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Onishi H, Sakata O. Preparation and evaluation of fast-dissolving films of etilefrine hydrochloride for practical buccal dosing. Pharm Dev Technol 2021; 26:610-616. [PMID: 33736577 DOI: 10.1080/10837450.2021.1904260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Etilefrine hydrochloride (ET) is an important drug in the treatment of hypotension, and parenteral injections and oral tablets are the conventional dosage forms. However, parenteral injections may cause abnormally high plasma levels as well as pain and necrosis, and oral tablets undergo first-pass metabolism. Although fast-dissolving buccal tablets were previously reported, the initial absorption rate was a little slow and the plasma levels were varied extensively. Recently, many films have been developed as novel dosage forms. Therefore, in the present study, film dosage forms containing ET were produced using water-soluble polymers and glycerin (GLY) as excipients to obtain a practical buccal dosage form. Films composed of ET, GLY, and sodium alginate (AL) exhibited good physical characteristics and rapid release in vitro (more than 70% at 2 min). The compacted AL film containing 2 mg ET (1 × 1 cm) exhibited rapid absorption (>19 ng/mL at 0.5 h), maintained an effective plasma level (>7 ng/mL) for a long time period (0.5-4 h), and had an adequate plasma concentration-time profile with a smaller standard error (<15.3 ng/mL). These results suggest that the present compacted buccal film is a superior dosage form of ET for practical use.
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Affiliation(s)
- Hiraku Onishi
- Department of Drug Delivery Research, Hoshi University, Tokyo, Japan
| | - Osamu Sakata
- Department of Drug Delivery Research, Hoshi University, Tokyo, Japan
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Derington CG, Cohen JB, Bress AP. Restoring the upward trend in blood pressure control rates in the United States: a focus on fixed-dose combinations. J Hum Hypertens 2020; 34:617-623. [PMID: 32332921 DOI: 10.1038/s41371-020-0340-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Catherine G Derington
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
| | - Jordana B Cohen
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam P Bress
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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Marques da Silva P, Lima MJ, Neves PM, Espiga de Macedo M. Prevalence of cardiovascular risk factors and other comorbidities in patients with hypertension in Portuguese primary health care populations: The PRECISE study. Rev Port Cardiol 2019; 38:427-437. [PMID: 31307727 DOI: 10.1016/j.repc.2018.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/15/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Cardiovascular (CV) disease is the leading cause of death in Portugal. The prevalence of hypertension, the second most important risk factor accounting for overall disability-adjusted life years (DALYs), is significant. Hypertension rarely occurs in isolation, but is usually associated with other determining risk factors that contribute to greater overall CV risk. The main objective of the PRECISE study, a cross-sectional epidemiological study, was to determine the prevalence of other concomitant modulating CV risk factors in hypertensive patients. METHODS The prevalence of other CV risk factors and target organ damage was assessed in 2848 hypertensive patients of both sexes followed in primary health care centers. Demographic, anthropometric and clinical data and antihypertensive and lipid-lowering therapies prescribed were collected. RESULTS Of the study population (mean age 65.8±11.0 years, 60.8% women), 98.0% were treated for hypertension, but only 56.7% had controlled blood pressure. Hypercholesterolemia was the most frequent concomitant CV risk factor (82.1%), followed by sedentary behavior (71.4%). Prevalences of concomitant modulating risk factors were significantly different between the sexes and age groups. Overall, 81.7% of hypertensive patients had three or more concomitant CV risk factors. CONCLUSIONS The study showed that, in Portugal, hypertensive patients have a high prevalence of other CV risk factors, confirming the need to identify these factors, calculate overall CV risk and continuously monitor the care provided and the results obtained.
