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Davey MG, Joyce WP. Evaluating the safety profile of anti-platelet therapy in patients undergoing elective inguinal hernia repair: a systematic review and meta-analysis. Ir J Med Sci 2024; 193:897-902. [PMID: 37526871 PMCID: PMC10961273 DOI: 10.1007/s11845-023-03480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/26/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION There remains no consensus surrounding the safety of prescribing anti-platelet therapies (APT) prior to elective inguinal hernia repair (IHR). AIMS To perform a systematic review and meta-analysis evaluating the safety profile of APT use in patients indicated to undergo elective IHR. METHODS A systematic review was performed in accordance with PRISMA guidelines. Meta-analyses were performed using the Mantel-Haenszel method using the Review Manager version 5.4 software. RESULTS Five studies including outcomes in 344 patients were included. Of these, 65.4% had APT discontinued (225/344), and 34.6% had APT continued (119/344). The majority of included patients were male (94.1%, 288/344). When continuing or discontinuing APT, there was no significant difference in overall haemorrhage rates (odds ratio (OR): 1.86, 95% confidence interval (CI): 0.29-11.78, P = 0.130) and in sensitivity analysis using only RCT data (OR: 0.63, 95% CI: 0.03-12.41, P = 0.760). Furthermore, there was no significant difference in reoperation rates (OR: 6.27, 95% CI: 0.72-54.60, P = 0.590); however, a significant difference was observed for readmission rates (OR: 5.67, 95% CI: 1.33-24.12, P = 0.020) when APT was continued or stopped pre-operatively. There was no significant difference in the estimated blood loss, intra-operative time, transfusion of blood products, rates of complications, cerebrovascular accidents, myocardial infarctions, or mortality observed. CONCLUSION This study illustrates the safety of continuing APT pre-operatively in patients undergoing elective IHR, with similar rates of haemorrhage, reoperation, and readmission observed. Clinical trials with larger patient recruitment will be required to fully establish the safety profile of prescribing APT in the pre-operative setting prior to elective IHR.
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Affiliation(s)
- Matthew G Davey
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland.
| | - William P Joyce
- Royal College of Surgeons Ireland, 123 St. Stephens Green, Dublin 2, D02 YN77, Ireland
- Department of Surgery, Galway Clinic, Co., Galway, H91 HHT0, Ireland
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2
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Li Z, Xu S, Chen L, Jiang D. Effect of aspirin on blood pressure in hypertensive patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:90. [PMID: 38321368 PMCID: PMC10845465 DOI: 10.1186/s12872-024-03737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Aspirin is widely used for secondary prevention in patients with hypertension. However, previous studies mainly focused on the preventive effects of aspirin, and there has been a lack of reliable evidence on whether taking aspirin affects blood pressure This study aimed to investigate whether aspirin would affect the blood pressure in patients with hypertension. METHODS PubMed, Cochrane database, Embase, Scopus and Medline databases were searched until September 2023. For continuous variables (e.g., blood pressure reduction), the mean difference (MD) was selected as the effect magnitude indices. We used the Cochrane Collaboration's Risk of Bias tool to assess the risk of bias. RESULT A total of five studies were included, comprising 20,312 patients. We found that aspirin did not affect SBP (MD = -0.78, 95% CI: - 2.41, 0.84). A similar result was found for DBP (MD = -0.86, 95% CI: - 2.14, 0.42). CONCLUSION This study showed no significant difference in blood pressure between the aspirin and control groups, suggesting that aspirin does not affect blood pressure.
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Affiliation(s)
- Zehan Li
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong Province, China
| | - Shengchao Xu
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong Province, China
| | - Lin Chen
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong Province, China
| | - Danxian Jiang
- Department of Head and Neck Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, Guangdong Province, China.
