17489. [PMID: 31651851 PMCID: PMC6824671 DOI: 10.1097/md.0000000000017489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Very few studies have been published on cardiovascular morbidity in Spanish patients diagnosed with systemic lupus erythematosus (SLE). Moreover, knowledge of the predictive factors for the occurrence of nonfatal events in this group of patients is scarce.This was a multicenter, observational, cross-sectional study designed to ascertain the prevalence of nonfatal cardiovascular risk factors and cardiovascular events (CVEs) in 335 Spanish women diagnosed with SLE between 2003 and 2013.The average patient age was 36.0 years (range: 26.4-45.6); 35 patients (10.7%) experienced at least 1 CVE, which most frequently affected the brain, followed by the heart, and finally, the peripheral vasculature. Both the number of admissions because of SLE (95% confidence interval [CI] odds ratio [OR] = 1.024-1.27, P = .017) and the systemic lupus international collaborating clinics (SLICC) chronicity index score (95% CI OR = 1.479-2.400, P = .000) resulted in an increase in the OR of these patients presenting a CVE. Regarding the classic risk factors, only the interaction between hypertension (HT) and treatment with antihypertensive drugs influenced the presence of CVEs (95% CI OR = 2.165-10.377, P = .000). The presence of a family history of early cardiovascular disease was also related to CVEs (95% CI OR = 2.355-40.544, P = .002). Binary logistic regression including the above factors resulted in a model in which the 3 main variables in each group persisted, implying that they must be independent of each other. However, the weight of the interaction between the family history of early cardiovascular disease and the interaction between HT and the use of antihypertensives was higher than for the number of admissions for SLE.The SLE disease activity over time (measured using the SLICC) and the number of hospital admissions due to the disease itself, both increase the risk of women with SLE presenting a CVE. Classic cardiovascular risk factors, especially HT and its treatment, as well as a family history of early CVEs, should be considered when assessing the risk of nonfatal CVEs in women with SLE.
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Affiliation(s)
| | - Gonzalo Haro
- TXP Research Group, Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón
- Provincial Hospital of Castellón
| | - María Luisa Micó
- Internal Medicine Service, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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128
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Wu Y, Cao Y, Song J, Tian Y, Wang M, Li M, Wang X, Huang Z, Li L, Zhao Y, Qin X, Hu Y. Antihypertensive drugs use over a 5-year period among children and adolescents in Beijing, China: An observational study. Medicine (Baltimore) 2019; 98:e17411. [PMID: 31577753 PMCID: PMC6783152 DOI: 10.1097/md.0000000000017411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Evidence on the prescription patterns of antihypertensive drug use in children and adolescents in China is scarce. A descriptive analysis of the Beijing Medical Claim Data, which covered over 95% of the urban residents, was conducted to investigate antihypertensive prescribing patterns and trends in children and adolescents aged under 18 from 2009 to 2014 in Beijing, China. An additional meta-analysis of trends in hypertension prevalence was conducted to compare trends with antihypertensive medications.A total of 11,882 patients received at least 1 prescription for antihypertensive drugs from 2009 to 2014. The number of annual antihypertensive users increased from 2009 to 2012, then declined steadily until 2014, which was consistent with the trend of the hypertension prevalence estimated from the meta-analysis. β-receptor blockers, thiazide diuretics, and angiotensin-converting enzyme inhibitors were the 3 most commonly prescribed antihypertensive drugs. More boys took the antihypertensive drugs than girls. For users aged under 3 years, thiazide diuretics, α-receptor blockers, and angiotensin-converting enzyme inhibitors were the most prescribed drugs, while β-receptor blockers, thiazide diuretics were the most used drugs for users above 3 years.In conclusion, antihypertensive drug prescribing for children and adolescents increased from 2009 to 2014, with different characteristics in different subgroups.
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Affiliation(s)
- Yao Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Mengying Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Man Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Xiaowen Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Zhe Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Lin Li
- Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing
| | - Yaling Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Xueying Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University
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129
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Affiliation(s)
- Franz H Messerli
- Departments of Cardiology and Clinical Research, University Hospital, Bern, Switzerland (F.H.M.)
| | - Sripal Bangalore
- New York University Langone Medical Center, New York University School of Medicine (S.B.)
| | - Adrian W Messerli
- Gill Heart & Vascular Institute, University of Kentucky, Lexington (A.W.M.)
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130
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Pyka-Pająk A, Parys W, Dołowy M. Comparison of the Utility of RP-TLC Technique and Different Computational Methods to Assess the Lipophilicity of Selected Antiparasitic, Antihypertensive, and Anti-inflammatory Drugs. Molecules 2019; 24:molecules24173187. [PMID: 31480762 PMCID: PMC6749294 DOI: 10.3390/molecules24173187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/23/2019] [Accepted: 08/31/2019] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the lipophilicity of selected antiparasitic, antihypertensive and non-steroidal anti-inflammatory drugs (NSAIDs) by means of reversed phase-thin layer chromatography (RP-TLC) as well by using Soczewiński-Wachtmeister's and J. Ościk's equations. The lipophilicity parameters of all examined compounds obtained under various chromatographic systems (i.e., methanol-water and acetone-water, respectively) and those determined on the basis of Soczewiński-Wachtmeister's and Ościk's equations (i.e., RMWS and RMWO) were compared with the theoretical ones (e.g., AlogPs, AClogP, milogP, AlogP, MlogP, XlogP2, XlogP3) and the experimental value of the partition coefficient (logPexp). It was found that the RMWS parameter may be a good alternative tool in describing the lipophilic nature of biologically active compounds with a high and low lipophilicity (i.e., antihypertensive and antiparasitic drugs). Meanwhile, the RMWO was more suitable for compounds with a medium lipophilicity (i.e., non-steroidal anti-inflammatory drugs). The chromatographic parameter 0(a) can be helpful for the prediction of partition coefficients, i.e., AClogP, XlogP3, as well as logPexp of examined compounds.
