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Nagy A, Májer R, Boczán J, Sipka S, Szabó A, Enyedi EE, Tatai O, Fagyas M, Papp Z, Csiba L, Tóth A. Enalapril Is Superior to Lisinopril in Improving Endothelial Function without a Difference in Blood-Pressure-Lowering Effects in Newly Diagnosed Hypertensives. Biomedicines 2023; 11:3323. [PMID: 38137544 PMCID: PMC10742010 DOI: 10.3390/biomedicines11123323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Angiotensin-converting enzyme (ACE) inhibitors are the primarily chosen drugs to treat various cardiovascular diseases, such as hypertension. Although the most recent guidelines do not differentiate among the various ACE inhibitory drugs, there are substantial pharmacological differences. GOAL Here, we tested if lipophilicity affects the efficacy of ACE inhibitory drugs when used as the first therapy in newly identified hypertensives in a prospective study. METHODS We tested the differences in the cardiovascular efficacy of the hydrophilic lisinopril (8.3 ± 3.0 mg/day) and the lipophilic enalapril (5.5 ± 2.3 mg/day) (n = 59 patients). The cardiovascular parameters were determined using sonography (flow-mediated dilation (FMD) in the brachial artery, intima-media thickness of the carotid artery), 24 h ambulatory blood pressure monitoring (peripheral arterial blood pressure), and arteriography (aortic blood pressure, augmentation index, and pulse wave velocity) before and after the initiation of ACE inhibitor therapy. RESULTS Both enalapril and lisinopril decreased blood pressure. However, lisinopril failed to improve arterial endothelial function (lack of effects on FMD) when compared to enalapril. Enalapril-mediated improved arterial endothelial function (FMD) positively correlated with its blood-pressure-lowering effect. In contrast, there was no correlation between the decrease in systolic blood pressure and FMD in the case of lisinopril treatment. CONCLUSION The blood-pressure-lowering effects of ACE inhibitor drugs are independent of their lipophilicity. In contrast, the effects of ACE inhibition on arterial endothelial function are associated with lipophilicity: the hydrophilic lisinopril was unable to improve, while the lipophilic enalapril significantly improved endothelial function. Moreover, the effects on blood pressure and endothelial function did not correlate in lisinopril-treated patients, suggesting divergent mechanisms in the regulation of blood pressure and endothelial function upon ACE inhibitory treatment.
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Affiliation(s)
- Attila Nagy
- Department of Health Informatics, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary;
| | - Réka Májer
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.M.); (J.B.); (L.C.)
- MTA–DE Cerebrovascular and Neurodegenerative Research Group, 4032 Debrecen, Hungary
| | - Judit Boczán
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.M.); (J.B.); (L.C.)
| | - Sándor Sipka
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary (M.F.)
| | - Attila Szabó
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Enikő Edit Enyedi
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Ottó Tatai
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Miklós Fagyas
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary (M.F.)
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.M.); (J.B.); (L.C.)
- MTA–DE Cerebrovascular and Neurodegenerative Research Group, 4032 Debrecen, Hungary
| | - Attila Tóth
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
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Randomized, double-blinded, controlled clinical trial of the effect of captopril, telmisartan and their combination on systemic inflammation of patients on hemodialysis. Sci Rep 2022; 12:17568. [PMID: 36266534 PMCID: PMC9584892 DOI: 10.1038/s41598-022-22656-5] [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: 06/25/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023] Open
Abstract
To evaluate individual and combined effect of captopril and telmisartan on systemic inflammation markers of hemodialysis (HD) patients. Randomized, double-blinded, controlled clinical trial. Patients on HD at least 2 months, with arteriovenous fistula, were randomly allocated to groups: (1) captopril/placebo (N 13); (2) telmisartan/placebo (N 13); (3) captopril + telmisartan (N 12); or (4) placebo/placebo (N 12). During 3 months, patients received oral drugs as follows: captopril 50 mg/day, telmisartan 80 mg/day or placebo. Patients excluded if they had conditions or were on drugs potentially influencing on inflammation. Clinical and biochemical evaluations were performed monthly. Serum tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), and C-reactive protein (CRP) were measured at 0, 1 and 3 months. Baseline, demographic, clinical and biochemical variables were comparable between groups. Baseline versus final inflammatory markers were: captopril/placebo TNFα, 2.47 (0.1-4.5) versus 1.73 (0.3-3.8) pg/ml; IL-6, 17.03 (7.2-23) versus 7.90 (0.7-19) pg/ml; CRP, 4.21 (1.6-18) versus 5.9 (3.0-28) mg/l; telmisartan/placebo TNFα, 3.03 (2.3-4.6) versus 1.70 (1.2-2.0) pg/ml; IL-6, 14.10 (5.5-23) versus 9.85 (6.2-13) pg/ml; CRP, 5.74 (2.1-13) versus 10.60 (1.5-27) mg/l; captopril + telmisartan TNFα, 1.43 (0.7-5.4) versus 0.40 (0.1-2.1) pg/ml; IL-6, 10.05 (4.9-23) versus 4.00 (0.7-7.7) pg/ml (p < 0.05); CRP, 3.26 (0.7-12) versus 2.83 (0.6-6.5) mg/l; placebo/placebo TNFα, 3.13 (1.6-5.6) versus 1.64 (1.6-2.3) pg/ml; IL-6, 8.12 (5.4-16) versus 7.60 (2.4-15) pg/ml; CRP, 5.23 (1.9-16) versus 3.13 (1.5-18) mg/l. Monotherapy with captopril or telmisartan display a trend, but their combined treatment significantly decreased serum levels of IL-6. No remarkable changes on TNFα and CRP were observed.
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Stock JM, Chelimsky G, Edwards DG, Farquhar WB. Dietary sodium and health: How much is too much for those with orthostatic disorders? Auton Neurosci 2022; 238:102947. [PMID: 35131651 PMCID: PMC9296699 DOI: 10.1016/j.autneu.2022.102947] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/09/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
High dietary salt (NaCl) increases blood pressure (BP) and can adversely impact multiple target organs including the vasculature, heart, kidneys, brain, autonomic nervous system, skin, eyes, and bone. However, patients with orthostatic disorders are told to increase their NaCl intake to help alleviate symptoms. While there is evidence to support the short-term benefits of increasing NaCl intake in these patients, there are few studies assessing the benefits and side effects of long-term high dietary NaCl. The evidence reviewed suggests that high NaCl can adversely impact multiple target organs, often independent of BP. However, few of these studies have been performed in patients with orthostatic disorders. We conclude that the recommendation to increase dietary NaCl in patients with orthostatic disorders should be done with care, keeping in mind the adverse impact on dietary NaCl in people without orthostatic disorders. Modest, rather than robust, increases in NaCl intake may be sufficient to alleviate symptoms but also minimize any long-term negative effects.
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Affiliation(s)
- Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America
| | - Gisela Chelimsky
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States of America.
