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Tian Y, Sun J, Qiu M, Lu Y, Qian X, Sun W, Kong X. Association between the triglyceride-glucose index and albuminuria in hypertensive individuals. Clin Exp Hypertens 2023; 45:2150204. [DOI: 10.1080/10641963.2022.2150204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Yunfan Tian
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jingyu Sun
- Department of Cardiology, The First People’s Hospital of Zhangjiagang, Zhangjiagang 215699, China
| | - Ming Qiu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yan Lu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xuesong Qian
- Department of Cardiology, The First People’s Hospital of Zhangjiagang, Zhangjiagang 215699, China
| | - Wei Sun
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Vázquez-Sánchez S, Poveda J, Navarro-García JA, González-Lafuente L, Rodríguez-Sánchez E, Ruilope LM, Ruiz-Hurtado G. An Overview of FGF-23 as a Novel Candidate Biomarker of Cardiovascular Risk. Front Physiol 2021; 12:632260. [PMID: 33767635 PMCID: PMC7985069 DOI: 10.3389/fphys.2021.632260] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
Fibroblast growth factor-23 (FGF)-23 is a phosphaturic hormone involved in mineral bone metabolism that helps control phosphate homeostasis and reduces 1,25-dihydroxyvitamin D synthesis. Recent data have highlighted the relevant direct FGF-23 effects on the myocardium, and high plasma levels of FGF-23 have been associated with adverse cardiovascular outcomes in humans, such as heart failure and arrhythmias. Therefore, FGF-23 has emerged as a novel biomarker of cardiovascular risk in the last decade. Indeed, experimental data suggest FGF-23 as a direct mediator of cardiac hypertrophy development, cardiac fibrosis and cardiac dysfunction via specific myocardial FGF receptor (FGFR) activation. Therefore, the FGF-23/FGFR pathway might be a suitable therapeutic target for reducing the deleterious effects of FGF-23 on the cardiovascular system. More research is needed to fully understand the intracellular FGF-23-dependent mechanisms, clarify the downstream pathways and identify which could be the most appropriate targets for better therapeutic intervention. This review updates the current knowledge on both clinical and experimental studies and highlights the evidence linking FGF-23 to cardiovascular events. The aim of this review is to establish the specific role of FGF-23 in the heart, its detrimental effects on cardiac tissue and the possible new therapeutic opportunities to block these effects.
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Affiliation(s)
- Sara Vázquez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jonay Poveda
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José Alberto Navarro-García
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura González-Lafuente
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Rodríguez-Sánchez
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M. Ruilope
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Doctoral Studies and Research, European University of Madrid, Madrid, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
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3
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Trenfield SJ, Tan HX, Goyanes A, Wilsdon D, Rowland M, Gaisford S, Basit AW. Non-destructive dose verification of two drugs within 3D printed polyprintlets. Int J Pharm 2020; 577:119066. [DOI: 10.1016/j.ijpharm.2020.119066] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 12/19/2022]
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Ruilope LM, Ruiz-Hurtado G. Monotherapy still useful in a bunch of patients with arterial hypertension. Int J Cardiol 2019; 291:119-120. [PMID: 31155327 DOI: 10.1016/j.ijcard.2019.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Luis M Ruilope
- Cardiorenal Translational Laboratory & Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, CIBERESP, Madrid, Spain; Faculty of Sport Sciences, European University of Madrid, Madrid, Spain.
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory & Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain
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5
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Ruilope LM, Ruiz-Hurtado G, Barderas MG, de la Cruz JJ, Lucia A, de la Sierra A, Gorostidi M, Vinyoles E, Segura J, Solís J, Arribas F, García-Puig J, Tamargo J, O'Brien E, Volpe M, Whelton PK, Williams B, Banegas JR. Frequency and Prognosis of Treated Hypertensive Patients According to Prior and New Blood Pressure Goals. Hypertension 2019; 74:130-136. [PMID: 31132953 DOI: 10.1161/hypertensionaha.119.12921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
United States and European guidelines have recommended new treatment goals for office blood pressure (BP). We examined 9784 hypertensives of the Spanish Ambulatory BP Monitoring (ABPM) registry with office BP treated to the prior goal (<140/90 mm Hg); and evaluated the frequency and all-cause mortality of 4 BP strata depending on whether or not they attained more conservative or new office BP goal (130-139/80-89 and <130/80 mm Hg, respectively) and whether or not BP was controlled according to ABPM criteria in the European and US guidelines (24-hour ambulatory BP <130/80 and <125/75 mm Hg, respectively). Whether achieving or not the new office BP goal, the total-mortality risk during a 5-year follow-up was only significantly higher than the reference (normal office BP and ABPM) when 24-hour ambulatory BP was above goal (hazard ratio from multivariable Cox models was in the range of 2.4-2.9; P<0.001). The frequency of patients achieving the new office BP goal was 34.4%, and the frequencies of those not achieving the ABPM goal were 31.6% and 53.7% using the 130/80 or the 125/75 ABPM goal, respectively. Mean office systolic BP was 129 mm Hg for patients not achieving the ABPM goal. In hypertensive patients controlled under prior office BP goal, the frequency of those achieving new office BP goal <130/80 was high, suggesting this goal can be attained. In addition, patients had a higher mortality risk only when ABPM was above goal despite having mean office systolic BP under control, a condition that was also common.
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Affiliation(s)
- Luis M Ruilope
- From the Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (L.M.R., G.R.-H., J. Segura).,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain (L.M.R., G.R.-H., J.Solis, F.A.).,Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Spain (L.M.R., J.d.l.C., J.R.B.).,Faculty of Sport Sciences, European University of Madrid, Spain (L.M.R., A.L.)
| | - Gema Ruiz-Hurtado
- From the Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (L.M.R., G.R.-H., J. Segura).,CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain (L.M.R., G.R.-H., J.Solis, F.A.)
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos (HNP), SESCAM, Toledo (M.G.B.)
| | - Juan J de la Cruz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Spain (L.M.R., J.d.l.C., J.R.B.)
| | - Alejandro Lucia
- Faculty of Sport Sciences, European University of Madrid, Spain (L.M.R., A.L.)
| | - Alejandro de la Sierra
- Departamento de Medicina Interna, Hospital Universitario Mútua Terrasa, Universidad de Barcelona, Terrasa, España (A.d.l.S.)
| | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.)
| | - Ernest Vinyoles
- La Mina Primary Care Center, University of Barcelona, Spain (E.V.)
| | - Julián Segura
- From the Cardiorenal Translational Laboratory and Hypertension Unit, Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain (L.M.R., G.R.-H., J. Segura)
| | - Jorge Solís
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain (L.M.R., G.R.-H., J.Solis, F.A.).,Cardiology Service, Hospital Univeristario 12 de Octubre (J. Solís, F.A.)
| | - Fernando Arribas
- CIBER-CV, Hospital Universitario 12 de Octubre, Madrid, Spain (L.M.R., G.R.-H., J.Solis, F.A.).,Cardiology Service, Hospital Univeristario 12 de Octubre (J. Solís, F.A.)
| | - Juan García-Puig
- Division of Internal Medicine, Hospital Universitario Quirón, Madrid, Spain (J.G.-P)
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, CIBERCV, Madrid, Spain (J.T.)
| | - Eoin O'Brien
- The Conway Institute, University College Dublin, Ireland (E.O.)
| | - Massimo Volpe
- Department of Cardiology, University of Rome Sapienza, Sant'Andrea Hospital, IRCCS Neuromed Pozzilli, Italy (M.V.)
