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Piepoli MF, Corrà U, Veglia F, Bonomi A, Salvioni E, Cattadori G, Metra M, Lombardi C, Sinagra G, Limongelli G, Raimondo R, Re F, Magrì D, Belardinelli R, Parati G, Minà C, Scardovi AB, Guazzi M, Cicoira M, Scrutinio D, Di Lenarda A, Bussotti M, Frigerio M, Correale M, Villani GQ, Paolillo S, Passino C, Agostoni P. Exercise tolerance can explain the obesity paradox in patients with systolic heart failure: data from the MECKI Score Research Group. Eur J Heart Fail 2016; 18:545-53. [DOI: 10.1002/ejhf.534] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/08/2016] [Accepted: 01/09/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Massimo F. Piepoli
- Heart Failure Unit, Cardiology Department; G da Saliceto Hospital; Piacenza Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | | | - Alice Bonomi
- Centro Cardiologico Monzino, IRCCS; Milano Italy
| | | | - Gaia Cattadori
- Centro Cardiologico Monzino, IRCCS; Milano Italy
- Unità Operativa Cardiologia Riabilitativa, Ospedale S.Giuseppe, Multimedica Spa, IRCCS; Milano Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
| | - Carlo Lombardi
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
| | - Gianfranco Sinagra
- Cardiovascular Department; Ospedali Riuniti and University of Trieste; Trieste Italy
| | - Giuseppe Limongelli
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli); Seconda Università di Napoli; Napoli Italy
| | - Rosa Raimondo
- Salvatore Maugeri Foundation, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa; Tradate Italy
| | - Federica Re
- Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, St.Camillo-Forlanini Hospital; Roma Italy
| | - Damiano Magrì
- Department of Clinical and Molecular Medicine; La Sapienza University; Roma Italy
| | | | - Gianfranco Parati
- Department of Health Science; University of Milano Bicocca and Department of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano; Milano Italy
| | - Chiara Minà
- ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo; Italy
| | | | - Marco Guazzi
- Department of Medical Sciences, Cardiology, IRCCS San Donato Hospital; University of Milan; San Donato Milanese Italy
| | | | - Domenico Scrutinio
- Division of Cardiology, Salvatore Maugeri Foundation; IRCCS, Institute of Cassano Murge; Bari Italy
| | | | - Maurizio Bussotti
- Division of Cardiology, Salvatore Maugeri Foundation; IRCCS, Institute of Milan; Milan Italy
| | - Maria Frigerio
- Cardiologic Department ‘A. De Gasperis’, Ospedale Cà Granda-A.O. Niguarda; Milano Italy
| | | | | | | | - Claudio Passino
- Centro Cardiologico Monzino, IRCCS; Milano Italy
- Gabriele Monasterio Foundation, CNR-Regione Toscana; Pisa Italy
- Scuola Superiore S. Anna; Pisa Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS; Milano Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section; University of Milano; Milano Italy
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Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses. Qual Life Res 2008; 18:71-85. [DOI: 10.1007/s11136-008-9416-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 10/24/2008] [Indexed: 10/21/2022]
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Mahé I, Chassany O, Grenard AS, Caulin C, Bergmann JF. Defining the role of calcium channel antagonists in heart failure due to systolic dysfunction. Am J Cardiovasc Drugs 2006; 3:33-41. [PMID: 14727944 DOI: 10.2165/00129784-200303010-00004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Calcium channel antagonists (CCAs) may either be divided into the dihydropyridines (e.g. amlodipine, felodipine, isradipine, lacidipine, nilvadipine, nifedipine, nicardipine etc.), the phenylalkylamines (e.g. verapamil) and the benzothiazepines (e.g. diltiazem) according to their chemical structure, or into first generation agents (nifedipine, verapamil and diltiazem) and second generation agents (subsequently developed dihydropyridine-derivatives). Second generation CCAs are characterized by greater selectivity for calcium channels in vascular smooth muscle cells than the myocardium, a longer duration of action and a small trough-to-peak variation in plasma concentrations. Heart failure is characterized by decreased cardiac output resulting in inadequate oxygen delivery to peripheral tissues. Although the accompanying neurohormonal activation, leading to vasoconstriction and increased blood pressure, is initially beneficial in increasing tissue perfusion, prolonged activation is detrimental because it increases afterload and further reduces cardiac output. At the level of the myocyte, heart failure is associated with increased intracellular calcium levels which are thought to impair diastolic function. These changes indicate that the CCAs would be beneficial in patients with heart failure. There has been a strong interest and increasing experience in the use of CCAs in patients with heart failure. Despite potential beneficial effects in initial small trials, findings from larger trials suggest that CCA may have detrimental effects upon survival and cardiovascular events. However, this may not necessarily be a 'class b' effect of the CCAs as there is considerable heterogeneity in the chemical structure of individual agents. Clinical experience with different CCAs in patients with heart failure includes trials that evaluated their effects on hemodynamic parameters, exercise tolerance and on symptomatology. However, the most relevant results are those from randomized clinical trials that assessed mortality as the primary endpoint. First generation CCAs have direct negative inotropic effects and even sustained release formulations have not proved any beneficial effect upon survival. With second generation CCAs, some benefit on hemodynamic parameters has been observed but none on survival, alone or in combination with ACE inhibitors. It is noteworthy that although amlodipine had a neutral effect on morbidity and mortality in large, randomized, placebo-controlled trials in patients with heart failure, the drug was well tolerated. There is no specific indication for CCAs (first or second generation) in patients with systolic heart failure, alone or in combination with ACE inhibitors, but amlodipine may be a considered in the management of hypertension or coronary artery disease in patients with heart failure.