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Chatterjee S, Caporale A, Tao JQ, Guo W, Johncola A, Strasser AA, Leone FT, Langham MC, Wehrli FW. Acute e-cig inhalation impacts vascular health: a study in smoking naïve subjects. Am J Physiol Heart Circ Physiol 2020; 320:H144-H158. [PMID: 33216614 DOI: 10.1152/ajpheart.00628.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study was designed to investigate the acute effects of nonnicotinized e-cigarette (e-cig) aerosol inhalation in nonsmokers both in terms of blood-based markers of inflammation and oxidative stress and evaluate their association with hemodynamic-metabolic MRI parameters quantifying peripheral vascular reactivity, cerebrovascular reactivity, and aortic stiffness. Thirty-one healthy nonsmokers were subjected to two blood draws and two identical MRI protocols, each one before and after a standardized e-cig vaping session. After vaping, the serum levels of C-reactive protein, soluble intercellular adhesion molecule, and the danger signal machinery high-mobility group box 1 (HMGB1) and its downstream effector and the NLR family pyrin domain containing 3 (NLRP3) inflammasome (as monitored by its adaptor protein ASC) increased significantly relative to the respective baseline (prevaping) values. Moreover, nitric oxide metabolites and reactive oxygen species production decreased and increased, respectively. These observations were paralleled by impaired peripheral vascular reactivity (with reduced flow-mediated dilation and attenuated hyperemic response after a cuff-occlusion test) and metabolic alterations expressed by decreased venous oxygen saturation, postvaping. The current results suggest propagation of inflammation signaling via activation of the danger signaling axis (HMGB1-NLRP3). The findings indicate that a single episode of vaping has adverse impacts on vascular inflammation and function.NEW & NOTWORTHY Endothelial cell signaling and blood biomarkers were found to correlate with functional vascular changes in a single episode e-cigarettes inhalation in healthy adults. This is indicative of the potential of e-cigarettes (even when inhaled acutely) to lead of vascular dysfunction.
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Affiliation(s)
- Shampa Chatterjee
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alessandra Caporale
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Jian Qin Tao
- Institute for Environmental Medicine and Department of Physiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Wensheng Guo
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alyssa Johncola
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Andrew A Strasser
- Department of Psychiatry and Center for Interdisciplinary Research on Nicotine Addiction, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael C Langham
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
| | - Felix W Wehrli
- Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology
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Yuan H, Yang G, Li S, Li L, Wei T, Song G, Luan H, Meng J, Wang Q, Yu Y, Sun J. Calcium sensing receptor involving in therapy of embryonic stem cell transplantation alleviates acute myocardial infarction by inhibiting apoptosis and oxidative stress in rats. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2020; 23:1353-1359. [PMID: 33149870 PMCID: PMC7585542 DOI: 10.22038/ijbms.2020.47436.10916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective(s): The aims of the present study were to investigate the expression of calcium sensing receptor (CaSR) at different times in acute myocardial infarction (AMI) rat myocardial tissue after mouse embryonic stem cells (mESCs) transplantation treatment and to assess its effects on apoptosis and oxidative stress of cardiomyocytes. Materials and Methods: The AMI rats were treated with mESCs, Calindol (a CaSR agonist) and Calhex231 (a CaSR inhibitor). Serum measurements, Echocardiographic analysis and TUNEL assay were performed. Myocardial ultrastructure changes were viewed by electron microscopy. Additionally, western blotting was used to detect the protein expressions. Results: Compared to the sham group, it was found that the expression levels of CaSR, caspase-3, cytoplasmic cytochrome C (cyt-C) and Bcl2-associated x (Bax), and the levels of Malondialdehyde (MDA) were significantly increased in both AMI and AMI + mESCs + Calindol groups with the development of myocardial infarction. Furthermore, the ultra-microstructure of cardiomyocyte was highly damaged, the expression levels of mitochondrial cyt-C and B-cell lymphoma 2 (Bcl-2) were significantly decreased, and there was decreased activity of superoxide dismutase (SOD). However, the combination of Calhex231 and mESCs transplantation could inhibit these changes. Conclusion: Our results suggested that CaSR expression in myocardial tissue of AMI rats was increased over time, and that Calhex231 could enhance the efficacy of ESCs transplantation for the treatment of AMI, which would be a new therapeutic strategy for the treatment of AMI.
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Affiliation(s)
- Hui Yuan
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Guohong Yang
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Shu Li
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Li Li
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Tao Wei
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Gaochen Song
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Hairong Luan
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Jin Meng
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Qi Wang
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Yaquan Yu
- Mudanjiang Medical University, Mudanjiang, 157011, China
| | - Jian Sun
- Mudanjiang Medical University, Mudanjiang, 157011, China
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Chiesa ST, Marcovecchio ML, Benitez-Aguirre P, Cameron FJ, Craig ME, Couper JJ, Davis EA, Dalton RN, Daneman D, Donaghue KC, Jones TW, Mahmud FH, Marshall SM, Neil HAW, Dunger DB, Deanfield JE. Vascular Effects of ACE (Angiotensin-Converting Enzyme) Inhibitors and Statins in Adolescents With Type 1 Diabetes. Hypertension 2020; 76:1734-1743. [PMID: 33100044 DOI: 10.1161/hypertensionaha.120.15721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An increased albumin-creatinine ratio within the normal range can identify adolescents at higher risk of developing adverse cardio-renal outcomes as they progress into adulthood. Utilizing a parallel randomized controlled trial and observational cohort study, we characterized the progression of vascular phenotypes throughout this important period and investigated the effect of ACE (angiotensin-converting enzyme) inhibitors and statins in high-risk adolescents. Endothelial function (flow-mediated dilation and reactive hyperemia index) and arterial stiffness (carotid-femoral pulse wave velocity) were assessed in 158 high-risk participants recruited to a randomized, double-blind placebo-controlled 2×2 factorial trial (randomized, placebo-controlled trial) of ACE inhibitors and/or statins in adolescents with type 1 diabetes (AdDIT [Adolescent Type 1 Diabetes cardio-renal Intervention Trial]). Identical measures were also assessed in 215 lower-risk individuals recruited to a parallel observational study. In the randomized, placebo-controlled trial, high-risk patients randomized to ACE inhibitors had improved flow-mediated dilation after 2 to 4 years of follow-up (mean [95% CI]: 6.6% [6.0-7.2] versus 5.3% [4.7-5.9]; P=0.005), whereas no effect was observed following statin use (6.2% [5.5-6.8] versus 5.8% [5.1-6.4]; P=0.358). In the observational study, patients classed as high-risk based on albumin-creatinine ratio showed evidence of endothelial dysfunction at the end of follow-up (flow-mediated dilation=4.8% [3.8-5.9] versus 6.3% [5.8-6.7] for high-risk versus low-risk groups; P=0.015). Neither reactive hyperemia index nor pulse wave velocity were affected by either treatment (P>0.05 for both), but both were found to increase over the duration of follow-up (0.07 [0.03-0.12]; P=0.001 and 0.5 m/s [0.4-0.6]; P<0.001 for reactive hyperemia index and pulse wave velocity, respectively). ACE inhibitors improve endothelial function in high-risk adolescents as they transition through puberty. The longer-term protective effects of this intervention at this early age remain to be determined. Registration- URL: https://www.clinicaltrials.gov; Unique identifier NCT01581476.