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3
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Almagazzachi A, Mustafa A, Eighaei Sedeh A, Vazquez Gonzalez AE, Polianovskaia A, Abood M, Abdelrahman A, Muyolema Arce V, Acob T, Saleem B. Generative Artificial Intelligence in Patient Education: ChatGPT Takes on Hypertension Questions. Cureus 2024; 16:e53441. [PMID: 38435177 PMCID: PMC10909311 DOI: 10.7759/cureus.53441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Uncontrolled hypertension significantly contributes to the development and deterioration of various medical conditions, such as myocardial infarction, chronic kidney disease, and cerebrovascular events. Despite being the most common preventable risk factor for all-cause mortality, only a fraction of affected individuals maintain their blood pressure in the desired range. In recent times, there has been a growing reliance on online platforms for medical information. While providing a convenient source of information, differentiating reliable from unreliable information can be daunting for the layperson, and false information can potentially hinder timely diagnosis and management of medical conditions. The surge in accessibility of generative artificial intelligence (GeAI) technology has led to increased use in obtaining health-related information. This has sparked debates among healthcare providers about the potential for misuse and misinformation while recognizing the role of GeAI in improving health literacy. This study aims to investigate the accuracy of AI-generated information specifically related to hypertension. Additionally, it seeks to explore the reproducibility of information provided by GeAI. Method A nonhuman-subject qualitative study was devised to evaluate the accuracy of information provided by ChatGPT regarding hypertension and its secondary complications. Frequently asked questions on hypertension were compiled by three study staff, internal medicine residents at an ACGME-accredited program, and then reviewed by a physician experienced in treating hypertension, resulting in a final set of 100 questions. Each question was posed to ChatGPT three times, once by each study staff, and the majority response was then assessed against the recommended guidelines. A board-certified internal medicine physician with over eight years of experience further reviewed the responses and categorized them into two classes based on their clinical appropriateness: appropriate (in line with clinical recommendations) and inappropriate (containing errors). Descriptive statistical analysis was employed to assess ChatGPT responses for accuracy and reproducibility. Result Initially, a pool of 130 questions was gathered, of which a final set of 100 questions was selected for the purpose of this study. When assessed against acceptable standard responses, ChatGPT responses were found to be appropriate in 92.5% of cases and inappropriate in 7.5%. Furthermore, ChatGPT had a reproducibility score of 93%, meaning that it could consistently reproduce answers that conveyed similar meanings across multiple runs. Conclusion ChatGPT showcased commendable accuracy in addressing commonly asked questions about hypertension. These results underscore the potential of GeAI in providing valuable information to patients. However, continued research and refinement are essential to evaluate further the reliability and broader applicability of ChatGPT within the medical field.
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Affiliation(s)
| | - Ahmed Mustafa
- Internal Medicine, Capital Health System, Trenton, USA
| | | | | | | | - Muhanad Abood
- Internal Medicine, Capital Health System, Trenton, USA
| | | | | | - Talar Acob
- Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA
| | - Bushra Saleem
- Internal Medicine, Capital Health System, Trenton, USA
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4
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Cortés-Ríos J, Rodriguez-Fernandez M. Understanding the dosing-time-dependent antihypertensive effect of valsartan and aspirin through mathematical modeling. Front Endocrinol (Lausanne) 2023; 14:1110459. [PMID: 36967780 PMCID: PMC10031009 DOI: 10.3389/fendo.2023.1110459] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/08/2023] [Indexed: 03/11/2023] Open
Abstract
Chronopharmacology of arterial hypertension impacts the long-term cardiovascular risk of hypertensive subjects. Therefore, clinical and computational studies have proposed optimizing antihypertensive medications' dosing time (Ta). However, the causes and mechanisms underlying the Ta-dependency antihypertensive effect have not been elucidated. Here we propose using a Ta- dependent effect model to understand and predict the antihypertensive effect of valsartan and aspirin throughout the day in subjects with grade I or II essential hypertension. The model based on physiological regulation mechanisms includes a periodic function for each parameter that changes significantly after treatment. Circadian variations of parameters depending on the dosing time allowed the determination of regulation mechanisms dependent on the circadian rhythm that were most relevant for the action of each drug. In the case of valsartan, it is the regulation of vasodilation and systemic vascular resistance. In the case of aspirin, the antithrombotic effect generates changes in the sensitivity of systemic vascular resistance and heart rate to changes in physical activity. Dosing time-dependent models predict a more significant effect on systemic vascular resistance and blood pressure when administering valsartan or aspirin at bedtime. However, circadian dependence on the regulation mechanisms showed different sensitivity of their circadian parameters and shapes of functions, presenting different phase shifts and amplitude. Therefore, different mechanisms of action and pharmacokinetic properties of each drug can generate different profiles of Ta-dependence of antihypertensive effect and optimal dosing times.
