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Schupp T, Akin I, Behnes M. Pharmacological Treatment Following Myocardial Infarction: How Large Is the Gap Between Guideline Recommendations and Routine Clinical Care? J Am Heart Assoc 2021; 10:e021799. [PMID: 34227398 PMCID: PMC8483471 DOI: 10.1161/jaha.121.021799] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Tobias Schupp
- First Department of Medicine Faculty of Medicine Mannheim University of Heidelberg Mannheim Germany
| | - Ibrahim Akin
- First Department of Medicine Faculty of Medicine Mannheim University of Heidelberg Mannheim Germany
| | - Michael Behnes
- First Department of Medicine Faculty of Medicine Mannheim University of Heidelberg Mannheim Germany
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2
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Carlos-Escalante JA, de Jesús-Sánchez M, Rivas-Castro A, Pichardo-Rojas PS, Arce C, Wegman-Ostrosky T. The Use of Antihypertensive Drugs as Coadjuvant Therapy in Cancer. Front Oncol 2021; 11:660943. [PMID: 34094953 PMCID: PMC8173186 DOI: 10.3389/fonc.2021.660943] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 12/23/2022] Open
Abstract
Cancer is a complex group of diseases that constitute the second largest cause of mortality worldwide. The development of new drugs for treating this disease is a long and costly process, from the discovery of the molecule through testing in phase III clinical trials, a process during which most candidate molecules fail. The use of drugs currently employed for the management of other diseases (drug repurposing) represents an alternative for developing new medical treatments. Repurposing existing drugs is, in principle, cheaper and faster than developing new drugs. Antihypertensive drugs, primarily belonging to the pharmacological categories of angiotensin-converting enzyme inhibitors, angiotensin II receptors, direct aldosterone antagonists, β-blockers and calcium channel blockers, are commonly prescribed and have well-known safety profiles. Additionally, some of these drugs have exhibited pharmacological properties useful for the treatment of cancer, rendering them candidates for drug repurposing. In this review, we examine the preclinical and clinical evidence for utilizing antihypertensive agents in the treatment of cancer.
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Affiliation(s)
- José A. Carlos-Escalante
- Plan de Estudios Combinados En Medicina (PECEM) (MD/PhD), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Marcela de Jesús-Sánchez
- Facultad de Ciencias Biológicas y Agropecuarias, Universidad Veracruzana, Orizaba-Córdoba, Mexico
| | - Alejandro Rivas-Castro
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Claudia Arce
- Medical Oncology/Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Talia Wegman-Ostrosky
- Basic Research Subdirection, Instituto Nacional de Cancerología, Mexico City, Mexico
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3
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Young MJ, Kanki M, Fuller PJ, Yang J. Identifying new cellular mechanisms of mineralocorticoid receptor activation in the heart. J Hum Hypertens 2021; 35:124-130. [PMID: 32733061 DOI: 10.1038/s41371-020-0386-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/01/2020] [Accepted: 07/16/2020] [Indexed: 01/30/2023]
Abstract
Recent studies have expanded our understanding of the actions of the mineralocorticoid receptor (MR) to a diverse array of tissue types that differ substantially from the epithelial cells of the renal nephron. In these cell types the role of the MR has been largely, but not exclusively, defined in terms of pathogenic signalling pathways leading to tissue injury and remodelling. Macrophages and cardiomyocytes are two cell types in which the MR plays a central role in the cardiac tissue response to injury, renovascular hypertension and oxidative stress for example. Macrophages are critical for resolution of tissue injury and wound healing and their pleiotropic actions are central to the development of many forms of heart, renal and vascular disease. The MR in cardiomyocytes is not only essential for the chronotropic and ionotropic actions of mineralocorticoids in the short and longer term, but also for induction of hypertrophic and proinflammatory signalling programs. The present review discusses recent studies, presented at the Aldosterone and Hypertension Satellite of the 15th Asian-Pacific Congress of Hypertension, investigating new mechanisms for MR signalling in these cells and how their dysfunction contributes to the onset and progression of cardiovascular disease and heart failure.