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Affiliation(s)
- Isabelle Mahé
- Service Médecine A, Hôpital Lariboisière, Paris, France.
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Otasević P, Putiniković B, Vukajlović Z, Ilisić B, Nesković AN. [Head-to-head comparison of clinical, biochemical and functional effects of fosinopril and enalapril in patients with systolic heart failure]. MEDICINSKI PREGLED 2006; 59:51-6. [PMID: 17068892 DOI: 10.2298/mpns0602051o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate short-term clinical, biochemical and functional effects of fosinopril versus enalapril in patients with heart failure. MATERIAL AND METHODS 59 consecutive patients (mean age 57 +/- 8 years, EF 18.9 +/- 6.3%, NYHA III or IV class 19/59) were randomized to receive fosinopril or enalapril for three months. All patients underwent echocardiography, metabolic testing, and a 6-minute walk test and completed the Minnesota questionnaire on inclusion and three months later. Additionally, serum creatinine, BUN, total cholesterol and triglycerides were measured. Kaplan-Meier curve was created to assess event-free survival for cardiac death and hospitalization for heart failure. RESULTS There was no statistically significant difference in event-free survival between patients on fosinopril and enalapril (86.7% vs. 82.8%, log rank 4.21 p=0.43). However, time to the event was longer in patients on fosinopril (77.0 +/- 25.35 vs. 40.2 +/- 6.8 days, p=0.04). At the end of the study, no difference between fosinopril and enalapril group existed with respect to maximal oxygen consumption (20.90 +/- 4.47 vs. 20.89 +/- 6.86 ml/kg/min), ejection fraction (20.5 +/- 7.4 vs. 21.4 +/- 7.8%), distance during the 6-minute test walk (313 +/- 74 vs. 352 +/- 129 meters) and quality of life (23.8 +/- 15.8 vs. 25.6 +/- 20.3 points), but patients on enalapril had higher creatinine (99 +/- 13 vs. 113 +/- 17 micromol/L, p=0.002) and BUN (7.28 +/- 1.7 vs. 8.89 +/- 2.39 mmol/L, p=0.01) levels. Increase in fosinopril dose during the study was higher than increase in enalapril dose (24.1% +/- 23.8% vs. 9.5 +/- 24.5%, p=0.04). CONCLUSIONS Fosinopril and enalapril have similar short-term effects on event-free survival, ejection fraction, functional capacity and quality of life in patients with heart failure. Patients on fosinopril presented with longer survival without event and had lower creatinine and BUN at the end-of the follow-up. Additionally, fosinopril can be easily titrated to the maximum therapeutic dose.
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Affiliation(s)
- Petar Otasević
- Institut za kardiovaskularne bolesti Dedinje Centar za kardiovaskularna istrazivanja Dr Aleksandar D. Popović.
