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Arumugam S, Sreedhar R, Thandavarayan RA, Karuppagounder V, Krishnamurthy P, Suzuki K, Nakamura M, Watanabe K. Angiotensin receptor blockers: Focus on cardiac and renal injury. Trends Cardiovasc Med 2015; 26:221-8. [PMID: 26169314 DOI: 10.1016/j.tcm.2015.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/13/2015] [Accepted: 06/04/2015] [Indexed: 12/31/2022]
Abstract
Angiotensin II, an important component of renin angiotensin system, is a potent vasopressor and its actions are mostly mediated via angiotensin II type 1 receptor (AT1R) and role of AT2R in counterbalancing the actions of AT1R stimulation are under extensive research. In addition to its physiological actions, angiotensin II plays important roles in the pathogenesis of atherosclerosis, hypertension, left ventricular hypertrophy, and heart failure. The effects of angiotensin II can be blocked by either suppressing its production by blocking angiotensin converting enzyme or by antagonizing its actions on AT1R using angiotensin II receptor blockers (ARBs). Instead of the extensive use of ARBs in the treatment of various cardiovascular diseases, proper selection of a particular ARB is crucial as the clinical condition of individual patient is different and also their economic status would play an essential role in medication compliance. Thus a critical review of the proven and promising actions of ARBs against various pathological conditions will be of great importance for the clinicians as well as for the researchers.
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Affiliation(s)
- Somasundaram Arumugam
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan
| | - Remya Sreedhar
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan
| | - Rajarajan A Thandavarayan
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan; Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX
| | - Vengadeshprabhu Karuppagounder
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan
| | - Prasanna Krishnamurthy
- Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX
| | - Kenji Suzuki
- Department of Gastroenterology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiko Nakamura
- Department of Cardiology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, Japan
| | - Kenichi Watanabe
- Department of Clinical Pharmacology, Niigata University of Pharmacy and Applied Life Sciences, Higashijima, Akiha-Ku, Niigata, Japan.
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Lee HY, Kim YJ, Ahn T, Youn HJ, Chull Chae S, Seog Seo H, Kim KS, Rhee MY, Choi DJ, Kim JJ, Chun KJ, Yoo BS, Park JS, Oh SK, Kim DS, Kwan J, Ahn Y, Bae Park J, Jeong JO, Hyon MS, Cho EJ, Han KR, Kim DI, Joo SJ, Shin JH, Sung KC, Jeon ES. A Randomized, Multicenter, Double-blind, Placebo-controlled, 3 × 3 Factorial Design, Phase II Study to Evaluate the Efficacy and Safety of the Combination of Fimasartan/Amlodipine in Patients With Essential Hypertension. Clin Ther 2015; 37:2581-2596.e3. [PMID: 25850881 DOI: 10.1016/j.clinthera.2015.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/16/2015] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to evaluate the efficacy and safety of a fimasartan/amlodipine combination in patients with hypertension and to determine the optimal composition for a future single-pill combination formulation. METHODS This Phase II study was conducted by using a randomized, multicenter, double-blind, placebo-controlled, 3 × 3 factorial design. After a 2-week placebo run-in period, eligible hypertensive patients (with a sitting diastolic blood pressure [SiDBP] between 90 and 114 mm Hg) were randomized to treatment. They received single or combined administration of fimasartan at 3 doses (0, 30, and 60 mg) and amlodipine at 3 doses (0, 5, and 10 mg) for 8 weeks. The primary efficacy end point was the change in SiDBP from baseline and at week 8; secondary end points included the change in SiDBP from baseline and at week 4 and the changes in sitting systolic blood pressure from baseline and at weeks 4 and 8. Treatment-emergent adverse events (AEs) were also assessed. FINDINGS 420 Korean patients with mild to moderate hypertension were randomly allocated to the 9 groups. Mean (SD) SiDBP changes in each group after 8 weeks were as follows: placebo, -6.0 (8.5) mm Hg; amlodipine 5 mg, -10.6 (9.2) mm Hg; amlodipine 10 mg, -15.9 (7.2) mm Hg; fimasartan 30 mg, -10.1 (9.1) mm Hg; fimasartan 60 mg, -13.0 (10.0) mm Hg; fimasartan 30 mg/amlodipine 5 mg, -16.2 (8.5) mm Hg; fimasartan 30 mg/amlodipine 10 mg, -19.5 (7.5) mm Hg; fimasartan 60 mg/amlodipine 5 mg, -16.6 (6.9) mm Hg; and fimasartan 60 mg/amlodipine 10 mg, -21.5 (8.3) mm Hg. All treatment groups produced significantly greater reductions in blood pressure compared with the placebo group. In addition, all combination treatment groups had superior reductions in blood pressure compared with the monotherapy groups. In the combination treatment groups, doubling fimasartan dose in the given dose of amlodipine did not show further BP reduction, whereas doubling amlodipine dose showed significantly further BP reduction in the given dose of fimasartan. During the study period, 75 (17.9%) of 419 patients experienced 110 AEs. Ninety-five AEs were mild, 9 were moderate, and 6 were severe in intensity. Eight patients discontinued the study due to AEs. There was no significant difference in incidence of AEs among groups (P = 0.0884). The most common AE was headache (12 patients [2.9%]), followed by dizziness (11 patients [2.6%]) and elevated blood creatine phosphokinase levels (6 patients [1.4%]). IMPLICATIONS Fimasartan combined with amlodipine produced superior blood pressure reductions and low levels of AEs compared with either monotherapy. Therefore, a single-pill combination with fimasartan 60 mg/amlodipine 10 mg will be developed. ClinicalTrials.gov: NCT01518998.