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Affiliation(s)
- Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia. .,Baker Heart and Diabetes Institute, Melborne, VIC, Australia.
| | - Monica Kanki
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia.,Baker Heart and Diabetes Institute, Melborne, VIC, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research and the Department of Molecular Translational Science, Monash University, Clayton, VIC, Australia
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4
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Aboktifa MA, Abbas DA. Interaction Toxicity Study between P-glycoprotein Inhibitor (Captopril) and Inducer (Spironolactone) with Their Substrate (Lovastatin) in Male Rats. THE IRAQI JOURNAL OF VETERINARY MEDICINE 2020. [DOI: 10.30539/ijvm.v44i(e0).1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
An interaction toxicity study was performed to evaluate and compare the effect of P-glycoprotein (P-gp) inhibitor (captopril) and inducer (spironolactone) on their common substrate (lovastatin) that were done by comparing LD50 of the acute study with their chronic form then with those combined therapeutic doses administered for 90 days. Therefore, isobolographic analysis and chronicity index were used as the parameters for this study. Forty rats were allocated into five groups according to the used treatment into: captopril, spironolactone, lovastatin, captopril + lovastatin and spironolactone + lovastatin using up and down method to determine their acute exposure LD50 while ninety rats were used to perform the chronic stage of the study divided equally into six groups according to daily dosing regimen as following G1- control group administered distilled water orally; G2 administered captopril 0.7 mg/kg BW orally; G3-administered spironolactone 1.4 mg/kg BW orally; G4- administered lovastatin 0.57 mg/kg BW orally; G5-administered spironolactone1.4 mg/kg BW orally and lovastatin 0.57 mg/kg BW, G6- administered captopril 0.7 mg/kg BW and lovastatin 0.57 mg/kg BW orally. The results of isobolographic analysis showed that the sort of interaction between P-gp inhibitor (captopril) and lovastatin alone and as combined administration showed to be antagonistic after acute administration while it was synergistic after chronic administration; for P-gp inducer, spironolactone and lovastatin were additive after acute administration and antagonistic after chronic administration. Chronicity index results showed that both captopril and lovastatin accumulated after administered each alone and showed more accumulation after their combined administration while the chronicity index for P-gp inducer (spironolactone) and lovastatin showed less total concentration in the body burden after their combined administration than alone one. In conclusion, it seems that P-gp inhibitor (captopril) causes accumulation of itself and substrate (lovastatin), while P-gp inducer (spironolactone) causes reduction on the body burden of itself as well as lovastatin possibly due to their effects on the kinetics of the body and this may affect the efficacy and safety of drugs.
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Zannad F, Ferreira JP, Pitt B. Potassium binders for the prevention of hyperkalaemia in heart failure patients: implementation issues and future developments. Eur Heart J Suppl 2019; 21:A55-A60. [PMID: 30837806 PMCID: PMC6392413 DOI: 10.1093/eurheartj/suy034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
New therapeutic options to treat hyperkalaemia, such as potassium binders, have been suggested as potentially beneficial by allowing the maintenance (or increase) of the dose of medications that improve outcomes in several cardiovascular conditions, but which have in common the propensity for raising serum potassium. However, potassium binding drugs have yet to prove their causal association with improvements in patients' prognosis before their widespread use can be recommended. In this review we provided an up-to-dare appraisal on potassium binders, their potential clinical applications and directions for future research.
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Affiliation(s)
- Faiez Zannad
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, France
| | - João Pedro Ferreira
- Université de Lorraine INSERM, Centre, d'Investigations Cliniques Plurithématique 1433, INSERM U1116, CHRU de Nancy, F-CRIN INI-CRCT, France
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Portugal
| | - Bertram Pitt
- Division of Cardiology, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
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Mineralocorticoid receptor antagonists in patients with acute myocardial infarction - A systematic review and meta-analysis of randomized trials. Am Heart J 2018; 195:60-69. [PMID: 29224647 DOI: 10.1016/j.ahj.2017.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/13/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although mineralocorticoid antagonists (MRAs) reduce mortality in patients with heart failure complicating myocardial infarction (MI), it is unclear if they could be beneficial to all patients with MI. To evaluate the utility of MRAs in MI patients, we performed a systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and Cochrane CENTRAL were searched from 1965 to June 2016. Conference abstracts were searched from 2000 to June 2016. Randomized trials evaluating the effect of MRA after MIs were included. Two reviewers independently extracted data and assessed study quality. Data were combined using fixed-/random-effects models. RESULTS Eleven randomized clinical trials (N = 11,258) were included; 1 trial (N = 6,642) included patients with apparent heart failure (Killip class III-IV). Administration of MRA versus placebo or standard therapy (no-MRA) after MI reduced overall and cardiovascular mortality (odds ratio [OR] 0.82, 95% CI 0.73-0.93, P = .002, and OR 0.82, 95% CI 0.71-0.93, P = .003, respectively; I2 for both = 0%). In the subgroup of trials with patients with heart failure, the mortality was 14.4% in MRA group versus 16.7% in no-MRA group (OR 0.84, 95% CI 0.73-0.96), and among those without heart failure, it was 2.5% with MRA versus 3.5% without MRA (OR 0.72, 95% CI 0.51-1.02, P for interaction = .43). Patients receiving MRA had fewer new or worsening heart failure events (OR 0.74, 95% CI 0.66-0.84, P < .0001; I2 = 14%). Nevertheless, MRA therapy increased risk for hyperkalemia (≥5.5 mmol/L) (OR 2.52, 95% CI 1.36-4.65, P = .003; I2 = 63%). CONCLUSIONS Administration of MRA may reduce mortality after acute MI. However, this is largely based on post-MI patients with heart failure. Further data are needed in MI patients without heart failure.