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Affiliation(s)
- Pedro Marques da Silva
- Núcleo de Investigação Arterial, Medicina 4, Hospital de Santa Marta - CHLC, EPE, Lisboa, Portugal.
| | - Maria João Lima
- Consulta de Hipertensão Arterial, Medicina Interna, Hospital São João - CHSJ, EPE, Lisboa, Portugal
| | - Pedro Macedo Neves
- Consulta de Hipertensão e Doença Vascular, Centro Hospitalar do Médio Ave, EPE, Lisboa, Portugal
| | - Mário Espiga de Macedo
- Programa Nacional para as Doenças Cérebro-Cardiovasculares, Direção-Geral de Saúde, Lisboa, Portugal
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Prevalence of cardiovascular risk factors and other comorbidities in patients with hypertension in Portuguese primary health care populations: The PRECISE study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kimani S, Mirie W, Chege M, Okube OT, Muniu S. Association of lifestyle modification and pharmacological adherence on blood pressure control among patients with hypertension at Kenyatta National Hospital, Kenya: a cross-sectional study. BMJ Open 2019; 9:e023995. [PMID: 30782721 PMCID: PMC6340423 DOI: 10.1136/bmjopen-2018-023995] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Association of lifestyle modification and pharmacological adherence among patients with hypertension attending a national referral hospital in Kenya. DESIGN Descriptive, cross-sectional. SETTING Medical wards and outpatient clinic of a national referral hospital. PARTICIPANTS Patients (n=229) diagnosed with primary hypertension for at least 6 months. PRIMARY OUTCOMES Clinical makers, cholesterol levels, anthropometrics, lifestyle/dietary habits adjusted for age, gender and education; antihypertensive adherence; views on prevention of hypertension and adequacy of hypertension information. RESULTS Ageing was associated with elevated diastolic blood pressure (BP) (p<0.05), heart rate (HR) and cholesterol. Females had higher body mass index (BMI). More males reported drinking alcohol and smoking (p<0.001), especially the highly educated. Higher BPs were observed in smokers and drinkers (p<0.05). Daily vegetables and fruits intake were linked to lower BP, HR and BMI (p<0.05). Intake of foods high in saturated fat and cholesterol were associated with raised HR (p<0.05). Respondents on antihypertensive medication, those engaged in healthy lifestyle and took their prescribed medications had lower mean BPs than those on medication only (138/85 vs 140/90). Few respondents (30.8%) considered hypertension as preventable, mainly the single and highly educated (p<0.05). Respondents (53.6%) believed they should stop taking their antihypertensive medication once hypertension is controlled. CONCLUSION Missed targets for BP control and hypertension-related risks are associated with ageing, female gender, fast food and animal fat intake. Alcohol and smoking is common in males associated with poor BP control. Daily vegetables and fruits intake are associated with better BP control and overall hypertension risk reduction. Observed suboptimal BP control despite pharmacological adherence suggests lifestyle modification is needed besides antihypertensive medication. Interventions should address modifiable risk factors aggravated by age and adverse lifestyles through adopting combined lifestyle modification, pharmacological adherence and tailored expert delivered hypertension-related information.
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Affiliation(s)
- Samuel Kimani
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Waithira Mirie
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Margaret Chege
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
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Zhu Y, Zhuo J, Li C, Wang Q, Liu X, Ye L. Regulatory network analysis of hypertension and hypotension microarray data from mouse model. Clin Exp Hypertens 2018; 40:631-636. [PMID: 29400567 DOI: 10.1080/10641963.2017.1416120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We aimed to identify the potential genes related to blood pressure regulation and screen target genes for high blood pressure (BPH) and low blood pressure (BPL) treatment. The GSE19817 microarray dataset, which included the aorta, liver, heart, and kidney samples from BPH, BPL, and normotensive mice, was downloaded from the Gene Expression Omnibus. Principal component analysis (PCA) was performed based on the entire expression profile. Differentially expressed genes (DEGs) were screened, followed by pathway enrichment analysis. Finally, gene regulatory networks were constructed based on BPH-related and BPL-related DEGs in the aorta, liver, heart, and kidney samples. As a result, DEGs were screened within their respective tissues due to high heterogeneity of different tissues. Totally, 2,726 BPH-related DEGs and 2,472 BPL-related DEGs were screened, which were mainly enriched in pathways such as immune response. The topology data of gene regulatory networks constructed by DEGs in the heart, kidney, and liver were similar than that in aorta. Finally, among BPH-related DEGs, Sept6 and Pigx were found in the top 10 differentially regulated DEGs by comparing the BPH-related DEGs of the aorta with the DEGs of the other 3 tissues in the regulatory network. Although among the top 10 differentially regulated BPL-related DEGs, no common differentially regulated DEGs were found, Wif1, Urb2, and Gtf2ird1 were found among the top ten DEGs in the three tissues other than the kidney tissue. Sept6 and Pigx might participate in the pathogenesis of BPH, whereas Gtf2ird1, Urb2, and Wif1 might be critical target genes for BPL treatment.