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Affiliation(s)
- Hae-Young Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Taehoon Ahn
- Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Ho-Joong Youn
- Catholic University of Korea, Seoul St. Mary׳s Hospital, Seoul, Republic of Korea
| | - Shung Chull Chae
- Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hong Seog Seo
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Ki-Sik Kim
- Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Moo-Yong Rhee
- Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Dong-Ju Choi
- Seoul National University Bundang Hospital, Sungnam, Busan, Republic of Korea
| | | | - Kook-Jin Chun
- Pusan University Yangsan Hospital, Busan, Republic of Korea
| | - Byung-Su Yoo
- Wonju Christian Hospital, Wonju, Republic of Korea
| | - Jong-Seon Park
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Seok-Kyu Oh
- Wonkwang University School of Medicine and Hospital, Iksan, Republic of Korea
| | - Dong-Soo Kim
- Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Jun Kwan
- Inha University Hospital, Incheon, Republic of Korea
| | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | | | - Jin-Ok Jeong
- Chungnam National University Hospital, Daegu, Republic of Korea
| | - Min-Soo Hyon
- Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Eun-Joo Cho
- Catholic University of Korea, St. Paul׳s Hospital, Seoul, Republic of Korea
| | - Kyoo-Rok Han
- Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Doo-Il Kim
- Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | | | - Jin-Ho Shin
- Hanyang University Hospital, Seoul, Republic of Korea
| | - Ki-Chul Sung
- Kangbuk Samsung Hospital, Seoul, Republic of Korea
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Singh B, Lokhandae RS, Dwivedi A, Sharma S, Dubey N. Improved simultaneous quantitation of candesartan and hydrochlorthiazide in human plasma by UPLC-MS/MS and its application in bioequivalence studies. J Pharm Anal 2013; 4:144-152. [PMID: 29403876 PMCID: PMC5761088 DOI: 10.1016/j.jpha.2013.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 05/13/2013] [Indexed: 12/03/2022] Open
Abstract
A validated ultra-performance liquid chromatography mass spectrometric method (UPLC–MS/MS) was used for the simultaneous quantitation of candesartan (CN) and hydrochlorothiazide (HCT) in human plasma. The analysis was performed on UPLC–MS/MS system using turbo ion spray interface. Negative ions were measured in multiple reaction monitoring (MRM) mode. The analytes were extracted using a liquid–liquid extraction (LLE) method by using 0.1 mL of plasma volume. The lower limit of quantitation for CN and HCT was 1.00 ng/mL whereas the upper limit of quantitation was 499.15 ng/mL and 601.61 ng/mL for CN and HCT respectively. CN d4 and HCT-13Cd2 were used as the internal standards for CN and HCT respectively. The chromatography was achieved within 2.0 min run time using a C18 Phenomenex, Gemini NX (100 mm×4.6 mm, 5 µm) column with organic mixture:buffer solution (80:20, v/v) at a flow rate of 0.800 mL/min. The method has been successfully applied to establish the bioequivalence of candesartan cilexetil (CNC) and HCT immediate release tablets with reference product in human subjects.
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Affiliation(s)
| | | | | | | | - Naveen Dubey
- Jubiliant Clinsys Limited, Noida, New Delhi, India
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