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Tamang HK, Yang R, Song Z, Hsu S, Peng C, Tung Y, Tzeng B, Chen C. Ca v 3.2 T-type calcium channel regulates mouse platelet activation and arterial thrombosis. J Thromb Haemost 2022; 20:1887-1899. [PMID: 35490411 PMCID: PMC9541131 DOI: 10.1111/jth.15745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cav 3.2 is a T-type calcium channel that causes low-threshold exocytosis. T-type calcium channel blockers reduce platelet granule exocytosis and aggregation. However, studies of the T-type calcium channel in platelets are lacking. OBJECTIVE To examine the expression and role of Cav 3.2 in platelet function. METHODS Global Cav 3.2-/- and platelet-specific Cav 3.2-/- mice and littermate controls were used for this study. Western blot analysis was used to detect the presence of Cav 3.2 and activation of the calcium-responsive protein extracellular signal-regulated kinase (ERK). Fura-2 dye was used to assess platelet calcium. Flow cytometry and light transmission aggregometry were used to evaluate platelet activation markers and aggregation, respectively. FeCl3 -induced thrombosis and a microfluidic flow device were used to assess in vivo and ex vivo thrombosis, respectively. RESULTS Cav 3.2 was expressed in mouse platelets. As compared with wild-type controls, Cav 3.2-/- mouse platelets showed reduced calcium influx. Similarly, treatment with the T-type calcium channel inhibitor Ni2+ decreased the calcium influx in wild-type platelets. As compared with controls, both Cav 3.2-/- and Ni2+ -treated wild-type platelets showed reduced activation of ERK. ATP release, P-selectin exposure, and αIIb β3 activation were reduced in Cav 3.2-/- and Ni2+ -treated wild-type platelets, as was platelet aggregation. On in vivo and ex vivo thrombosis assay, Cav3.2 deletion caused delayed thrombus formation. However, tail bleeding assay showed intact hemostasis. CONCLUSION These results suggest that Cav 3.2 is required for the optimal activation of platelets.
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Affiliation(s)
- Hem Kumar Tamang
- Taiwan International Graduate Program in Molecular MedicineNational Yang Ming Chiao Tung University and Academia SinicaTaipeiTaiwan
- Institute of Biomedical SciencesAcademia SinicaTaipeiTaiwan
| | - Ruey‐Bing Yang
- Taiwan International Graduate Program in Molecular MedicineNational Yang Ming Chiao Tung University and Academia SinicaTaipeiTaiwan
- Institute of Biomedical SciencesAcademia SinicaTaipeiTaiwan
| | - Zong‐Han Song
- Institute of Biomedical SciencesAcademia SinicaTaipeiTaiwan
| | - Shao‐Chun Hsu
- Institute of Biomedical SciencesAcademia SinicaTaipeiTaiwan
| | | | - Yi‐Chung Tung
- Research Center for Applied SciencesAcademia SinicaTaipeiTaiwan
| | - Bing‐Hsiean Tzeng
- Division of CardiologyFar Eastern Memorial Hospital and Tri‐Service General HospitalNational Defense Medical CenterTaipeiTaiwan
| | - Chien‐Chang Chen
- Taiwan International Graduate Program in Molecular MedicineNational Yang Ming Chiao Tung University and Academia SinicaTaipeiTaiwan
- Institute of Biomedical SciencesAcademia SinicaTaipeiTaiwan
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Bovbjerg ML. Current Resources for Evidence-Based Practice, September 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:642-654. [PMID: 34437841 DOI: 10.1016/j.jogn.2021.08.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes an assessment of safety of birth centers in the United States and commentaries on reviews focused on aspirin prophylaxis in pregnancy and the new gestational weight gain evidence summary from the United States Preventive Services Task Force.