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Affiliation(s)
- Alina Pyka-Pająk
- Department of Analytical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, PL-4 Jagiellońska Street, 41-200 Sosnowiec, Poland.
| | - Wioletta Parys
- Department of Analytical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, PL-4 Jagiellońska Street, 41-200 Sosnowiec, Poland.
| | - Małgorzata Dołowy
- Department of Analytical Chemistry, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia in Katowice, PL-4 Jagiellońska Street, 41-200 Sosnowiec, Poland
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131
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Affiliation(s)
- Rhian M. Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Ninian N. Lang
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
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132
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Swaminathan A, Balaguru UM, Manjunathan R, Bhuvaneswari S, Kasiviswanathan D, Sirishakalyani B, Nayak P, Chatterjee S. Live Imaging and Analysis of Vasoactive Properties of Drugs Using an in-ovo Chicken Embryo Model: Replacing and Reducing Animal Testing. Microsc Microanal 2019; 25:961-970. [PMID: 31072413 DOI: 10.1017/s1431927619000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Vasodilation occurs as a result of the relaxation of the smooth muscle cells present in the walls of blood vessels. Various suitable models are available for the analysis of the vasoactive properties of drugs with therapeutic applications. But all these models have limitations, such as ethical issues and high cost. The purpose of this study is to develop an alternative model for studying the vasoactive properties of drugs using an in-ovo chicken embryo model. In the preliminary experiment, we used a well-known vasoconstrictor (adrenaline) and a vasodilator (spermine NoNoate) in the chick embryo area vasculosa and evaluated their concentration-response curve. Adrenaline (10 µM) and spermine NoNoate (10 µM) were administered in different arteries and veins and different positions of the right vitelline artery of the chick embryo. Results showed the middle of the vessel bed of the right vitelline artery having the best vasoactive effect compared to others. Finally, anti-hypertensive drugs, calcium channel blockers, and NOS agonists were administered in the chick embryo area vasculosa to validate the model. Results demonstrate that the chick embryo area vasculosa can be an alternative, robust, and unique in-ovo model for screening of anti-hypertensive drugs in real time.
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Affiliation(s)
- Akila Swaminathan
- Vascular Biology Lab,AU-KBC Research Centre, Anna University,MIT Campus, Chennai,India
| | | | - Reji Manjunathan
- Vascular Biology Lab,AU-KBC Research Centre, Anna University,MIT Campus, Chennai,India
| | | | | | - Bandi Sirishakalyani
- Department of Physiology,NRI Medical College & General Hospital,Andhra Pradesh,India
| | - Prasunpriya Nayak
- Department of Physiology,NRI Medical College & General Hospital,Andhra Pradesh,India
| | - Suvro Chatterjee
- Vascular Biology Lab,AU-KBC Research Centre, Anna University,MIT Campus, Chennai,India
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133
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Santala EEE, Kotsar A, Veitonmäki T, Tammela TLJ, Murtola TJ. Risk of urothelial cancer death among people using antihypertensive drugs-a cohort study from Finland. Scand J Urol 2019; 53:185-192. [PMID: 31250699 DOI: 10.1080/21681805.2019.1634147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: To analyse the association between antihypertensive (anti-HT) drug use and risk of urothelial cancer (UC) death. UC occurs as bladder cancer (BCa) and upper tract urothelial carcinomas (UTUCs). Hypertension is a suggested risk factor for BCa and may impair disease prognosis. However, it's unclear if use of anti-HT drugs could improve the prognosis of UC.Materials and methods: This study evaluated the association between use of anti-HT drugs and UC survival among 14,065 participants diagnosed with BCa and 1080 with UTUC during 1995-2012 in Finland. It analyzed data using the multivariable adjusted conditional Cox regression model.Results: Angiotensin-receptor (ATR) blocker use before BCa diagnosis was associated with slightly decreased risk of BCa death (HR = .81, CI = .71-0.93). The association was dose-dependent and it decreased in association with elevated intensity of ATR-blocker use. Post-diagnostic use of ATR-blockers was similarly associated with better survival compared to non-users (HR = .81, CI = .71-0.92. Interestingly, use of calcium-channel blockers also associated with better survival and the risk of BCa death decreased with increasing intensity of use (HR = .67, CI = .52-0.86 for highest intensity).Conclusions: This large population-based cohort suggests decreased risk of BCa death among ATR-blocker and calcium-channel blocker users. The risk association among ATR-blockers and calcium-channel blockers was dose-dependent suggesting a causal explanation. Similar risk associations are not observed for other anti-HT drug users, which may suggest a direct effect of ATR blocker or calcium-channel blocker use. Further studies are needed to elucidate the potential anticancer mechanism.
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Affiliation(s)
- Eerik E E Santala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Andres Kotsar
- Department of Urology, Tartu University Hospital, Tartu, Estonia
| | - Thea Veitonmäki
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teuvo L J Tammela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Teemu J Murtola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland
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134
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Gill D, Georgakis MK, Koskeridis F, Jiang L, Feng Q, Wei WQ, Theodoratou E, Elliott P, Denny JC, Malik R, Evangelou E, Dehghan A, Dichgans M, Tzoulaki I. Use of Genetic Variants Related to Antihypertensive Drugs to Inform on Efficacy and Side Effects. Circulation 2019; 140:270-279. [PMID: 31234639 PMCID: PMC6687408 DOI: 10.1161/circulationaha.118.038814] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Supplemental Digital Content is available in the text. Background: Drug effects can be investigated through natural variation in the genes for their protein targets. The present study aimed to use this approach to explore the potential side effects and repurposing potential of antihypertensive drugs, which are among the most commonly used medications worldwide. Methods: Genetic proxies for the effect of antihypertensive drug classes were identified as variants in the genes for the corresponding targets that associated with systolic blood pressure at genome-wide significance. Mendelian randomization estimates for drug effects on coronary heart disease and stroke risk were compared with randomized, controlled trial results. A phenome-wide association study in the UK Biobank was performed to identify potential side effects and repurposing opportunities, with findings investigated in the Vanderbilt University biobank (BioVU) and in observational analysis of the UK Biobank. Results: Suitable genetic proxies for angiotensin-converting enzyme inhibitors, β-blockers, and calcium channel blockers (CCBs) were identified. Mendelian randomization estimates for their effect on coronary heart disease and stroke risk, respectively, were comparable to results from randomized, controlled trials against placebo. A phenome-wide association study in the UK Biobank identified an association of the CCB standardized genetic risk score with increased risk of diverticulosis (odds ratio, 1.02 per standard deviation increase; 95% CI, 1.01–1.04), with a consistent estimate found in BioVU (odds ratio, 1.01; 95% CI, 1.00–1.02). Cox regression analysis of drug use in the UK Biobank suggested that this association was specific to nondihydropyridine CCBs (hazard ratio 1.49 considering thiazide diuretic agents as a comparator; 95% CI, 1.04–2.14) but not dihydropyridine CCBs (hazard ratio, 1.04; 95% CI, 0.83–1.32). Conclusions: Genetic variants can be used to explore the efficacy and side effects of antihypertensive medications. The identified potential effect of nondihydropyridine CCBs on diverticulosis risk could have clinical implications and warrants further investigation.
