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The endothelial mineralocorticoid receptor: Contributions to sex differences in cardiovascular disease. Pharmacol Ther 2019; 203:107387. [PMID: 31271793 DOI: 10.1016/j.pharmthera.2019.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/26/2019] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease remains the leading cause of death for both men and women. The observation that premenopausal women are protected from cardiovascular disease relative to age-matched men, and that this protection is lost with menopause, has led to extensive study of the role of sex steroid hormones in the pathogenesis of cardiovascular disease. However, the molecular basis for sex differences in cardiovascular disease is still not fully understood, limiting the ability to tailor therapies to male and female patients. Therefore, there is a growing need to investigate molecular pathways outside of traditional sex hormone signaling to fully understand sex differences in cardiovascular disease. Emerging evidence points to the mineralocorticoid receptor (MR), a steroid hormone receptor activated by the adrenal hormone aldosterone, as one such mediator of cardiovascular disease risk, potentially serving as a sex-dependent link between cardiovascular risk factors and disease. Enhanced activation of the MR by aldosterone is associated with increased risk of cardiovascular disease. Emerging evidence implicates the MR specifically within the endothelial cells lining the blood vessels in mediating some of the sex differences observed in cardiovascular pathology. This review summarizes the available clinical and preclinical literature concerning the role of the MR in the pathophysiology of endothelial dysfunction, hypertension, atherosclerosis, and heart failure, with a special emphasis on sex differences in the role of endothelial-specific MR in these pathologies. The available data regarding the molecular mechanisms by which endothelial-specific MR may contribute to sex differences in cardiovascular disease is also summarized. A paradigm emerges from synthesis of the literature in which endothelial-specific MR regulates vascular function in a sex-dependent manner in response to cardiovascular risk factors to contribute to disease. Limitations in this field include the relative paucity of women in clinical trials and, until recently, the nearly exclusive use of male animals in preclinical investigations. Enhanced understanding of the sex-specific roles of endothelial MR could lead to novel mechanistic insights underlying sex differences in cardiovascular disease incidence and outcomes and could identify additional therapeutic targets to effectively treat cardiovascular disease in men and women.
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Gorini S, Kim SK, Infante M, Mammi C, La Vignera S, Fabbri A, Jaffe IZ, Caprio M. Role of Aldosterone and Mineralocorticoid Receptor in Cardiovascular Aging. Front Endocrinol (Lausanne) 2019; 10:584. [PMID: 31507534 PMCID: PMC6716354 DOI: 10.3389/fendo.2019.00584] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 08/09/2019] [Indexed: 12/28/2022] Open
Abstract
The mineralocorticoid receptor (MR) was originally identified as a regulator of blood pressure, able to modulate renal sodium handling in response to its principal ligand aldosterone. MR is expressed in several extra-renal tissues, including the heart, vasculature, and adipose tissue. More recent studies have shown that extra-renal MR plays a relevant role in the control of cardiovascular and metabolic functions and has recently been implicated in the pathophysiology of aging. MR activation promotes vasoconstriction and acts as a potent pro-fibrotic agent in cardiovascular remodeling. Aging is associated with increased arterial stiffness and vascular tone, and modifications of arterial structure and function are responsible for these alterations. MR activation contributes to increase blood pressure with aging by regulating myogenic tone, vasoconstriction, and vascular oxidative stress. Importantly, aging represents an important contributor to the increased prevalence of cardiometabolic syndrome. In the elderly, dysregulation of MR signaling is associated with hypertension, obesity, and diabetes, representing an important cause of increased cardiovascular risk. Clinical use of MR antagonists is limited by the adverse effects induced by MR blockade in the kidney, raising the risk of hyperkalaemia in older patients with reduced renal function. Therefore, there is an unmet need for the enhanced understanding of the role of MR in aging and for development of novel specific MR antagonists in the context of cardiovascular rehabilitation in the elderly, in order to reduce relevant side effects.