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.W.)
| | - Bryan Williams
- UCL Institute of Cardiovascular Sciences, University College London, United Kingdom; and National Institute for Health Research, UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.)
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Spain (L.M.R., J.d.l.C., J.R.B.)
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Martin-Lorenzo M, Martinez PJ, Baldan-Martin M, Lopez JA, Minguez P, Santiago-Hernandez A, Vazquez J, Segura J, Ruiz-Hurtado G, Vivanco F, Barderas MG, Ruilope LM, Alvarez-Llamas G. Urine Haptoglobin and Haptoglobin-Related Protein Predict Response to Spironolactone in Patients With Resistant Hypertension. Hypertension 2019; 73:794-802. [PMID: 30712426 DOI: 10.1161/hypertensionaha.118.12242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Resistant hypertension prevalence is progressively increasing, and prolonged exposure to suboptimal blood pressure control results in higher cardiovascular risk and end-organ damage. Among various antihypertensive agents, spironolactone seems the most effective choice to treat resistant hypertension once triple therapy including a diuretic fails. However success in blood pressure control is not guaranteed, adverse effects are not negligible, and no clinical tools are available to predict patient's response. Complementary to our previous study of resistant hypertension metabolism, here we investigated urinary proteome changes with potential capacity to predict response to spironolactone. Twenty-nine resistant hypertensives were included. A prospective study was conducted and basal urine was collected before spironolactone administration. Patients were classified in responders or nonresponders in terms of blood pressure control. Protein quantitation was performed by liquid chromatography-mass spectrometry; ELISA and target mass spectrometry analysis were performed for confirmation. Among 3310 identified proteins, HP (haptoglobin) and HPR (haptoglobin-related protein) showed the most significant variations, with increased levels in nonresponders compared with responders before drug administration (variation rate, 5.98 and 7.83, respectively). Protein-coordinated responses were also evaluated by functional enrichment analysis, finding oxidative stress, chronic inflammatory response, blood coagulation, complement activation, and regulation of focal adhesions as physiopathological mechanisms in resistant hypertension. In conclusion, protein changes able to predict patients' response to spironolactone in basal urine were here identified for the first time. These data, once further confirmed, will support clinical decisions on patients' management while contributing to optimize the rate of control of resistant hypertensives with spironolactone.
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Affiliation(s)
- Marta Martin-Lorenzo
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Paula J Martinez
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Montserrat Baldan-Martin
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.)
| | - Juan A Lopez
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain (J.A.L., J.V.)
| | - Pablo Minguez
- Department of Genetics (P.M.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Aranzazu Santiago-Hernandez
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain
| | - Jesus Vazquez
- Laboratory of Cardiovascular Proteomics CNIC, Madrid, Spain (J.A.L., J.V.)
| | - Julian Segura
- Department of Nephrology, Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid, Spain (J.S., L.M.R.)
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación I+12 Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain (G.R.-H., L.M.R.)
| | - Fernando Vivanco
- Department of Biochemistry and Molecular Biology, I Universidad Complutense, Madrid, Spain (F.V.)
| | - Maria G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Parapléjicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.)
| | - Luis M Ruilope
- Department of Nephrology, Hypertension Unit, Hospital Universitario 12 de Octubre, Madrid, Spain (J.S., L.M.R.).,Cardiorenal Translational Laboratory, Instituto de Investigación I+12 Hospital Universitario 12 de Octubre/CIBER-CV, Madrid, Spain (G.R.-H., L.M.R.).,School of Doctoral Studies and Research, Universidad Europea de Madrid, Spain (L.M.R.)
| | - Gloria Alvarez-Llamas
- From the Laboratory of Immunoallergy and Proteomics, Department of Immunology (M.M.-L., P.J.M., A.S.-H., G.A.-L.), IIS-Fundación Jiménez Díaz-UAM, Madrid, Spain.,REDINREN, Madrid, Spain (G.A.-L.)
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Rodríguez-Sánchez E, Navarro-García JA, Aceves-Ripoll J, Álvarez-Llamas G, Segura J, Barderas MG, Ruilope LM, Ruiz-Hurtado G. Association between renal dysfunction and metalloproteinase (MMP)-9 activity in hypertensive patients. Nefrologia 2018; 39:184-191. [PMID: 30509751 DOI: 10.1016/j.nefro.2018.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/04/2018] [Accepted: 08/30/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Matrix metalloproteinases (MMPs) are involved in deleterious tissue remodeling associated with target organ damage in renal disease. The aim of this study was to study the association between renal dysfunction and activity of the inflammatory metalloproteinase MMP-9 in hypertensive patients with mild-moderate chronic kidney disease (CKD). MATERIAL AND METHODS Plasmatic active MMP-9, total MMP-9, tissue inhibitor of MMP-9 (TIMP-1), MMP-9/TIMP-1 ratio and MMP-9-TIMP-1 interaction were analyzed in 37 hypertensive patients distributed by estimated glomerular filtration rate (eGFR) in 3 groups:>90, 90-60 y 60-30mL/min/1.73 m2. RESULTS Total MMP-9 was not different as eGFR declines. TIMP-1 was significantly increased in hypertensive patients with eGFR 60-30mL/min/1.73 m2 (P<.01 versus>90mL/min/1.73 m2). This relates to the significant decrease in the interaction between MMP-9-TIMP-1 observed in patients with eGFR 60-30mL/min/1.73 m2 (P<.01 versus>90mL/min/1.73 m2). Despite the systemic elevation of TIMP-1, active MMP-9 was significantly increased in hypertensive patients with eGFR 60-30mL/min/1.73 m2 (P<.05 and P<0.01 versus>90 and 90-60mL/min/1.73 m2, respectively). TIMP-1, active MMP-9 and MMP-9-TIMP-1 interaction significantly correlate with the decline in renal function, which was not observed with total MMP-9. CONCLUSIONS The progression of CKD, even in stages where the decline of renal function is still moderate, is associated with an increase in MMP-9 activity, which could be considered as a potential therapeutic target.
