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Du K, Li A, Zhang CY, Li SM, Chen P. Repurposing antihypertensive drugs for pain disorders: a drug-target mendelian randomization study. Front Pharmacol 2024; 15:1448319. [PMID: 39268473 PMCID: PMC11390634 DOI: 10.3389/fphar.2024.1448319] [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] [Received: 06/13/2024] [Accepted: 08/16/2024] [Indexed: 09/15/2024] Open
Abstract
Objective Addressing the rising prevalence of pain disorders and limitations of current analgesics, our study explores repurposing antihypertensive drugs for pain management, inspired by the link between hypertension and pain. We leverage a drug-target Mendelian Randomization (MR) approach to explore their dual benefits and establish causal connections. Methods A comprehensive compilation of antihypertensive drug classes was undertaken through British National Formulary, with their target genes identified using the DrugBank database. Relevant single nucleotide polymorphisms (SNPs) associated with these targets were selected from published genomic studies on systolic blood pressure (SBP) as genetic instruments. These SNPs were validated through MR against acute coronary artery disease (CAD) to ensure genes not linked to CAD were excluded from acting as proxies for antihypertensive drugs. An MR analysis of 29 pain-related outcomes was conducted using the FinnGen R10 database employing the selected and validated genetic instruments. We utilized the Inverse Variance Weighted (IVW) method for primary analysis, applying Bonferroni correction to control type I error. IVW's multiplicative random effects (MRE) addressed heterogeneity, and MR-PRESSO managed pleiotropy, ensuring accurate causal inference. Results Our analysis differentiates strong and suggestive evidence in linking antihypertensive drugs to pain disorder risks. Strong evidence was found for adrenergic neuron blockers increasing migraine without aura risk, loop diuretics reducing panniculitis, and vasodilator antihypertensives lowering limb pain risk. Suggestive evidence suggests alpha-adrenoceptor blockers might increase migraine risk, while beta-adrenoceptor blockers could lower radiculopathy risk. Adrenergic neuron blockers also show a potential protective effect against coxarthrosis (hip osteoarthritis) and increased femgenpain risk (pain and other conditions related to female genital organs and menstrual cycle). Additionally, suggestive links were found between vasodilator antihypertensives and reduced radiculopathy risk, and both alpha-adrenoceptor blockers and renin inhibitors possibly decreasing dorsalgianas risk (unspecified dorsalgia). These findings highlight the intricate effects of antihypertensive drugs on pain disorders, underlining the need for further research. Conclusion The findings indicate that antihypertensive medications may exert varied effects on pain management, suggesting a repurposing potential for treating specific pain disorders. The results advocate for further research to confirm these associations and to explore underlying mechanisms, to optimize pain management practices.
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Affiliation(s)
- Kai Du
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Ao Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Chen-Yu Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Shu-Ming Li
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Ping Chen
- Department of Pain Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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2
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Djukic M, Grewe J, Kunz O, Gross O, Nau R. Hyponatremia in geriatric patients. Z Gerontol Geriatr 2024:10.1007/s00391-024-02342-z. [PMID: 39143233 DOI: 10.1007/s00391-024-02342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/21/2024] [Indexed: 08/16/2024]
Abstract
Hyponatremia is the most frequent electrolyte imbalance in geriatric medicine. Causes of hyponatremia were retrospectively analyzed in all in-patients treated in 2016 (N = 2267, 1564 women, 703 men, mean age ± standard deviation 81.9 ± 7.6 years). Any form of hyponatremia on admission, during the stay or on discharge was noted in 308 patients (13.6%, 231 women, 77 men; mean age ± standard deviation 83.1 ± 7.3 years, p = 0.009 vs. age of all patients). Women had a higher probability of developing hyponatremia compared to men (p = 0.019), 131 patients were hypovolemic, and dyspnea as an indicator of hypervolemia was noted in 71 patients.Only 12 patients suffering from hyponatremia (3.9%) did not receive any of the potentially sodium-lowering drugs assessed (diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, antidepressants, neuroleptics, nonsteroidal antirheumatics, carbamazepine, oxcarbazepine). The median number of drugs per patient potentially lowering the plasma sodium level was 3 and the maximum number was 7.Hypovolemic hyponatremia and the syndrome of inadequate antidiuretic hormone secretion were the most important causes of hyponatremia. Adverse drug effects were the main origins of both conditions. In patients with hyponatremia the drug load influencing plasma sodium level should be minimized, thiazide diuretics should be avoided and older individuals should receive a diet with sufficient salt content.