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Hao Z, Sun Y, Wen Y, Cui L, Li G, Liu Y. Effects and Mechanisms of Dapagliflozin Treatment on Ambulatory Blood Pressure in Diabetic Patients with Hypertension. Med Sci Monit 2020; 26:e925987. [PMID: 33010148 PMCID: PMC7539640 DOI: 10.12659/msm.925987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Studies have shown that dapagliflozin has antihypertensive effects. However, the effects and mechanisms of dapagliflozin on ambulatory blood pressure (ABP) have not been fully evaluated. In this study, we aimed to evaluate the effects of dapagliflozin treatment on ABP in patients with type 2 diabetes and hypertension. Material/Methods Patients were prospectively enrolled and divided into 2 groups: dapagliflozin treatment group (n=182) and no dapagliflozin treatment group (n=304). Clinical characteristics and measures of treatment, serum uric acid (SUA), 24-h urinary UA (UUA) excretion, and 24-h ABP were collected. The effects and mechanisms of dapagliflozin on 24-h ABP were evaluated. Results After 3 months, the patients without dapagliflozin treatment had higher SUA, lower 24-h UUA excretion, and higher 24-h and daytime systolic blood pressure (SBP) (P<0.05) compared to patients with dapagliflozin treatment. After adjusting for covariates, results showed that dapagliflozin treatment was significantly associated with reduced 24-h SBP (β=−0.29 and P=0.02) and reduced daytime SBP (β=−0.33 and P=0.009). After additionally adjusting for SUA and 24-h UUA excretion, there were no significant relationships found between dapagliflozin treatment and 24-h (β=−012, P=0.10) and daytime SBP (β=−0.20, P=0.06). Conclusions In patients with diabetes and hypertension, dapagliflozin treatment was associated with reduced 24-h and daytime SBP, which could be related to the drug’s effect of increasing 24-h UUA excretion.
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Affiliation(s)
- Zirao Hao
- Department of Endocrinology, The Third People's Hospital of Huizhou, Huizhou, Guangdong, China (mainland)
| | - Yue Sun
- Department of Endocrinology, The Third People's Hospital of Huizhou, Huizhou, Guangdong, China (mainland)
| | - Yingzhen Wen
- Department of Endocrinology, The Third People's Hospital of Huizhou, Huizhou, Guangdong, China (mainland)
| | - Lijuan Cui
- Department of Endocrinology, The Third People's Hospital of Huizhou, Huizhou, Guangdong, China (mainland)
| | - Guiping Li
- Department of Endocrinology, The Third People's Hospital of Huizhou, Huizhou, Guangdong, China (mainland)
| | - Yan Liu
- Department of Cardiology, The Third People's Hospital of Huizhou, Huizhou, Guangdong, China (mainland)
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8
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Jiang X, Liu X, Liu X, Wu X, Jose PA, Liu M, Yang Z. Low-Dose Aspirin Treatment Attenuates Male Rat Salt-Sensitive Hypertension via Platelet Cyclooxygenase 1 and Complement Cascade Pathway. J Am Heart Assoc 2020; 9:e013470. [PMID: 31852420 PMCID: PMC6988172 DOI: 10.1161/jaha.119.013470] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/29/2019] [Indexed: 12/15/2022]
Abstract
Background The role of platelets in the development of vascular inflammation and endothelial dysfunction in the pathogenesis of hypertension is well established at this time. Aspirin is known to relieve pain, decrease fever, reduce inflammation, impair platelet aggregation, and prevent clotting, yet its effect in the context of salt-sensitive hypertension remains unclear. The present study investigated the importance of aspirin in inhibiting the abnormal activation of platelets and promoting the normal function of the vascular endothelium in a rat model of salt-sensitive hypertension. Method and Results Dahl salt-sensitive rats and salt-resistant rats were fed a normal-salt diet (4% NaCl), a high-salt diet (8% NaCl), or a high-salt diet with aspirin gavage (10 mg/kg per day) for 8 weeks. Blood pressure, platelet activation, vascular function, inflammatory response, and potential mechanism were measured. Low-dose aspirin (10 mg/kg per day) decreased the high-salt diet-induced elevation of blood pressure, platelet activation, leukocyte infiltration, and leukocyte-platelet aggregation (CD45+CD61+), as well as vascular endothelial and renal damage. These effects were related to the ability of aspirin to prevent the adhesion of leukocytes to endothelial cells via inhibition of the platelet cyclooxygenase 1 but not the cyclooxygenase 2 pathway. Aspirin also reversed the high-salt diet-induced abnormal activation of complement and coagulation cascades in platelets. Conclusions These results highlight a new property of aspirin in ameliorating vascular endothelial dysfunction induced by platelet activation, which may be beneficial in the treatment of salt-sensitive hypertension.