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Affiliation(s)
- Yanli Zhu
- a Department of Cardiology , Shandong Provincial Hospital affiliated to Shandong University , Jinan City , China
| | - Jingming Zhuo
- a Department of Cardiology , Shandong Provincial Hospital affiliated to Shandong University , Jinan City , China
| | - Chunmei Li
- a Department of Cardiology , Shandong Provincial Hospital affiliated to Shandong University , Jinan City , China
| | - Qian Wang
- a Department of Cardiology , Shandong Provincial Hospital affiliated to Shandong University , Jinan City , China
| | - Xuefei Liu
- a Department of Cardiology , Shandong Provincial Hospital affiliated to Shandong University , Jinan City , China
| | - Lin Ye
- a Department of Cardiology , Shandong Provincial Hospital affiliated to Shandong University , Jinan City , China
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Tocci G, Cicero AF, Salvetti M, Musumeci MB, Ferrucci A, Borghi C, Volpe M. Attitudes and preferences for the clinical management of hypertension and hypertension-related cerebrovascular disease in the general practice: results of the Italian hypertension and brain survey. Clin Hypertens 2017; 23:10. [PMID: 28515958 PMCID: PMC5430606 DOI: 10.1186/s40885-017-0066-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/24/2017] [Indexed: 01/13/2023] Open
Abstract
Background The aim of this survey was to evaluate attitudes and preferences for the clinical management of hypertension and hypertension-related cerebrovascular diseases (CVD) in Italy. Methods A predefined 16-item survey questionnaire was anonymously administered to a large community sample of general practitioners (GPs), trained by specialized physicians (SPs), who have been included in an educational program between January and November 2015. Results A total of 591 physicians, among whom 48 (8%) training SPs and 543 (92%) trained GPs, provided 12,258 valid answers to the survey questionnaire. Left ventricular hypertrophy was considered the most frequent marker of hypertension-related organ damage, whereas atrial fibrillation and carotid atherosclerosis were considered relatively not frequent (10–20%). The most appropriate blood pressure (BP) targets to be achieved in hypertensive patients with CVD were <140/90 mmHg for SPs and <135/85 mmHg for GPs. To achieve these goals, ACE inhibitors were considered the most effective strategies by GPs, whereas SPs expressed a preference for ARBs, both in monotherapies and in combination therapies with beta-blockers. Conclusions This survey demonstrates that Italian physicians considered left ventricular hypertrophy frequently associated to CVD and that drugs inhibiting the renin-angiotensin system the most appropriate therapy to manage hypertension and hypertension-related CVD. Electronic supplementary material The online version of this article (doi:10.1186/s40885-017-0066-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, Rome, 00189 Italy
| | - Arrigo F Cicero
- Division of Internal Medicine, University of Bologna, Bologna, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Beatrice Musumeci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, Rome, 00189 Italy
| | - Andrea Ferrucci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, Rome, 00189 Italy
| | - Claudio Borghi
- Division of Internal Medicine, University of Bologna, Bologna, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, Rome, 00189 Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
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Tocci G, Palano F, Battistoni A, Citoni B, Musumeci MB, Ferrucci A, Borghi C, Volpe M. Clinical management of patients with hypertension and high cardiovascular risk in specialised centers and in general practice. Analysis from an Italian Survey Questionnaire. Nutr Metab Cardiovasc Dis 2015; 25:866-874. [PMID: 26093813 DOI: 10.1016/j.numecd.2015.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Hypertension control remains poorly achieved worldwide, despite the use of modern diagnostic tools and advanced therapeutic strategies. We aimed to evaluate the preferences expressed by either specialised physicians (SPs) or general practitioners (GPs) for the clinical management of hypertension and high cardiovascular risk in Italy. METHODS AND RESULTS A predefined questionnaire was anonymously administered to a large community sample of physicians, stratified according to clinical expertise. From a total of 64 questions, 557 physicians (478 male, mean age 54.2 ± 7.1 years, average age of medical activity 28.0 ± 8.1 years), including 261 (46.9%) SPs and 296 (53.1%) GPs, provided 9564 answers to the survey questionnaire. Involved clinicians spent the majority of their time and practice for hypertension management and control. SPs aimed to achieve the recommended BP targets (<140/90 mmHg), whereas GPs tended to achieve more rigorous BP goals (<130/80 mmHg); nonetheless, they both reported a very high rate of BP control (about 70%). Concomitant presence of diabetes, organ damage, as well as comorbidities, was reported to be relatively frequent (26-50%), mostly by SPs. ESH/ESC 2007 risk score stratification was preferred by SPs compared to GPs, who favored a comprehensive clinical evaluation. ACE inhibitors or ARBs were considered the best pharmacological option to start antihypertensive treatment, thus adding diuretics or calcium-channel blockers, if needed. CONCLUSIONS This predefined analysis of a survey questionnaire showed relatively different opinions with respect to recommended BP targets and distributions of cardiovascular risk profile, and similar diagnostic and therapeutic choices between GPs and SPs.