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Affiliation(s)
- Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (D.G., P.E., E.E., A.D., I.T.)
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research, University Hospital (M.K.G., R.M., M.D.), Ludwig-Maximilians-Universität LMU, Munich, Germany.,Graduate School for Systemic Neurosciences (M.K.G.), Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Fotios Koskeridis
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Greece (F.K., E.E., I.T.)
| | - Lan Jiang
- Division of Clinical Pharmacology, Department of Medicine (L.J., Q.F.), Vanderbilt University Medical Center, Nashville, TN
| | - Qiping Feng
- Division of Clinical Pharmacology, Department of Medicine (L.J., Q.F.), Vanderbilt University Medical Center, Nashville, TN
| | - Wei-Qi Wei
- Department of Biomedical Informatics (W.-Q.W., J.C.D.), Vanderbilt University Medical Center, Nashville, TN
| | - Evropi Theodoratou
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (E.T.)
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (D.G., P.E., E.E., A.D., I.T.).,Medical Research Council-Public Health England Centre for Environment, School of Public Health, Imperial College London, United Kingdom (P.E., A.D., I.T.).,Imperial Biomedical Research Centre, Imperial College London and Imperial College NHS Healthcare Trust, UK (P.E.).,UK Dementia Research Institute at Imperial College London, UK (P.E., A.D., I.T.).,Health Data Research UK-London (P.E.)
| | - Joshua C Denny
- Department of Biomedical Informatics (W.-Q.W., J.C.D.), Vanderbilt University Medical Center, Nashville, TN
| | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital (M.K.G., R.M., M.D.), Ludwig-Maximilians-Universität LMU, Munich, Germany
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (D.G., P.E., E.E., A.D., I.T.).,Department of Hygiene and Epidemiology, University of Ioannina Medical School, Greece (F.K., E.E., I.T.)
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (D.G., P.E., E.E., A.D., I.T.).,Medical Research Council-Public Health England Centre for Environment, School of Public Health, Imperial College London, United Kingdom (P.E., A.D., I.T.).,UK Dementia Research Institute at Imperial College London, UK (P.E., A.D., I.T.)
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital (M.K.G., R.M., M.D.), Ludwig-Maximilians-Universität LMU, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Germany (M.D.).,German Center for Neurodegenerative Diseases (DZNE, Munich), Germany (M.D.)
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, United Kingdom (D.G., P.E., E.E., A.D., I.T.).,Department of Hygiene and Epidemiology, University of Ioannina Medical School, Greece (F.K., E.E., I.T.).,Medical Research Council-Public Health England Centre for Environment, School of Public Health, Imperial College London, United Kingdom (P.E., A.D., I.T.).,UK Dementia Research Institute at Imperial College London, UK (P.E., A.D., I.T.)
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135
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Brewster LM, Karamat FA, van Montfrans GA. Creatine Kinase and Blood Pressure: A Systematic Review. Med Sci (Basel) 2019; 7:medsci7040058. [PMID: 30970679 PMCID: PMC6524008 DOI: 10.3390/medsci7040058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Hypertension is a main risk factor for premature death. Although blood pressure is a complex trait, we have shown that the activity of the ATP-generating enzyme creatine kinase (CK) is a significant predictor of blood pressure and of failure of antihypertensive drug therapy in the general population. In this report, we systematically review the evidence on the association between this new risk factor CK and blood pressure outcomes. Method: We used a narrative synthesis approach and conducted a systematic search to include studies on non-pregnant adult humans that address the association between plasma CK and blood pressure outcomes. We searched electronic databases and performed a hand search without language restriction. We extracted data in duplo. The main outcome was the association between CK and blood pressure as continuous measures. Other outcomes included the association between CK and blood pressure categories (normotension and hypertension, subdivided in treated controlled, treated uncontrolled, and untreated hypertension). Results: We retrieved 139 reports and included 11 papers from 10 studies assessing CK in 34,578 participants, men and women, of African, Asian, and European ancestry, aged 18 to 87 years. In 9 reports, CK was associated with blood pressure levels, hypertension (vs. normotension), and/or treatment failure. The adjusted increase in systolic blood pressure (mmHg/log CK increase) was reported between 3.3 [1.4 to 5.2] and 8.0 [3.3 to 12.7] and the odds ratio of hypertension with high vs. low CK ranged between 1.2 and 3.9. In addition, CK was a strong predictor of treatment failure in the general population, with an adjusted odds ratio of 3.7 [1.2 to 10.9]. Discussion: This systematic review largely confirms earlier reports that CK is associated with blood pressure and failure of antihypertensive therapy. Further work is needed to address whether this new risk factor is useful in clinical medicine.
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Affiliation(s)
- L. M. Brewster
- Creatine Kinase Foundation, POB 23639, 1100 EC Amsterdam, the Netherlands
- Correspondence:
| | - F. A. Karamat
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands;
| | - G. A. van Montfrans
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands;
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Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) represent a major cause of maternal, fetal and neonatal morbidity and mortality and identifies women at risk for cardiovascular and other chronic diseases later in life. When antihypertensive drugs are used during pregnancy, their benefit and harm to both mother and fetus should be evaluated. AREAS COVERED This review summarizes the pharmacological characteristics of the recommended antihypertensive drugs and their impact on mother and fetus when administered during pregnancy and/or post-partum. Drugs were identified using MEDLINE and the main international Guidelines for the management of HDP. EXPERT OPINION Although there is a consensus that severe hypertension should be treated, treatment of mild hypertension without end-organ damage (140-159/90-109 mmHg) remains controversial and there is no agreement on when to initiate therapy, blood pressure targets or recommended drugs in the absence of robust evidence for the superiority of one drug over others. Furthermore, the long-term outcomes of in-utero antihypertensive exposure remain uncertain. Therefore, evidence-based data regarding the treatment of HDP is lacking and well designed randomized clinical trials are needed to resolve all these controversial issues related to the management of HDP.
