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Farag SM, Rabea HM, Abdelrahim ME, Mahmoud HB. Target Blood Pressure and Combination Therapy: Focus on Angiotensin Receptor Blockers Combination with Either Calcium Channel Blockers or Beta Blockers. Curr Hypertens Rev 2022; 18:138-144. [PMID: 36508272 DOI: 10.2174/1573402118666220627120254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The target blood pressure has changed many times in the guidelines in past years. However, there is always a question; is it good to lower blood pressure below 120/80 or not? Control of blood pressure in hypertension is very important in reducing hypertension-modified organ damage. So, the guidelines recommend combining more than one antihypertensive drug to reach the target blood pressure goal. RESULTS Combination therapy is recommended by guidelines to reach the blood pressure goal. The guidelines recommend many combinations, such as the combination of angiotensin receptor blockers with either calcium channel blockers (CCB) or beta-blocker (BB). Angiotensin receptor blocker (ARB) combination with CCB has gained superiority over other antihypertension drug combinations because it reduces blood pressure and decreases the incidence of CV events and organ damage. BB combinations are recommended by guidelines in patients with ischemic events but not all hypertensive patients. Unfortunately, the new generation BB, for example, nebivolol, has a vasodilator effect, making it new hope for BB. CONCLUSION Combination therapy is a must in treating the hypertensive patient. The new generation BBs may change the recommendations of guidelines because they have an effect that is similar to CCBs.
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Affiliation(s)
- Selvia M Farag
- Cardiovascular Department, Beni-Suef University Hospital, Egypt
| | - Hoda M Rabea
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed Ea Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Hesham B Mahmoud
- Department of Cardiology, Beni-Suef University Hospital, Beni-Suef, Egypt
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Baroroh F, Sari A, Masruroh N. Cost Effectiveness Analysis of Candesartan Therapy in Comparison to Candesartan-Amlodipine Therapy on Hypertensive Outpatients. Open Access Maced J Med Sci 2019; 7:3837-3840. [PMID: 32127987 PMCID: PMC7048362 DOI: 10.3889/oamjms.2019.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: he achievement of optimal hypertension therapy requires cost-effective medicine. The treatment of hypertensive patients needs for long-term medication have made medical costs a prime issue in health economics. AIM: This study aims to determine the cost effectiveness of candesartan therapy compared to candesartan-amlodipine therapy on hypertensive outpatients. METHODS: This is a prospective cohort study that compares candesartan therapy to candesartan-amlodipine therapy at a public hospital from payers’ perspective. The outcome is the percentage of targeted blood pressure decrease after three months of therapy. The cost effectiveness analysis uses the Incremental Cost Effectiveness Ratio (ICER) based on the ratio of cost difference to the outcome in both therapy groups. RESULTS: As many as 111 patients participated in this research, comprising 40 candesartan therapy patients and 71 patients with the combination of candesartan-amlodipine. Of the participants, 63.96% were female, 57.66% were aged 60 or older, and 56.32% had diabetes mellitus as the most common complication. Results show that the average direct medical cost per patient for a therapy of three months with candesartan was IDR 1,050,536 ± 730,007 and IDR 760,040 ± 614,290 for a candesartan-amlodipine therapy. The mean decline of systolic and diastolic blood pressure under candesartan therapy is less than that of candesartan-amlodipine, although without any significant difference (p > 0.05). It follows that the effectiveness of candesartan (85%) is greater than that of the candesartan-amlodipine combination (84.50%). Candesartan therapy is thereby more cost-effective with an ICER value of IDR 580,993/%. CONCLUSION: Hypertension therapy by candesartan is more cost-effective than candesartan-amlodipine therapy with a cost addition of IDR 580,993.
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Affiliation(s)
- Faridah Baroroh
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia
| | - Andriana Sari
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia
| | - Noviana Masruroh
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia
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Brainin M, Feigin V, Bath PM, Collantes E, Martins S, Pandian J, Sacco R, Teuschl Y. Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization. Int J Stroke 2019; 14:818-825. [DOI: 10.1177/1747493019873706] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The increasing burden of stroke and dementia emphasizes the need for new, well-tolerated and cost-effective primary prevention strategies that can reduce the risks of stroke and dementia worldwide, and specifically in low- and middle-income countries (LMICs). This paper outlines conceptual frameworks of three primary stroke prevention strategies: (a) the “polypill” strategy; (b) a “population-wide” strategy; and (c) a “motivational population-wide” strategy. (a) A polypill containing generic low-dose ingredients of blood pressure and lipid-lowering medications (e.g. candesartan 16 mg, amlodipine 2.5 mg, and rosuvastatin 10 mg) seems a safe and cost-effective approach for primary prevention of stroke and dementia. (b) A population-wide strategy reducing cardiovascular risk factors in the whole population, regardless of the level of risk is the most effective primary prevention strategy. A motivational population-wide strategy for the modification of health behaviors (e.g. smoking, diet, physical activity) should be based on the principles of cognitive behavioral therapy. Mobile technologies, such as smartphones, offer an ideal interface for behavioral interventions (e.g. Stroke Riskometer app) even in LMICs. (c) Community health workers can improve the maintenance of lifestyle changes as well as the adherence to medication, especially in resource poor areas. An adequate training of community health workers is a key point. Conclusion An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.