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Lin MS, Chan KA, Wang CH, Chang NC. Effects of low-dose treatment with felodipine versus fosinopril in Chinese patients with nonischemic heart failure and normal blood pressure: A double-blind, randomized, crossover study. Curr Ther Res Clin Exp 2004; 65:204-21. [PMID: 24936117 DOI: 10.1016/s0011-393x(04)90034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2004] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Two second-generation calcium channel blockers, felodipine and amlodipine besylate, have been associated with similar high mortality rates in patients with ischemic heart failure (HF) but not in patients with nonischemic causes of HF. In patients with nonischemic HF, amlodipine might have a beneficial effect on survival. However, no difference in mortality rates was found between felodipine and placebo in a nonischemic HF group. Felodipine 10 mg/d was used in 1 large study, a dose considered high for nonischemic HF usually associated with normal blood pressure (BP). OBJECTIVE The aim of this study was to compare the effects of 12-week, low-dose treatment with felodipine versus those of an angiotensin-converting enzyme inhibitor, fosinopril sodium, in patients with nonischemic HF and normal BP. METHODS This double-blind, randomized, crossover trial was conducted at Taipei Medical University Hospital (Taipei, Taiwan). Patients aged ≥ 18 years with angiographically proved, nonischemic HF and normal BP who were being treated with an optimal regimen of digitalis and diuretics were enrolled. After a 2-week run-in period, patients were randomized to first receive 12 weeks of treatment with felodipine tablets (2.5 mg/d) or fosinopril tablets (7.5 mg/d) and, after a 2-week washout period, were crossed over to the opposite treatment. Efficacy analysis was performed before (baseline) and after treatment and included symptomatic assessment using a 7-grade clinical scale; 2-dimensional echocardiography (2-D echo); exercise tests; and neurohumoral data, including plasma renin activity, plasma aldosterone, and 24-hour urinary epinephrine (E) and norepinephrine (NE) measurements. The primary end point was death due to HF, and the secondary end point was hospital admission due to worsening HF. Compliance was measured using a pill count at the end of each treatment period. RESULTS We enrolled 33 patients. One developed worsening HF during the run-in period and was admitted. A total of 32 patients entered the study (18 men, 14 women; mean [SD] age, 48.2 [6.3] years [range, 34-56 years]; mean [SD] systolic BP, 117.2 [9.8] mm Hg [range, 100-138 mm Hg]; mean [SD] diastolic BP, 59.4 [5.7] mm Hg [range, 50-72 mm Hg]). No hospital admission or cardiac death due to HF occurred during 12 weeks of treatment. Twenty-seven patients were included in the felodipine assessment, and 30 patients were included in the fosinopril assessment. Significant improvement in clinical score was noted in both treatment groups (both P < 0.01). The clinical scores did not differ significantly between the 2 treatments. No significant differences were found in 2-D echo parameters between treatments or within groups after treatment versus baseline. Significant improvement in exercise duration was noted with both study drugs after treatment versus baseline (both P < 0.01). No significant difference in exercise duration was found between the 2 treatments. Urinary E and NE were not significantly different between treatments or after treatment with either study drug compared with baseline. CONCLUSION The present findings suggest that, in Chinese patients with moderate to severe HF who have normal BP and insignificant coronary artery disease and were being treated with diuretics and digitalis, a 12-week, low-dose course of felodipine (2.5 mg/d) as a vasodilator was associated with as satisfactory an outcome as standard treatment with fosinopril (7.5 mg/d).
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Affiliation(s)
- Mei-Shu Lin
- Graduate Institute of Epidemiology, College of Public Health, National Taiwan University and Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
| | - K Arnold Chan
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Chih-Hao Wang
- Department of Cardiology, Cardinal Tien Hospital, Taipei, Taiwan
| | - Nen-Chang Chang
- Section of Cardiology, Department of Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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Murawski MM, Mychaskiw MA, Surdej J. Exploration of the Relationship between Health-Related Quality of Life and the Price of Pharmaceutical Products. ACTA ACUST UNITED AC 2003. [DOI: 10.1177/009286150303700211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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al-Kaade S, Hauptman PJ. Health-related quality of life measurement in heart failure: challenges for the new millennium. J Card Fail 2001; 7:194-201. [PMID: 11420772 DOI: 10.1054/jcaf.2001.24664] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Health-related quality of life (HRQL), representing a patient-driven end point, has been increasingly emphasized in randomized clinical trials of new heart failure therapies. Measurement of HRQL depends on the use of validated instruments, with attention paid to the timing of administration and analysis of data in the context of conventional morbidity and mortality end points. In a review of HRQL measurement in heart failure drug trials published from 1966 to 1999, we found that important data, such as the number of participating subjects, are often lacking. HRQL is analyzed as a stand-alone end point without consideration of the underlying clinical trajectory of the disease. Improvements in trials methodology are warranted if quality-of-life data are to be meaningful in the determination of drug efficacy in heart failure.
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Affiliation(s)
- S al-Kaade
- Cardiology Division, Department of Medicine, Saint Louis University School of Medicine, St Louis, MO 63110, USA
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Cleophas TJ, van Marum R. Meta-analysis of efficacy and safety of second-generation dihydropyridine calcium channel blockers in heart failure. Am J Cardiol 2001; 87:487-90, A7-8. [PMID: 11179544 DOI: 10.1016/s0002-9149(00)01413-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Second-generation dihydropyridine calcium channel blockers slightly increase cardiac index, left ventricular ejection fraction, and exercise treadmill tests in patients with chronic heart failure, and do not increase norepinephrine levels; these drugs seem to be safe and beneficial in this category of patients. A 6% reduction in mortality was found, which, although not significantly different from 0%, does indicate that these drugs do not increase mortality in this category of patients.