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Affiliation(s)
- Juan Tamargo
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Ricardo Caballero
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
| | - Eva Delpón
- a Department of Pharmacology and Toxicology, School of Medicine , Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV , Madrid , Spain
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Wunder C, Persu A, Lengelé JP, Mg Georges C, Renkin J, Pasquet A, Carlier M, Zhang ZY, Staessen JA. Adherence to antihypertensive drug treatment in patients with apparently treatment-resistant hypertension in the INSPiRED pilot study. Blood Press 2019; 28:168-172. [PMID: 30942111 DOI: 10.1080/08037051.2019.1599814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Drug adherence may be a major problem in the therapy of hypertension and in the diagnosis of therapy resistance. Adherence can be assessed by indirect methods or by direct methods like drug detection in urine with liquid chromatography-mass spectrometric methods. MATERIALS AND METHODS The current analysis included patients with apparently treatment- resistant hypertension (TRH) referred for renal denervation (RDN) and included in the the INSPiRED pilot trial (NCT01505010). Adherence was repeatedly assessed by toxicological urine analysis over a time range of up to 17 months in a total of 18 patients. RESULTS In the first urine samples of 18 patients the adherence rate (percentage of number of detected vs. prescribed medical drugs) ranged from 0 to 100% with a median of 73.2%. In further urine samples collected during the following up to 17 months every individual patient exhibited considerable changes in the adherence rate, neither a constancy nor a tendency could be deduced. CONCLUSIONS Urine analysis results exhibit variation over time and an assessment at a certain time point cannot be regarded as representative or predictor for future behavior. Therefore, it appears necessary to perform drug adherence testing repeatedly over time.
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Affiliation(s)
- Cora Wunder
- a Institute of Legal Medicine, Goethe-University Frankfurt , Frankfurt , Germany
| | - Alexandre Persu
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,c Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique , Université Catholique de Louvain , Brussels , Belgium
| | - Jean-Philippe Lengelé
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,d Department of Nephrology , Grand Hôpital de Charleroi , Gilly , Belgium
| | - Coralie Mg Georges
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Jean Renkin
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium.,c Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique , Université Catholique de Louvain , Brussels , Belgium
| | - Agnès Pasquet
- b Division of Cardiology , Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels , Belgium
| | - Marc Carlier
- e Department of Cardiology , Grand Hôpital de Charleroi , Gilly , Belgium
| | - Zhen-Yu Zhang
- f Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium
| | - Jan A Staessen
- f Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,g Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands
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- a Institute of Legal Medicine, Goethe-University Frankfurt , Frankfurt , Germany
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Hernández-Aceituno A, Guallar-Castillón P, García-Esquinas E, Rodríguez-Artalejo F, Banegas JR. Association between sleep characteristics and antihypertensive treatment in older adults. Geriatr Gerontol Int 2019; 19:537-540. [PMID: 30912276 DOI: 10.1111/ggi.13660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/19/2019] [Accepted: 02/26/2019] [Indexed: 12/01/2022]
Abstract
AIM The relationship between sleeping characteristics and antihypertensive medication is little known. We examined the association of sleep quality or duration and the use of sleeping pills with the number of antihypertensive drugs used in older adults. METHODS This was a prospective cohort study of treated hypertensive patients aged ≥60 years participating in a seniors cohort, followed from 2008 to 2010 through 2012 to 2013. Self-reported sleep duration, sleep quality (usually having difficulty falling asleep or staying asleep) and sleeping pills use were ascertained at baseline, and the change in the number of antihypertensive drugs (active agents) between 2008-2010 and 2012-2013 was calculated. Analyses were carried out with logistic regression, and adjusted for demographics, lifestyle, comorbidity, baseline number of antihypertensive drugs and hypertension control. RESULTS Among the 752 participants at baseline (mean age 69.9 years, 49.2% men), the mean sleep duration was 6.9 h/day, 37% had poor sleep quality, 16.5% usually consumed sleeping pills and the mean number of antihypertensive drugs was 1.8. During the follow-up period, 156 (20.7%) patients increased the number of antihypertensive drugs. No association was found between sleep duration or quality and the change in antihypertensive drug use. Usual sleeping pills consumption was associated with a higher risk of increasing (vs decreasing/maintaining) the number of antihypertensive drugs (odds ratio 1.85; 95% confidence interval 1.12-3.07, P-value 0.02). CONCLUSIONS Consumption of sleeping pills was prospectively linked to an increased number of antihypertensive drugs. "Sleeping pill use" might be an indicator of future needs of antihypertensive treatment, and a warning indicator to investigate underlying sleep disorders or unhealthy lifestyles. Geriatr Gerontol Int 2019; 19: 537-540.
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Affiliation(s)
- Ana Hernández-Aceituno
- Department of Preventive Medicine and Public Health, School of Medicine, University Autonoma of Madrid/Research Institute of University Hospital La Paz (IdiPAZ) and Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, University Autonoma of Madrid/Research Institute of University Hospital La Paz (IdiPAZ) and Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, University Autonoma of Madrid/Research Institute of University Hospital La Paz (IdiPAZ) and Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, University Autonoma of Madrid/Research Institute of University Hospital La Paz (IdiPAZ) and Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, University Autonoma of Madrid/Research Institute of University Hospital La Paz (IdiPAZ) and Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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139
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van Dalen JW, Moll van Charante EP, van Gool WA, Richard E. Discontinuation of Antihypertensive Medication, Cognitive Complaints, and Incident Dementia. J Am Med Dir Assoc 2019; 20:1091-1097.e3. [PMID: 30738826 DOI: 10.1016/j.jamda.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 11/27/2018] [Accepted: 12/09/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate whether discontinuation of antihypertensive medication in community-dwelling older people is associated with a reduction in memory complaints and/or incident dementia. DESIGN Prospective observational cohort study within the Prevention of Dementia by Intensive Vascular Care (preDIVA) trial. SETTING AND PARTICIPANTS Community-dwelling participants (aged 70-78 years at baseline) who underwent 2-yearly assessments during 6-8 years of follow-up. MEASURES Cox regression analyses of the relation between discontinuation of antihypertensive medication during the study and change in subjective memory complaints, incident dementia, and mortality. RESULTS Dementia occurred more often in participants discontinuing antihypertensive treatment (13.4% vs 6.2%, P = .02); mortality was similar (16.5% vs 13.9%, P = .52). Discontinuation of antihypertensive medication was associated with a double dementia hazard [hazard ratio (HR) (95% confidence interval) = 2.15 (1.15-4.03)], which somewhat attenuated after adjustment for sex, blood pressure, number of antihypertensives and other medications [HR = 1.92 (1.01-3.65)], and additionally for stroke, cardiovascular disease, diabetes, smoking, memory complaints, and MMSE score [HR = 1.79 (0.93-3.44)]. Antihypertensive discontinuation was associated with an approximately 50% higher hazard of dementia and/or mortality combined [HR = 1.58 (1.04-2.40); model 2: HR = 1.64 (1.07-2.51); model 3: HR = 1.49 (0.96-2.30)]. Antihypertensive discontinuation was not associated with change in memory complaints [odds ratio (95% confidence interval) = 0.96 (0.55-1.67)]. Subgroup and sensitivity analyses addressing possible sources of bias and confounding gave similar results. CONCLUSIONS/IMPLICATIONS Our results suggest that antihypertensive withdrawal in community-dwelling older people does not preserve cognition and may in fact increase dementia risk. This is not due to reduced mortality as competing risk. Additional analyses suggest results are unlikely to be explainable by confounding, reverse causality, or observational biases. Studies with person-specific reasons for antihypertensive discontinuation may be able to exclude reverse causality completely. Given the beneficial effects of antihypertensive medication on cardiovascular risk, observational data may be the best currently obtainable on the pressing issue of when withdrawal of antihypertensives in older people is acceptable and what consequences need to be weighed.