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Affiliation(s)
- Elena Rodríguez-Sánchez
- Laboratorio Traslacional Cardiorrenal, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España
| | - José Alberto Navarro-García
- Laboratorio Traslacional Cardiorrenal, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jennifer Aceves-Ripoll
- Laboratorio Traslacional Cardiorrenal, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Julián Segura
- Laboratorio Traslacional Cardiorrenal, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | - María G Barderas
- Departamento de Fisiopatología Vascular, Hospital Nacional de Parapléjicos (HNP), SESCAM, Toledo, España
| | - Luis Miguel Ruilope
- Laboratorio Traslacional Cardiorrenal, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España; Escuela de Estudios de Doctorado e Investigación, Universidad Europea de Madrid, Madrid, España
| | - Gema Ruiz-Hurtado
- Laboratorio Traslacional Cardiorrenal, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Madrid, España; Unidad de Hipertensión, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España.
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Translational science in albuminuria: a new view of de novo albuminuria under chronic RAS suppression. Clin Sci (Lond) 2018; 132:739-758. [DOI: 10.1042/cs20180097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/09/2018] [Accepted: 03/22/2018] [Indexed: 12/29/2022]
Abstract
The development of de novo albuminuria during chronic renin–angiotensin system (RAS) suppression is a clinical entity that remains poorly recognized in the biomedical literature. It represents a clear increment in global cardiovascular (CV) and renal risk that cannot be counteracted by RAS suppression. Although not specifically considered, it is clear that this entity is present in most published and ongoing trials dealing with the different forms of CV and renal disease. In this review, we focus on the mechanisms promoting albuminuria, and the predictors and new markers of de novo albuminuria, as well as the potential treatment options to counteract the excretion of albumin. The increase in risk that accompanies de novo albuminuria supports the search for early markers and predictors that will allow practising physicians to assess and prevent the development of de novo albuminuria in their patients.
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Ruilope LM, Banegas JR. The use of antihypertensive fixed combinations in clinical practice needs a reappraisal. J Clin Hypertens (Greenwich) 2018; 20:716-717. [PMID: 29457378 DOI: 10.1111/jch.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luis M Ruilope
- Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre, CIBER of Cardiovascular Disease (CIBERCV), Madrid, Spain.,School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid⁄IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Jose R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid⁄IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Patients’ confidence in methods of blood pressure assessment and their reported adherence to antihypertensive medications. Blood Press Monit 2017; 22:259-264. [DOI: 10.1097/mbp.0000000000000269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin-Lorenzo M, Martinez PJ, Baldan-Martin M, Ruiz-Hurtado G, Prado JC, Segura J, de la Cuesta F, Barderas MG, Vivanco F, Ruilope LM, Alvarez-Llamas G. Citric Acid Metabolism in Resistant Hypertension: Underlying Mechanisms and Metabolic Prediction of Treatment Response. Hypertension 2017; 70:1049-1056. [PMID: 28874460 DOI: 10.1161/hypertensionaha.117.09819] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/17/2017] [Accepted: 08/09/2017] [Indexed: 12/16/2022]
Abstract
Resistant hypertension (RH) affects 9% to 12% of hypertensive adults. Prolonged exposure to suboptimal blood pressure control results in end-organ damage and cardiovascular risk. Spironolactone is the most effective drug for treatment, but not all patients respond and side effects are not negligible. Little is known on the mechanisms responsible for RH. We aimed to identify metabolic alterations in urine. In addition, a potential capacity of metabolites to predict response to spironolactone was investigated. Urine was collected from 29 patients with RH and from a group of 13 subjects with pseudo-RH. For patients, samples were collected before and after spironolactone administration and were classified in responders (n=19) and nonresponders (n=10). Nuclear magnetic resonance was applied to identify altered metabolites and pathways. Metabolites were confirmed by liquid chromatography-mass spectrometry. Citric acid cycle was the pathway most significantly altered (P<0.0001). Metabolic concentrations were quantified and ranged from ng/mL malate to μg/mL citrate. Citrate and oxaloacetate increased in RH versus pseudoresistant. Together with α-ketoglutarate and malate, they were able to discriminate between responders and nonresponders, being the 4 metabolites increased in nonresponders. Combined as a prediction panel, they showed receiver operating characteristiccurve with area under the curve of 0.96. We show that citric acid cycle and deregulation of reactive oxygen species homeostasis control continue its activation after hypertension was developed. A metabolic panel showing alteration before spironolactone treatment and predicting future response of patients is shown. These molecular indicators will contribute optimizing the rate of control of RH patients with spironolactone.
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Affiliation(s)
- Marta Martin-Lorenzo
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Paula J Martinez
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Montserrat Baldan-Martin
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Gema Ruiz-Hurtado
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Jose Carlos Prado
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Julian Segura
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Fernando de la Cuesta
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Maria G Barderas
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Fernando Vivanco
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Luis Miguel Ruilope
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.)
| | - Gloria Alvarez-Llamas
- From the Department of Immunology, IIS-Fundacion Jimenez Diaz, REDinREN, Madrid, Spain (M.M.-L., P.J.M., F.V., G.A.-L.); Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain (M.B.-M., M.G.B.); Hypertension Unit, Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Madrid, Spain (G.R.-H., J.C.P., J.S., L.M.R.); Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom (F.d.l.C.); Department of Biochemistry and Molecular Biology I, Universidad Complutense, Madrid, Spain (F.V.); and Universidad Europea, Madrid, Spain (L.M.R.).
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Ruiz-Hurtado G, Ruilope LM. Sacubitril/valsartan in the treatment of arterial hypertension: an unaccomplished promise? Hypertens Res 2017; 40:439-440. [PMID: 28275236 DOI: 10.1038/hr.2017.27] [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]
Affiliation(s)
- Gema Ruiz-Hurtado
- Institute of Investigation Imas12 and Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain
| | - Luis M Ruilope
- Institute of Investigation Imas12 and Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad Autonoma, Madrid, Spain.,School of Doctoral Studies and Research, Universidad Europea de Madrid, Madrid, Spain
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Xiong X, Yang X, Duan L, Liu W, Zhang Y, Liu Y, Wang P, Li S, Li X. Traditional Chinese medicine suppresses left ventricular hypertrophy by targeting extracellular signal-regulated kinases signaling pathway in spontaneously hypertensive rats. Sci Rep 2017; 7:42965. [PMID: 28225023 PMCID: PMC5320505 DOI: 10.1038/srep42965] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/17/2017] [Indexed: 12/28/2022] Open
Abstract
Chinese herbal medicine Bu-Shen-Jiang-Ya decoction (BSJYD) is reported to be beneficial for hypertension. Over expression of extracellular signal regulated kinases (ERK) pathway plays an important role in left ventricular hypertrophy (LVH). This study aimed to observe effects of BSJYD on LVH in spontaneously hypertensive rats (SHRs) and explore its possible mechanism on regulation of ERK pathway. Sixty 12-week-old SHRs were randomly allocated into 5 groups: BSJYD high dose group, middle dose group, low dose group, captopril group, and control group. Besides, a control group of Wistar-Kyoto rats was established. All rats were treated for 8 weeks. Systolic blood pressure (SBP), heart rate (HR), pathology, and left ventricular mass index (LVMI) were measured. Western blotting and Real-time PCR were used to assess the expressions of BDNF, Ras, ERK1/2, and c-fox levels. SBP and HR were significantly decreased compared with the control group and LVMI was markedly improved by BSJYD treatment in a dose-dependent manner. BSJYD inhibited the expression of BDNF, Ras, ERK1/2, and c-fox mRNA in LVH. In conclusion, BSJYD suppressed hypertension-induced cardiac hypertrophy by inhibiting the expression of ERK pathway. These changes in gene expression may be a possible mechanism by which BSJYD provides myocardial protection from hypertension.