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Affiliation(s)
- Stefania Gorini
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Seung Kyum Kim
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
- Department of Sports Science, Seoul National University of Science and Technology, Seoul, South Korea
| | - Marco Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - Caterina Mammi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - Iris Z. Jaffe
- Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA, United States
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
- *Correspondence: Massimiliano Caprio
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Kim SK, McCurley AT, DuPont JJ, Aronovitz M, Moss ME, Stillman IE, Karumanchi SA, Christou DD, Jaffe IZ. Smooth Muscle Cell-Mineralocorticoid Receptor as a Mediator of Cardiovascular Stiffness With Aging. Hypertension 2018; 71:609-621. [PMID: 29463624 PMCID: PMC5843545 DOI: 10.1161/hypertensionaha.117.10437] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/26/2017] [Accepted: 01/24/2018] [Indexed: 12/22/2022]
Abstract
Stiffening of the vasculature with aging is a strong predictor of adverse cardiovascular events, independent of all other risk factors including blood pressure, yet no therapies target this process. MRs (mineralocorticoid receptors) in smooth muscle cells (SMCs) have been implicated in the regulation of vascular fibrosis but have not been explored in vascular aging. Comparing SMC-MR-deleted male mice to MR-intact littermates at 3, 12, and 18 months of age, we demonstrated that aging-associated vascular stiffening and fibrosis are mitigated by MR deletion in SMCs. Progression of cardiac stiffness and fibrosis and the decline in exercise capacity with aging were also mitigated by MR deletion in SMC. Vascular gene expression profiling analysis revealed that MR deletion in SMC is associated with recruitment of a distinct antifibrotic vascular gene expression program with aging. Moreover, long-term pharmacological inhibition of MR in aged mice prevented the progression of vascular fibrosis and stiffness and induced a similar antifibrotic vascular gene program. Finally, in a small trial in elderly male humans, short-term MR antagonism produced an antifibrotic signature of circulating biomarkers similar to that observed in the vasculature of SMC-MR-deleted mice. These findings suggest that SMC-MR contributes to vascular stiffening with aging and is a potential therapeutic target to prevent the progression of aging-associated vascular fibrosis and stiffness.
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MESH Headings
- Aged
- Animals
- Cellular Senescence/drug effects
- Cellular Senescence/physiology
- Disease Progression
- Exercise Tolerance/physiology
- Fibrosis/metabolism
- Fibrosis/pathology
- Fibrosis/prevention & control
- Gene Expression/drug effects
- Gene Expression Profiling
- Humans
- Male
- Mice
- Mineralocorticoid Receptor Antagonists/metabolism
- Mineralocorticoid Receptor Antagonists/pharmacology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Myocytes, Smooth Muscle/drug effects
- Myocytes, Smooth Muscle/metabolism
- Receptors, Mineralocorticoid/genetics
- Receptors, Mineralocorticoid/metabolism
- Spironolactone/metabolism
- Spironolactone/pharmacology
- Treatment Outcome
- Vascular Stiffness/drug effects
- Vascular Stiffness/physiology
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Affiliation(s)
- Seung Kyum Kim
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - Amy T McCurley
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - Jennifer J DuPont
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - Mark Aronovitz
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - M Elizabeth Moss
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - Isaac E Stillman
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - S Ananth Karumanchi
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - Demetra D Christou
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.)
| | - Iris Z Jaffe
- From the Molecular Cardiology Research Institute, Tufts Medical Center, Boston, MA (S.K.K., A.T.M., J.J.D., M.A., M.E.M., I.Z.J.); Departments of Pathology (I.E.S.) and Medicine and Obstetrics and Gynecology (S.A.K.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; and Department of Applied Physiology and Kinesiology, University of Florida, Gainesville (D.D.C.).
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Neves MF, Cunha AR, Cunha MR, Gismondi RA, Oigman W. The Role of Renin-Angiotensin-Aldosterone System and Its New Components in Arterial Stiffness and Vascular Aging. High Blood Press Cardiovasc Prev 2018; 25:137-145. [PMID: 29476451 DOI: 10.1007/s40292-018-0252-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 02/12/2018] [Indexed: 01/13/2023] Open
Abstract
Many cardiovascular diseases present renin-angiotensin-aldosterone system (RAAS) hyperactivity as an important pathophysiological mechanism to be target in the therapeutic approaches. Moreover, arterial stiffness is currently considered as a new independent risk factor for cardiovascular disease in different clinical conditions, including hypertension and chronic kidney disease. In fact, excessive stimulation of angiotensin type 1 (AT1) receptors, as well as mineralocorticoid receptors, results in cellular growth, oxidative stress and vascular inflammation, which may lead to arterial stiffness and accelerate the process of vascular aging. In the last decades, a vasoprotective axis of the RAAS has been discovered, and now it is well established that new components with antioxidant and anti-inflammatory properties play important roles promoting vasodilation, natriuresis and reducing collagen deposition, thus attenuating arterial stiffness and improving endothelial function. In this review, we will focus on these pathophysiological mechanisms and the relevance of RAAS inhibition by different strategies to increase arterial compliance and to decelerate vascular aging.