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Affiliation(s)
- Scott T Chiesa
- From the Institute of Cardiovascular Science, University College London, United Kingdom (S.T.C., J.E.D.)
| | | | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Camperdown, Australia (P.B.-A., K.C.D.)
| | - Fergus J Cameron
- Department of Paediatrics, University of Melbourne, Australia (F.J.C.)
| | - Maria E Craig
- School of Women's and Children's Health, University of New South Wales, Australia (M.E.C.)
| | - Jennifer J Couper
- Departments of Endocrinology and Diabetes, Women's and Children's Hospital, Robinson Research Institute, University of Adelaide, Australia (J.J.C.)
| | - Elizabeth A Davis
- Telethon Kids Institute, University of Western Australia, Perth (E.A.D., T.W.J.)
| | - R Neil Dalton
- Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom (R.N.D.)
| | - Denis Daneman
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada (D.D., F.H.M.)
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, University of Sydney, Camperdown, Australia (P.B.-A., K.C.D.)
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth (E.A.D., T.W.J.)
| | - Farid H Mahmud
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada (D.D., F.H.M.)
| | - Sally M Marshall
- Institute of Cellular Medicine (Diabetes), Faculty of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (S.M.M.)
| | - H Andrew W Neil
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, United Kingdom (H.A.W.N.)
| | - David B Dunger
- Department of Paediatrics (M.L.M., D.B.D.), University of Cambridge, United Kingdom.,Wellcome Trust-MRC Institute of Metabolic Science (D.B.D.), University of Cambridge, United Kingdom
| | - John E Deanfield
- From the Institute of Cardiovascular Science, University College London, United Kingdom (S.T.C., J.E.D.)
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Srivastava P, Badhwar S, Chandran DS, Jaryal AK, Jyotsna VP, Deepak KK. Improvement in Angiotensin 1-7 precedes and correlates with improvement in Arterial stiffness and endothelial function following Renin-Angiotensin system inhibition in type 2 diabetes with newly diagnosed hypertension. Diabetes Metab Syndr 2020; 14:1253-1263. [PMID: 32688242 DOI: 10.1016/j.dsx.2020.06.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Studies in cell cultures and animal models have revealed the possible pathophysiological factors associated with vascular endothelial dysfunction. However, the same in human subjects has not been clearly established. The current study uses a novel approach to identify the factors associated with endothelial function and arterial function by altering these vascular parameters using Angiotensin-Converting-Enzyme (ACE) inhibition. METHODS Diabetic patients with newly diagnosed hypertension (n = 60) were recruited for the study. Flow-mediated-dilation (FMD), carotid-femoral (cf), carotid-radial (cr) Pulse-wave-velocity (PWV), Augmentation-Index, Carotid-Intima-Media-Thickness (CIMT), serum levels of Renin, Angiotensin II (AngII), Angiotensin-Converting-Enzyme2 (ACE2), Angiotensin1-7 (Ang1-7), E-selectin, Vascular-Cell-Adhesion-Molecule-1 (VCAM-1), Highly-sensitive-C-Reactive-Protein (hsCRP) and Interleukin-10 were measured at baseline (V1), after 1 week (V2) and 3 months (V3) of ACE inhibition in patients of diabetes with newly diagnosed hypertension. The amplitude of change after 1 week (V2-V1) and 3 months (V3-V1) for the clinical and various parameters were correlated with the change in endothelial function and arterial stiffness. RESULTS Carotid radial-PWVV2-V1 (p = 0.001) and Ang1-7V2-V1 (p = 0.01) emerged as independent predictors of FMDV2-V1. ReninV2-V1 and VCAM-1V2-V1 independently predicted E-selectinV2-V1 [(p = 0.01) and (p = 0.001), respectively]. ACE 2V2-V1 was the only independent predictor of cf-PWVV2-V1. The same parameters remained as independent predictors of the respective vascular factors after 3 months of ACE inhibition. CONCLUSION The study highlights the role of AngII/Ang1-7 balance in alteration of endothelial function and central arterial stiffness in humans in addition to identifying the interrelationship between the renin-angiotensin-aldosterone-system components and clinically ascertainable parameters.
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Affiliation(s)
- Prachi Srivastava
- Autonomic & Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Badhwar
- Autonomic & Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Dinu S Chandran
- Autonomic & Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Autonomic & Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore Kumar Deepak
- Autonomic & Vascular Function Lab, Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
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Suliburska J, Skrypnik K, Szulińska M, Kupsz J, Bogdański P. Effect of hypotensive therapy combined with modified diet or zinc supplementation on biochemical parameters and mineral status in hypertensive patients. J Trace Elem Med Biol 2018; 47:140-148. [PMID: 29544801 DOI: 10.1016/j.jtemb.2018.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hypotensive therapy leads to a number of trace elements metabolism disturbances. Zinc balance is frequently affected by antihypertensive treatment. AIM To evaluate the effect of a hypotensive treatment, modified diet and zinc supplementation on mineral status and selected biochemical parameters in newly diagnosed hypertensive patients on monotherapy. METHODS In the first stage, arterial hypertension in ninety-eight human subjects was diagnosed. In the second stage, antihypertensive monopharmacotherapy was implemented. In the third stage, patients were randomized into three groups and continued antihypertensive monotherapy: group D received an optimal-mineral-content diet, group S received zinc supplementation, and group C had no changes in diet or zinc supplementation. Iron, zinc, and copper concentrations in serum, erythrocytes, urine, and hair were determined. Lipids, glucose, ceruloplasmin, ferritin, albumin, C-reactive protein (CRP), tumor necrosis factor α (TNF-α), nitric oxide (NO), superoxide dismutase (SOD) and catalase (CAT) were assayed in serum. RESULTS Antihypertensive monotherapy decreased zinc concentration in serum and erythrocytes and increased the level of zinc in urine, decreased CAT and SOD activity, TNF-α concentration in serum, and increased the level of NO in the serum. Zinc supply led to an increase in zinc concentration in serum, erythrocytes, and hair (in group S only). In the groups with higher zinc intake, decreased glucose concentration in the serum was observed. Significant correlation was seen between the zinc and glucose serum concentrations. CONCLUSION Hypotensive drugs disturb zinc status in newly diagnosed hypertensive patients. Antihypertensive monotherapy combined with increased zinc supply in the diet or supplementation favorably modify zinc homeostasis and regulate glucose status without blood pressure affecting in patients with hypertension.