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Affiliation(s)
- Xingjiang Xiong
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaochen Yang
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lian Duan
- Department of Cardiology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei Liu
- Department of Cardiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yun Zhang
- Department of Molecular Biology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yongmei Liu
- Department of Molecular Biology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Pengqian Wang
- Department of Pharmacology, Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shengjie Li
- Department of Molecular Biology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoke Li
- Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, USA
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14
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Gonzalez-Calero L, Martin-Lorenzo M, Martínez PJ, Baldan-Martin M, Ruiz-Hurtado G, Segura J, de la Cuesta F, Barderas MG, Ruilope LM, Vivanco F, Alvarez-Llamas G. Hypertensive patients exhibit an altered metabolism. A specific metabolite signature in urine is able to predict albuminuria progression. Transl Res 2016; 178:25-37.e7. [PMID: 27477079 DOI: 10.1016/j.trsl.2016.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/22/2016] [Accepted: 07/06/2016] [Indexed: 11/27/2022]
Abstract
Hypertension (HTN) is increasing in prevalence, and albuminuria is a strong indicator of cardiovascular risk and renal damage progression. Despite blood pressure control with chronic treatment, a relevant subgroup of patients develop albuminuria. However, the biological factors responsible for albuminuria development and progression are underexplored. We aimed to identify key metabolic targets and biological pathways involved in the negative progression of cardiovascular and renal damage in hypertensives undergoing chronic treatment. A series of 1533 patients were followed for 5 years to investigate the evolution of albuminuria. Patients were classified as: (1) patients with persistent normoalbuminuria; (2) patients developing de novo albuminuria; and (3) patients with maintained albuminuria. At the end of follow-up, urine from 30 nonhypertensive subjects (control group) and a representative cohort of 118 patients was collected for metabolomic analysis. Metabolic patterns of interest were identified in a first discovery phase by nuclear magnetic resonance and further confirmed by liquid chromatography-mass spectrometry. Metabolites corresponding to HTN or albuminuria were measured in a prospective study carried out in 35 individuals still in normoalbuminuria, to evaluate their potential as predictors of albuminuria development. Nine metabolites were significantly altered, linking β-alanine metabolism, arginine and proline metabolism, and tricarboxylic acid cycle. The prospective study revealed a panel composed of guanidinoacetate, glutamate, and pantothenate, which was able to predict development of albuminuria. These metabolic signatures open new possibilities in hypertensive therapy and cardiovascular risk control, providing prompt and more efficient intervention, particularly in patients with worse cardiovascular prognosis.
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Affiliation(s)
| | | | - Paula J Martínez
- Departamento de Inmunologia, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | | | - Gema Ruiz-Hurtado
- Unidad de Hipertension, Instituto de Investigacion i+12, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto Pluridisciplinar, Universidad Complutense de Madrid, Spain
| | - Julian Segura
- Unidad de Hipertension, Instituto de Investigacion i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando de la Cuesta
- Laboratorio de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain
| | - Maria G Barderas
- Laboratorio de Fisiopatologia Vascular, Hospital Nacional de Paraplejicos SESCAM, Toledo, Spain
| | - Luis M Ruilope
- Unidad de Hipertension, Instituto de Investigacion i+12, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Fernando Vivanco
- Departamento de Inmunologia, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain; Departamento de Bioquimica y Biologia Molecular I, Universidad Complutense de Madrid, Spain
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15
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Ruiz-Hurtado G, Ruilope LM. New Strategy to Control Blood Pressure: Interactive Mobile Phone Support. J Clin Hypertens (Greenwich) 2015; 18:109-10. [PMID: 26462732 DOI: 10.1111/jch.12683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gema Ruiz-Hurtado
- Instituto de Investigación Imas12 and Unidad de Hipertensión, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto Pluridisplinar, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis M Ruilope
- Instituto de Investigación Imas12 and Unidad de Hipertensión, Hospital Universitario 12 de Octubre, Madrid, Spain.,Departamento de Salud Publica and Medicina Preventiva, Universidad Autonoma, Madrid, Spain
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16
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Márquez DF, Ruiz-Hurtado G, Ruilope LM, Segura J. An update of the blockade of the renin angiotensin aldosterone system in clinical practice. Expert Opin Pharmacother 2015; 16:2283-92. [PMID: 26389772 DOI: 10.1517/14656566.2015.1079623] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death worldwide. Blockade of this system is commonly used in the treatment of cardiovascular (CV) and renal disease. AREAS COVERED Data from multiple clinical trials have provided good evidence about the benefit of blocking the system as a therapeutic target to reduce CV and renal events. We have reviewed all the tested combinations of different drugs counteracting the effects of the renin-angiotensin-aldosterone system. EXPERT OPINION Monotherapy with an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) remains valid in all the guidelines, whereas their dual combination has been discarded due to the absence of proven benefits in high CV risk patients and in patients with chronic kidney disease (CKD). The combination of the standard therapy with an ACEi or an ARB with a mineralocorticoid receptor blocker is a valid option, but has the inconvenience of frequent hyperkalemia in patients with CKD. Similarly, the addition of the direct renin inhibitor, aliskiren, to this standard therapy is not particularly supported in diabetic patients. New dual-acting blockers, for example, those combining valsartan and neprilysin inhibitors (LCZ696-Novartis) or endothelin converting enzyme inhibitors and neprilysin inhibitors (ECEI, Daglutril-Solvay), are currently under investigation.
