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Watanabe D, Morimoto S, Morishima N, Ichihara A. Clinical impacts of endothelium-dependent flow-mediated vasodilation assessment on primary aldosteronism. Endocr Connect 2021; 10:578-587. [PMID: 33984834 PMCID: PMC8240713 DOI: 10.1530/ec-21-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Primary aldosteronism (PA) is divided into two major subtypes, aldosterone-producing adenoma (APA) and bilateral idiopathic hyperplasia (IHA) and is associated with a higher risk of cardiovascular events. However, the nature of vascular function in PA patients remains to be determined. The aim of this study was to determine the vascular function and investigate the implications of vascular function assessments in the patients. METHODS Flow-mediated dilation (FMD), as an index of endothelial function, and cardio-ankle vascular index (CAVI), as an index of arterial stiffness, were retrospectively compared between 42 patients with APA, 37 patients with IHA, and 42 patients with essential hypertension (EH). These values were also compared with background factors, KCNJ5 mutation and clinical outcome in terms of blood pressure reduction after adrenalectomy in the APA group. RESULTS FMD was significantly lower in the APA group (4.8 ± 2.1%) and IHA group (4.1 ± 1.9%) than in the EH group (5.7 ± 2.1%). CAVI did not differ significantly among groups. Although no significant correlations were seen between FMD and background factors in the IHA group, FMD correlated negatively with BMI and plasma aldosterone concentration in the APA group (rs = -0.313, rs = -0.342, respectively). KCNJ5 mutational status was not associated with FMD value. High FMD was associated with blood pressure normalization after adrenalectomy in the APA group. CONCLUSIONS Patients with PA displayed impaired endothelial function. Complete clinical success after adrenalectomy was associated with preserved endothelial function. This study provides a better understanding of FMD assessment in patients with PA.
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Affiliation(s)
- Daisuke Watanabe
- Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Morimoto
- Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
- Correspondence should be addressed to S Morimoto:
| | - Noriko Morishima
- Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
| | - Atsuhiro Ichihara
- Department of Endocrinology and Hypertension, Tokyo Women’s Medical University, Shinjuku-ku, Tokyo, Japan
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102
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Lacroix C, Salvo F, Gras-Champel V, Gautier S, Massy N, Valnet-Rabier MB, Grandvuillemin A, Mounier C, Benkebil M, Pariente A, Jonville-Béra AP, Micallef J. French organization for the pharmacovigilance of COVID-19 vaccines: A major challenge. Therapie 2021; 76:297-303. [PMID: 34059351 PMCID: PMC8103768 DOI: 10.1016/j.therap.2021.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022]
Abstract
In this special issue, we present the main highlights of the first weeks of pharmacovigilance monitoring of coronavirus disease 2019 (COVID-19) vaccines in this unprecedented situation in France: the deployment of a vaccination during an epidemic period with the aim of vaccinating the entire population and the intense pharmacovigilance and surveillance of these vaccines still under conditional marketing authorizations. In this unprecedented situation, the cross approach and interaction between the French pharmacovigilance network and French National Agency for the Safety of Medicines and Health Products (ANSM) has been optimized to provide a real-time safety related to COVID-19 vaccines. Every week, pair of regional pharmacovigilance centers gathered safety data from the French pharmacovigilance network, to acutely expertise all the adverse drug reactions (ADRs) reported with each COVID-19 vaccine within a direct circuit with ANSM. Results of this expertise are presented and discussed with ANSM in order to raise safety signals and take appropriate measures if necessary. These reports are then published online. At the 25th of March 2021, more than 9 815 000 doses were injected and 20,265 ADRs were reported, mostly non-serious (76%). Several potential or confirmed signals were raised at the european level for those vaccines and others ADRs are under special attentions. This underlines the adaptiveness of the French pharmacovigilance system to both the identification of new patient profiles experiencing ADRs and the evolution of the vaccine strategy. Such an efficiency is necessary to manage a careful and acute surveillance of these new COVID-19 vaccines for and to face the pandemic at the same time.