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Affiliation(s)
- G Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
| | - F Palano
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - A Battistoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - B Citoni
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - M B Musumeci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - A Ferrucci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy
| | - C Borghi
- Chair of Internal Medicine, University of Bologna, Bologna, Italy
| | - M Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
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Managing hypertension after acute coronary syndrome. J Hypertens 2015; 33:700-1. [DOI: 10.1097/hjh.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Borghi C, Urso R, Cicero AFG. The cost-effectiveness of irbesartan for hypertension. Expert Rev Pharmacoecon Outcomes Res 2015; 15:199-207. [PMID: 25703678 DOI: 10.1586/14737167.2015.1018894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
High blood pressure is a very common problem in the adult and elderly population, both in developed and developing countries. A relatively large number of drug classes are available to treat this condition and prevent its complications, which are not only more frequent in the aforementioned patients but also those affected by metabolic syndrome and/or Type 2 diabetes. Irbesartan is an angiotensin-receptor blocker class drug with good antihypertensive efficacy and specific pharmacological characteristics, whose efficacy has been more deeply evaluated in metabolically complex hypertensive patients. In this review, the authors will analyze its effectiveness in preventing or delaying organ damage in hypertensive patients, with a closer look at the economic implications of treating hypertension with irbesartan in the context of available antihypertensive drugs.
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Affiliation(s)
- Claudio Borghi
- Department of Medical and Surgical Sciences, U.O di Medicina Interna, Ospedale Policlinico S.Orsola-Malpighi, University of Bologna, Via Albertoni, 15, 40138 Bologna, Italy
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Attitudes and preferences for the clinical management of hypertension and hypertension-related cardiac disease in general practice: results of the Italian Hypertension and Heart Survey. J Hum Hypertens 2014; 29:409-16. [PMID: 25518895 DOI: 10.1038/jhh.2014.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 01/13/2023]
Abstract
The aim of this study was to evaluate attitudes and preferences for the clinical management of hypertensive patients with cardiac organ disease, including left ventricular hypertrophy (LVH) and coronary artery disease (CAD), in Italy. A predefined 15-item questionnaire was anonymously administered to a large community sample of general practitioners (GPs) and specialised physicians between November 2012 and June 2013. Estimated prevalence of hypertension-related clinical conditions was stratified into four groups (10-20%, 20-40%, 40-50%, >50%); preferences were reported as percentage among valid answers to the survey questionnaire. A total of 1319 physicians (672 males, age 55.0 ± 7.1 years, age of medical activity 27.1 ± 7.6 years), among whom 1264 GPs and 55 specialised physicians, was included. LVH was reported to be the most frequent marker of organ damage by the majority of physicians (73.5%). LV diastolic dysfunction was reported to be relatively frequent (>40%) by more than half of the specialised physicians (58.2%) and less frequent (10-20%) by GPs (49.8%); LV systolic dysfunction, atrial fibrillation and CAD were considered to be less frequent (10-20%) by the majority of physicians (61.3, 71.6 and 53.3%, respectively). Echocardiography was the preferred diagnostic tool used to estimate LVH (76.6%). Tight blood pressure control (130/80 mm Hg) was considered to be the most appropriate by the majority of physicians, both in hypertensive patients with LVH and in those with CAD. With the well-known limitations of a cross-sectional survey, this study provides information on attitudes and preferences for the clinical management of outpatients with hypertension and high CV risk profile in general practice in Italy.
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