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Affiliation(s)
- Diego F Márquez
- a 1 Unidad de Hipertensión, Servicio de Clínica Médica, Hospital San Bernardo , Salta, Argentina
| | - Gema Ruiz-Hurtado
- b 2 Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Unidad de Hipertensión , Avda Cordoba s/n 28041, Madrid, Spain +349 143 177 41 ; +349 157 656 44 ; .,c 3 Universidad Complutense de Madrid (UCM), Instituto Pluridisciplinar , Madrid, Spain
| | - Luis M Ruilope
- b 2 Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Unidad de Hipertensión , Avda Cordoba s/n 28041, Madrid, Spain +349 143 177 41 ; +349 157 656 44 ; .,d 4 Universidad Autónoma, Departamento de Salud Pública y Medicina Preventiva , Madrid, Spain
| | - Julián Segura
- b 2 Instituto de Investigación imas12, Hospital Universitario 12 de Octubre, Unidad de Hipertensión , Avda Cordoba s/n 28041, Madrid, Spain +349 143 177 41 ; +349 157 656 44 ;
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17
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The Effects of Red Yeast Rice Dietary Supplement on Blood Pressure, Lipid Profile and C-reactive Protein in Hypertension: A Systematic Review. Crit Rev Food Sci Nutr 2015; 57:1831-1851. [DOI: 10.1080/10408398.2015.1018987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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In vivo antihypertensive mechanism of lactoferrin-derived peptides: Reversion of angiotensin I- and angiotensin II-induced hypertension in Wistar rats. J Funct Foods 2015. [DOI: 10.1016/j.jff.2015.03.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ruiz-Hurtado G, Ruilope LM. Cardiorenal protection during chronic renin–angiotensin–aldosterone system suppression: evidences and caveats. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:126-31. [DOI: 10.1093/ehjcvp/pvu023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/12/2014] [Indexed: 11/14/2022]
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Abstract
OBJECTIVES This study aimed to summarise the current evidence from randomised control trials (RCTs) concerning treatment of patients with resistant hypertension with Chinese herbal medicine (CHM). DESIGN Seven databases, including the Cochrane Library, PubMed, EMBASE, CNKI, VIP, CBM and Wanfang, were systematically searched from their inception to March 2014 for RCTs investigating treatment of resistant hypertension in which CHM was used either as a monotherapy or in combination with conventional medicine versus placebo, no intervention or conventional medicine. RESULTS Five trials containing 446 hypertensive patients were identified. The methodological quality of most trials was evaluated as generally low. All included trials compared CHM plus antihypertensive drugs with antihypertensive drugs alone for resistant hypertension. Formulations of CHM included tablet, decoction and injection. It was found that, compared with antihypertensive drugs alone, CHM (tablet) plus antihypertensive drugs resulted in clinically, but not statistically, significant reductions in systolic blood pressure (SBP; weighted mean difference (WMD)=-10.32 mm Hg; 95% CI -21.10 to 0.46; p=0.06) and diastolic blood pressure (DBP; WMD=-3.30 mm Hg; 95% CI -7.66 to 1.06; p=0.14). CHM (decoction) plus antihypertensive drugs also produced a clinically meaningful, but not statistically significant, reduction in SBP (WMD=-12.56 mm Hg; 95% CI -26.83 to 1.71; p=0.08), and did significantly decrease DBP (WMD=-7.89 mm Hg; 95% CI -11.74 to -4.04; p<0.0001). There were no significant differences in SBP (WMD=-3.50 mm Hg; 95% CI -8.95 to 1.95; p=0.21) and DBP (WMD=1.00 mm Hg; 95% CI -1.39 to 3.39; p=0.41) between CHM (injection) plus the antihypertensive drugs group and antihypertensive drugs alone. The safety of CHM remained uncertain. CONCLUSIONS No definite conclusions about the effectiveness and safety of CHM for resistant hypertension could be drawn. More rigorously designed trials are warranted.
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Affiliation(s)
- Xingjiang Xiong
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoke Li
- Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, California, USA
| | - Yuqing Zhang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Jie Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Suzuki H, Shimada K, Fujiwara K. Antihypertensive effectiveness of combination therapy with losartan/hydrochlorothiazide for 'real world' management of isolated systolic hypertension. Ther Adv Cardiovasc Dis 2014; 9:10-8. [PMID: 25367171 DOI: 10.1177/1753944714558244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The guidelines for hypertension require the presence of compelling indications for pharmacological management of hypertension associated with various diseases. Data mainly obtained through randomized controlled trials have provided evidence supporting effectiveness of the combination of losartan (Lo) and hydrochlorothiazide (HCTZ) for management of hypertensive patients. However, there have been few reports discussing the effectiveness of Lo/HTCZ (losartan 50 mg/hydrochlorothizide 12.5 mg) in the 'real world' in the management of isolated systolic hypertension (ISH). This study was designed to investigate the 'real world' effectiveness of Lo/HTCZ-based treatment of ISH associated with various diseases. METHODS This was a retrospective, uncontrolled analysis of data derived from a large, cross-sectional web-based clinical database collected by physicians. RESULTS Of 24,825 eligible patients, 20,726 were followed during a 6-month period. Among these, subjects for analysis included those with systolic blood pressure (SBP) >140 mmHg and diastolic BP (DBP) <90 mmHg; patients with diabetes mellitus and chronic kidney disease were excluded. A total of 15,846 patients were analysed. Among the various complications, hypercholesterolemia was the most frequent concomitant cardiovascular (CV) risk factor (48.1%), followed by obesity (16.3%). Associated clinical conditions were cerebrovascular diseases (9.6%), ischemic heart disease (7.9%) and left ventricular hypertrophy (4.6%). Total numbers of patients exhibiting any type of complications were 62% (≤64 years old), 69% (65-74 years old) and 67% (≥75 years old) (stratification of age). Mean SBP/DBP measurements (mm Hg) were 156/78 at the start, 140/72 at 1 month and 134/72 at 6 months. Blood pressure (BP) reductions associated with various diseases were similar among patients. Laboratory data including serum levels of total cholesterol, uric acid, hemoglobin A1c and serum potassium did not change during the study. Adverse effects such as orthostatic hypotension and considerable reductions in BP (>30 mmHg SBP) were rare. CONCLUSIONS Lo/HTCZ is safe and effective in reducing and improving BP control in a 'real world' setting. Treatment with Lo/HTCZ enabled a substantial proportion of hypertensive patients with associated diseases to achieve the recommended goal of <140 mm Hg.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Nephrology, Saitama Medical University 38 Morohonngo, Moroyama machi, Iruma gun, Saitama 350-0495, Japan
| | - Kazuyuki Shimada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Kalavagunta PK, Bagul PK, Jallapally A, Kantevari S, Banerjee SK, Ravirala N. Design and green synthesis of 2-(diarylalkyl)aminobenzothiazole derivatives and their dual activities as angiotensin converting enzyme inhibitors and calcium channel blockers. Eur J Med Chem 2014; 83:344-54. [DOI: 10.1016/j.ejmech.2014.06.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 01/17/2023]
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Lepièce B, Reynaert C, van Meerbeeck P, Lorant V. General practice and ethnicity: an experimental study of doctoring. BMC FAMILY PRACTICE 2014; 15:89. [PMID: 24884670 PMCID: PMC4101847 DOI: 10.1186/1471-2296-15-89] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/25/2014] [Indexed: 11/23/2022]
Abstract
Background There is extensive evidence of health inequality across ethnic groups. Inequity is a complex social phenomenon involving several underlying factors, including ethnic discrimination. In the field of health care, it has been established that ethnic discrimination stems partially from bias or prejudice on the part of doctors. Indeed, it has been hypothesized that patient ethnicity may affect doctors’ social cognition, thus modifying their social interactions and decision-making processes. General practitioners (GPs) are the primary access point to health care for ethnic minority groups. In this study, we examine whether patient ethnicity affects the relational and decisional features of doctoring. Methods The sample was made up of 171 Belgian GPs, who were each randomly allocated to one of two experimental conditions. One group were given a hypertension vignette case with a Belgian patient (non-minority patient), while the other group were given a hypertension vignette case with a Moroccan patient (minority patient). We evaluated the time devoted by GPs to examining medical history; time devoted by GPs to examining socio-relational history; cardiovascular risk assessments by GPs; electrocardiogram (ECG) recommendations by GPs, and drug prescriptions by GPs. Results We observed that for ethnic minority patients, GPs prescribed more drugs and devoted less time to examining socio-relational history. Neither cardiovascular risk assessments nor ECG recommendations were affected by patient ethnicity. GPs who were very busy devoted less time to examining medical history when dealing with minority patients. Conclusions We found no evidence that GPs discriminated against ethnic minority patients when it came to medical decisions. However, our study did identify a risk of drugs being used inappropriately in some ethnic-specific encounters. We also observed that, with ethnic minority patients, GPs engage less in the relational dimension of doctoring, particularly when working within a demanding environment. In general practice, the quality of the relationship between doctor and patient is an essential component of the effective management of chronic illness. Our research highlights the complexity of ethnic discrimination in general practice, and the need for further studies.