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Affiliation(s)
- Mario Fritsch Neves
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil.
| | - Ana Rosa Cunha
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
| | - Michelle Rabello Cunha
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
| | - Ronaldo Altenburg Gismondi
- Centro de Ciências Médicas, Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Niterói, RJ, 24033-900, Brazil
| | - Wille Oigman
- Departamento de Clinica Medica, Universidade do Estado do Rio de Janeiro, Ave. 28 de Setembro, 77 sala 329, Rio De Janeiro, 20551-030, Brazil
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5
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Tam TSC, Wu MHY, Masson SC, Tsang MP, Stabler SN, Kinkade A, Tung A, Tejani AM. Eplerenone for hypertension. Cochrane Database Syst Rev 2017; 2:CD008996. [PMID: 28245343 PMCID: PMC6464701 DOI: 10.1002/14651858.cd008996.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Eplerenone is an aldosterone receptor blocker that is chemically derived from spironolactone. In Canada, it is indicated for use as adjunctive therapy to reduce mortality for heart failure patients with New York Heart Association (NYHA) class II systolic chronic heart failure and left ventricular systolic dysfunction. It is also used as adjunctive therapy for patients with heart failure following myocardial infarction. Additionally, it is indicated for the treatment of mild and moderate essential hypertension for patients who cannot be treated adequately with other agents. It is important to determine the clinical impact of all antihypertensive medications, including aldosterone antagonists, to support their continued use in essential hypertension. No previous systematic reviews have evaluated the effect of eplerenone on cardiovascular morbidity, mortality, and magnitude of blood pressure lowering in patients with hypertension. OBJECTIVES To assess the effects of eplerenone monotherapy versus placebo for primary hypertension in adults. Outcomes of interest were all-cause mortality, cardiovascular events (fatal or non-fatal myocardial infarction), cerebrovascular events (fatal or non fatal strokes), adverse events or withdrawals due to adverse events, and systolic and diastolic blood pressure. SEARCH METHODS We searched the Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE, Embase, and two trials registers up to 3 March 2016. We handsearched references from retrieved studies to identify any studies missed in the initial search. We also searched for unpublished data by contacting the corresponding authors of the included studies and pharmaceutical companies involved in conducting studies on eplerenone monotherapy in primary hypertension. The search had no language restrictions. SELECTION CRITERIA We selected randomized placebo-controlled trials studying adult patients with primary hypertension. We excluded studies in people with secondary or gestational hypertension and studies where participants were receiving multiple antihypertensives. DATA COLLECTION AND ANALYSIS Three review authors independently reviewed the search results for studies meeting our criteria. Three review authors independently extracted data and assessed trial quality using a standardized data extraction form. A fourth independent review author resolved discrepancies or disagreements. We performed data extraction and synthesis using a standardized format on Covidence. We conducted data analysis using Review Manager 5. MAIN RESULTS A total of 1437 adult patients participated in the five randomized parallel group studies, with treatment durations ranging from 8 to 16 weeks. The daily doses of eplerenone ranged from 25 mg to 400 mg daily. Meta-analysis of these studies showed a reduction in systolic blood pressure of 9.21 mmHg (95% CI -11.08 to -7.34; I2 = 58%) and a reduction of diastolic pressure of 4.18 mmHg (95% CI -5.03 to -3.33; I2 = 0%) (moderate quality evidence).There may be a dose response effect for eplerenone in the reduction in systolic blood pressure at doses of 400 mg/day. However, this finding is uncertain, as it is based on a single included study with low quality evidence. Overall there does not appear to be a clinically important dose response in lowering systolic or diastolic blood pressure at eplerenone doses of 50 mg to 400 mg daily. There did not appear to be any differences in the number of patients who withdrew due to adverse events or the number of patients with at least one adverse event in the eplerenone group compared to placebo. However, only three of the five included studies reported adverse events. Most of the included studies were of moderate quality, as we judged multiple domains as being at unclear risk in the 'Risk of bias' assessment. AUTHORS' CONCLUSIONS Eplerenone 50 to 200 mg/day lowers blood pressure in people with primary hypertension by 9.21 mmHg systolic and 4.18 mmHg diastolic compared to placebo, with no difference of effect between doses of 50 mg/day to 200 mg/day. A dose of 25 mg/day did not produce a statistically significant reduction in systolic or diastolic blood pressure and there is insufficient evidence for doses above 200 mg/day. There is currently no available evidence to determine the effect of eplerenone on clinically meaningful outcomes such as mortality or morbidity in hypertensive patients. The evidence available on side effects is insufficient and of low quality, which makes it impossible to draw conclusions about potential harm associated with eplerenone treatment in hypertensive patients.
