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The Difference between Sacubitril Valsartan and Valsartan on Vascular Endothelial Function, APN, MMP-9, and BNP Levels in Patients with Hypertension and Chronic Heart Failure. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9494981. [PMID: 35222898 PMCID: PMC8881145 DOI: 10.1155/2022/9494981] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022]
Abstract
Background Sacubitril valsartan and valsartan are the first new drugs approved for angiotensin receptor neprilysin lysine inhibitors (ARNIs) in outpatients with chronic heart failure (CHF) and hypertension. Compared with enalapril, sacubitril valsartan and valsartan have been shown to reduce the mortality and morbidity of cardiovascular diseases. However, there is little actual evidence regarding the efficacy of ARNIs in hypertensive patients with CHF. Methods From January 2019 to January 2021, 60 patients with hypertension and chronic heart failure were diagnosed and treated in our hospital. The patients were randomly divided into an observation group and a control group, with 30 cases in each group. The control group was given valsartan, the observation group was given sacubitril valsartan, and both groups were treated for six months. The endothelium-dependent vasodilation (EDD) function of the brachial artery and serum nitric oxide (NO), endothelin-1 (ET-1), carotid artery intima-media thickness, and glomerular filtration, excess rate (eGFR), and left ventricular ejection fraction (LVEF) were compared between the two groups of patients before and after treatment. The serum adiponectin (APN), matrix metalloproteinase-9 (MMP-9), and brain natriuretic peptide (BNP) levels were compared before and after treatment. Results The total effective rate of treatment in the research group was higher than that in the control group (P < 0.05). After treatment, the cardiac function indexes LVESD and LVEDD of the two groups of patients were lower than before treatment, and LVEF was higher than before treatment, and the improvement rate of the treatment group was better than that of the control group (P < 0.05). After treatment, the serum APN of the two groups was higher than before treatment, the levels of MMP-9 and BNP were lower than before treatment, and the improvement rate of patients in the treatment group was better than that of patients in the control group (P < 0.05). There was no statistically significant in the levels of EDD, NO, and ET-1 of the two groups of patients before treatment (P < 0.05). After treatment, compared with the control group, the EDD function and NO level of the research group were significantly increased (P < 0.05), and the level of ET-1 was significantly reduced (P < 0.05). There was no statistically significant difference in carotid artery intima-media thickness, glomerular filtration rate, and left ventricular ejection fraction before and after treatment in the two groups (P < 0.05). Conclusion In the treatment of hypertension and chronic heart failure, sacubitril valsartan can improve the clinical symptoms of patients to the greatest extent and can significantly improve the levels of LVEF, LVEDD, NT-proBNP, heart function, and other indicators. Sacubitril valsartan can increase serum APN levels, reduce MMP-9 and BNP levels, and have good clinical effects. Sacubitril valsartan has a protective effect on the vascular endothelial function of patients with hypertension and CHF. However, these results need to be confirmed in studies involving more subjects and require longer follow-up times.
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Cwynar M, Gąsowski J, Gryglewska B, Głuszewska A, Kwater A, Królczyk J, Fołta M, Bartoń H, Grodzicki T. Insulin Resistance and Renal Sodium Handling Influence Arterial Stiffness in Hypertensive Patients with Prevailing Sodium Intake. Am J Hypertens 2019; 32:848-857. [PMID: 31102435 DOI: 10.1093/ajh/hpz063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Insulin resistance and renal tubular sodium handling influence arterial structure and function and play an essential role in salt-sensitive forms of hypertension. METHODS In a population with prevailing sodium consumption, we assessed the relationship between cardiovascular phenotypes (peripheral and central blood pressures, elastic properties of large arteries, the left ventricular structure) and sodium handling parameters (daily urinary sodium excretion, fractional urinary lithium excretion in proximal-FELi and distal tubules), as a function of insulin sensitivity-measured by homeostasis model assessment-insulin resistance (HOMA-IR), leptin-to-adiponectin (L/A) ratio, and homeostasis model assessment-adiponectin (HOMA-AD). RESULTS In patients with FELi below the median value (corresponding to the group with increased proximal sodium reabsorption) and higher insulin resistance as measured by HOMA-IR, pulse wave augmentation indexes were significantly higher-AIxP (99.4% vs. 86.2%; P = 0.007), AIxC1 (159.4% vs. 144.2%; P = 0.04), and AIxC2 (36.1% vs. 28.3%; P = 0.02), than in patients with lower insulin resistance. The same trend was observed in relation to L/A ratio-AIxP (98.7% vs. 87.1%; P = 0.005), AIxC1 (158.6% vs. 144.5%; P = 0.02), and AIxC2 (35.6% vs. 28.5%; P = 0.01) and HOMA-AD-AIxP (99.7% vs. 83.8%; P = 0.001), AIxC1 (160.5% vs. 140.3%; P = 0.007), and AIxC2 (36.6% vs. 26.3%; P = 0.003). Such relationships were not observed in patients with FELi above the median value. CONCLUSIONS In the hypertensive population with prevailing sodium intake, insulin resistance and increased sodium reabsorption in proximal tubules may affect arterial wall function.