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Affiliation(s)
- Marija Djukic
- Department of Neuropathology, University Medicine Göttingen, Georg-August-University Göttingen, 37075, Göttingen, Germany
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany
| | - Jeannine Grewe
- Department of Neuropathology, University Medicine Göttingen, Georg-August-University Göttingen, 37075, Göttingen, Germany
| | - Olga Kunz
- Amedes MVZ for Laboratory Medicine, Medical Microbiology and Infectiology, 37077, Göttingen, Germany
| | - Oliver Gross
- Department of Nephrology and Rheumatology, University Medicine Göttingen, Georg-August-University Göttingen, 37075, Göttingen, Germany
| | - Roland Nau
- Department of Neuropathology, University Medicine Göttingen, Georg-August-University Göttingen, 37075, Göttingen, Germany.
- Department of Geriatrics, Protestant Hospital Göttingen-Weende, An der Lutter 24, 37075, Göttingen, Germany.
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3
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Zhao Y, Schubert H, Blakely A, Forbush B, Smith MD, Rinehart J, Cao E. Structural bases for Na +-Cl - cotransporter inhibition by thiazide diuretic drugs and activation by kinases. Nat Commun 2024; 15:7006. [PMID: 39143061 PMCID: PMC11324901 DOI: 10.1038/s41467-024-51381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
The Na+-Cl- cotransporter (NCC) drives salt reabsorption in the kidney and plays a decisive role in balancing electrolytes and blood pressure. Thiazide and thiazide-like diuretics inhibit NCC-mediated renal salt retention and have been cornerstones for treating hypertension and edema since the 1950s. Here we determine NCC co-structures individually complexed with the thiazide drug hydrochlorothiazide, and two thiazide-like drugs chlorthalidone and indapamide, revealing that they fit into an orthosteric site and occlude the NCC ion translocation pathway. Aberrant NCC activation by the WNKs-SPAK kinase cascade underlies Familial Hyperkalemic Hypertension, but it remains unknown whether/how phosphorylation transforms the NCC structure to accelerate ion translocation. We show that an intracellular amino-terminal motif of NCC, once phosphorylated, associates with the carboxyl-terminal domain, and together, they interact with the transmembrane domain. These interactions suggest a phosphorylation-dependent allosteric network that directly influences NCC ion translocation.
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Affiliation(s)
- Yongxiang Zhao
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, P. R. China
| | - Heidi Schubert
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alan Blakely
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Biff Forbush
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
| | - Micholas Dean Smith
- Department of Biochemistry and Cellular and Molecular Biology, The University of Tennessee, Knoxville, Knoxville, TN, 37996, USA
| | - Jesse Rinehart
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
- Systems Biology Institute, Yale University, New Haven, CT, USA
| | - Erhu Cao
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA.
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4
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Wira CR, Kearns T, Fleming-Nouri A, Tyrrell JD, Wira CM, Aydin A. Considering Adverse Effects of Common Antihypertensive Medications in the ED. Curr Hypertens Rep 2024; 26:355-368. [PMID: 38687403 DOI: 10.1007/s11906-024-01304-5] [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] [Accepted: 02/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW To evaluate the adverse effects of common antihypertensive agents utilized or encountered in the Emergency Department. RECENT FINDINGS All categories of antihypertensive agents may manifest adverse effects, inclusive of adverse drug reactions (ADRs), drug-to-drug interactions, or accidental overdose. Adverse effects, and specifically ADRs, may be stratified into the organ systems affected, might require specific time-sensitive interventions, could pose particular risks to vulnerable populations, and may result in significant morbidity, and potential mortality. Adverse effects of common antihypertensive agents may be encountered in the ED, necessitating that ED systems of care are poised to prevent, recognize, and intervene when adverse effects arise.
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Affiliation(s)
- Charles R Wira
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA.
- Yale Acute Stroke Program, Section of Vascular Neurology, Department of Neurology, New Haven, CT, USA.
| | - Thomas Kearns
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - Alex Fleming-Nouri
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - John D Tyrrell
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Ani Aydin
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Section of Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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5
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Sanou A, Konaté K, Belemnaba L, Sama H, Kaboré K, Dakuyo R, Nitiéma M, Dicko MH. In Vivo Diuretic Activity and Anti-Hypertensive Potential of Hibiscus sabdariffa Extract by Inhibition of Angiotensin-Converting Enzyme and Hypertension Precursor Enzymes. Foods 2024; 13:534. [PMID: 38397511 PMCID: PMC10888337 DOI: 10.3390/foods13040534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2024] Open
Abstract
Aqueous extracts of calyx from Hibiscus sabdariffa (HS) (roselle) are highly appreciated for their nutritional and therapeutic effects, especially as anti-hypertensive substances. This study aimed to evaluate their anti-hypertensive potential through an in vitro inhibition assay of angiotensin-converting enzyme (ACE) and hypertension precursor enzymes and to assess the in vivo diuretic activity of HS. Results showed that HS extract inhibited enzymes belonging to several classes, such as α-amylase, trypsin, chymotrypsin, xanthine oxidase, lipoxygenase, and angiotensin-converting enzyme. In particular, enzymatic kinetics of ACE indicated a competitive inhibition fashion of HS extract. Furthermore, the extracts showed remarkable diuretic and natriuretic effects at doses of 50 mg/kg/bw, 100 mg/kg/b.w, and 200 mg/kg.b.w. These activities can be explained by the high content of phenolic compounds and essential amino acids. Roselle could be a potential source of nutraceuticals and anti-hypertensive bioactive compounds.