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Affiliation(s)
- Brice Lepièce
- Institute of Health and Society, Université Catholique de Louvain, Clos Chapelle-aux-Champs 30, box 3016-1200, Brussels, Belgium.
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Affiliation(s)
- Luis M Ruilope
- Instituto de Investigacion, Unidad de Hipertension, Hospital 12 de Octubre, Madrid, Spain
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26
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Fontil V, Pletcher MJ, Khanna R, Guzman D, Victor R, Bibbins-Domingo K. Physician underutilization of effective medications for resistant hypertension at office visits in the United States: NAMCS 2006-2010. J Gen Intern Med 2014; 29:468-76. [PMID: 24249113 PMCID: PMC3930772 DOI: 10.1007/s11606-013-2683-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 08/09/2013] [Accepted: 10/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The American Heart Association (AHA) published guidelines for treatment of resistant hypertension in 2008 recommending use of thiazide diuretics (particularly chlorthalidone), aldosterone antagonists, and fixed-dose combination medications, but it is unclear the extent to which these guidelines are being followed. OBJECTIVE To describe trends in physician use of recommended medications for resistant hypertension and assess variations in medication use based on geography, physician specialty and patient characteristics. DESIGN Cross-sectional analysis using the National Ambulatory Medical Care Survey from 2006 to 2010. STUDY SAMPLE We analyzed visits of hypertension patients to family physicians, general internists, and cardiologists. Resistant hypertension was defined as concurrent use of ≥ 4 classes of blood pressure (BP) medications or elevated BP despite the use of ≥ 3 medications. Pregnant patients and visits with diagnosed heart failure or end-stage renal disease were excluded. MAIN OUTCOME Use of AHA-recommended medications for management of resistant hypertension. RESULTS Of 19,500 patient visits with hypertension, 1,567 or 7.1 % CI (6.6-7.7 %) met criteria for resistant hypertension. Thiazide diuretic use was reported in 58.9 % of visits pre-guidelines vs. 54.8 % post-guidelines (p = 0.37). Use of aldosterone antagonists was low and also did not change significantly after guideline publication (3.1 % vs. 4.5 %, p = 0.27). Fixed-dose combinations use was 42.0 % before and 37 % after guideline publication (p = 0.29). Each 10-year increase in patient age was associated with lower thiazide use (OR 0.87, CI 0.77-0.97), as was presence of comorbid ischemic heart disease (OR 0.62, CI 0.41-0.94). Medication use did not vary by geography or physician specialty. CONCLUSION Use of AHA-recommended medications for resistant hypertension remains low after publication of guidelines. Healthcare systems should encourage more frequent prescribing of these medications to improve care in this high-risk population.
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Affiliation(s)
- Valy Fontil
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Omboni S, Malacco E, Mallion JM, Fabrizzi P, Volpe M. Olmesartan vs. ramipril in elderly hypertensive patients: review of data from two published randomized, double-blind studies. High Blood Press Cardiovasc Prev 2014; 21:1-19. [PMID: 24435506 DOI: 10.1007/s40292-013-0037-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/30/2013] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a frequent condition among individuals over 65 years of age worldwide and is one of the most important risk factors for cardiovascular (CV) disease. Effective drug treatment of elderly hypertensives is usually associated with a marked reduction in CV morbidity and mortality. Among the different classes of antihypertensive agents, angiotensin receptor blockers (ARBs) and ACE-inhibitors are supposed to provide the best efficacy in lowering blood pressure (BP) and protecting target organ damage while featuring a good tolerability profile. However, up to date, few randomized clinical studies have directly compared the activity and safety of ARBs and ACE-inhibitors in elderly hypertensive patients. Aim of this review of published and unpublished pooled data from two recent randomized, double-blind, controlled trials, is to offer a comprehensive head-to-head comparison of the antihypertensive efficacy of the ARB olmesartan medoxomil vs. the ACE-inhibitor ramipril in a large study population including more than 1,400 hypertensive subjects aged 65-89 years with mild-to-moderate essential hypertension. The efficacy of the two drugs was separately evaluated in subgroups of patients classified according to the presence of metabolic syndrome, reduced renal function, CV risk level, gender, class of age, type of arterial hypertension and previous antihypertensive treatments. Olmesartan showed a greater efficacy than ramipril both in terms of clinic BP reduction and rate normalization. Olmesartan appeared significantly superior to ramipril in providing a more homogeneous and long-lasting 24-h BP control and maintaining an effective antihypertensive action in the last 6-h period from drug intake. In subgroups of patients with additional clinical conditions, olmesartan gave comparable, and in some cases greater, BP responses than those achieved with the ACE-inhibitor. The incidence of adverse events was similar for both drugs. Olmesartan may thus represent an effective alternative to ACE-inhibitors among first-line drug treatments for hypertension in older people.