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Affiliation(s)
- Clémence Lacroix
- Centre régional de pharmacovigilance et d'information sur le médicament, service de pharmacologie clinique et pharmacovigilance, Aix Marseille Université, AP-HM, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite 13009, Marseille, France
| | - Francesco Salvo
- University Bordeaux, Inserm, BPH, U1219, Team Pharmacoepidemiology, 33000 Bordeaux, France; CHU de Bordeaux, pôle de santé publique, service de pharmacologie médicale, centre régional de pharmacovigilance et d'information sur le médicament de Bordeaux, 33076 Bordeaux, France
| | - Valérie Gras-Champel
- Centre régional de pharmacovigilance, service de pharmacologie clinique, CHU Amiens-Picardie, 80054 Amiens, France
| | - Sophie Gautier
- Centre régional de pharmacovigilance Lille, service de pharmacologie clinique, CHU Lille, université de Lille, 59045 Lille, France
| | - Nathalie Massy
- Centre régional de pharmacovigilance, service de pharmacologie clinique, CHU de Rouen, 76031 Rouen, France
| | - Marie-Blanche Valnet-Rabier
- Centre régional de pharmacovigilance Franche Comté, service de pharmacologie clinique, CHU de Besançon, 25030 Besançon, France
| | - Aurélie Grandvuillemin
- Centre régional de pharmacovigilance, service de vigilances, qualité, risques, centre hospitalier universitaire de Dijon-Bourgogne, université de Bourgogne, 21079 Dijon, France
| | - Céline Mounier
- Agence nationale de sécurité du médicament et des produits de santé, Direction de la surveillance, 93200 Saint-Denis, France
| | - Mehdi Benkebil
- Agence nationale de sécurité du médicament et des produits de santé, Direction de la surveillance, 93200 Saint-Denis, France
| | - Antoine Pariente
- University Bordeaux, Inserm, BPH, U1219, Team Pharmacoepidemiology, 33000 Bordeaux, France
| | - Annie-Pierre Jonville-Béra
- Centre régional de pharmacovigilance et d'information sur le médicament, service de pharmacosurveillance, CHU de Tours, 37044 Tours, France
| | - Joëlle Micallef
- Centre régional de pharmacovigilance et d'information sur le médicament, service de pharmacologie clinique et pharmacovigilance, Aix Marseille Université, AP-HM, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite 13009, Marseille, France.
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103
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Kim KJ, Hong N, Yu MH, Lee H, Lee S, Lim JS, Rhee Y. Time-Dependent Risk of Atrial Fibrillation in Patients With Primary Aldosteronism After Medical or Surgical Treatment Initiation. Hypertension 2021; 77:1964-1973. [PMID: 33866798 DOI: 10.1161/hypertensionaha.120.16909] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text]. Increased risk of atrial fibrillation was reported in patients with primary aldosteronism. However, data are limited
regarding the time-dependent risk of atrial fibrillation in surgically or medically treated primary aldosteronism. From the
National Health Insurance Claim database in Korea (2003–2017), a total of 1418 patients with primary aldosteronism
(adrenalectomy [ADX], n=755, mineralocorticoid receptor antagonist n=663) were age- and sex-matched at a 1:5 ratios
to patients with essential hypertension (n=7090). Crude incidence of new onset atrial fibrillation was 2.96% in primary
aldosteronism and 1.97% in essential hypertension. Because of nonproportional hazard observed in new onset atrial
fibrillation, analysis time was split at 3 years. Compared with essential hypertension, risk of new onset atrial fibrillation peaked at 1 year gradually declined but remained elevated up to 3 years in overall treated primary aldosteronism (adjusted hazard ratio [aHR] 3.02; P<0.001) as well as in both ADX (aHR, 3.54; P<0.001) and mineralocorticoid receptor antagonist groups (aHR 2.27; P=0.031), which became comparable to essential hypertension afterward in both groups (ADX aHR, 0.38; P=0.102; mineralocorticoid receptor antagonist aHR, 0.60; P=0.214). Nonetheless, mineralocorticoid receptor antagonist group was associated with increased risk of nonfatal stroke (aHR, 1.21; P=0.031) compared with essential hypertension, whereas ADX was not (aHR, 1.26; P=0.288). Our results suggest the risk of new-onset atrial fibrillation remained elevated up to 3 years in treated primary aldosteronism compared with essential hypertension, which declined to comparable risk in essential hypertension thereafter. Monitoring for atrial fibrillation up to 3 years after treatment, particularly ADX, might be warranted.