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Affiliation(s)
- Abdoudramane Sanou
- Laboratory Biochemistry, Biotechnology, Food Technology and Nutrition, Department of Biohemistry and Microbiology, University Joseph KI-ZERBO, Ouagadougou 03 BP 7021, Burkina Faso
| | - Kiessoun Konaté
- Laboratory Biochemistry, Biotechnology, Food Technology and Nutrition, Department of Biohemistry and Microbiology, University Joseph KI-ZERBO, Ouagadougou 03 BP 7021, Burkina Faso
- Applied Sciences and Technologies Training and Research Unit, Department of Biochemistry and Microbiology, University of Dedougou, Dedougou 09 BP 176, Burkina Faso
| | - Lazare Belemnaba
- Department of Traditional Medicine and Pharmacopoeia and Pharmacy, Institute of Research in Health Sciences/National Centre for Scientific and Technological Research (MEPHATRA PH/IRSS/CNRST), Ouagadougou 03 BP 7034, Burkina Faso
| | - Hemayoro Sama
- Laboratory Biochemistry, Biotechnology, Food Technology and Nutrition, Department of Biohemistry and Microbiology, University Joseph KI-ZERBO, Ouagadougou 03 BP 7021, Burkina Faso
| | - Kabakdé Kaboré
- Laboratory Biochemistry, Biotechnology, Food Technology and Nutrition, Department of Biohemistry and Microbiology, University Joseph KI-ZERBO, Ouagadougou 03 BP 7021, Burkina Faso
| | - Roger Dakuyo
- Laboratory Biochemistry, Biotechnology, Food Technology and Nutrition, Department of Biohemistry and Microbiology, University Joseph KI-ZERBO, Ouagadougou 03 BP 7021, Burkina Faso
| | - Mathieu Nitiéma
- Department of Traditional Medicine and Pharmacopoeia and Pharmacy, Institute of Research in Health Sciences/National Centre for Scientific and Technological Research (MEPHATRA PH/IRSS/CNRST), Ouagadougou 03 BP 7034, Burkina Faso
| | - Mamoudou Hama Dicko
- Laboratory Biochemistry, Biotechnology, Food Technology and Nutrition, Department of Biohemistry and Microbiology, University Joseph KI-ZERBO, Ouagadougou 03 BP 7021, Burkina Faso
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Zhao Y, Shen J, Wang Q, Ruiz Munevar MJ, Vidossich P, De Vivo M, Zhou M, Cao E. Structure of the human cation-chloride cotransport KCC1 in an outward-open state. Proc Natl Acad Sci U S A 2022; 119:e2109083119. [PMID: 35759661 PMCID: PMC9271165 DOI: 10.1073/pnas.2109083119] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 04/25/2022] [Indexed: 12/30/2022] Open
Abstract
Cation-chloride cotransporters (CCCs) catalyze electroneutral symport of Cl- with Na+ and/or K+ across membranes. CCCs are fundamental in cell volume homeostasis, transepithelia ion movement, maintenance of intracellular Cl- concentration, and neuronal excitability. Here, we present a cryoelectron microscopy structure of human K+-Cl- cotransporter (KCC)1 bound with the VU0463271 inhibitor in an outward-open state. In contrast to many other amino acid-polyamine-organocation transporter cousins, our first outward-open CCC structure reveals that opening the KCC1 extracellular ion permeation path does not involve hinge-bending motions of the transmembrane (TM) 1 and TM6 half-helices. Instead, rocking of TM3 and TM8, together with displacements of TM4, TM9, and a conserved intracellular loop 1 helix, underlie alternate opening and closing of extracellular and cytoplasmic vestibules. We show that KCC1 intriguingly exists in one of two distinct dimeric states via different intersubunit interfaces. Our studies provide a blueprint for understanding the mechanisms of CCCs and their inhibition by small molecule compounds.