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140
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Imprialos KP, Stavropoulos K, Doumas M, Tziomalos K, Karagiannis A, Athyros VG. Sexual Dysfunction, Cardiovascular Risk and Effects of Pharmacotherapy. Curr Vasc Pharmacol 2019; 16:130-142. [PMID: 28595561 DOI: 10.2174/1570161115666170609101502] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sexual dysfunction affects millions of people with an increasing prevalence, worldwide. The pathophysiology of the disease shares several similarities with cardiovascular disease (CVD), including atherosclerosis, endothelial dysfunction, structural vascular damage and subclinical inflammation. Erectile dysfunction (ED) and female sexual dysfunction are common among patients with CVD and risk factors such as hypertension, diabetes, obesity and metabolic syndrome. Given the common pathogenesis of the diseases, ED is an independent prognostic factor of future ED events. Patients with overt ED or risk factors are usually treated with several drugs for the management of these conditions. Several of these drugs have been evaluated for their effect on sexual activity. RESULTS AND CONCLUSION Among the antihypertensive drugs, diuretics and beta-blockers seem to exert a detrimental impact on sexual function, with nebivolol being the only beta-blocker with favorable properties through an increase in nitric oxide bioavailability. In contrast, renin-angiotensin system inhibitors and calcium-channel blockers have a neutral effect on sexual activity. Hypoglycemic drugs have been less evaluated in the ED setting, with metformin, pioglitazone and liraglutide presenting favorable results. Statins on the other hand have not provided consistent results with observational studies suggesting a detrimental role in sexual activity and a few randomized studies indicating a neutral or even beneficial effect on erectile function.
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Affiliation(s)
- Konstantinos P Imprialos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Konstantinos Stavropoulos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Konstantinos Tziomalos
- First Propaedeutic Department of Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki. Greece
| | - Asterios Karagiannis
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
| | - Vasilios G Athyros
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki. Greece
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141
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Magvanjav O, Cooper‐DeHoff RM, McDonough CW, Gong Y, Segal MS, Hogan WR, Johnson JA. Antihypertensive therapy prescribing patterns and correlates of blood pressure control among hypertensive patients with chronic kidney disease. J Clin Hypertens (Greenwich) 2019; 21:91-101. [PMID: 30427124 PMCID: PMC6329007 DOI: 10.1111/jch.13429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
Abstract
We used electronic health records (EHRs) data from 5658 ambulatory chronic kidney disease (CKD) patients with hypertension and prescribed antihypertensive therapy to examine antihypertensive drug prescribing patterns, blood pressure (BP) control, and risk factors for resistant hypertension (RHTN) in a real-world setting. Two-thirds of CKD patients and three-fourths of those with proteinuria were prescribed guideline-recommended renoprotective agents including an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB); however, one-third were not prescribed an ACEI or ARB. CKD patients, particularly those with stages 1-2 CKD, who were prescribed regimens including beta-blocker (BB) + diuretic or ACEI/ARB + BB + diuretic were more likely to have controlled BP (<140/90 mm Hg) compared to those prescribed other combinations. Risk factors for RHTN included African American race and major comorbidities. Clinicians may use these findings to tailor antihypertensive therapy to the needs of each patient, including providing CKD stage-specific treatment, and better identify CKD patients at risk of RHTN.
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Affiliation(s)
- Oyunbileg Magvanjav
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
| | - Rhonda M. Cooper‐DeHoff
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Florida College of MedicineGainesvilleFlorida
| | - Caitrin W. McDonough
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
| | - Yan Gong
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
| | - Mark S. Segal
- Division of Nephrology, Hypertension and Renal Transplant, Department of MedicineUniversity of Florida, and North Florida/South Georgia Veterans Health SystemGainesvilleFlorida
| | - William R. Hogan
- Department of Health Outcomes and Biomedical InformaticsUniversity of Florida College of MedicineGainesvilleFlorida
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational ResearchUniversity of Florida College of PharmacyGainesvilleFlorida
- Division of Cardiovascular Medicine, Department of MedicineUniversity of Florida College of MedicineGainesvilleFlorida
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142
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Petek B, Villa-Lopez M, Loera-Valencia R, Gerenu G, Winblad B, Kramberger MG, Ismail MAM, Eriksdotter M, Garcia-Ptacek S. Connecting the brain cholesterol and renin-angiotensin systems: potential role of statins and RAS-modifying medications in dementia. J Intern Med 2018; 284:620-642. [PMID: 30264910 DOI: 10.1111/joim.12838] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Millions of people worldwide receive agents targeting the renin-angiotensin system (RAS) to treat hypertension or statins to lower cholesterol. The RAS and cholesterol metabolic pathways in the brain are autonomous from their systemic counterparts and are interrelated through the cholesterol metabolite 27-hydroxycholesterol (27-OHC). These systems contribute to memory and dementia pathogenesis through interference in the amyloid-beta cascade, vascular mechanisms, glucose metabolism, apoptosis, neuroinflammation and oxidative stress. Previous studies examining the relationship between these treatments and cognition and dementia risk have produced inconsistent results. Defining the blood-brain barrier penetration of these medications has been challenging, and the mechanisms of action on cognition are not clearly established. Potential biases are apparent in epidemiological and clinical studies, such as reverse epidemiology, indication bias, problems defining medication exposure, uncertain and changing doses, and inappropriate grouping of outcomes and medications. This review summarizes current knowledge of the brain cholesterol and RAS metabolism and the mechanisms by which these pathways affect neurodegeneration. The putative mechanisms of action of statins and medications inhibiting the RAS will be examined, together with prior clinical and animal studies on their effects on cognition. We review prior epidemiological studies, analysing their strengths and biases, and identify areas for future research. Understanding the pathophysiology of the brain cholesterol system and RAS and their links to neurodegeneration has enormous potential. In future, well-designed epidemiological studies could identify potential treatments for Alzheimer's disease (AD) amongst medications that are already in use for other indications.