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Affiliation(s)
- Kyoung Jin Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul (K.J.K.)
| | - Namki Hong
- Department of Internal Medicine (N.H., H.L., S.L., Y.R.), Yonsei University College of Medicine, Seoul
| | - Min Heui Yu
- SENTINEL team, Division of Endocrinology, Department of Internal Medicine (M.H.Y.), Yonsei University College of Medicine, Seoul
| | - Hokyou Lee
- Department of Internal Medicine (N.H., H.L., S.L., Y.R.), Yonsei University College of Medicine, Seoul
- Department of Preventive Medicine (H.L.), Yonsei University College of Medicine, Seoul
| | - Seunghyun Lee
- Department of Internal Medicine (N.H., H.L., S.L., Y.R.), Yonsei University College of Medicine, Seoul
| | - Jung Soo Lim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, South Korea (J.S.L.)
| | - Yumie Rhee
- Department of Internal Medicine (N.H., H.L., S.L., Y.R.), Yonsei University College of Medicine, Seoul
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Abstract
Cells respond to stress by activating a variety of defense signaling pathways, including cell survival and cell death pathways. Although cell survival signaling helps the cell to recover from acute insults, cell death or senescence pathways induced by chronic insults can lead to unresolved pathologies. Arterial hypertension results from chronic physiological maladaptation against various stressors represented by abnormal circulating or local neurohormonal factors, mechanical stress, intracellular accumulation of toxic molecules, and dysfunctional organelles. Hypertension and aging share common mechanisms that mediate or prolong chronic cell stress, such as endoplasmic reticulum stress and accumulation of protein aggregates, oxidative stress, metabolic mitochondrial stress, DNA damage, stress-induced senescence, and proinflammatory processes. This review discusses common adaptive signaling mechanisms against these stresses including unfolded protein responses, antioxidant response element signaling, autophagy, mitophagy, and mitochondrial fission/fusion, STING (signaling effector stimulator of interferon genes)-mediated responses, and activation of pattern recognition receptors. The main molecular mechanisms by which the vasculature copes with hypertensive and aging stressors are presented and recent advancements in stress-adaptive signaling mechanisms as well as potential therapeutic targets are discussed.
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Affiliation(s)
- Stephanie M. Cicalese
- These authors contributed equally and are considered co-first authors
- Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Josiane Fernandes da Silva
- These authors contributed equally and are considered co-first authors
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
| | - Fernanda Priviero
- These authors contributed equally and are considered co-first authors
- Cardiovascular Translational Research Center and Department of Cell Biology and Anatomy, University of South Carolina, Columbia, South Carolina, USA
| | - R. Clinton Webb
- Cardiovascular Translational Research Center and Department of Cell Biology and Anatomy, University of South Carolina, Columbia, South Carolina, USA
| | - Satoru Eguchi
- Cardiovascular Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Rita C. Tostes
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, SP, Brazil
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105
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Schiffrin EL. From the Editor-in-Chief: Issue at a glance. Am J Hypertens 2021; 34:1-2. [PMID: 33599749 DOI: 10.1093/ajh/hpaa214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ernesto L Schiffrin
- The American Journal of Hypertension, Lady Davis Institute for Medical Research, and Department of Medicine, Sir Mortimer B. Davis, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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