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Affiliation(s)
- Yongxiang Zhao
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT 84112
| | - Jiemin Shen
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030
| | - Qinzhe Wang
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT 84112
| | | | | | - Marco De Vivo
- Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Ming Zhou
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030
| | - Erhu Cao
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT 84112
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7
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Polymorphisms in common antihypertensive targets: Pharmacogenomic implications for the treatment of cardiovascular disease. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2022; 94:141-182. [PMID: 35659371 DOI: 10.1016/bs.apha.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The idea of personalized medicine came to fruition with sequencing the human genome; however, aside from a few cases, the genetic revolution has yet to materialize. Cardiovascular diseases are the leading cause of death globally, and hypertension is a common prelude to nearly all cardiovascular diseases. Thus, hypertension is an ideal candidate disease to apply tenants of personalized medicine to lessen cardiovascular disease. Herein is a survey that visually depicts the polymorphisms in the top eight antihypertensive targets. Although there are numerous genome-wide association studies regarding cardiovascular disease, few studies look at the effects of receptor polymorphisms on drug treatment. With 17,000+ polymorphisms in the combined target proteins examined, it is expected that some of the clinical variability in the treatment of hypertension is due to polymorphisms in the drug targets. Recent advances in techniques and technology, such as high throughput examination of single mutations, structure prediction, computational power for modeling, and CRISPR models of point mutations, allow for a relatively rapid and comprehensive examination of the effects of known and future polymorphisms on drug affinity and effects. As hypertension is easy to measure and has a plethora of clinically viable ligands, hypertension makes an excellent disease to study pharmacogenomics in the lab and the clinic. If the promises of personalized medicine are to materialize, a concerted effort to examine the effects polymorphisms have on drugs is required. A clinician with the knowledge of a patient's genotype can then prescribe drugs that are optimal for treating that specific patient.
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Structural basis for inhibition of the Cation-chloride cotransporter NKCC1 by the diuretic drug bumetanide. Nat Commun 2022; 13:2747. [PMID: 35585053 PMCID: PMC9117670 DOI: 10.1038/s41467-022-30407-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/28/2022] [Indexed: 11/08/2022] Open
Abstract
Cation-chloride cotransporters (CCCs) NKCC1 and NKCC2 catalyze electroneutral symport of 1 Na+, 1 K+, and 2 Cl− across cell membranes. NKCC1 mediates trans-epithelial Cl− secretion and regulates excitability of some neurons and NKCC2 is critical to renal salt reabsorption. Both transporters are inhibited by the so-called loop diuretics including bumetanide, and these drugs are a mainstay for treating edema and hypertension. Here, our single-particle electron cryo-microscopy structures supported by functional studies reveal an outward-facing conformation of NKCC1, showing bumetanide wedged into a pocket in the extracellular ion translocation pathway. Based on these and the previously published inward-facing structures, we define the translocation pathway and the conformational changes necessary for ion translocation. We also identify an NKCC1 dimer with separated transmembrane domains and extensive transmembrane and C-terminal domain interactions. We further define an N-terminal phosphoregulatory domain that interacts with the C-terminal domain, suggesting a mechanism whereby (de)phosphorylation regulates NKCC1 by tuning the strength of this domain association. Loop diuretics including bumetanide inhibit Na+-K+-Cl−-cotransporters (NKCCs) and are used for the treatment of edema and hypertension. Here, Zhao et. al. report structures of NKCC1 with bumetanide bound, revealing its mechanism of action that would facilitate design of novel diuretics.
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9
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Garg M, Singh MK, Koli SM, Sreedhar B, Ramakrishna S, Nanubolu JB. Crystalline salts of a diuretic drug torasemide with improved solubility and dissolution properties. CrystEngComm 2022. [DOI: 10.1039/d2ce00383j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Two novel pharmaceutical crystalline salts of a diuretic drug torasemide with improved solubility and dissolution profiles are disclosed in this manuscript.
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Affiliation(s)
- Monika Garg
- Centre for X-ray Crystallography, Department of Analytical & Structural Chemistry, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad-500007, Telangana, India
| | - Mayank K. Singh
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad-500007, Telangana, India
| | - Saylee Manohar Koli
- Centre for X-ray Crystallography, Department of Analytical & Structural Chemistry, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad-500007, Telangana, India
| | - Bojja Sreedhar
- Department of Analytical & Structural Chemistry, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad-500007, Telangana, India
- Academy of Scientific and Innovative Research (AcSIR), New Delhi, 110025, India
| | - Sistla Ramakrishna
- Department of Applied Biology, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad-500007, Telangana, India
- Academy of Scientific and Innovative Research (AcSIR), New Delhi, 110025, India
| | - Jagadeesh Babu Nanubolu
- Centre for X-ray Crystallography, Department of Analytical & Structural Chemistry, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad-500007, Telangana, India
- Academy of Scientific and Innovative Research (AcSIR), New Delhi, 110025, India
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10
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The Road to Better Management in Resistant Hypertension-Diagnostic and Therapeutic Insights. Pharmaceutics 2021; 13:pharmaceutics13050714. [PMID: 34068168 PMCID: PMC8153016 DOI: 10.3390/pharmaceutics13050714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/29/2022] Open
Abstract
Resistant hypertension (R-HTN) implies a higher mortality and morbidity compared to non-R-HTN due to increased cardiovascular risk and associated adverse outcomes—greater risk of developing chronic kidney disease, heart failure, stroke and myocardial infarction. R-HTN is considered when failing to lower blood pressure below 140/90 mmHg despite adequate lifestyle measures and optimal treatment with at least three medications, including a diuretic, and usually a blocker of the renin-angiotensin system and a calcium channel blocker, at maximally tolerated doses. Hereby, we discuss the diagnostic and therapeutic approach to a better management of R-HTN. Excluding pseudoresistance, secondary hypertension, white-coat hypertension and medication non-adherence is an important step when diagnosing R-HTN. Most recently different phenotypes associated to R-HTN have been described, specifically refractory and controlled R-HTN and masked uncontrolled hypertension. Optimizing the three-drug regimen, including the diuretic treatment, adding a mineralocorticoid receptor antagonist as the fourth drug, a β-blocker as the fifth drug and an α1-blocker or a peripheral vasodilator as a final option when failing to achieve target blood pressure values are current recommendations regarding the correct management of R-HTN.