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Affiliation(s)
- B Petek
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,University of Ljubljana, Ljubljana, Slovenia
| | - M Villa-Lopez
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - R Loera-Valencia
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - G Gerenu
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosciences, Biodonostia Health Research Institute, San Sebastian, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases, CIBERNED, Health Institute Carlos III, Ministry of Economy and Competitiveness, Madrid, Spain
| | - B Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - M G Kramberger
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,University of Ljubljana, Ljubljana, Slovenia
| | - M-A-M Ismail
- Center for Alzheimer Research, Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Neuro, Diseases of the Nervous System patient flow, Karolinska University Hospital, Huddinge, Sweden
| | - M Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Neurology Section, Södersjukhuset, Stockholm, Sweden
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143
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Espíndola B, Bortolon FF, Pinto JMO, Pezzini BR, Stulzer HK. New Approach for the Application of USP Apparatus 3 in Dissolution Tests: Case Studies of Three Antihypertensive Immediate-Release Tablets. AAPS PharmSciTech 2018; 19:2866-2874. [PMID: 29934804 DOI: 10.1208/s12249-018-1086-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022] Open
Abstract
The USP Apparatus 3 is a compendial dissolution Apparatus that has been mainly used to assess the performance of modified-release drug products. However, this Apparatus can be applied to dissolution testing of immediate-release tablets as well, with several advantages such as lower consumption of dissolution media, reduced setup time in quality control routine, and minimized hydrodynamic issues. In this work, three immediate-release (IR) tablets containing antihypertensive drugs of different Biopharmaceutic Classification System (BCS) classes were evaluated in order to assess the possible interchangeability between the official dissolution method using typical USP Apparatus 1 or 2 and the proposed methods using USP Apparatus 3. Depending on the selection of the appropriate operational conditions, such as dip rate and sieve mesh size, it was observed that USP Apparatus 3 could provide similar dissolution profiles compared to USP Apparatus 1 or 2 to the drug products tested. In addition, USP Apparatus 3 avoided conning issues related to USP Apparatus 2. The successful application of USP Apparatus 3 in dissolution tests for IR drug products depends on the definition of specific test conditions for each product, considering all the equipment variables, as well as drug and formulation characteristics.
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144
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Trindade NR, Lopes PR, Naves LM, Fajemiroye JO, Alves PH, Amaral NO, Lião LM, Rebelo ACS, Castro CH, Braga VA, Menegatti R, Pedrino GR. The Newly Synthesized Pyrazole Derivative 5-(1-(3 Fluorophenyl)-1 H-Pyrazol-4-yl)-2 H-Tetrazole Reduces Blood Pressure of Spontaneously Hypertensive Rats via NO/cGMO Pathway. Front Physiol 2018; 9:1073. [PMID: 30131720 PMCID: PMC6091002 DOI: 10.3389/fphys.2018.01073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 07/17/2018] [Indexed: 01/13/2023] Open
Abstract
The search for new antihypertensive drugs has grown in recent years because of high rate of morbidity among hypertensive patients and several side effects that are associated with the first-line medications. The current study sought to investigate the antihypertensive effect of a newly synthesized pyrazole derivative known as 5-(1-(3 fluorophenyl)-1H-pyrazol-4-yl)-2H-tetrazole (LQFM-21). Spontaneously hypertensive rats (SHR) were used to evaluate the effect of LQFM-21 on mean arterial pressure (MAP), heart rate (HR), renal vascular conductance (RVC), arterial vascular conductance (AVC), baroreflex sensitivity (BRS) index, and vascular reactivity. Acute intravenous (iv) administration of LQFM-21 (0.05, 0.1, 0.2, and 0.4 mg kg-1) reduced MAP and HR, and increased RVC and AVC. Chronic oral administration of LQFM-21 (15 mg kg-1) for 15 days reduced MAP without altering BRS. The blockade of muscarinic receptors and nitric oxide synthase by intravenous infusion of atropine and L-NAME, respectively, attenuated cardiovascular effects of LQFM-21. In addition, ex vivo experiments showed that LQFM-21 induced an endothelium-dependent relaxation in isolated aortic rings from SHR. This effect was blocked by guanylyl cyclase inhibitor (ODQ) and L-NAME. These findings suggest the involvement of muscarinic receptor and NO/cGMP pathway in the antihypertensive and vasodilator effects of LQFM-21.