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Ferreira JP, Rossignol P, Machu JL, Sharma A, Girerd N, Anker SD, Cleland JG, Dickstein K, Filippatos G, Hillege HL, Lang CC, Ter Maaten JM, Metra M, Ng L, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zwinderman AH, Voors A, Zannad F. Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction: findings from BIOSTAT-CHF. Eur J Heart Fail 2017; 19:1284-1293. [PMID: 28580625 DOI: 10.1002/ejhf.900] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022] Open
Abstract
AIMS Mineralocorticoid receptor antagonists (MRAs) are recommended (unless contraindicated) to all patients with heart failure with reduced ejection fraction (HFrEF). However, MRAs are still largely underused in routine clinical practice. This study aims to describe the determinants and pattern of use of MRAs in HFrEF. METHODS AND RESULTS BIOSTAT-CHF is a European multicentre, prospective study which enrolled patients suboptimally treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) and/or beta-blockers, with the aim of optimizing guideline-based use of these agents. From the original 2516 subjects, this retrospective post hoc analysis included the 1325 patients with an indication for MRA therapy (i.e. left ventricular ejection fraction ≤35%, estimated glomerular filtration rate ≥30 mL/min/1.73 m2 , K+ ≤5.0 mmol/L). The mean age was 66.1 ± 12.2 years. At baseline an MRA was prescribed to 741 (56%) patients. Patients who were prescribed MRAs at baseline were younger, more often male, had higher body mass index, lower sodium, higher proportion of hypertension history and ACEi/ARB prescription (all P < 0.05). Of the 1049 patients who completed the baseline plus the 9 month visit, 585 (56%) had an MRA prescribed at baseline and 662 (63%) had an MRA prescribed at 9 months. Among the 585 patients with MRA at baseline, 91 (16%) had discontinued therapy and among the 461 (44%) patients without MRA at baseline 168 (36%) had initiated therapy subsequently. MRA discontinuation was more likely in subjects with higher left ventricular ejection fraction and NYHA class III/IV (P < 0.05 for both). MRA prescription both at baseline and 9 months was not associated with the outcome of death or heart failure hospitalization (adjusted hazard ratio 1.02, 95% confidence interval 0.66-1.58; P = 0.93). CONCLUSIONS In this prospective observational study across Europe, MRAs were largely under-prescribed and frequently discontinued. Owing to these dynamic changes, outcome inferences are inconclusive.
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Affiliation(s)
- João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.,Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Jean-Loup Machu
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medical Centre Göttingen (UMG), Robert-Koch-Straße, D-37075, Göttingen, Germany
| | - John G Cleland
- Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Glasgow, UK
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway.,Stavanger University Hospital, Stavanger, Norway
| | - Gerasimos Filippatos
- National and Kopodistrian University of Athens, School of Medicine, Heart Failure Unit, Department of Cardiology, Athens University Hospital Attikon, Rimini 1, Athens, 12462, Greece
| | - Hans L Hillege
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.,Program of Applied Translational Research, Yale University, New Haven, CT, USA
| | | | - Leong Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Piotr Ponikowski
- Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland and Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Groby Rd, Leicester, LE3 9QP, UK
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Aeilko H Zwinderman
- Academic Medical Center, Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam, The Netherlands
| | - Adriaan Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
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Carone L, Oxberry SG, Twycross R, Charlesworth S, Mihalyo M, Wilcock A. Spironolactone. J Pain Symptom Manage 2017; 53:288-292. [PMID: 28024992 DOI: 10.1016/j.jpainsymman.2016.12.320] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 11/18/2016] [Indexed: 01/28/2023]
Abstract
Therapeutic Reviews aim to provide essential independent information for health professionals about drugs used in palliative and hospice care. Additional content is available on www.palliativedrugs.com. Country-specific books (Hospice and Palliative Care Formulary USA, and Palliative Care Formulary, British and Canadian editions) are also available and can be ordered from www.palliativedrugs.com. The series editors welcome feedback on the articles (hq@palliativedrugs.com).