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11
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Docheva N, Nieman KM, Rana S. Treat It While You Can: Use of Furosemide in Management of Postpartum Hypertension. Hypertension 2021; 77:1525-1527. [PMID: 33826400 DOI: 10.1161/hypertensionaha.121.16966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nikolina Docheva
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago, IL (N.D., S.R.)
| | | | - Sarosh Rana
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago, IL (N.D., S.R.)
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Abstract
Amyloidosis is a disorder characterized by misfolded precursor proteins that form depositions of fibrillar aggregates with an abnormal cross-beta-sheet conformation, known as amyloid, in the extracellular space of several tissues. Although there are more than 30 known amyloidogenic proteins, both hereditary and non-hereditary, cardiac amyloidosis (CA) typically arises from either misfolded transthyretin (ATTR amyloidosis) or immunoglobulin light-chain aggregation (AL amyloidosis). Its prevalence is more common than previously thought, especially among patients with heart failure and preserved ejection fraction (HFpEF) and aortic stenosis. If there is a clinical suspicion of CA, focused echocardiography, laboratory screening for the presence of a monoclonal protein (serum and urinary electrophoresis with immunofixation and serum free light-chain ratio), and cardiac scintigraphy with 99mtechnetium-labeled bone-tracers are sensitive and specific initial diagnostic tests. In some cases, more advanced/invasive techniques are necessary and, in the last several years, treatment options for both AL CA and ATTR CA have rapidly expanded. It is important to note that the aims of therapy are different. Systemic AL amyloidosis requires treatment targeted against the abnormal plasma cell clone, whereas therapy for ATTR CA must be targeted to the production and stabilization of the TTR molecule. It is likely that a multistep treatment approach will be optimal for both AL CA and ATTR CA. Additionally, treatment of CA includes the management of restrictive cardiomyopathy with preserved or reduced ejection fraction in addition to treating the amyloid deposition. Future studies are necessary to define optimal management strategies for AL CA and ATTR CA and confirm cardiac response to therapy.
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Affiliation(s)
- Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - WH Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Photia A, Traivaree C, Monsereenusorn C, Simthamnimit P, Rujkijyanont P. Clinical Usefulness of Furosemide to Prevent Volume Overload Among Children and Young Adults with Transfusion-Dependent Thalassemia: A Randomized, Open-Label, Crossover Study. J Blood Med 2021; 11:503-513. [PMID: 33402857 PMCID: PMC7778446 DOI: 10.2147/jbm.s285647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Red blood cell transfusion is a key element of treatment among patients with transfusion-dependent thalassemia (TDT). Volume overload and HCC syndrome (hypertension, convulsion, and intracranial hemorrhage) are fatal complications related to transfusion. Furosemide has been widely used to prevent hypertension secondary to volume overload with unclear supportive evidence. This study aimed to evaluate the efficacy of furosemide to prevent volume overload among children and young adults diagnosed with TDT. Methods Patients diagnosed with TDT were enrolled and randomized to receive either furosemide pretransfusion or no furosemide pretransfusion. After 3 weeks to 4 months of wash-out periods, those patients underwent the alternate regimens as per crossover design of the study. Clinical and laboratory parameters including blood pressure and NT-proBNP levels were measured before and after each transfusion. The difference of those parameters between two randomized groups and their potential associated factors were analyzed. Results In all, 30 patients undergoing 60 red blood cell transfusions were enrolled in the study. All were randomized and crossover was designed as receiving and not receiving furosemide pretransfusion. No transfusion reactions, symptoms of volume overload and HCC syndrome were observed. No statistically significant correlation was found between pretransfusion furosemide and the difference between pre- and posttransfusion systolic blood pressure (2 mmHg systolic blood pressure difference in pretransfusion furosemide and 1.5 mmHg in no pretransfusion furosemide; p-value = 0.721), as well as between pretransfusion furosemide and the difference between pre- and posttransfusion NT-proBNP levels (−3.8 pg/mL NT-proBNP level difference in pretransfusion furosemide and −2.4 pg/mL in no pretransfusion furosemide; p-value = 0.490). No significant correlation was also observed even in selected patients with high NT-proBNP levels (p-value = 0.262). Associated factors affecting the difference between pre- and posttransfusion NT-proBNP levels were analyzed, and none of those were affected concerning the difference in the levels. Conclusion Furosemide has been included in standard transfusion guidelines in many institutions. Our study provided important evidence of the unnecessary use of the drug in preventing volume overload particularly in pediatric and young adult patients with TDT. Thai Clinical Trials Registry (Tctr) Number TCTR20180209001. Registered 6 February 2018, https://www.clinicaltrials.in.th/.