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Affiliation(s)
- Joanna Suliburska
- Instytut Żywienia Człowieka i Dietetyki, Uniwersytet Przyrodniczy w Poznaniu (Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences), ul. Wojska Polskiego 31, 60-624 Poznań, Poland.
| | - Katarzyna Skrypnik
- Instytut Żywienia Człowieka i Dietetyki, Uniwersytet Przyrodniczy w Poznaniu (Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences), ul. Wojska Polskiego 31, 60-624 Poznań, Poland.
| | - Monika Szulińska
- Zakład Edukacji i Leczenia Otyłości oraz Zaburzeń Metabolicznych, Uniwersytet Medyczny w Poznaniu (Department of Education and Obesity Treatment and Metabolic Disorders, University of Medical Sciences, Poznan, Poland), ul. Szamarzewskiego 82/84, 60-569 Poznan, Poland.
| | - Justyna Kupsz
- Katedra i Zakład Fizjologii, Uniwersytet Medyczny w Poznaniu (Department of Physiology, University of Medical Sciences, Poznan, Poland), ul. Święcickiego 6, 61-781 Poznan, Poland.
| | - Paweł Bogdański
- Zakład Edukacji i Leczenia Otyłości oraz Zaburzeń Metabolicznych, Uniwersytet Medyczny w Poznaniu (Department of Education and Obesity Treatment and Metabolic Disorders, University of Medical Sciences, Poznan, Poland), ul. Szamarzewskiego 82/84, 60-569 Poznan, Poland.
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Abstract
BACKGROUND Previous literature indicates that flow-mediated dilation (FMD) is associated with impaired cognition among patients with stroke. The relationship between FMD and cognition in individuals without cerebrovascular disease has yet to be systematically reviewed. METHODS The literature was searched using MEDLINE. Exclusion criteria were as follows: focus on neurological disease (e.g., stroke), animal studies, no quantitative measure of endothelial function or cognition, newborn studies, articles with no original data, and articles that are irrelevant to the topic of interest. Neurocognitive tests were categorized in the following domains: executive function, memory (general, working, episodic/semantic, verbal, visual), global cognitive function, information processing speed, language, psychomotor speed, and visual-spatial ability. RESULTS The search yielded 700 articles, of which 10 articles, consisting of 2791 participants, met the criteria for inclusion. Most studies conclude that impaired FMD is associated with poorer neuropsychological functioning, particularly in executive functioning (effect sizes: r = 0.07-0.58) and working memory tasks (effect sizes: r = 0.19-0.39). No association was found between other subdomains of memory and FMD. Visual spatial tasks, information processing speed, language tasks, and global cognition were not associated with FMD overall; however fewer studies examined these domains. CONCLUSIONS Even in the absence of cerebrovascular disease, there are links between cognition, particularly executive tasks, and vascular function. Public health implications include the potential value of examining FMD as a predictor of cognitive decline, as well as the potential value of improving cognition through pharmacological and behavioral interventions that improve vascular function. Future studies incorporating neuroimaging measures of cerebral blood flow are warranted.
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10
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Endothelial dysfunction in conduit arteries and in microcirculation. Novel therapeutic approaches. Pharmacol Ther 2014; 144:253-67. [PMID: 24928320 DOI: 10.1016/j.pharmthera.2014.06.003] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/28/2014] [Indexed: 11/22/2022]
Abstract
The vascular endothelium not only is a single monolayer of cells between the vessel lumen and the intimal wall, but also plays an important role by controlling vascular function and structure mainly via the production of nitric oxide (NO). The so called "cardiovascular risk factors" are associated with endothelial dysfunction, that reduces NO bioavailability, increases oxidative stress, and promotes inflammation contributing therefore to the development of atherosclerosis. The significant role of endothelial dysfunction in the development of atherosclerosis emphasizes the need for efficient therapeutic interventions. During the last years statins, angiotensin-converting enzyme inhibitors, angiotensin-receptor antagonists, antioxidants, beta-blockers and insulin sensitizers have been evaluated for their ability to restore endothelial function (Briasoulis et al., 2012). As there is not a straightforward relationship between therapeutic interventions and improvement of endothelial function but rather a complicated interrelationship between multiple cellular and sub-cellular targets, research has been focused on the understanding of the underlying mechanisms. Moreover, the development of novel diagnostic invasive and non-invasive methods has allowed the early detection of endothelial dysfunction expanding the role of therapeutic interventions and our knowledge. In the current review we present the available data concerning the contribution of endothelial dysfunction to atherogenesis and review the methods that assess endothelial function with a view to understand the multiple targets of therapeutic interventions. Finally we focus on the classic and novel therapeutic approaches aiming to improve endothelial dysfunction and the underlying mechanisms.
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11
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Weiner SD, Ahmed HN, Jin Z, Cushman M, Herrington DM, Nelson JC, Di Tullio MR, Homma S. Systemic inflammation and brachial artery endothelial function in the Multi-Ethnic Study of Atherosclerosis (MESA). Heart 2014; 100:862-6. [PMID: 24714919 DOI: 10.1136/heartjnl-2013-304893] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Inflammation and endothelial dysfunction have been implicated in the pathogenesis of atherosclerotic vascular disease. Brachial artery flow-mediated dilation (FMD) is a reliable, non-invasive method of assessing endothelial function. We hypothesised that increased levels of systemic inflammatory markers are associated with impaired endothelial function as assessed by FMD in a multi-ethnic cohort. METHODS We assessed brachial artery FMD in 3501 participants (1739 men, 1762 women; median age 61 years) in the Multi-Ethnic Study of Atherosclerosis and measured serum concentrations of interleukin (IL)-6, C reactive protein (CRP) and tumour necrosis factor (TNF)-α receptor 1. Spearman correlation coefficients were used to evaluate the association of each inflammatory marker with FMD, adjusting for the effect of other variables associated with FMD. RESULTS There was a significant inverse correlation between IL-6 levels and FMD (-0.042; p=0.02) after adjustment for age, gender, race/ethnicity, education, income, low-density lipoprotein, diabetes, glucose, hypertension status and treatment, waist circumference, triglycerides, baseline brachial diameter, recent infection and use of medications that may alter inflammation. There was no significant correlation between CRP and FMD (0.008; p=0.64) or TNF-α receptor 1 and FMD (0.014; p=0.57). There was no evidence of effect modification by race/ethnicity. CONCLUSIONS In this multi-ethnic cohort, increased levels of the pro-inflammatory cytokine IL-6 were associated with impaired endothelial function assessed by FMD. Elevated IL-6 levels may reflect a state that promotes vascular inflammation and development of subclinical atherosclerosis independent of traditional cardiovascular risk factors.
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Affiliation(s)
- Shepard D Weiner
- Department of Medicine, Columbia University College of Physicians and Surgeons, , New York, New York, USA
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12
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Ahimastos AA, Latouche C, Natoli AK, Reddy-luthmoodoo M, Golledge J, Kingwell BA. Potential Vascular Mechanisms of Ramipril Induced Increases in Walking Ability in Patients With Intermittent Claudication. Circ Res 2014; 114:1144-55. [DOI: 10.1161/circresaha.114.302420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rationale:
We recently reported that ramipril more than doubled maximum walking times in patients with peripheral artery disease with intermittent claudication.
Objective:
Our aim was to conduct exploratory analyses of the effects of ramipril therapy on circulating biomarkers of angiogenesis/arteriogenesis, thrombosis, inflammation, and leukocyte adhesion in patients with intermittent claudication.