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Affiliation(s)
- Laura Carone
- University of Nottingham, Nottingham, United Kingdom
| | | | | | | | - Mary Mihalyo
- Mylan School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania, USA
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Inampudi C, Parvataneni S, Morgan CJ, Deedwania P, Fonarow GC, Sanders PW, Prabhu SD, Butler J, Forman DE, Aronow WS, Allman RM, Ahmed A. Spironolactone use and higher hospital readmission for Medicare beneficiaries with heart failure, left ventricular ejection fraction <45%, and estimated glomerular filtration rate <45 ml/min/1.73 m(2.). Am J Cardiol 2014; 114:79-82. [PMID: 24846806 PMCID: PMC4169696 DOI: 10.1016/j.amjcard.2014.03.062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
Although randomized controlled trials have demonstrated benefits of aldosterone antagonists for patients with heart failure and reduced ejection fraction (HFrEF), they excluded patients with serum creatinine >2.5 mg/dl, and their use is contraindicated in those with advanced chronic kidney disease (CKD). In the present analysis, we examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD. Of the 1,140 patients with HFrEF (EF <45%) and advanced CKD (estimated glomerular filtration rate [eGFR] <45 ml/min/1.73 m(2)), 207 received discharge prescriptions for spironolactone. Using propensity scores (PSs) for the receipt of discharge prescriptions for spironolactone, we estimated PS-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for spironolactone-associated outcomes. Patients (mean age 76 years, 49% women, 25% African-American) had mean EF 28%, mean eGFR 31 ml/min/1.73 m(2), and mean potassium 4.5 mEq/L. Spironolactone use had significant PS-adjusted association with higher risk of 30-day (HR 1.41, 95% CI 1.04 to 1.90) and 1-year (HR 1.36, 95% CI 1.13 to 1.63) all-cause readmissions. The risk of 1-year all-cause readmission was higher among 106 patients with eGFR <15 ml/min/1.73 m(2) (HR 4.75, 95% CI 1.84 to 12.28) than among those with eGFR 15 to 45 ml/min/1.73 m(2) (HR 1.34, 95% CI 1.11 to 1.61, p for interaction 0.003). Spironolactone use had no association with HF readmission and all-cause mortality. In conclusion, among hospitalized patients with HFrEF and advanced CKD, spironolactone use was associated with higher all-cause readmission but had no association with all-cause mortality or HF readmission.
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Affiliation(s)
| | | | | | | | | | - Paul W Sanders
- University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama
| | - Sumanth D Prabhu
- University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama
| | | | | | | | - Richard M Allman
- Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, District of Columbia
| | - Ali Ahmed
- University of Alabama at Birmingham, Birmingham, Alabama; Veterans Affairs Medical Center, Birmingham, Alabama
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Katholi RE, Rocha-Singh KJ, Goswami NJ, Sobotka PA. Renal nerves in the maintenance of hypertension: a potential therapeutic target. Curr Hypertens Rep 2011; 12:196-204. [PMID: 20424950 DOI: 10.1007/s11906-010-0108-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Renal sympathetic efferent and afferent nerves, which lie within and immediately adjacent to the wall of the renal arteries, contribute to the maintenance of hypertension. Because the causative factors of hypertension change over time, denervation of both efferent and afferent renal nerves should result in long-term attenuation of hypertension. The importance of the renal nerves in hypertensive patients can now be defined with the novel development of percutaneous, minimally invasive renal denervation from within the renal artery using radiofrequency energy as a therapeutic strategy. Studies thus far show that catheter-based renal denervation in patients with resistant essential hypertension lowers systolic blood pressure 27 mm Hg by 12 months, with the estimated glomerular filtration rate remaining stable. The decrease in arterial pressure after renal denervation is associated with decreased peripheral sympathetic nervous system activity, suggesting that the kidney is a source of significant central sympathetic outflow via afferent renal nerve activity.
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Affiliation(s)
- Richard E Katholi
- Prairie Education and Research Cooperative, 317 North 5th Street, Springfield, IL 62701, USA.
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11
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Russo A, Autelitano M, Bisanti L. Spironolactone and gastrointestinal bleeding: a population based study. Pharmacoepidemiol Drug Saf 2008; 17:495-500. [DOI: 10.1002/pds.1583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2006. [DOI: 10.1002/pds.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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