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Affiliation(s)
- Marcin Cwynar
- Department of Internal Medicine and Gerontology, Medical College, Jagiellonian University, Krakow, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Medical College, Jagiellonian University, Krakow, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Medical College, Jagiellonian University, Krakow, Poland
| | - Anna Głuszewska
- Department of Internal Medicine and Gerontology, Medical College, Jagiellonian University, Krakow, Poland
| | - Aleksander Kwater
- Department of Internal Medicine and Gerontology, Medical College, Jagiellonian University, Krakow, Poland
| | - Jarosław Królczyk
- Department of Internal Medicine and Gerontology, Medical College, Jagiellonian University, Krakow, Poland
| | - Maria Fołta
- Trace Element Research Laboratory, Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Medical College, Jagiellonian University, Krakow, Poland
| | - Henryk Bartoń
- Trace Element Research Laboratory, Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Medical College, Jagiellonian University, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Medical College, Jagiellonian University, Krakow, Poland
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Ajayi S, Adebiyi A, Kadiri S. Increased urinary sodium excretion is associated with systolic blood pressure in first degree relatives of hypertensive patients in Ibadan, Southwestern Nigeria. Pan Afr Med J 2018; 31:168. [PMID: 31086621 PMCID: PMC6488237 DOI: 10.11604/pamj.2018.31.168.16611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/24/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Understanding the risk factors of hypertension has led to a better understanding of the pathogenesis, prevention and reduction in morbidity of hypertension. It is well known that offsprings of hypertensive parents have an increased risk of developing hypertension. It is therefore necessary to explore the physiological differences between normotensive patients with and without a positive family history of hypertension with respect to their urinary excretion of sodium. METHODS This study was carried out at the University College Hospital, Ibadan Nigeria, to determine if normotensive patients with a positive family history of hypertension are different with respect to their urinary excretion of electrolytes and blood pressure. It examined the relationship between 24-hour urinary excretion of sodium, chloride and potassium, urea and creatinine and blood pressure in subjects with and without family history of hypertension. It was a case-control study of sixty-two subjects: normotensive patients' first degree relatives of primary hypertensive patients and normotensive patients without positive family history. RESULTS The mean (SD) systolic blood pressures for subjects with and without family history of hypertension were significantly different: 120.0(22.25) and 105.0(17.50) respectively, (p=0.001). The mean arterial blood pressures were significantly different: 86.4(10.2) mmHg and 80.1(8.1) mmHg respectively (p=0.010). The mean (SD) 24-hour urinary excretion of sodium for normotensive patients with and without positive family history of hypertension were 180.5 (45.50) mEq/L, and 156.0(36.25) mEq/L respectively. Systolic blood pressure and 24-hour urinary excretion of sodium was also higher in normotensive subjects with a positive family history of hypertension. CONCLUSION Systolic blood pressure and twenty-four hour urinary excretion of sodium were higher in normotensive subjects with a positive family history of hypertension than in those without a family history of hypertension.
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Affiliation(s)
- Samuel Ajayi
- Nephrology Unit, Department of Medicine, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adewole Adebiyi
- Cardiology Unit, Department of Medicine, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Solomon Kadiri
- Nephrology Unit, Department of Medicine, University College Hospital and College of Medicine, University of Ibadan, Ibadan, Nigeria
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Relationships between urinary electrolytes excretion and central hemodynamics, and arterial stiffness in hypertensive patients. Hypertens Res 2017; 40:746-751. [DOI: 10.1038/hr.2017.29] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/18/2017] [Accepted: 01/21/2017] [Indexed: 12/19/2022]
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Abstract
Left ventricular (LV) diastolic dysfunction (LVDD) is characterized by alterations in LV diastolic filling, and is a strong predictor of cardiovascular events and heart failure. Hypertension is the most important risk factor for LVDD in the community and promotes LVDD through several mechanisms, including hemodynamic overload and myocardial ischemia. Associated factors such as age, ethnicity, dietary sodium, obesity, diabetes mellitus, and chronic kidney disease also contribute to LVDD in hypertensive individuals. Blood pressure lowering using antihypertensive medications can improve LVDD; however, it remains unclear whether this improvement in LV diastolic function can improve cardiovascular outcomes.