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Affiliation(s)
- T J Cleophas
- Department of Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
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Abstract
Diastolic left ventricular function is altered substantially with advancing age in healthy persons, and diastolic dysfunction impacts most cardiovascular disorders in the elderly. Older, healthy persons have a delayed relaxation Doppler filling pattern and their early deceleration time is similar to, or modestly lengthened, compared with younger, healthy persons. Two abnormal Doppler filling patterns, the pseudo-normal and the restricted, are discerned more easily, and are more specific in the elderly than the young, because they are the opposite (reverse) of the normal elderly pattern. Most heart failure in the elderly occurs in the presence of preserved systolic function (presumed diastolic heart failure). Elderly patients with diastolic heart failure tend to be women with hypertrophied, hyperdynamic left ventricles, and chronic hypertension. Prognosis may be somewhat better than in systolic heart failure, but the difference diminishes when adjusted for gender and in the very elderly. The pathophysiology of this disorder is not well characterized, diagnostic criteria have not been standardized, and there are no large, multicenter, randomized trials to guide therapy. Further research in this area should be a high priority.
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Affiliation(s)
- D W Kitzman
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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Abstract
Contrary to popular belief, population studies indicate that most elderly patients with heart failure have preserved left ventricular systolic function (i.e., presumed diastolic heart failure). Several normal aging changes may predispose older individuals to diastolic heart failure, including increased hypertrophy and stiffness of the left ventricle, increased vascular stiffness, and decreased cardiovascular reserve. Progress in diastolic heart failure has been hindered by a lack of standard case definition; absence of a readily available, reliable test to quantitate diastolic function; poor understanding of the pathophysiology of heart failure; and lack of data from randomized, controlled, multicenter trials. Typical patients are older women with chronic hypertension, left ventricular hypertrophy, chronic exercise intolerance, and occasional acute exacerbations (pulmonary edema). Although heart failure is a clinical, bedside diagnosis, echocardiography is helpful in differentiating diastolic from systolic heart failure and in ruling out other disorders. Although optimal pharmacologic therapy has not been clarified, control of blood pressure; exercise conditioning; and a multidisciplinary, case management approach seem beneficial.
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Affiliation(s)
- D W Kitzman
- Section of Cardiology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
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de Vries RJ, van Veldhuisen DJ, Dunselman PH. Efficacy and safety of calcium channel blockers in heart failure: Focus on recent trials with second-generation dihydropyridines. Am Heart J 2000. [DOI: 10.1016/s0002-8703(00)90224-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Progressive heart disease after the onset of left ventricular dysfunction has typically been attributed to hemodynamic factors. As left ventricular function declines, decreased cardiac output and tissue hypoperfusion lead to compensatory increases in afterload, preload, and heart rate. The purpose of these compensatory responses is to increase cardiac output and maintain tissue perfusion; however, they may also create hemodynamic stress for the failing heart. However, this does not explain the progression of heart failure despite hemodynamic maintenance with pharmacologic therapy. Activation of neurohormonal systems that are essential for homeostasis in the normal heart plays a key role in the progression of heart failure. In acute heart failure, these systems have beneficial effects, but in chronic heart failure their activation produces deleterious effects by increasing the load on the left ventricle and promoting structural remodeling, which may further impair left ventricular function. The issue of neurohormonal activation is an important one in cardiovascular medicine, not only for patients with heart failure but also for patients with hypertension and ischemic heart disease when left ventricular dysfunction is present. As neurohormonal activation may play a pathogenic role in the long-term outcome of patients, interventions that have favorable hemodynamic but unfavorable neurohormonal effects can actually exacerbate cardiac disease and may increase cardiovascular morbidity and mortality. As neurohormonal activation appears to parallel the severity of heart failure, whether assessed according to symptoms or prognosis, an understanding of neurohormonal activation and its interaction with hemodynamic factors is essential for optimizing pharmacologic therapy for cardiovascular disease.