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Affiliation(s)
- Apichat Photia
- Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chanchai Traivaree
- Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chalinee Monsereenusorn
- Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | | | - Piya Rujkijyanont
- Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Longur ES, Yiğit Ö, Kalaycık Ertugay Ç, Araz Server E, Adatepe T, Akakın D, Orun O, Karagöz Köroğlu A. Effect of Bumetanide on Facial Nerve Regeneration in Rat Model. Otolaryngol Head Neck Surg 2021; 164:117-123. [PMID: 32600218 DOI: 10.1177/0194599820937670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We investigated the effects of bumetanide alone and in combination with dexamethasone on facial nerve regeneration in rats with facial paralysis. STUDY DESIGN A prospective controlled animal study. SETTING An animal laboratory. SUBJECTS AND METHODS Facial paralysis was induced in 32 Wistar rats that we then divided into 4 groups: group 1, control; group 2, bumetanide; group 3, dexamethasone; group 4, bumetanide and dexamethasone. Electroneurography was performed 1, 2, and 4 weeks later, and nerve regeneration was evaluated by electron and light microscopy and Western blotting in week 4. RESULTS Regarding the comparison between preoperative values and week 4, the latency difference in group 1 (1.25 milliseconds) was significantly higher than those of groups 2 to 4 (0.56, 0.34, and 0.10 milliseconds, respectively; P = .001). The latency increment in groups 2 and 3 was higher than that of group 4 (P = .002 and P = .046) in week 4, whereas groups 2 and 3 did not differ significantly (P = .291). Amplitude difference was not statistically significant from week 4 among all groups (all P > .05). The number of myelinated axons was significantly higher in all treatment groups than in the control group (P = .001). Axon number and intensity were significantly higher in group 4 as compared with groups 2 and 3 (P = .009, P = .005). CONCLUSION After primary neurorrhaphy, dexamethasone and bumetanide alone promoted nerve recovery based on electrophysiologic and histologic measures. Combination therapy was, however, superior.
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Affiliation(s)
- Ecem Sevim Longur
- Department of Otorhinolaryngology-Head and Neck Surgery, Ercis State Hospital, Van, Turkey
| | - Özgür Yiğit
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Çiğdem Kalaycık Ertugay
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ela Araz Server
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Turgut Adatepe
- Department of Neurology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Dilek Akakın
- Department of Histology and Embryology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Oya Orun
- Department of Biophysics, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ayça Karagöz Köroğlu
- Department of Histology and Embryology, School of Medicine, Marmara University, Istanbul, Turkey
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15
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Meor Azlan NF, Zhang J. Role of the Cation-Chloride-Cotransporters in Cardiovascular Disease. Cells 2020; 9:E2293. [PMID: 33066544 PMCID: PMC7602155 DOI: 10.3390/cells9102293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023] Open
Abstract
The SLC12 family of cation-chloride-cotransporters (CCCs) is comprised of potassium chloride cotransporters (KCCs), which mediate Cl- extrusion and sodium-potassium chloride cotransporters (N[K]CCs), which mediate Cl- loading. The CCCs play vital roles in cell volume regulation and ion homeostasis. The functions of CCCs influence a variety of physiological processes, many of which overlap with the pathophysiology of cardiovascular disease. Although not all of the cotransporters have been linked to Mendelian genetic disorders, recent studies have provided new insights into their functional role in vascular and renal cells in addition to their contribution to cardiovascular diseases. Particularly, an imbalance in potassium levels promotes the pathogenesis of atherosclerosis and disturbances in sodium homeostasis are one of the causes of hypertension. Recent findings suggest hypothalamic signaling as a key signaling pathway in the pathophysiology of hypertension. In this review, we summarize and discuss the role of CCCs in cardiovascular disease with particular emphasis on knowledge gained in recent years on NKCCs and KCCs.