Methods and Results:
One hundred sixty-five patients with intermittent claudication (mean, 65.3 [SD, 6.7] years) were administered ramipril 10 mg per day (n=82) or matching placebo (n=83) for 24 weeks in a randomized, double-blind study. Plasma biomarkers of angiogenesis/arteriogenesis (vascular endothelial growth factor-A, fibroblast growth factor-2), thrombosis (D-dimer, von Willebrand factor, thrombin-antithrombin III), inflammation (high-sensitivity C-reactive protein, osteopontin), and leukocyte adhesion (soluble vascular cell adhesion molecule-1, soluble intracellular adhesion molecule-1) were measured at baseline and 24 weeks. Relative to placebo, ramipril was associated with increases in vascular endothelial growth factor-A by 38% (95% confidence interval [CI], 34%–42%) and fibroblast growth factor-2 by 64% (95% CI, 44–85%;
P
<0.001 for both), and reductions in D-dimer by 24% (95% CI, −30% to −18%), von Willebrand factor by 22% (95% CI, −35% to −9%), thrombin-antithrombin III by 16% (95% CI, −19% to −13%), high-sensitivity C-reactive protein by 13% (95% CI, −14% to −9%), osteopontin by 12% (95% CI, −14% to −10%), soluble vascular cell adhesion molecule-1 by 14% (95% CI, −18% to −10%), and soluble intracellular adhesion molecule-1 by 15% (95% CI, −17% to −13%; all
P
<0.001). With the exception of von Willebrand factor, all the above changes correlated significantly with the change in maximum walking time (
P
=0.02−0.001) in the group treated with ramipril.
Conclusions:
Ramipril is associated with an increase in the biomarkers of angiogenesis/arteriogenesis and reduction in the markers of thrombosis, inflammation, and leukocyte adhesion. This study informs strategies to improve mobility in patients with intermittent claudication.
Clinical Trial Registration Information:
URL:
http://clinicaltrials.gov
. Unique identifier: NCT00681226.
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Affiliation(s)
- Anna A. Ahimastos
- From Baker IDI Heart and Diabetes Institute and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (A.A.A., C.L., A.K.N., M.R., B.A.K.); Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, Townsville Hospital, Queensland, Australia (J.G.)
| | - Celine Latouche
- From Baker IDI Heart and Diabetes Institute and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (A.A.A., C.L., A.K.N., M.R., B.A.K.); Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, Townsville Hospital, Queensland, Australia (J.G.)
| | - Alaina K. Natoli
- From Baker IDI Heart and Diabetes Institute and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (A.A.A., C.L., A.K.N., M.R., B.A.K.); Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, Townsville Hospital, Queensland, Australia (J.G.)
| | - Medini Reddy-luthmoodoo
- From Baker IDI Heart and Diabetes Institute and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (A.A.A., C.L., A.K.N., M.R., B.A.K.); Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, Townsville Hospital, Queensland, Australia (J.G.)
| | - Jonathan Golledge
- From Baker IDI Heart and Diabetes Institute and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (A.A.A., C.L., A.K.N., M.R., B.A.K.); Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, Townsville Hospital, Queensland, Australia (J.G.)
| | - Bronwyn A. Kingwell
- From Baker IDI Heart and Diabetes Institute and Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia (A.A.A., C.L., A.K.N., M.R., B.A.K.); Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, Queensland, Australia (J.G.); and Department of Vascular and Endovascular Surgery, Townsville Hospital, Queensland, Australia (J.G.)
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13
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Chen Q, Wang J, Tian J, Tang X, Yu C, Marshall RJ, Chen D, Cao W, Zhan S, Lv J, Lee L, Hu Y. Association between ambient temperature and blood pressure and blood pressure regulators: 1831 hypertensive patients followed up for three years. PLoS One 2013; 8:e84522. [PMID: 24391962 PMCID: PMC3877276 DOI: 10.1371/journal.pone.0084522] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 11/14/2013] [Indexed: 12/27/2022] Open
Abstract
Several studies have suggested an association between ambient air temperature and blood pressure. However, this has not been reliably confirmed by longitudinal studies. Also, whether the reaction to temperature stimulation is modified by other factors such as antihypertensive medication is rarely investigated. The present study explores the relationship between ambient temperature and blood pressure, without and with antihypertensive medication, in a study of 1,831 hypertensive patients followed up for three years, in two or four weekly check ups, accumulating 62,452 follow-up records. Both baseline and follow-up blood pressure showed an inverse association with ambient temperature, which explained 32.4% and 65.6% of variation of systolic blood pressure and diastolic blood pressure (P<0.05) respectively. The amplitude of individual blood pressure fluctuation with temperature throughout a year (a 29 degrees centigrade range) was 9.4/7.3 mmHg. Medication with angiotensin converting enzyme inhibitor benazepril attenuated the blood pressure fluctuation by 2.4/1.3 mmHg each year, though the inverse association of temperature and blood pressure remained. Gender, drinking behavior and body mass index were also found to modify the association between temperature and diastolic blood pressure. The results indicate that ambient temperature may negatively regulate blood pressure. Hypertensive patients should monitor and treat blood pressure more carefully in cold days, and it could be especially important for the males, thinner people and drinkers.
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Affiliation(s)
- Qing Chen
- Department of Hygienic Toxicology, College of Preventive Medicine, Third Military Medical University, Chongqing, P. R. China
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Jinwei Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Jun Tian
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Xun Tang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Roger J. Marshall
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Dafang Chen
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Weihua Cao
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Siyan Zhan
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Liming Lee
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
| | - Yonghua Hu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, P. R. China
- * E-mail:
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14
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Shan Y, Lin J, Xu P, Zeng M, Lin H, Yan H. The combined effect of hypertension and type 2 diabetes mellitus on aortic stiffness and endothelial dysfunction: an integrated study with high-resolution MRI. Magn Reson Imaging 2013; 32:211-6. [PMID: 24462301 DOI: 10.1016/j.mri.2013.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 10/26/2013] [Accepted: 12/23/2013] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to investigate the combined effect of hypertension and type 2 diabetes mellitus (DM2) on aortic stiffness and endothelial dysfunction by using an integrated MRI approach. MATERIALS AND METHODS A total of 31 non-hypertensive DM2 patients and 31 hypertensive DM2 patients underwent 3.0-T MRI. Aortic distensibility (AD), pulse wave velocity (PWV) and brachial artery flow-mediated dilation (FMD) were assessed. Student's t-test, Mann-Whitney U test, chi-squared test, Pearson correlation analysis, and univariable and multiple linear regression analyses were used for statistical analyses. RESULTS The hypertensive patients showed lower AD at multiple levels (ascending aorta [AA]: 2.07±0.98×10(-3)mm Hg(-1) vs. 3.21±1.70×10(-3)mm Hg(-1), p<0.01; proximal thoracic descending aorta [PDA]: 2.58±0.72×10(-3)mm Hg(-1) vs. 3.58±1.47×10(-3)mm Hg(-1), p<0.01; distal descending aorta [DDA]: 3.11±1.84×10(-3)mm Hg(-1) vs. 4.27±1.75×10(-3)mm Hg(-1), p<0.01); faster PWV (7.46±2.28m/s vs. 5.82±1.12m/s, p<0.05) and lower FMD (12.67%±6.49% vs. 20.66%±9.7%; p<0.01). Systolic blood pressure was an independent predictor of PWV, AA-AD, DDA-AD and FMD. FMD was statistically significantly associated with PWV (r=-0.37, p<0.01) and AD (p<0.01). CONCLUSIONS Hypertension has a contributive effect on aortic stiffness and endothelial dysfunction in DM2 patients.