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Affiliation(s)
- P E Pool
- Reno Cardiology Research Laboratory, Nevada, USA
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Abstract
Continuing high morbidity and mortality have spurred an ongoing search for new therapeutic agents for patients with congestive heart failure. Calcium antagonists (CAs) have been under active investigation in patients with heart failure since their introduction into clinical medicine, because their anti-ischemic and vasodilator properties were thought to be of potential benefit in this patient population. However, review of published clinical trials of CAs in patients with heart failure reveals that some of these drugs are associated with detrimental effects, including acute hemodynamic deterioration, increased symptoms of heart failure, and increased mortality. The adverse effects of short-acting CAs in patients with heart failure include negative inotropic effects and neurohormonal activation. Long-acting CAs, such as amlodipine and felodipine, had fewer negative inotropic effects, showed less evidence of neurohormonal activation, and were better tolerated in clinical trials. Amlodipine, in combination with an angiotensin-converting enzyme inhibitor, had a neutral effect in patients with ischemic heart failure and an unexplained benefit in a subgroup of patients with non-ischemic cardiomyopathy. Although the preliminary experience with long-acting dihydropyridine CAs in heart failure has been encouraging, safety concerns raised by past trials dictate that no CA can be recommended for the treatment of heart failure at this time.
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Affiliation(s)
- S Katz
- Heart Failure Center, Columbia-Presbyterian Medical Center, New York, New York, USA
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de Vries RJ, Anthonio R, van Veldhuisen DJ, Scholtens E, Buikema H, van Gilst WH. Effects of amlodipine on endothelial function in rats with chronic heart failure after experimental myocardial infarction. J Cardiovasc Pharmacol 1997; 30:683-9. [PMID: 9388052 DOI: 10.1097/00005344-199711000-00020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In chronic heart failure, the role of endothelial dysfunction is not yet well established. As calcium metabolism plays an important role in the endothelium, it might be suggested that calcium channel blockers influence endothelial function. Although calcium channel blockers are generally contraindicated in chronic heart failure, because they are believed to stimulate neurohumoral mechanisms and to exert negative inotropic effects, recently it has been suggested that amlodipine might have a favorable affect on mortality in patients with heart failure. The mechanism of amlodipine that contributes to this beneficial effect is not known. Therefore we investigated whether 10 weeks of amlodipine treatment could influence endothelial function in rats with congestive heart failure induced by myocardial infarction. The main finding of our study was that amlodipine, when administered for 10 weeks to rats after a myocardial infarction had been induced, had no significant effects on in vitro and in vivo hemodynamics or neurohormones. The effect of amlodipine on endothelium-intact, norepinephrine-precontracted aortic rings appears to differ from the placebo treatment with respect to the endothelium-dependent relaxation, whereas no differences are seen in endothelium-independent relaxation. We conclude that our data do not support a beneficial role of amlodipine on endothelial function in chronic heart failure.
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Affiliation(s)
- R J de Vries
- Department of Cardiology, University Hospital Groningen, The Netherlands
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Lombardo M, Alli C, Broccolino M, Ferrari S, Montemurro L, Zaini G, Zanni D. Long-term effects of angiotensin-converting enzyme inhibitors and calcium antagonists on the right and left ventricles in essential hypertension. Am Heart J 1997; 134:557-64. [PMID: 9327716 DOI: 10.1016/s0002-8703(97)70095-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To compare the effects of chronic antihypertensive treatment on left and right ventricular structure and function, 24 patients with mild to moderate, never-treated hypertension were randomized to receive fosinopril (20 mg daily) or amlodipine (10 mg daily) for 12 months. At baseline and subsequently at the end of third, sixth, and twelfth months, each patient underwent an integrated echocardiographic study and noninvasive ambulatory blood pressure monitoring. Both drugs significantly reduced blood pressure, casual or monitored (p < 0.01), and left ventricular mass index (from 125 +/- 32 to 100 +/- 12 gm/m2 [p < 0.02] with amlodipine and from 106 +/- 18 to 89 +/- 10 gm/m2 [p < 0.02] with fosinopril). The decrease in left ventricular mass was essentially caused by a reduction of ventricular thickness. Free right ventricular wall thickness was also lowered in both groups, more consistently with amlodipine (from 8.0 +/- 2.1 to 6.4 +/- 0.8 mm; p < 0.01), without an increase in plasma natriuretic peptide and insulin concentrations or heart rate. With both treatments, the decrease in ventricular mass was not associated with impairment of systolic function, whereas a trend toward an improvement of Doppler echocardiographic indexes of biventricular diastolic function was observed. In conclusion, both amlodipine and fosinopril induced similar qualitative effects on anatomy and function of both ventricles. The clinical meaning of these observations must be defined further by means of adequately sized prospective trials.
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Affiliation(s)
- M Lombardo
- Second Division of Cardiology, Niguarda-Cá Granda Hospital, Milano, Italy
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