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Affiliation(s)
- Xiaoliang Jiang
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences CAMS&PUMC)BeijingChina
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Xue Liu
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences CAMS&PUMC)BeijingChina
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Xing Liu
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences CAMS&PUMC)BeijingChina
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Xianxian Wu
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences CAMS&PUMC)BeijingChina
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Pedro A. Jose
- Division of Kidney Diseases & HypertensionDepartment of MedicineThe George Washington University School of Medicine & Health SciencesWashingtonDC
- Department of Pharmacology and PhysiologyThe George Washington University School of Medicine & Health SciencesWashingtonDC
| | - Min Liu
- Department of HypertensionHenan Provincial People's HospitalPeople's Hospital of Zhengzhou UniversityZhengzhouChina
| | - Zhiwei Yang
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences CAMS&PUMC)BeijingChina
- Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
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9
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Al-Taie A, Albasry Z, Mohammed NH. Clinical Characteristics of Pregnant Women on the Use of Daily Low-dose Aspirin in Different Hypertensive Pregnancy Disorders: A Retrospective Comparative Study. J Pharm Bioallied Sci 2019; 11:77-82. [PMID: 30906143 PMCID: PMC6394152 DOI: 10.4103/jpbs.jpbs_183_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Hypertensive disorders represent major causes of maternal and fetal complications. It includes a range of conditions, most notably preeclampsia. Aspirin is a well-accepted therapy for the primary and secondary prevention of cardiovascular events. The indications for the use of aspirin during pregnancy are, however, the subject of much concern. This study aimed to assess the clinical characteristics from the benefits of daily low-dose aspirin administration alongside antihypertensive in pregnant women with different hypertensive disorders. Materials and Methods: A retrospective observational study was carried out on pregnant women during their routine visit to the obstetric clinic at Baghdad Teaching Hospital. Patients diagnosed during pregnancy with different hypertensive disorders on the prescription of antihypertensive medication with or without daily low-dose aspirin administration were selected. Data were collected to structure a detailed assessment regarding the patients’ demographic, gestational, and medical records. Results: Methyldopa was the main antihypertensive agent (98%). Among pregnant women with daily aspirin use, 68% had gestational hypertension, 24% had preeclampsia alongside proteinuria (P = 0.0001), the frequency of daily dose intake of methyldopa (250 mg) tablet (two vs. three times) was significant (P = 0.0001). All pregnant women within the group of daily low-dose aspirin were safe from the incidence of eclampsia (P = 0.0001). Conclusion: This study provides intriguing evidence for the benefits of daily low-dose aspirin use during pregnancy as it is considered as a simple protective measure from serious maternal complications of hypertensive disorders, where these complications continue to affect maternal health long after delivery.
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Affiliation(s)
- Anmar Al-Taie
- Pharmacy Department, Osol Aldeen University College, Baghdad-IRAQ
| | - Zahraa Albasry
- Clinical Pharmacy Department, College of Pharmacy, Mustansiriya University, Baghdad-IRAQ
| | - Nadia H Mohammed
- Clinical Laboratory Sciences Department, College of Pharmacy, Mustansiriya University, Baghdad-IRAQ
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10
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Khan SI, Shihata WA, Andrews KL, Lee MKS, Moore XL, Jefferis AM, Vinh A, Gaspari T, Dragoljevic D, Jennings GL, Murphy AJ, Chin-Dusting JPF. Effects of high- and low-dose aspirin on adaptive immunity and hypertension in the stroke-prone spontaneously hypertensive rat. FASEB J 2018; 33:1510-1521. [PMID: 30156911 DOI: 10.1096/fj.201701498rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Despite its well-known antithrombotic properties, the effect of aspirin on blood pressure (BP) and hypertension pathology is unclear. The hugely varying doses used clinically have contributed to this confusion, with high-dose aspirin still commonly used due to concerns about the efficacy of low-dose aspirin. Because