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Affiliation(s)
- Tina SC Tam
- Lower Mainland Pharmacy ServicesPharmacyVancouverBCCanada
| | - May HY Wu
- Lower Mainland Pharmacy ServicesSurrey Memorial Hospital PharmacySurreyBCCanada
| | - Sarah C Masson
- Fraser Health AuthorityPharmacy Services3938 Kincaid StBurnabyBCCanadaV5G 1V7
| | - Matthew P Tsang
- Fraser Health AuthorityPharmacy Services32900 Marshall RoadAbbotsfordBCCanadaV2S 0C2
| | - Sarah N Stabler
- Lower Mainland Pharmacy ServicesCardiac Clinics, Royal Columbian HospitalVancouverBCCanada
| | - Angus Kinkade
- Lower Mainland Pharmacy ServicesPharmacyVancouverBCCanada
| | - Anthony Tung
- Lower Mainland Pharmacy ServicesPharmacyVancouverBCCanada
| | - Aaron M Tejani
- University of British ColumbiaTherapeutics Initiative2176 Health Sciences MallVancouverBCCanadaV6T 1Z3
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6
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Low dose-eplerenone treatment decreases aortic stiffness in patients with resistant hypertension. J Clin Hypertens (Greenwich) 2017; 19:669-676. [DOI: 10.1111/jch.12986] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/13/2016] [Accepted: 12/25/2016] [Indexed: 11/26/2022]
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7
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Eguchi K, Kabutoya T, Hoshide S, Ishikawa S, Kario K. Add-On Use of Eplerenone Is Effective for Lowering Home and Ambulatory Blood Pressure in Drug-Resistant Hypertension. J Clin Hypertens (Greenwich) 2016; 18:1250-1257. [DOI: 10.1111/jch.12860] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/23/2016] [Accepted: 04/29/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Kazuo Eguchi
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Shizukiyo Ishikawa
- Division of Community and Family Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
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Hwang MH, Yoo JK, Luttrell M, Kim HK, Meade TH, English M, Talcott S, Jaffe IZ, Christou DD. Acute effect of mineralocorticoid receptor antagonism on vascular function in healthy older adults. Exp Gerontol 2015; 73:86-94. [PMID: 26639352 DOI: 10.1016/j.exger.2015.11.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/04/2015] [Accepted: 11/26/2015] [Indexed: 12/27/2022]
Abstract
Mineralocorticoid receptor (MR) activation by aldosterone may regulate vascular function in health or contribute to vascular dysfunction in cardiovascular disease. Whether the effects are beneficial or detrimental to vascular function appear to be dependent on the integrity of the vascular endothelium and whether the responses are short-term or chronic. Acute modulation of MR activation has resulted in conflicting outcomes on vascular function in young healthy adults. Little is known about the vascular role of aldosterone and MR activation in healthy human aging. The primary objective of this study was to examine whether acute inhibition of MR by the selective antagonist eplerenone, influences vascular function in healthy older adults. We performed a randomized, double-blind, placebo-controlled crossover study in 22 adults (61±1 years; mean±SE, 53-79 years) who were free from overt clinical cardiovascular disease. We measured brachial artery flow-mediated endothelium-dependent dilation and endothelium-independent dilation to sublingual nitroglycerin (0.4 mg) following eplerenone (100 mg/dose, 2 doses, 24h between doses) or placebo. In response to acute MR antagonism, flow-mediated dilation decreased by 19% (from 6.9±0.5 to 5.6±0.6%, P=0.02; placebo vs. eplerenone). Endothelial nitric oxide synthase (eNOS) activity also decreased following MR antagonism based on the ratio of phosphorylated eNOS(Ser1177) to total eNOS (1.53±0.08 vs. 1.29±0.06, P=0.02). Nitroglycerin-induced dilation and blood pressure were unaffected (nitroglycerin-induced dilation: 21.9±1.9 vs. 21.0±1.5%, P=0.5 and systolic/diastolic blood pressure: 135/77±4/2 vs. 134/77±4/2 mmHg, P≥0.6). In conclusion, acute MR antagonism impairs vascular endothelial function in healthy older adults without influencing vascular smooth muscle responsiveness to exogenous nitric oxide or blood pressure.