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Affiliation(s)
- Yan Shan
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China.
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Huandong Lin
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Hongmei Yan
- Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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15
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Sheppard RJ, Schiffrin EL. Inhibition of the renin-angiotensin system for lowering coronary artery disease risk. Curr Opin Pharmacol 2013; 13:274-9. [PMID: 23523606 DOI: 10.1016/j.coph.2013.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 01/15/2023]
Abstract
The renin-angiotensin system when activated exerts proliferative and pro-inflammatory actions and thereby contributes to progression of atherosclerosis, including that occurring in the coronary arteries. It thus contributes as well to coronary artery disease (CAD). Several clinical trials have examined effects of renin-angiotensin system inhibition for primary and secondary prevention of coronary heart disease. These include important trials such as HOPE, EUROPA and PEACE using angiotensin converting enzyme inhibitors, VALIANT, OPTIMAAL and TRANSCEND using angiotensin receptor blockers, and the ongoing TOPCAT study in patients with preserved ejection fraction heart failure, many of who also have coronary artery disease. Data are unavailable as yet of effects of either direct renin inhibitors or the new angiotensin receptor/neprilysin inhibitor agents. Today, inhibition of the renin-angiotensin system is standard-of-care therapy for lowering cardiovascular risk in secondary prevention in high cardiovascular risk subjects.
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Affiliation(s)
- Richard J Sheppard
- Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, PQ, Canada
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16
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Patarroyo Aponte MM, Francis GS. Effect of Angiotensin-converting enzyme inhibitors and Angiotensin receptor antagonists in atherosclerosis prevention. Curr Cardiol Rep 2012; 14:433-42. [PMID: 22562592 DOI: 10.1007/s11886-012-0275-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Atherosclerosis is a highly complex biological process that has become the scourge of modern civilization. Endothelial dysfunction is the first step in the development of atherosclerosis. The renin-angiotensin-aldosterone system (RAAS) plays an important role in the development of endothelial dysfunction and atherosclerosis. Several studies have shown that in vitro blockade of the RAAS is associated with improvement in markers of endothelial dysfunction and inflammation. Many clinical trials have demonstrated a clear benefit of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) manifested by a reduction of cardiovascular events. These findings suggest that ACEIs and ARBs can play an important role in prevention of atherosclerosis and in the delay of its progression. In this review we focus on the importance of RAAS blockade to prevent or delay progression of atherosclerosis and its impact on reduction of cardiovascular events.
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Affiliation(s)
- Maria M Patarroyo Aponte
- Division of Cardiovascular Medicine, Lillehei Heart Institute, University of Minnesota Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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17
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Cunningham S, Rush J, Freeman L. Systemic Inflammation and Endothelial Dysfunction in Dogs with Congestive Heart Failure. J Vet Intern Med 2012; 26:547-57. [DOI: 10.1111/j.1939-1676.2012.00923.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 01/31/2012] [Accepted: 03/01/2012] [Indexed: 11/26/2022] Open
Affiliation(s)
- S.M. Cunningham
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton; MA
| | - J.E. Rush
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton; MA
| | - L.M. Freeman
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; North Grafton; MA
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18
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Antoniades C, Cunnington C, Antonopoulos A, Neville M, Margaritis M, Demosthenous M, Bendall J, Hale A, Cerrato R, Tousoulis D, Bakogiannis C, Marinou K, Toutouza M, Vlachopoulos C, Leeson P, Stefanadis C, Karpe F, Channon KM. Induction of vascular GTP-cyclohydrolase I and endogenous tetrahydrobiopterin synthesis protect against inflammation-induced endothelial dysfunction in human atherosclerosis. Circulation 2011; 124:1860-70. [PMID: 21969008 PMCID: PMC5238937 DOI: 10.1161/circulationaha.111.029272] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The endothelial nitric oxide synthase cofactor tetrahydrobiopterin (BH4) is essential for maintenance of enzymatic function. We hypothesized that induction of BH4 synthesis might be an endothelial defense mechanism against inflammation in vascular disease states. METHODS AND RESULTS In Study 1, 20 healthy individuals were randomized to receive Salmonella typhi vaccine (a model of acute inflammation) or placebo in a double-blind study. Vaccination increased circulating BH4 and interleukin 6 and induced endothelial dysfunction (as evaluated by brachial artery flow-mediated dilation) after 8 hours. In Study 2, a functional haplotype (X haplotype) in the GCH1 gene, encoding GTP-cyclohydrolase I, the rate-limiting enzyme in biopterin biosynthesis, was associated with endothelial dysfunction in the presence of high-sensitivity C-reactive protein in 440 coronary artery disease patients. In Study 3, 10 patients with coronary artery disease homozygotes for the GCH1 X haplotype (XX) and 40 without the haplotype (OO) underwent S Typhi vaccination. XX patients were unable to increase plasma BH4 and had a greater reduction of flow-mediated dilation than OO patients. In Study 4, vessel segments from 19 patients undergoing coronary bypass surgery were incubated with or without cytokines (interleukin-6/tumor necrosis factor-α/lipopolysaccharide) for 24 hours. Cytokine stimulation upregulated GCH1 expression, increased vascular BH4, and improved vasorelaxation in response to acetylcholine, which was inhibited by the GTP-cyclohydrolase inhibitor 2,4-diamino-6-hydroxypyrimidine. CONCLUSIONS The ability to increase vascular GCH1 expression and BH4 synthesis in response to inflammation preserves endothelial function in inflammatory states. These novel findings identify BH4 as a vascular defense mechanism against inflammation-induced endothelial dysfunction.
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Affiliation(s)
- Charalambos Antoniades
- Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Hedley Way, OX3 9DU, Oxford, UK
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19
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Abdel-Zaher AO, Elkoussi AEA, Abudahab LH, Elbakry MH, Elsayed EAE. Simvastatin enhances the antihypertensive effect of ramipril in hypertensive hypercholesterolemic animals and patients. Possible role of nitric oxide, oxidative stress, and high sensitivity C-reactive protein. Fundam Clin Pharmacol 2011; 26:701-11. [DOI: 10.1111/j.1472-8206.2011.00975.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Reduced cardiorespiratory fitness after stroke: biological consequences and exercise-induced adaptations. Stroke Res Treat 2011; 2012:959120. [PMID: 21876848 PMCID: PMC3159380 DOI: 10.1155/2012/959120] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 06/27/2011] [Indexed: 01/08/2023] Open
Abstract
Evidence from several studies consistently shows decline in cardiorespiratory (CR) fitness and physical function after disabling stroke. The broader implications of such a decline to general health may be partially understood through negative poststroke physiologic adaptations such as unilateral muscle fiber type shifts, impaired hemodynamic function, and decrements in systemic metabolic status. These physiologic changes also interrelate with reductions in activities of daily living (ADLs), community ambulation, and exercise tolerance, causing a perpetual cycle of worsening disability and deteriorating health. Fortunately, initial evidence suggests that stroke participants retain the capacity to adapt physiologically to an exercise training stimulus. However, despite this evidence, exercise as a therapeutic intervention continues to be clinically underutilized in the general stroke population. Far more research is needed to fully comprehend the consequences of and remedies for CR fitness impairments after stroke. The purpose of this brief review is to describe some of what is currently known about the physiological consequences of CR fitness decline after stroke. Additionally, there is an overview of the evidence supporting exercise interventions for improving CR fitness, and associated aspects of general health in this population.