prostaglandins have been shown to both promote and inhibit T-cell activation, we also explored the immunomodulatory properties of aspirin in hypertension. Although the common preclinical high dose of 100 mg/kg/d improved vascular dysfunction and cardiac hypertrophy, this effect was accompanied by indices of elevated adaptive immunity, renal T-cell infiltration, renal fibrosis, and BP elevation in stroke-prone spontaneously hypertensive rats and in angiotensin II-induced hypertensive mice. The cardioprotective effects of aspirin were conserved with a lower dose (10 mg/kg/d) while circumventing heightened adaptive immunity and elevated BP. We also show that low-dose aspirin improves renal fibrosis. Differential inhibition of the COX-2 isoform may underlie the disparate effects of the 2 doses. Our results demonstrate the efficacy of low-dose aspirin in treating a vast array of cardiovascular parameters and suggest modulation of adaptive immunity as a novel mechanism underlying adverse cardiovascular profiles associated with COX-2 inhibitors. Clinical studies should identify the dose of aspirin that achieves maximal cardioprotection with a new awareness that higher doses of aspirin could trigger undesired autoimmunity in hypertensive individuals. This work also warrants an evaluation of high-dose aspirin and COX-2 inhibitor therapy in sufferers of inflammatory conditions who are already at increased risk for cardiovascular disease.-Khan, S. I., Shihata, W. A., Andrews, K. L., Lee, M. K. S., Moore, X.-L., Jefferis, A.-M., Vinh, A., Gaspari, T., Dragoljevic, D., Jennings, G. L., Murphy, A. J., Chin-Dusting, J. P. F. Effects of high- and low-dose aspirin on adaptive immunity and hypertension in the stroke-prone spontaneously hypertensive rat.
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Affiliation(s)
- Shanzana I Khan
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Waled A Shihata
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen L Andrews
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Man K S Lee
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiao-Lei Moore
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Ann-Maree Jefferis
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Antony Vinh
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Tracey Gaspari
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Dragana Dragoljevic
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Garry L Jennings
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Murphy
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jaye P F Chin-Dusting
- Department of Pharmacology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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11
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Evaluation of the antihypertensive effect of nocturnal administration of acetylsalicylic acid: a cross-over randomized clinical trial. J Hypertens 2018; 37:406-414. [PMID: 30095728 DOI: 10.1097/hjh.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Several studies have shown that evening intake of aspirin has antihypertensive effect in healthy adults, which has not been proven in patients with cardiovascular disease, who mostly take aspirin in the morning. We have evaluated the antihypertensive effect of bedtime administration of aspirin in patients with cardiovascular disease already treated for hypertension. METHODS This is a multicenter randomized triple-blind placebo-controlled crossover trial, with hypertensive patients treated with aspirin for secondary prevention. There was a baseline-randomized assignment to 2-month periods of bedtime aspirin (100 mg) first and morning-time aspirin later, or inversely, both periods separated by an open label 2-4 weeks period of morning-time aspirin. At the start and end of each treatment period, a 24-h ambulatory blood pressure monitoring was performed. The main outcome measure was mean 24-h blood pressure. The analyses were performed according to the intention-to-treat principle. RESULTS Overall, 225 patients were randomized. No significant differences were observed in ambulatory blood pressure by time of intake of usual low doses of aspirin. The mean SBP/DBP was 123.2/69.9 (95% CI 121.58-124.9/68.86-76.86) with bedtime administration and 122.4/68.8 (95% CI 120.76-124.01/67.85-69.83) with daytime administration (P = 0.3 and P = 0.23 for SBP and DBP, respectively). CONCLUSION Administering aspirin at bedtime rather than in the morning does not modify the 24-h ambulatory blood pressure in hypertensive patients in secondary cardiovascular prevention.The trial was registered with ClinicalTrials.gov (number NCT01741922).