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Affiliation(s)
- Moon-Hyon Hwang
- Dept of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States; Division of Health and Exercise Science, Incheon National University, Incheon, Korea
| | - Jeung-Ki Yoo
- Dept of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States
| | - Meredith Luttrell
- Dept of Human Physiology, University of Oregon, Eugene, OR, United States
| | - Han-Kyul Kim
- Dept of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States
| | - Thomas H Meade
- Dept of Cardiology, Baylor Scott & White Health, College Station, TX, United States; Texas A&M University Health Science Center, Bryan, TX, United States
| | - Mark English
- Dept of Family & Community Medicine, Baylor Scott & White Health, College Station, TX, United States
| | - Susanne Talcott
- Dept of Nutrition and Food Science and Dept of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, TX, United States
| | - Iris Z Jaffe
- Molecular Cardiology Research Institute and Division of Cardiology, Department of Medicine, Tufts Medical Center, Boston, MA, United States
| | - Demetra D Christou
- Dept of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL, United States.
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9
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Ohta Y, Ishizuka A, Hayashi S, Iwashima Y, Kishida M, Yoshihara F, Nakamura S, Kawano Y. Effects of a selective aldosterone blocker and thiazide-type diuretic on blood pressure and organ damage in hypertensive patients. Clin Exp Hypertens 2015; 37:569-73. [DOI: 10.3109/10641963.2015.1026041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yuko Ohta
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Azusa Ishizuka
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichiro Hayashi
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshio Iwashima
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatsugu Kishida
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Fumiki Yoshihara
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoko Nakamura
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuhei Kawano
- Division of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan
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10
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Shibata T, Tsutsumi J, Hasegawa J, Sato N, Murashima E, Mori C, Hongo K, Yoshimura M. Effects of Add-on Therapy Consisting of a Selective Mineralocorticoid Receptor Blocker on Arterial Stiffness in Patients with Uncontrolled Hypertension. Intern Med 2015; 54:1583-9. [PMID: 26134187 DOI: 10.2169/internalmedicine.54.3427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Aldosterone plays an important role in the pathogenesis of atherosclerosis; however, the significance of mineralocorticoid receptor blockade for atherosclerosis has not been fully elucidated. In this study, the effect of add-on eplerenone on the degree of arterial stiffness was examined in patients with uncontrolled hypertension. METHODS Forty-seven uncontrolled hypertensive patients who had previously been treated with anti-hypertensive drugs were examined retrospectively. Thirty-two patients received add-on therapy consisting of eplerenone (Group E) and 15 patients received add-on therapy with a Calcium channel blocker (CCB) or an increased dose of CCB (Group C) in addition to their baseline medications. Both the systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were significantly decreased at two and 12 months in Group C. In contrast, neither the SBP nor DBP values were significantly changed at two months and eventually decreased at 12 months in Group E. The degree of arterial stiffness, as evaluated according to the cardio-ankle vascular index (CAVI), did not improve at either two or 12 months in Group C, whereas the CAVI values improved as early as at two months and the improvement was sustained at 12 months in Group E. The extent of change in the CAVI was not associated with the level of changes in the SBP or DBP values in Group E. CONCLUSION Treatment with eplerenone added to the patient's baseline medications improves the degree of arterial stiffness as early as at two months after the beginning of treatment, independent of the blood pressure-lowering actions of these drugs in patients with uncontrolled hypertension.
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Affiliation(s)
- Takahiro Shibata
- Division of Cardiology, Department of Internal Medicine, The Jikei Daisan Hospital, Japan
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