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Affiliation(s)
- Nur Farah Meor Azlan
- Institute of Biomedical and Clinical Sciences, Medical School, College of Medicine and Health, Hatherly Laboratories, University of Exeter, Exeter EX4 4PS, UK;
| | - Jinwei Zhang
- Institute of Biomedical and Clinical Sciences, Medical School, College of Medicine and Health, Hatherly Laboratories, University of Exeter, Exeter EX4 4PS, UK;
- Xiamen Cardiovascular Hospital, School of Medicine, Xiamen University, Xiamen 361004, Fujian, China
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16
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Şahinarslan A, Gazi E, Aktoz M, Özkan Ç, Okyay GU, Elalmış ÖU, Belen E, Bitigen A, Derici Ü, Tütüncü NB, Yıldırır A. Consensus paper on the evaluation and treatment of resistant hypertension by the Turkish Society of Cardiology. Anatol J Cardiol 2020; 24:137-152. [PMID: 32870176 PMCID: PMC7585974 DOI: 10.14744/anatoljcardiol.2020.74154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Asife Şahinarslan
- Department of Cardiology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | - Emine Gazi
- Department of Cardiology, Faculty of Medicine, 18 Mart University; Çanakkale-Turkey
| | - Meryem Aktoz
- Department of Cardiology, Faculty of Medicine, Trakya University; Edirne-Turkey
| | - Çiğdem Özkan
- Department of Endocrinology, İzmir Bozyaka Training and Research Hospital; İzmir-Turkey
| | - Gülay Ulusal Okyay
- Department of Nephrology, Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital; Ankara-Turkey
| | | | - Erdal Belen
- Department of Cardiology, İstanbul Okmeydanı State Hospital; İstanbul-Turkey
| | - Atila Bitigen
- Department of Cardiology, Fatih Medical Park Hospital; İstanbul-Turkey
| | - Ülver Derici
- Department of Nephrology, Faculty of Medicine, Gazi University; Ankara-Turkey
| | | | - Aylin Yıldırır
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
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17
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The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2020; 42:1235-1481. [PMID: 31375757 DOI: 10.1038/s41440-019-0284-9] [Citation(s) in RCA: 1059] [Impact Index Per Article: 264.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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18
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Pathan MK, Cohen DL. Resistant Hypertension: Where are We Now and Where Do We Go from Here? Integr Blood Press Control 2020; 13:83-93. [PMID: 32801854 PMCID: PMC7415451 DOI: 10.2147/ibpc.s223334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022] Open
Abstract
Resistant hypertension is an important subtype of hypertension that leads to an increased risk of cerebrovascular, cardiovascular, and kidney disease. The revised guidelines from the American College of Cardiology and American Heart Association now define resistant hypertension as blood pressure that remains above goal despite use of three maximally titrated anti-hypertensive medications including a diuretic or as a hypertensive patient who requires 4 or more agents for adequate BP control. These agents typically include a calcium-channel blocker, a renin-angiotensin system inhibitor, and a diuretic at maximal or maximally tolerated doses. As recognition of resistant hypertension increases, it is important to distinguish pseudo-resistant or apparent hypertension from true resistant hypertension. Etiologies of apparent resistant hypertension include measurement error and medication non-adherence. The prevalence of true resistant hypertension is likely much lower than reported in the literature when accounting for patients with apparent resistant hypertension. Evaluation of patients with true resistant hypertension includes screening for causes of secondary hypertension and interfering medications. Successful management of resistant hypertension includes lifestyle modification and optimization of medical therapy, often including the use of mineralocorticoid receptor antagonists. Looking ahead at developments in hypertension management, a slew of new device-based therapies are under active development. Of these, renal denervation is the closest to routine clinical application. Further study is needed before these devices can be recommended in the routine treatment of resistant hypertension.
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Affiliation(s)
- Mansur K Pathan
- Perelman School of Medicine at the University of Pennsylvania, Renal, Electrolyte and Hypertension Division, Philadelphia, PA19104, USA
| | - Debbie L Cohen
- Perelman School of Medicine at the University of Pennsylvania, Renal, Electrolyte and Hypertension Division, Philadelphia, PA19104, USA
- Correspondence: Debbie L Cohen; Mansur K Pathan Perelman School of Medicine at the University of Pennsylvania, Renal, Electrolyte and Hypertension Division, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA19104, USATel + 1 215-615-0794 Email ;
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Bavishi A, Patel RB. Addressing Comorbidities in Heart Failure: Hypertension, Atrial Fibrillation, and Diabetes. Heart Fail Clin 2020; 16:441-456. [PMID: 32888639 DOI: 10.1016/j.hfc.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Heart failure (HF) is a growing global epidemic and an increasingly cumbersome burden on health care systems worldwide. As such, optimal management of existing comorbidities in the setting of HF is particularly important to prevent disease progression, reduce HF hospitalizations, and improve quality of life. In this review, the authors address 3 key comorbidities commonly associated with HF: hypertension, atrial fibrillation, and diabetes mellitus. They comprehensively describe the epidemiology, management, and emerging therapies in these 3 disease states as they relate to the overall HF syndrome.