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Affiliation(s)
- Neidiane R Trindade
- Center for Neuroscience and Cardiovascular Research, Department of Physiological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Paulo R Lopes
- Center for Neuroscience and Cardiovascular Research, Department of Physiological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Lara M Naves
- Center for Neuroscience and Cardiovascular Research, Department of Physiological Sciences, Federal University of Goiás, Goiânia, Brazil
| | | | - Pedro H Alves
- Integrative Laboratory of Cardiovascular and Neurological Pathophysiology, Department of Physiological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Nathalia O Amaral
- Center for Neuroscience and Cardiovascular Research, Department of Physiological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Luciano M Lião
- Institute of Chemistry, Federal University of Goiás, Goiânia, Brazil
| | - Ana C S Rebelo
- Department of Morphology, Federal University of Goiás, Goiânia, Brazil
| | - Carlos H Castro
- Integrative Laboratory of Cardiovascular and Neurological Pathophysiology, Department of Physiological Sciences, Federal University of Goiás, Goiânia, Brazil
| | - Valdir A Braga
- Department of Biotechnology, Biotechnology Center, Federal University of Paraiba, João Pessoa, Brazil
| | | | - Gustavo R Pedrino
- Center for Neuroscience and Cardiovascular Research, Department of Physiological Sciences, Federal University of Goiás, Goiânia, Brazil
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145
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Ostroumova OD, Kochetkov AI. [Effects of Amlodipine/Lisinopril Fixed-Dose Combination on Severity of Left Ventricular Hypertrophy and Parameters of Myocardial Stiffness in Patients With Hypertension]. Kardiologiia 2018; 56:27-37. [PMID: 28290816 DOI: 10.18565/cardio.2016.11.27-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To assess effects of 12 weeks treatment with the amlodipine/lisinopril fixed-dose combination (ALFDC) on the left ventricular (LV) mass index (LVMI), parameters of LV and left atrial stiffness. METHODS At phase 1 of the study we examined 44 healthy subjects (21 men, 23 women, mean age 51.5+/-1.0 years) and 60 untreated patients (31 men, 29 women, mean age 53.6+/-0.8 years) with stage II grade 1-2hypertension. Myocardial stiffness parameters, LVMI were calculated using data of transthoracic echocardiography. 2-D speckle tracking echocardiography was used for determination of LV myocardial global longitudinal peak strain (GLPS). All participants underwent ambulatory blood pressure (BP) monitoring, and office BP measurement. At phase 2 a subgroup of 30 untreated patients (16 men, 14 women; mean age 52.7+/-1.11years) received ALFDC in a start dose of 5 mg/10 mg titrated every 14 days to achieve BP<140/90 mm Hg. Therapy in selected doses was continued for 12 weeks thereafter. RESULTS In hypertensive patients LV GLPS was significantly lower while LA stiffness index higher compared with controls (17.08+/-0.38 vs. 19.91+/-0.41%, p<0.001, and 0.20+/-0.01 vs. 0.16+/-0.01, p<0.01, respectively). There were no significant differences in the LA tissue Doppler derived strain, LV end-systolic elastance, LA expansion index between hypertensive and control groups. After ALFDC therapy BP was significantly (p<0.001) reduced: systolic (S)BP from 154.4+/-2.7 to 130.6+/-1.2, diastolic (D)BP from 96.5+/-1.3 to 83.0+/-0.5 mm Hg. After therapy LV GLPS, LA expansion index, LV diastolic elastance significantly increased (from 17.10+/-0.57 to 18.29+/-0.35%, p<0.01; from 1.47+/-0.08 to 1.68+/-0.08, p<0.001; from 9.25+/-0.99 [10-2] to 10.88+/-1.0 8 [10-2], p<0.05, respectively) while LVMI, LV end-diastolic stiffness, and LA stiffness index significantly (p<0.001) decreased (from 129.4+/-4.5 to 111.8+/-3.3 g/m2, from 0.16+/-0.01 to 0.12+/-0.01 mm Hg/ml, from 0.21+/-0.02 to 0.15+/-0.01, respectively). Change in the LA tissue Doppler derived strain correlated with the change in dynamics of nighttime SBP (r=-0.410, p<0.05). There was direct relationship between change in LV diastolic elastance and nighttime DBP (r=0.424; p<0.05); and an inverse correlation between changes in LV end-diastolic stiffness and dynamics of the daytime SBP and DBP (r=-0.404; p<0.05 and r=-0.364; p<0.05, respectively). Change of LVMI after ALFDC treatment correlated with dynamics of 24-hour, daytime SBP, and daytime pulse pressure (r=0.382, p<0.05, r=0.478, p<0.01, and r=0.364, p<0.05, respectively). CONCLUSION In untreated patients with stage II, 1-2 degree hypertension 12-week therapy with ALFDC allowed to achieve target BP levels, reduced severity of LV hypertrophy and improved stiffness parameters of the myocardium.
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Affiliation(s)
- O D Ostroumova
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Sechenov First Moscow State Medical University, Moscow, Russia
| | - A I Kochetkov
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.,Sechenov First Moscow State Medical University, Moscow, Russia
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146
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Boruzs K, Juhász A, Nagy C, Szabó Z, Jakovljevic M, Bíró K, Ádány R. High Inequalities Associated With Socioeconomic Deprivation in Cardiovascular Disease Burden and Antihypertensive Medication in Hungary. Front Pharmacol 2018; 9:839. [PMID: 30123128 PMCID: PMC6085562 DOI: 10.3389/fphar.2018.00839] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
The wide life expectancy gap between the old and new member states of the European Union is most strongly related to the high rate of premature mortality caused by cardiovascular diseases (CVDs). To learn more about the background of this gap, the relationship of socioeconomic status (SES) with CVD mortality, morbidity and the utilization of antihypertensive drugs was studied in Hungary, a Central-Eastern European country with an extremely high relative risk of premature CVD mortality. Risk analysis capabilities were used to estimate the relationships between SES, which was characterized by tertiles of a multidimensional composite indicator (the deprivation index) and CVD burden (mortality and morbidity) as well as the antihypertensive medications at the district level in Hungary. The excess risks caused by premature mortality from CVDs showed a strong correlation with deprivation using the Rapid Inquiry Facility. The distribution of prevalence values related to these diseases was found to be similar, but in the areas of highest deprivation, where the prevalence of chronic ischaemic heart diseases and cerebrovascular diseases was found to be higher than the national average by 30 and 20%, the prevalence of hypertension exceeded the national average by only 4%. A linear association between the relative frequency of prescriptions/redemptions and deprivation for most antihypertensive drugs, except angiotensinogen receptor blockers, was shown. More intense screening for hypertension is proposed to improve the control of CVDs in countries affected by high disease burden.
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Affiliation(s)
- Klára Boruzs
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Juhász
- Department of Public Health, Government Office of Capital City Budapest, Budapest, Hungary
| | - Csilla Nagy
- Department of Public Health, Government Office of Capital City Budapest, Budapest, Hungary
| | - Zoltán Szabó
- Department of Emergency Medicine, Medical Center, University of Debrecen, Debrecen, Hungary
| | - Mihajlo Jakovljevic
- Department of Global Health, Economics & Policy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Klára Bíró
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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147
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Ostroumova OD, Borisova EV, Guseva TF, Temirbulatov II. [Day-by Day Blood Pressure Variability: Methodological Aspects, Prognostic Value, Effects of Antihypertensive Therapy]. Kardiologiia 2018:82-88. [PMID: 30131046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlodipine/perindopril combination for lowering day-by-day BP variability.