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Affiliation(s)
- Stefano Omboni
- Italian Institute of Telemedicine, Via Colombera 29, 21048, Solbiate Arno (Varese), Italy,
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Fernández-Musoles R, Castelló-Ruiz M, Arce C, Manzanares P, Ivorra MD, Salom JB. Antihypertensive mechanism of lactoferrin-derived peptides: angiotensin receptor blocking effect. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2014; 62:173-181. [PMID: 24354413 DOI: 10.1021/jf404616f] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Looking for antihypertensive mechanisms beyond ACE inhibition, we assessed whether lactoferrin (LF)-derived peptides can act as receptor blockers to inhibit vasoconstriction induced by angiotensin II or endothelin-1. The lactoferricin B (LfcinB)-derived peptide LfcinB20-25 (RRWQWR), the low molecular weight LF hydrolysate (LFH < 3 kDa), and two peptides identified in LFH < 3 kDa (LIWKL and RPYL) were tested in ex vivo assays of vasoactive responses. The peptide RPYL was tested in radioligand receptor binding assays. Both LFH < 3 kDa and individual peptides inhibited angiotensin II-induced vasoconstriction. RPYL showed the highest ex vivo inhibitory effect and also inhibited binding of [(125)I]-(Sar(1),Ile(8))-angiotensin II to AT1 receptors. By contrast, neither LFH < 3 kDa nor RPYL inhibited endothelin-1 and depolarization-induced vasoconstrictions. In conclusion, LF-derived peptides selectively inhibit angiotensin II-induced vasoconstriction by blocking angiotensin AT1 receptors. Therefore, inhibition of angiotensin II-induced vasocontriction is suggested as a mechanism contributing along with ACE inhibition to the antihypertensive effect of some LF-derived peptides.
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Affiliation(s)
- Ricardo Fernández-Musoles
- Departamento de Biotecnologı́a de Alimentos, Instituto de Agroquı́mica y Tecnologı́a de Alimentos, Consejo Superior de Investigaciones Científicas , Avenida Agustín Escardino 7, 46980 Paterna, Valencia, Spain
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Cerezo C, Muñiz L. Evolución de la enfermedad cardiorrenal bajo la supresión crónica del sistema renina-angiotensina. HIPERTENSION Y RIESGO VASCULAR 2014. [DOI: 10.1016/j.hipert.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Are we Evaluating Correctly the Risk Accompanying Blood Pressure? The Case of White Coat and Masked Hypertension and Blood Pressure Variability. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0360-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ruilope LM. Difficult-to-Control or Resistant Hypertension? CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0359-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lehmann M, Zeymer U, Dechend R, Kaiser E, Hagedorn I, Deeg E, Senges J, Schmieder R. Ambulatory blood pressure monitoring: Is it mandatory for blood pressure control in treated hypertensive patients? Int J Cardiol 2013; 168:2255-63. [DOI: 10.1016/j.ijcard.2013.01.209] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/18/2013] [Indexed: 12/31/2022]
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Affiliation(s)
- Luis M Ruilope
- Hypertension Unit, Hospital 12 de Octubre and Department of Preventive Medicine and Public Health, University Autonoma, Madrid, Spain
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Addla D, Jallapally A, Kanwal A, Sridhar B, Banerjee SK, Kantevari S. Design, synthesis and evaluation of novel 2-hydroxypyrrolobenzodiazepine-5,11-dione analogues as potent angiotensin converting enzyme (ACE) inhibitors. Bioorg Med Chem 2013; 21:4485-93. [DOI: 10.1016/j.bmc.2013.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/20/2013] [Accepted: 05/21/2013] [Indexed: 12/19/2022]
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Sierra C, Ruilope LM. [Effectiveness of antihypertensive treatment and control of blood pressure: is it improvable?]. Med Clin (Barc) 2013; 141:343-5. [PMID: 23831401 DOI: 10.1016/j.medcli.2013.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/12/2013] [Accepted: 04/18/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Cristina Sierra
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, España
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Segura J, Salazar J, Ruilope LM. Dual neurohormonal intervention in CV disease: angiotensin receptor and Neprilysin inhibition. Expert Opin Investig Drugs 2013; 22:915-25. [PMID: 23731190 DOI: 10.1517/13543784.2013.797962] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Cardiovascular disease is the leading cause of death worldwide, accounting for 30% of all deaths, with elevated blood pressure probably the most important modifiable risk factor. Worldwide, elevated blood pressure is estimated to cause 7.5 million deaths, about 12.8% of the total of all annual deaths. New drugs with different efficacy and effectiveness to control cardiovascular and renal disease are always welcomed. AREAS COVERED Adequate control of arterial hypertension is needed in order to reduce the consequences of cardiovascular and renal disease. A novel compound, LCZ696 , is currently in development based on the concept of comprising in the same entity a Neprilysin inhibitor, with a renin-angiotensin-aldosterone system inhibitor, in this case an angiotensin receptor blocker. This review, performed in PubMed including the last five years under the keywords cited below, presents the available data about LCZ696, the first-in-class angiotensin receptor Neprilysin inhibitor. EXPERT OPINION Available data show that positive efficacy and a good tolerability profile of LCZ696 in the treatment of arterial hypertension as well as preliminary data indicate that it can also be useful in the treatment of cardiovascular disease. These data are particularly promising in the treatment of arterial hypertension.
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Affiliation(s)
- Julian Segura
- Hospital 12 de Octubre, Department of Nephrology, Hypertension Unit , Av. Córdoba s/n, 28041 Madrid, Spain
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Xu T, Zhang Y, Tan X. Estimate of nocturnal blood pressure and detection of non-dippers based on clinical or ambulatory monitoring in the inpatient setting. BMC Cardiovasc Disord 2013; 13:37. [PMID: 23692688 PMCID: PMC3665662 DOI: 10.1186/1471-2261-13-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/17/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ambulatory blood pressure monitoring is regarded as the gold standard for monitoring nocturnal blood pressure (NBP) and is usually performed out of office. Currently, a novel method for monitoring NBP is indispensible in the inpatient setting. The widely used manual BP monitoring procedure has the potential to monitor NBP in the hospital setting. The feasibility and accuracy of manual sphygmomanometer to monitor NBP has not been explored widely. METHODS A cross-sectional study was conducted at the cardiology department of a university-affiliated hospital to study patients with mild-to-moderate essential hypertension. One hundred and fifty-five patients were recruited to compare BP derived from a manual device and ambulatory BP monitoring (ABPM). The manual BP measurement was performed six times at 22:00, 02:00, 06:00, 10:00, 14:00 and 18:00 h. The measurements at 22:00, 02:00 and 06:00 h were defined as night-time and the others as daytime. ABPM was programmed to measure at 30-min intervals between measurements. RESULTS All-day, daytime and night-time BP did not differ significantly from 24-h ambulatory systolic BP [all-day mean difference -0.52±4.67 mmHg, 95% confidence interval (CI) -1.26 to 0.22, P=0.168; daytime mean difference 0.24±5.45 mmHg, 95% CI -0.62 to 1.11, P=0.580; night-time mean difference 0.30±7.22 mmHg, 95% CI -0.84 to 1.45, P=0.601) rather than diastolic BP. There was a strong correlation between clinical and ambulatory BP for both systolic and diastolic BP. On the basis of ABPM, 101 (65%) patients were classified as non-dippers, compared with 106 (68%) by manual sphygmomanometer (P<0.001). CONCLUSIONS Traditional manual sphygmomanometer provides similar daytime and night-time systolic BP measurements in hospital. Moreover, the detection of non-dippers by manual methods is in good agreement with 24-h ABPM. Further studies are required to confirm the clinical relevance of these findings by comparing the association of NBP in the hospital ward assessed by manual monitoring with preclinical organ damage and cardiovascular and cerebrovascular outcomes.