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Affiliation(s)
- Aakash Bavishi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St Clair Street, Suite 600, Chicago, IL 60611, USA.
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Yang X, Wang Q, Cao E. Structure of the human cation-chloride cotransporter NKCC1 determined by single-particle electron cryo-microscopy. Nat Commun 2020; 11:1016. [PMID: 32081947 PMCID: PMC7035313 DOI: 10.1038/s41467-020-14790-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/29/2020] [Indexed: 11/09/2022] Open
Abstract
The secondary active cation-chloride cotransporters (CCCs) utilize the existing Na+ and/or K+ gradients to move Cl- into or out of cells. NKCC1 is an intensively studied member of the CCC family and plays fundamental roles in regulating trans-epithelial ion movement, cell volume, chloride homeostasis and neuronal excitability. Here, we report a cryo-EM structure of human NKCC1 captured in a partially loaded, inward-open state. NKCC1 assembles into a dimer, with the first ten transmembrane (TM) helices harboring the transport core and TM11-TM12 helices lining the dimer interface. TM1 and TM6 helices break α-helical geometry halfway across the lipid bilayer where ion binding sites are organized around these discontinuous regions. NKCC1 may harbor multiple extracellular entryways and intracellular exits, raising the possibility that K+, Na+, and Cl- ions may traverse along their own routes for translocation. NKCC1 structure provides a blueprint for further probing structure-function relationships of NKCC1 and other CCCs.
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Affiliation(s)
- Xiaoyong Yang
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, 84112-5650, USA
| | - Qinzhe Wang
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, 84112-5650, USA
| | - Erhu Cao
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, 84112-5650, USA.
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21
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Abstract
Hypertension is still the number one global killer. No matter what causes are, lowering blood pressure can significantly reduce cardiovascular complications, cardiovascular death, and total death. Unfortunately, some hypertensive individuals simply do not know having hypertension. Some knew it but either not being treated or treated but blood pressure does not achieve goal. The reasons for inadequate control of blood pressure are many. One important reason is that we are not very familiar with antihypertensive agents and less attention has been paid to comorbidities, complications as well as the hypertension-modified target organ damage in patients with hypertension. The right antihypertensive drug was not given to the right hypertensive patients at right time. This reviewer studied comprehensively the literature, hopefully that the review will help improve antihypertensive drug selection and antihypertensive therapy.
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Affiliation(s)
- Rutai Hui
- Chinese Academy of Medical Sciences FUWAI Hospital Hypertension Division, 167 Beilishilu West City District, 100037, Beijing People's Republic of China, China.
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22
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Model based population PK-PD analysis of furosemide for BP lowering effect: A comparative study in primary and secondary hypertension. Eur J Pharm Sci 2017; 109:253-261. [PMID: 28821435 DOI: 10.1016/j.ejps.2017.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/05/2017] [Accepted: 08/14/2017] [Indexed: 11/20/2022]
Abstract
Though numerous reports have demonstrated multiple mechanisms by which furosemide can exert its anti-hypertensive response. However, lack of studies describing PK-PD relationship for furosemide featuring its anti-hypertensive property has limited its usage as a blood pressure (BP) lowering agent. Serum concentrations and mean arterial BP were monitored following 40 and 80mgkg-1 multiple oral dose of furosemide in spontaneously hypertensive rats (SHR) and DOCA-salt induced hypertensive (DOCA-salt) rats. A simultaneous population PK-PD relationship using Emax model with effect compartment was developed to compare the anti-hypertensive efficacy of furosemide in these rat models. A two-compartment PK model with Weibull-type absorption and first-order elimination best described the serum concentration-time profile of furosemide. In the present study, post dose serum concentrations of furosemide were found to be lower than the EC50. The EC50 predicted in DOCA-salt rats was found to be lower (4.5-fold), whereas the tolerance development was higher than that in SHR model. The PK-PD parameter estimates, particularly lower values of EC50, Ke and Q in DOCA-salt rats as compared to SHR, pinpointed the higher BP lowering efficacy of furosemide in volume overload induced hypertensive conditions. Insignificantly altered serum creatinine and electrolyte levels indicated a favorable side effect profile of furosemide. In conclusion, the final PK-PD model described the data well and provides detailed insights into the use of furosemide as an anti-hypertensive agent.
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23
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Hine J, Schwell A, Kairys N. An Unlikely Cause of Hypokalemia. J Emerg Med 2017; 52:e187-e191. [DOI: 10.1016/j.jemermed.2016.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/05/2016] [Accepted: 12/16/2016] [Indexed: 12/25/2022]
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