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Affiliation(s)
- Michael Brainin
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, School of Public Health and Psychosocial Studies, Auckland, New Zealand
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, UK
| | - Epifania Collantes
- Department of Neurosciences, Philippine General Hospital, Manila, Philippines
| | - Sheila Martins
- Neurology and Neurosurgery Service, Hospital Moinhos de Vento, Brazil
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ralph Sacco
- Miller School of Medicine, University of Miami, FL, USA
| | - Yvonne Teuschl
- Department for Clinical Neuroscience and Preventive Medicine, Danube University Krems, Krems, Austria
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Cheng YQ, Tan BY, Yu XH, Dong WZ, Su DF, Zhu DQ, Liu AJ. Synergism of amlodipine and candesartan on blood pressure reduction and organ protection in hypertensive rats. Clin Exp Pharmacol Physiol 2018; 45:514-524. [PMID: 29193272 DOI: 10.1111/1440-1681.12901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 01/18/2023]
Abstract
This study was designed to investigate the possible synergism of amlodipine and candesartan on the reduction of blood pressure (BP) in hypertensive rats. The end organ protection was also observed. In acute experiment, spontaneously hypertensive rats (SHRs) were treated with intragastric administration of amlodipine (0.5, 1, 2, 3 mg/kg), candesartan (1, 2, 3, 4, 6, 8 mg/kg), and 14 different combinations to find the possible ratio of synergistic interaction. In two kidneys, one clip (2K1C) rats, the effects of amlodipine (1 mg/kg), canderastan (2 mg/kg) and their combination on BP reduction were also observed. In chronic study, SHRs were treated with amlodipine (1 mg/kg), candesartan (2 mg/kg), and their combination for 5 months. Organ damage evaluation was performed after BP recording. The probability sum test (q test) was used to evaluate the synergistic action. There is a synergistic interaction between amlodipine and candesartan on BP reduction. The optimal dose ratio is 1:2. The synergistic effect was also confirmed by 2K1C hypertensive rats. In chronic study, this combination (1:2) possessed an obvious synergism on the reduction of BP and BP variability (BPV) and protection on end organs. Multiple regression analysis showed that heart and aortic hypertrophy indexes and glomerular damage parameters were positively related to BP and BPV. In conclusion, combination of amlodipine and candesartan exhibited a potent antihypertensive effect and possessed an obvious synergism on BP reduction and organ protection in hypertension. The optimal proportion was 1:2. BP and BPV reduction may both importantly contribute to end organ protection.
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Affiliation(s)
- Yan-Qiong Cheng
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China.,Department of Urinary Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bing-Yi Tan
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xu-Hong Yu
- Department of Pharmacy, People Liberation Army 305 Hospital, Beijing, China
| | - Wen-Zhe Dong
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China.,Department of Pharmacology, Shanghai Institute of Health Sciences, Shanghai, China
| | - Ding-Feng Su
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China
| | - De-Qiu Zhu
- Division of Pharmacy, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ai-Jun Liu
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China
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Ma J, Wang XY, Hu ZD, Zhou ZR, Schoenhagen P, Wang H. Meta-analysis of the efficacy and safety of adding an angiotensin receptor blocker (ARB) to a calcium channel blocker (CCB) following ineffective CCB monotherapy. J Thorac Dis 2016; 7:2243-52. [PMID: 26793346 DOI: 10.3978/j.issn.2072-1439.2015.12.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND We conducted this meta-analysis to systematically review and analyze the clinical benefits of angiotensin receptor blocker (ARB) combined with calcium channel blocker (CCB) following ineffective CCB monotherapy. METHODS PubMed was searched for articles published until August 2015. Randomized controlled trials (RCTs) evaluating the clinical benefits of ARB combined with CCB following ineffective CCB monotherapy were included. The primary efficacy endpoint of the studies was normal rate of blood pressure, the secondary efficacy endpoints were the response rate and change in blood pressure from baseline. The safety endpoint of the studies was incidence of adverse events. Differences are expressed as relative risks (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and weighted mean differences (WMDs) with 95% CIs for continuous outcomes. Heterogeneity across studies was tested by using the I(2) statistic. RESULTS Seven RCTs were included and had sample sizes ranging from 185 to 1,183 subjects (total: 3,909 subjects). The pooled analysis showed that the on-target rate of hypertension treatment was significantly higher in the amlodipine + ARB group than in the amlodipine monotherapy group (RR =1.59; 95% CI, 1.31-1.91; P<0.01). The response rate of systolic blood pressure (SBP) (RR =1.28; 95% CI, 1.04-1.58; P<0.01) and diastolic blood pressure (DBP) (RR =1.27; 95% CI, 1.12-1.44; P=0.04) were significantly higher in the amlodipine + ARB group than in the amlodipine monotherapy group. The change in SBP (RR =-3.56; 95% CI, -7.76-0.63; P=0.10) and DBP (RR =-3.03; 95% CI, -6.51-0.45; P=0.09) were higher in hypertensive patients receiving amlodipine + ARB but the difference did not reach statistical significance. ARB + amlodipine treatment carried a lower risk of adverse events relative to amlodipine monotherapy (RR =0.88; 95% CI, 0.80-0.96; P<0.01). CONCLUSIONS The results of our meta-analysis demonstrate that adding an ARB to CCB after initial ineffective CCB monotherapy, significantly improved blood pressure control and the percentage of on-target hypertension treatment with significantly reduced incidence of adverse events compared with continued CCB monotherapy.