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21
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Sychev DA, Muslimova OV. Organo-protective effects of quinapril: pharmacogenetic aspects. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-2-98-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The review presents current experimental and clinical evidence on organo-protective effects of an ACE inhibitor quinapril. These effects are dependent on I/D polymorphism of ACE gene. The data available are consistent that quinapril could modulate this genetic risk factor, highly prevalent in Russian patients.
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Affiliation(s)
- D. A. Sychev
- I.M. Sechenov First Moscow State Medical University;
Clinical Pharmacology Centre, Research Centre for Drug Expertise and Standardization
| | - O. V. Muslimova
- Clinical Pharmacology Centre, Research Centre for Drug Expertise and Standardization
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22
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Kieback AG, Felix SB, Reffelmann T. Quinaprilat: a review of its pharmacokinetics, pharmacodynamics, toxicological data and clinical application. Expert Opin Drug Metab Toxicol 2009; 5:1337-47. [PMID: 19761414 DOI: 10.1517/17425250903282773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Quinaprilat is an ACE inhibitor for intravenous use especially in patients with arterial hypertension or chronic heart failure. In contrast to the oral prodrug quinapril, it has not been approved for clinical application. OBJECTIVE In this review, the pharmacokinetic and pharmacodynamic profile of quinaprilat as well as toxicological data and results of preclinical and clinical studies are summarized. METHODS In a PubMed search for the terms "quinaprilat" and "quinapril", literature relevant for this review was selected. RESULTS Quinaprilat is a potent nonsulfhydryl selective ACE inhibitor with a short elimination half-life of 2 - 3 h, but due to slow dissociation from tissue ACE, once daily dosing is sufficient for effective ACE inhibition. Quinaprilat is excreted mainly in urine. In long-term animal studies, quinaprilat was not teratogenic, mutagenic or carcinogenic. However, due to the risk of fetal and neonatal morbidity and death, it should not be administrated in pregnancy. Quinaprilat is characterized by an excellent safety profile; adverse events occur infrequently and are rarely serious. CONCLUSION Quinaprilat is an attractive ACE inhibitor, which potently inhibits tissue ACE.
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Affiliation(s)
- Arne Georg Kieback
- Universitätsklinikum Greifswald, Klinik für Innere Medizin B, Friedrich-Loeffler-Str. 23a, 17475 Greifswald, Germany.
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Effect of angiotensin-converting enzyme inhibition on C-reactive protein levels: the ramipril C-reactive pRotein randomized evaluation (4R) trial results. Can J Cardiol 2009; 25:e236-40. [PMID: 19584979 DOI: 10.1016/s0828-282x(09)70508-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Plasma levels of the inflammatory biomarker C-reactive protein (CRP) predict cardiovascular risk and may represent a target for treating and/or monitoring risk-reduction strategies. The effect of angiotensin-converting enzyme inhibitors on CRP levels has not been adequately studied. METHODS A total of 264 men and women, with CRP levels of 2 mg/L or greater and no history of cardiovascular disease, were enrolled in a 12-week randomized, double-blind, placebo-controlled study. Participants were randomly assigned to receive 10 mg/day of ramipril (n=132) or placebo (n=132) for 12 weeks. The main outcome measure was the change in CRP levels from baseline to 12 weeks in the ramipril- versus placebo treated patients. RESULTS The mean (+/- SD) age was 53+/-9 years (60% men). Baseline demographics were similar between the volunteers allocated to receive either placebo or ramipril. The geometric mean CRP at baseline was 3.84 mg/L (95% CI 3.62 mg/L to 4.06 mg/L). The percentage change in geometric mean CRP values over 12 weeks was --13.2% (95% CI --22.3% to --3.2% ) in the placebo group compared with --21.1% (95% CI --29.9% to --11.2%) in the ramipril group (P nonsignificant), indicating no significant reduction in the primary end point of the trial. CONCLUSIONS A 12-week ramipril treatment protocol for healthy middle-aged volunteers did not lower CRP levels compared with placebo. However, because of the inherent variability of CRP levels, a much larger study is required to exclude a small treatment effect.
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24
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Atorvastatin Improves Endothelial Function and Cardiac Performance in Patients with Dilated Cardiomyopathy: The Role of Inflammation. Cardiovasc Drugs Ther 2009; 23:369-76. [DOI: 10.1007/s10557-009-6186-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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25
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Abstract
Healthy vascular function is primarily regulated by several factors including EDRF (endothelium-dependent relaxing factor), EDCF (endothelium-dependent contracting factor) and EDHF (endothelium-dependent hyperpolarizing factor). Vascular dysfunction or injury induced by aging, smoking, inflammation, trauma, hyperlipidaemia and hyperglycaemia are among a myriad of risk factors that may contribute to the pathogenesis of many cardiovascular diseases, such as hypertension, diabetes and atherosclerosis. However, the exact mechanisms underlying the impaired vascular activity remain unresolved and there is no current scientific consensus. Accumulating evidence suggests that the inflammatory cytokine TNF (tumour necrosis factor)-α plays a pivotal role in the disruption of macrovascular and microvascular circulation both in vivo and in vitro. AGEs (advanced glycation end-products)/RAGE (receptor for AGEs), LOX-1 [lectin-like oxidized low-density lipoprotein receptor-1) and NF-κB (nuclear factor κB) signalling play key roles in TNF-α expression through an increase in circulating and/or local vascular TNF-α production. The increase in TNF-α expression induces the production of ROS (reactive oxygen species), resulting in endothelial dysfunction in many pathophysiological conditions. Lipid metabolism, dietary supplements and physical activity affect TNF-α expression. The interaction between TNF-α and stem cells is also important in terms of vascular repair or regeneration. Careful scrutiny of these factors may help elucidate the mechanisms that induce vascular dysfunction. The focus of the present review is to summarize recent evidence showing the role of TNF-α in vascular dysfunction in cardiovascular disease. We believe these findings may prompt new directions for targeting inflammation in future therapies.