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Affiliation(s)
- O D Ostroumova
- Federal State Budgetary Educational Institution of Higher Education, "A. I. Evdokimov Moscow State University for Medicine and Dentistry" of the Ministry of Health of the Russian Federation
| | | | - T F Guseva
- Federal State Budgetary Educational Institution of Higher Education, "A. I. Evdokimov Moscow State University for Medicine and Dentistry" of the Ministry of Health of the Russian Federation
| | - I I Temirbulatov
- Federal State Budgetary Educational Institution of Higher Education "I. M. Sechenov First Moscow State Medical University" of the Ministry of Health of the Russian Federation
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148
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Kucan M, Mrsic-Pelcic J, Vitezic D. Antihypertensive Drugs in Croatia: What Changes the Drug Usage Patterns? Clin Ther 2018; 40:1159-1169. [PMID: 30017168 DOI: 10.1016/j.clinthera.2018.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/10/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Possible factors that could influence changes in patterns of prescribing antihypertensives could be identified by monitoring national trends in hypertension treatment. The choice of pharmacologic treatment in people with hypertension has important therapeutic and financial implications, due to the fact that the financial costs associated with hypertension continue to increase. The aims of our study were to identify and analyze changes in the usage of antihypertensive drugs in Croatia from 2000 to 2016 and to identify the changes in prescribing patterns as well as mean prices per defined daily dose (DDD). METHODS Data on consumption in Croatia were obtained from the International Medical Statistics database. According to the World Health Organization's Collaborating Center for Drugs Statistics Methodology, per-annum volumes of drugs are presented in DDD per 1000 population per day (DDD/1000), while data on financial expenditure are presented in euros. FINDINGS The consumption of drugs for cardiovascular disease in Croatia during the period from 2000 to 2016 increased 150.81%, while financial expenditure in the same period increased 47.32%. The most frequently prescribed subgroup was agents acting on the renin-angiotensin system (RAS). Their share among antihypertensives increased from 39.13% (2000) to 53.39% (2016). The share of diuretics in the same period decreased from 20.16% in 2000 to 12.73% in 2016. IMPLICATIONS The prescribing patterns of antihypertensive drugs in Croatia have changed, which could be a result of a combination of different factors, such as changes in laws, pharmaceutical marketing, and guidelines on hypertension therapy. The most prescribed subgroup in all of the investigated years was agents acting on the RAS, mainly because of the increased prescribing of combinations of RAS agents plus diuretics. The financial implications of legal changes and the introduction of new generic drugs led to decreased cost per DDD of antihypertensives during the investigated period, but the total expenditure on antihypertensives in Croatia increased due to increased consumption.
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Affiliation(s)
- Marta Kucan
- University Hospital Center Rijeka, Rijeka, Croatia.
| | | | - Dinko Vitezic
- University Hospital Center Rijeka, Rijeka, Croatia; University of Rijeka Medical School, Rijeka, Croatia
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149
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Chen H, McGowan EM, Ren N, Lal S, Nassif N, Shad-Kaneez F, Qu X, Lin Y. Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases. Biomark Insights 2018; 13:1177271918785130. [PMID: 30013308 PMCID: PMC6043915 DOI: 10.1177/1177271918785130] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/23/2018] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the world and our approach to the control and management of CVD mortality is limited. Nattokinase (NK), the most active ingredient of natto, possesses a variety of favourable cardiovascular effects and the consumption of Natto has been linked to a reduction in CVD mortality. Recent research has demonstrated that NK has potent fibrinolytic activity, antihypertensive, anti-atherosclerotic, and lipid-lowering, antiplatelet, and neuroprotective effects. This review covers the major pharmacologic effects of NK with a focus on its clinical relevance to CVD. It outlines the advantages of NK and the outstanding issues pertaining to NK pharmacokinetics. Available evidence suggests that NK is a unique natural compound that possesses several key cardiovascular beneficial effects for patients with CVD and is therefore an ideal drug candidate for the prevention and treatment of CVD. Nattokinase is a promising alternative in the management of CVD.
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Affiliation(s)
- Hongjie Chen
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Eileen M McGowan
- School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
| | - Nina Ren
- Guangdong Online Hospital Clinic, Guangdong No.2 Provincial People’s Hospital, Guangzhou, China
| | - Sara Lal
- School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
| | - Najah Nassif
- School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
| | - Fatima Shad-Kaneez
- School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
| | - Xianqin Qu
- School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
| | - Yiguang Lin
- School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia
- Yiguang Lin, School of Life Sciences, University of Technology Sydney, Broadway, NSW 2007, Australia.
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150
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Guerrero-García C, Rubio-Guerra AF. Combination therapy in the treatment of hypertension. Drugs Context 2018; 7:212531. [PMID: 29899755 PMCID: PMC5992964 DOI: 10.7573/dic.212531] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/01/2023] Open
Abstract
Hypertension is a major preventable risk factor for atherosclerosis and ischemic heart disease. Although modern and effective antihypertensive drugs are available, most patients remain with a suboptimal blood pressure control. Most hypertensive patients will need a combination of antihypertensive agents to achieve the therapeutic goals – recent guidelines recommend initiating treatment with two drugs in those patients with a systolic blood pressure >20 mmHg and/or a diastolic blood pressure >10 mmHg above the goals, and in those patients with high cardiovascular risk. In addition, approximately 25% of patients will require three antihypertensive agents to achieve the therapeutic targets. In this review, we analyse the latest information available regarding the treatment of hypertension with combination therapy.
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Affiliation(s)
- Carolina Guerrero-García
- Unidad de Investigación Clínico-Metabólica, Hospital General de Ticomán SS DF, Mexico City, Mexico.,Mexican Group for Basic and Clinical Research in Internal Medicine, A.C., Mexico City, Mexico
| | - Alberto Francisco Rubio-Guerra
- Unidad de Investigación Clínico-Metabólica, Hospital General de Ticomán SS DF, Mexico City, Mexico.,Mexican Group for Basic and Clinical Research in Internal Medicine, A.C., Mexico City, Mexico
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