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Affiliation(s)
- Wilson Nadruz
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Internal Medicine, University of Campinas, Campinas, Brazil
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Cwynar M, Gąsowski J, Głuszewska A, Królczyk J, Bartoń H, Słowik A, Grodzicki T. Blood pressure, arterial stiffness and endogenous lithium clearance in relation to AGTR1 A1166C and AGTR2 G1675A gene polymorphisms. J Renin Angiotensin Aldosterone Syst 2016; 17:1470320316655669. [PMID: 27339867 PMCID: PMC5843941 DOI: 10.1177/1470320316655669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/17/2016] [Indexed: 01/18/2023] Open
Abstract
Introduction: Although recently a matter of epidemiologic controversy, sodium overload and its interaction with genetic factors predispose to hypertension and related target organ complications. Methods: In 131 (66 male) treated hypertensives, we measured peripheral and central arterial pressures and pulse wave augmentation indexes (AIxP, AIxC1, AIxC2), pulse wave velocity (PWV), daily urinary sodium excretion and did genetic studies of AGTR1 A1166C and AGTR2 G1675A polymorphisms. Proximal (FELi) and distal (FDRNa) sodium reabsorption measurements were performed using endogenous lithium clearance. Results: In men, we found interaction between FDRNa and AGTR2 G1675A polymorphism with respect to AIxC1 (pINT=0.01), AIxC2 (pINT=0.05) and AIxP (pINT=0.006). Arterial stiffness increased with higher sodium reabsorption in the distal tubule, in the presence of AGTR2 G allele with the opposite tendency in A allele carriers. In the subgroup with FDRNa below median, as compared to those with FDRNa above median, the AIxC1 (139.6±3.8 vs 159.1±5.7%; p=0.009), AIxC2 (26.3±1.8 vs 33.3±1.7%; p=0.016) and AIxP (83.4±2.5 vs 96.5±2.6%; p<0.0001) were lower, in the G allele carrying men and GG homozygous women. Conclusions: The relation between sodium reabsorption in the distal tubule and the development of arterial stiffness depends on the AGTR2 G1675A polymorphism in blood pressure independent fashion.
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Affiliation(s)
- Marcin Cwynar
- Department of Internal Medicine and Gerontology, Jagiellonian University, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University, Poland
| | - Anna Głuszewska
- Department of Internal Medicine and Gerontology, Jagiellonian University, Poland
| | - Jarosław Królczyk
- Department of Internal Medicine and Gerontology, Jagiellonian University, Poland
| | - Henryk Bartoń
- Department of Food Chemistry and Nutrition, Jagiellonian University, Poland
| | | | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University, Poland
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Liu K, Wang S, Wan S, Zhou Y, Pan P, Wen B, Zhang X, Liao H, Shi D, Shi R, Chen X, Jangala T. Arterial Stiffness, Central Pulsatile Hemodynamic Load, and Orthostatic Hypotension. J Clin Hypertens (Greenwich) 2015; 18:655-62. [PMID: 26543017 DOI: 10.1111/jch.12726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/25/2015] [Accepted: 09/08/2015] [Indexed: 02/05/2023]
Abstract
The association between central pulsatile hemodynamic load, arterial stiffness, and orthostatic hypotension (OH) is unclear. The authors recruited 1099 participants from the community. Questionnaire, physical examination, and laboratory tests were performed. To assess the correlation between central pulsatile hemodynamic load, arterial stiffness, and OH, multiple logistic regression analysis was performed, and the discriminatory power was assessed by the area under the receiver operating curve. The prevalence of OH in this population was 5.6%. After adjusting for potential confounders, brachial-ankle pulse wave velocity (BaPWV) was significantly and positively correlated with OH in both the hypertension and nonhypertension groups (all P<.05), while central systolic blood pressure (CSBP) was only significantly associated with OH in the hypertension subgroup. In addition, BaPWV seemed to have a better discriminatory power than CSBP in both subgroups. BaPWV appears to be a better indicator of OH than CSBP in routine clinical practice.
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Affiliation(s)
- Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Si Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shixi Wan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yufei Zhou
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pei Pan
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Di Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rufeng Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tulasiram Jangala
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Salt, hypertension, vascular stiffness and diastolic dysfunction, what comes first? J Hum Hypertens 2015; 29:573-4. [DOI: 10.1038/jhh.2015.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cwynar M, Gąsowski J, Gryglewska B, Głuszewska A, Bartoń H, Słowik A, Grodzicki T. The relation between ACE D/I and CYP11B2 C-344T polymorphisms and parameters of arterial stiffness in the context of renal sodium handling. Blood Press 2015. [DOI: 10.3109/08037051.2015.1070476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marcin Cwynar
- Department of Internal Medicine and Gerontology, Krakow, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Krakow, Poland
| | | | - Anna Głuszewska
- Department of Internal Medicine and Gerontology, Krakow, Poland
| | - Henryk Bartoń
- Trace Element Research Laboratory, Department of Food Chemistry and Nutrition, Faculty of Pharmacy, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Medical College, Jagiellonian University, Krakow, Poland
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