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Affiliation(s)
- Jin Ma
- 1 Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai 20090, China ; 2 Graduate School, Dalian Medical University, Dalian 116044, China ; 3 Department of Laboratory Medicine, General Hospital of Ji'nan Military Region, Ji'nan 250031, China ; 4 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 5 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 6 Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA
| | - Xiao-Yan Wang
- 1 Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai 20090, China ; 2 Graduate School, Dalian Medical University, Dalian 116044, China ; 3 Department of Laboratory Medicine, General Hospital of Ji'nan Military Region, Ji'nan 250031, China ; 4 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 5 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 6 Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA
| | - Zhi-De Hu
- 1 Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai 20090, China ; 2 Graduate School, Dalian Medical University, Dalian 116044, China ; 3 Department of Laboratory Medicine, General Hospital of Ji'nan Military Region, Ji'nan 250031, China ; 4 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 5 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 6 Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA
| | - Zhi-Rui Zhou
- 1 Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai 20090, China ; 2 Graduate School, Dalian Medical University, Dalian 116044, China ; 3 Department of Laboratory Medicine, General Hospital of Ji'nan Military Region, Ji'nan 250031, China ; 4 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 5 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 6 Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA
| | - Paul Schoenhagen
- 1 Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai 20090, China ; 2 Graduate School, Dalian Medical University, Dalian 116044, China ; 3 Department of Laboratory Medicine, General Hospital of Ji'nan Military Region, Ji'nan 250031, China ; 4 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 5 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 6 Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA
| | - Hao Wang
- 1 Department of Cardiology, Yangpu Hospital, Tongji University, Shanghai 20090, China ; 2 Graduate School, Dalian Medical University, Dalian 116044, China ; 3 Department of Laboratory Medicine, General Hospital of Ji'nan Military Region, Ji'nan 250031, China ; 4 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 5 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 6 Cleveland Clinic, Imaging Institute and Heart&Vascular Institute, Cleveland, USA
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Sohn YI, Lee NJ, Chung A, Saavedra JM, Scott Turner R, Pak DTS, Hoe HS. Antihypertensive drug Valsartan promotes dendritic spine density by altering AMPA receptor trafficking. Biochem Biophys Res Commun 2013; 439:464-70. [PMID: 24012668 DOI: 10.1016/j.bbrc.2013.08.091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 08/29/2013] [Indexed: 02/07/2023]
Abstract
Recent studies demonstrated that the antihypertensive drug Valsartan improved spatial and episodic memory in mouse models of Alzheimer's Disease (AD) and human subjects with hypertension. However, the molecular mechanism by which Valsartan can regulate cognitive function is still unknown. Here, we investigated the effect of Valsartan on dendritic spine formation in primary hippocampal neurons, which is correlated with learning and memory. Interestingly, we found that Valsartan promotes spinogenesis in developing and mature neurons. In addition, we found that Valsartan increases the puncta number of PSD-95 and trends toward an increase in the puncta number of synaptophysin. Moreover, Valsartan increased the cell surface levels of AMPA receptors and selectively altered the levels of spinogenesis-related proteins, including CaMKIIα and phospho-CDK5. These data suggest that Valsartan may promote spinogenesis by enhancing AMPA receptor trafficking and synaptic plasticity signaling.
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Affiliation(s)
- Young In Sohn
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC 20057, USA
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