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Affiliation(s)
- Tan Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
| | - Yongqing Zhang
- Department of Cardiology, Peoples’ Hospital of SanYan, SanYan, Hainan 572000, China
| | - Xuerui Tan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515041, China
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Abstract
Resistant hypertension is highly prevalent, and is the form of arterial hypertension that is most difficult to treat. Many patients diagnosed with this disease do not have resistant hypertension, but rather have mismanaged primary hypertension. In many cases blood pressure can be controlled by directly addressing underlying causes such as primary aldosteronism, obstructive sleep apnoea, or excessive neurogenic stimulation. Clinicians should ensure that appropriate blood-pressure measurements are used to diagnose resistant hypertension, explore a variety of drug combinations, and battle clinical inertia. Patients should comply with medication schedules and dietary modifications. Correction of these factors will greatly diminish the prevalence of 'resistant' hypertension and avoid the consequences of a persistently elevated blood pressure in these patients.
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Malacco E, Omboni S, Mallion JM, Volpe M. Antihypertensive Efficacy of Olmesartan Medoxomil and Ramipril in Elderly Patients with Mild to Moderate Hypertension Grouped According to Renal Function Status. High Blood Press Cardiovasc Prev 2012; 19:213-22. [DOI: 10.1007/bf03297633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022] Open
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Abstract
Azilsartan medoxomil (Edarbi®; Ipreziv™) is an orally administered angiotensin II receptor type 1 antagonist (blocker) used in the treatment of adults with essential hypertension. This article reviews data on the clinical efficacy and tolerability of azilsartan medoxomil in adults with essential hypertension and provides a summary of its pharmacological properties. Azilsartan medoxomil is a prodrug that undergoes rapid hydrolysis in the gastrointestinal tract after oral administration to the bioactive moiety azilsartan, before systemic absorption. Azilsartan medoxomil produces antihypertensive effects by selectively blocking the binding of angiotensin II to the angiotensin type 1 (AT(1)) receptor, thereby antagonizing the pressor response activity of angiotensin II. In vitro, azilsartan produced greater and more sustained AT(1) receptor binding/blockade activity than several comparator angiotensin II receptor antagonists. Azilsartan medoxomil reduces blood pressure (BP) in hypertensive adults. In addition, the drug has been shown to have pleiotropic effects (i.e. effects beyond AT(1) receptor blockade). In adults with essential hypertension, azilsartan medoxomil 20, 40 or 80 mg effectively reduced BP over a 24-hour period with once-daily administration in three major, randomized, controlled trials in which the primary endpoints were changes from baseline in 24-hour mean systolic BP (SBP) at week 6 (two trials) or week 24, assessed by ambulatory BP monitoring (ABPM). In the two 6-week trials, azilsartan medoxomil showed dose-dependent efficacy over all evaluated dosages and was more effective than placebo in lowering SBP. At the maximum approved dosage of 80 mg once daily, azilsartan medoxomil was significantly more effective than maximum dosages of olmesartan medoxomil (40 mg once daily) or valsartan (320 mg once daily), based on primary endpoint assessments. Mean reductions in clinic measurements of SBP and diastolic BP (DBP) measurements were also generally greater with azilsartan medoxomil 80 mg once daily than with the comparator drugs in these 6-week studies. Over a longer treatment period of 24 weeks, azilsartan medoxomil showed sustained BP-lowering efficacy, with the reduction in 24-hour mean SBP at week 24 significantly greater with azilsartan medoxomil 40 or 80 mg once daily than with valsartan 320 mg once daily. Mean reductions from baseline in mean clinic SBP and DBP as well as DBP by ABPM were also significantly greater with azilsartan medoxomil 40 or 80 mg once daily than with valsartan. Azilsartan medoxomil was generally well tolerated, with a tolerability profile similar to that of placebo in the 6-week trials. Across the three major trials, headache and dizziness were among the most common adverse events. Overall, rates of treatment discontinuation as a result of adverse events were low in the 6-week and 24-week trials. In conclusion, once-daily azilsartan medoxomil effectively lowers BP in adults with essential hypertension and has shown better antihypertensive efficacy than maximum therapeutic dosages of olmesartan medoxomil or valsartan in major trials of up to 24 weeks' duration. Azilsartan medoxomil is generally well tolerated and the low rates of discontinuation due to adverse events suggest that patients are likely to persist with long-term treatment. Azilsartan medoxomil is therefore a useful and attractive new option for lowering BP in patients with essential hypertension, particularly for those not able to tolerate other antihypertensive drugs. Further studies are required to evaluate the effects of azilsartan medoxomil on cardiovascular morbidity and mortality.
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Lyamina NP, Smith ML, Lyamina SV, Manukhina EB, Senchikhin VN, Pacchia CF, Downey HF. Pressor response to 30-s breathhold: A predictor of masked hypertension. Blood Press 2012; 21:372-6. [DOI: 10.3109/08037051.2012.694213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Segura J, Ruilope L. Presión arterial medida en la consulta y presión arterial real. ¿Son similares? HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2011.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sarafidis PA, Ruilope LM. Cardiorenal disease development under chronic renin–angiotensin–aldosterone system suppression. J Renin Angiotensin Aldosterone Syst 2012; 13:217-9. [DOI: 10.1177/1470320312439140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Drugs suppressing the renin-angiotensin-aldosterone system (RAAS) are now widely used to treat patients all along the cardiorenal continuum. It supposes that many patients, in particular those with arterial hypertension are treated with converting-enzyme inhibitors and angiotensin receptor blockers for years during which the development and prograssion of cardiorenal disease can be observed. The meaning of this progression in the presence of RAAS suppression requires to be clarified and to be treated in order to diminish the velocity of progression of cardiorenal disease.
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Affiliation(s)
| | - Luis M Ruilope
- Hypertension Unit, Hospital 12 de Octubre and Department of Preventive Medicine and Public Health, University Autonoma, Madrid, Spain
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