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12
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Aspirin and blood pressure: Effects when used alone or in combination with antihypertensive drugs. Rev Port Cardiol 2017; 36:551-567. [PMID: 28684123 DOI: 10.1016/j.repc.2017.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/22/2017] [Indexed: 12/31/2022] Open
Abstract
Arterial hypertension is a major risk factor for cardiovascular and renal events. Lowering blood pressure is thus an important strategy for reducing morbidity and mortality. Since low-dose aspirin is a cornerstone in the prevention of adverse cardiovascular outcomes, combined treatment with aspirin and antihypertensive drugs is very common. However, the impact of aspirin therapy on blood pressure control remains a subject of intense debate. Recent data suggest that the cardioprotective action of aspirin extends beyond its well-known antithrombotic effect. Aspirin has been shown to trigger the synthesis of specialized pro-resolving lipid mediators from arachidonic acid and omega-3 fatty acids. These novel anti-inflammatory and pro-resolving mediators actively stimulate the resolution of inflammation and tissue regeneration. Additionally, they may contribute to other protective effects on redox status and vascular reactivity that have also been attributed to aspirin. Of note, aspirin has been shown to improve vasodilation through cyclooxygenase-independent mechanisms. On the other hand, higher aspirin doses have been reported to exert a negative impact on blood pressure due to inhibition of cyclooxygenase-2 activity, which reduces renal blood flow, glomerular filtration rate and sodium and water excretion. This review aims to provide an overview of the effects of aspirin on blood pressure and the underlying mechanisms, focusing on the interaction between aspirin and antihypertensive drugs. Studies in both experimental and human hypertension are presented.
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Costa AC, Reina-Couto M, Albino-Teixeira A, Sousa T. Aspirin and blood pressure: Effects when used alone or in combination with antihypertensive drugs. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Bem D, Lordkipanidzé M, Hodgkinson J, Stevens S, Bayliss S, Moore D, Fitzmaurice D, Dretzke J. The Effects of Different Aspirin Dosing Frequencies and the Timing of Aspirin Intake in Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review. Clin Pharmacol Ther 2016; 100:500-512. [DOI: 10.1002/cpt.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/23/2016] [Accepted: 07/15/2016] [Indexed: 12/19/2022]
Affiliation(s)
- D Bem
- Institute of Applied Health Research, College of Medical & Dental Sciences; University of Birmingham; Edgbaston Birmingham UK
| | - M Lordkipanidzé
- Montreal Heart Institute; Research Centre; Montréal QC Canada
- Université de Montreal, Faculté de pharmacie; Montreal QC Canada
| | - J Hodgkinson
- Institute of Applied Health Research, College of Medical & Dental Sciences; University of Birmingham; Edgbaston Birmingham UK
| | - S Stevens
- Institute of Applied Health Research, College of Medical & Dental Sciences; University of Birmingham; Edgbaston Birmingham UK
| | - S Bayliss
- Institute of Applied Health Research, College of Medical & Dental Sciences; University of Birmingham; Edgbaston Birmingham UK
| | - D Moore
- Institute of Applied Health Research, College of Medical & Dental Sciences; University of Birmingham; Edgbaston Birmingham UK
| | - D Fitzmaurice
- Institute of Applied Health Research, College of Medical & Dental Sciences; University of Birmingham; Edgbaston Birmingham UK
| | - J Dretzke
- Institute of Applied Health Research, College of Medical & Dental Sciences; University of Birmingham; Edgbaston Birmingham UK
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Becerra AZ, Georas S, Brenna JT, Hopke PK, Kane C, Chalupa D, Frampton MW, Block R, Rich DQ. Increases in ambient particulate matter air pollution, acute changes in platelet function, and effect modification by aspirin and omega-3 fatty acids: A panel study. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2016; 79:287-98. [PMID: 27029326 PMCID: PMC4919023 DOI: 10.1080/15287394.2016.1157539] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Increased particulate matter (PM) air pollutant concentrations have been associated with platelet activation. It was postulated that elevated air pollutant concentrations would be associated with increases in measures of platelet function and that responses would be blunted when taking aspirin and/or fish oil. Data from a sequential therapy trial (30 subjects with type 2 diabetes mellitus), with 4 clinic visits (first: no supplements, second: aspirin, third: omega-3 fatty acid supplements, fourth: aspirin and omega-3 fatty acids) per subject, were utilized. Using linear mixed models, adjusted for relative humidity, temperature, visit number, and season, changes in three platelet function measures including (1) aggregation induced by adenosine diphosphate (ADP), (2) aggregation induced by collagen, and (3) thromboxane B2 production were associated with interquartile range (IQR) increases in mean concentrations of ambient PM2.5, black carbon, ultrafine particles (UFP; 10-100 nm), and accumulation mode particles (AMP; 100-500 nm) in the previous 1-96 h. IQR increases in mean UFP and AMP concentrations were associated with significant decreases in platelet response, with the largest being a -0.43 log(pg/ml) decrease in log(thromboxane B2) (95% CI = -0.8, -0.1) associated with each 582-particles/cm(3) increase in AMP, and a -1.7 ohm reduction in collagen-induced aggregation (95% CI = -3.1, -0.3) associated with each 2097-particles/cm(3) increase in UFP in the previous 72 h. This UFP effect on thromboxane B2 was significantly muted in diabetic subjects taking aspirin (-0.01 log[pg/ml]; 95% CI = -0.4, 0.3). The reason for this finding remains unknown, and needs to be investigated in future studies.