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26
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Guazzi M, Reina G, Gripari P, Tumminello G, Vicenzi M, Arena R. Prognostic value of flow-mediated dilatation following myocardial infarction. Int J Cardiol 2009; 132:45-50. [DOI: 10.1016/j.ijcard.2007.10.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 07/12/2007] [Accepted: 10/27/2007] [Indexed: 11/26/2022]
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27
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Abstract
We hypothesized that there is a correlation between the magnitude of endothelial-mediated dilation of brachial artery and erectile function in patients. Thus, flow-mediated dilation of the brachial artery (FMD)-used to assess the function of endothelium-was measured in 56 patients (aged approximately 35 years) having erectile dysfunction for 6-12 months. The patients were grouped based on International Index of Erectile Dysfunction: severe (5-10), moderate (11-16), mild to moderate (17-21), and mild (22-25). As compared to the mild group (8.8 +/- 1.7%), FMD was significantly reduced in the mild-to-moderate group (5.7 +/- 1.1%), moderate group (5.3 +/- 0.8%), and severe group (4.4 +/- 0.6%). Also, there was a positive correlation between the magnitude of endothelial and erectile dysfunction. Patients were treated with the 5-phosphodiesterase inhibitor sildenafil, known to elevate vascular cGMP level and thus the vascular efficacy of internal nitric oxide, for 3 to 6 months prior to the study. The mean doses of sildenafil used were as follows: severe group, 100 mg/event; moderate group, 86.1 +/- 21.4 mg/event; mild-to-moderate group, 71.8 +/- 23.2 mg/event; mild group, 25 mg/event. We found a positive correlation between the sildenafil dose requirement and the severity of erectile dysfunction. On the bases on these findings, together with the known mechanism of action of sildenafil, we propose that vascular endothelial dysfunction could contribute to erectile dysfunction and that erectile dysfunction may be an early marker of peripheral vascular disease.
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28
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Colombo PC, Onat D, Sabbah HN. Acute heart failure as "acute endothelitis"--Interaction of fluid overload and endothelial dysfunction. Eur J Heart Fail 2008; 10:170-5. [PMID: 18279772 DOI: 10.1016/j.ejheart.2007.12.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 12/12/2007] [Indexed: 02/07/2023] Open
Affiliation(s)
- Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University, New York, New York 10032, USA.
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29
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Van Guilder GP, Pretorius M, Luther JM, Byrd JB, Hill K, Gainer JV, Brown NJ. Bradykinin type 2 receptor BE1 genotype influences bradykinin-dependent vasodilation during angiotensin-converting enzyme inhibition. Hypertension 2008; 51:454-9. [PMID: 18180402 DOI: 10.1161/hypertensionaha.107.102574] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
To test the hypothesis that the bradykinin receptor 2 (BDKRB2) BE1+9/-9 polymorphism affects vascular responses to bradykinin, we measured the effect of intra-arterial bradykinin on forearm blood flow and tissue-type plasminogen activator (t-PA) release in 89 normotensive, nonsmoking, white American subjects in whom degradation of bradykinin was blocked by enalaprilat. BE1 genotype frequencies were +9/+9:+9/-9:-9/-9=19:42:28. BE1 genotype was associated with systolic blood pressure (121.4+/-2.8, 113.8+/-1.8, and 110.6+/-1.8 mm Hg in +9/+9, +9/-9, and -9/-9 groups, respectively; P=0.007). In the absence of enalaprilat, bradykinin-stimulated forearm blood flow, forearm vascular resistance, and net t-PA release were similar among genotype groups. Enalaprilat increased basal forearm blood flow (P=0.002) and decreased basal forearm vascular resistance (P=0.01) without affecting blood pressure. Enalaprilat enhanced the effect of bradykinin on forearm blood flow, forearm vascular resistance, and t-PA release (all P<0.001). During enalaprilat, forearm blood flow was significantly lower and forearm vascular resistance was higher in response to bradykinin in the +9/+9 compared with +9/-9 and -9/-9 genotype groups (P=0.04 for both). t-PA release tended to be decreased in response to bradykinin in the +9/+9 group (P=0.08). When analyzed separately by gender, BE1 genotype was associated with bradykinin-stimulated t-PA release in angiotensin-converting enzyme inhibitor-treated men but not women (P=0.02 and P=0.77, respectively), after controlling for body mass index. There was no effect of BE1 genotype on responses to the bradykinin type 2 receptor-independent vasodilator methacholine during enalaprilat. In conclusion, the BDKRB2 BE1 polymorphism influences bradykinin type 2 receptor-mediated vasodilation during angiotensin-converting enzyme inhibition.
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Affiliation(s)
- Gary P Van Guilder
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-6602, USA
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30
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Balakumar P, Koladiya RU, Ramasamy S, Rathinavel A, Singh M. Pharmacological Interventions to Prevent Vascular Endothelial Dysfunction: Future Directions. ACTA ACUST UNITED AC 2008. [DOI: 10.1248/jhs.54.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Pitchai Balakumar
- Cardiovascular Pharmacology Division, I.S.F. Institute of Pharmaceutical Sciences and Drug Research
| | | | - Subbiah Ramasamy
- Department of Biochemistry, School of Biological Sciences, Madurai Kamaraj University
| | - Andiappan Rathinavel
- Department of Cardio-Thoracic Surgery, Madurai Medical College and Government Rajaji Hospital
| | - Manjeet Singh
- Cardiovascular Pharmacology Division, I.S.F. Institute of Pharmaceutical Sciences and Drug Research
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31
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Fulop T, Jebelovszki E, Erdei N, Szerafin T, Forster T, Edes I, Koller A, Bagi Z. Adaptation of Vasomotor Function of Human Coronary Arterioles to the Simultaneous Presence of Obesity and Hypertension. Arterioscler Thromb Vasc Biol 2007; 27:2348-54. [PMID: 17823369 DOI: 10.1161/atvbaha.107.147991] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives—
We hypothesized that simultaneous presence of obesity and hypertension activates adaptive vascular mechanisms affecting dilations of human coronary arterioles.
Methods and Results—
Agonist-induced dilations were assessed in isolated pressurized coronary arterioles from patients (n=38) who underwent cardiac surgery. Among normotensives we found that dilations to bradykinin (BK) and the NO-donor, sodium-nitroprusside (SNP) were reduced in obese subjects (BK, 10
−7
mol/L, lean:90±4%, obese:64±7%; SNP, 10
−6
mol/L, lean:89±7%, obese:76±5%). However, among hypertensives, both BK- and SNP-induced dilations were significantly enhanced in obese patients, when compared with lean individuals (BK, lean:71±7%, obese:85±3%; SNP, lean:60±6%, obese:83±2%). Correspondingly, in hypertensive patients, but not in those of normotensives, a positive correlation was found between body mass index (BMI) and BK-induced (
P
=0.036,
r
=0.46), and also SNP-evoked (
P
=0.031,
r
=0.44) coronary dilations. Moreover, in additional 55 hypertensive patients flow-mediated (FMD) and nitroglycerin (NTG)-induced dilations of the brachial artery were assessed. In obese hypertensive individuals, FMD- and NTG-induced dilations were greater (FMD:6.2±0.7%, NTG:17.2±0.9%), than in lean hypertensive patients (FMD:3.7±0.6%, NTG:13.6±1.1%). Correspondingly, FMD- and NTG-induced dilations were positively correlated with BMI (
P
=0.020,
r
=0.31 and
P
=0.033,
r
=0.29, respectively).
Conclusions—
These findings are the first to suggest that obesity may lead to activation of adaptive vascular mechanisms to enhance the dilator function of coronary and peripheral arterial vessels in hypertensive patients.
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Affiliation(s)
- Tibor Fulop
- Institute of Cardiology, University of Debrecen, Moricz Zs. Krt. 22, 4032-Debrecen, Hungary
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