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Affiliation(s)
- Adan Z. Becerra
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Steve Georas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - J. Thomas Brenna
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Philip K. Hopke
- Institute for a Sustainable Environment, Clarkson University, Potsdam, New York, USA
| | - Cathleen Kane
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David Chalupa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Mark W. Frampton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Robert Block
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David Q. Rich
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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High-dose, but not low-dose, aspirin impairs anticontractile effect of ticagrelor following ADP stimulation in rat tail artery smooth muscle cells. BIOMED RESEARCH INTERNATIONAL 2013; 2013:928271. [PMID: 23841099 PMCID: PMC3690229 DOI: 10.1155/2013/928271] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/13/2013] [Indexed: 11/18/2022]
Abstract
Objective. To compare effects of low- versus high-dose aspirin coadministered with ticagrelor on the reactivity of vascular smooth muscle cells (VSMCs). Methods. Wistar rats were orally administered ticagrelor (10 mg/kg) and/or aspirin (2 or 10 mg/kg) (n = 7 per each of 4 groups) or placebo (n = 9) 12 and 2 hours before experiments. Anticontractile effects of ticagrelor were assessed in perfusion solution containing ticagrelor (1 μM/L). Changes in perfusion pressure proportional to the degree of adenosine diphosphate analogue- (2-MeS-ADP-) and phenylephrine-induced constriction of rat tail arteries were evaluated. Results. Pretreatment with high- but not low-dose aspirin enhanced the reactivity of VSMCs only in endothelium-lined vessels. Suppression of 2-MeS-ADP-induced VSMC contraction by ticagrelor observed in arteries with and without endothelium was maintained in endothelialized arteries pretreated only with low-dose aspirin. For endothelium-denuded vessels and low-dose aspirin we observed a significant reduction of the maximal effect of ticagrelor with no rightward shift of the concentration-response curve for phenylephrine. With high-dose aspirin pretreatment ticagrelor exerted no anticontractile effect. Conclusion. High-dose, but not low-dose, aspirin impairs the anticontractile effect of ticagrelor on ADP-induced VSMC contraction in the rat model. Both the clinical significance and detailed underlying mechanism of our findings require further investigation.
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Dimitrov Y, Baguet JP, Hottelart C, Marboeuf P, Tartiere JM, Ducher M, Fauvel JP. Is there a BP benefit of changing the time of aspirin administration in treated hypertensive patients? Eur J Prev Cardiol 2011; 19:706-11. [DOI: 10.1177/1741826711418165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and design: The effects of aspirin on blood pressure (BP) are controversial and a chronopharmacological effect of aspirin on 24-hour BP was reported recently in otherwise untreated hypertensive patients. The study was designed to test the timing effect of aspirin dosing on 24-hour BP in treated hypertensive patients routinely taking aspirin for cardiovascular prevention. Method and results: Seventy-five patients were randomized into two groups. One group was to receive aspirin in the evening then in the morning for 1 month and the other group in the morning then in the evening, following a cross-over design. The principal assessment criterion was 24-hour systolic BP (SBP) measured by 24-hour ambulatory BP monitoring (ABPM). Patients were aged 65 ± 9 years and had been hypertensive for 12 ± 10 years. They were all taking a mean of 2.8 antihypertensive drugs and did not modify their treatment throughout the study. Of the included subjects, 70% were men and 33% were diabetics. Mean 24-hour SBP values were clinically equivalent and were not statistically different, depending on whether the aspirin was taking in the morning or evening (128.3 ± 1.4 vs. 128.3 ± 1.4 mmHg, respectively). Neither was there any significant difference in diurnal and nocturnal SBP or in 24-hour, diurnal, and nocturnal diastolic BP (DBP). Conclusion: It does not appear useful to advise patients with long-standing hypertension to modify timing of aspirin intake in order to reduce BP values.
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