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Wang Y, Smolinski NE, Ewig C, Thai TN, Wen TS, Winterstein AG. Antihypertensive utilization patterns among pregnant persons with pre-existing hypertension in the US: A population-based study. PLoS One 2024; 19:e0306547. [PMID: 38959230 PMCID: PMC11221741 DOI: 10.1371/journal.pone.0306547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Hypertension among persons with childbearing potential is on the rise. Maintaining proper blood pressure during pregnancy is vital to prevent maternal and neonatal complications. Yet, limited evidence on the risk-benefit of various antihypertensives presents challenges for informed decision-making during this critical period. This study aimed to examine the utilization patterns of different classes of antihypertensives among persons with pre-existing hypertension before, during, and after pregnancy. METHODS We used MarketScan® Commercial Database 2011-2020 to analyze antihypertensive utilization among pregnant persons aged 12 to 55 identified via a validated algorithm. Pre-existing hypertension was defined as ≥1 inpatient or ≥2 outpatient encounters for hypertension within the 180 days preceding the LMP. Antihypertensive utilization was described during target periods: 0-3 months (0-3M) before pregnancy, 1st/2nd/3rd trimester (T1/2/3), 0-3M, and 4-6M after pregnancy. RESULTS We identified 1,950,292 pregnancies, of which 20,576 (12,978 live and 7,598 non-live) had pre-existing hypertension. Both groups had similar antihypertensive use (80.1% and 81.0%, respectively) during the 6 months before pregnancy (baseline). For live-birth pregnancies, 13.9% of baseline users discontinued treatment during pregnancy, while 28.9% of non-users initiated antihypertensives during pregnancy, and 17.2% started postpartum. Before pregnancy, the predominant antihypertensives included thiazide diuretics (21.9%), combined α- and β-blockers (18.4%), and dihydropyridines (16.2%). During pregnancy, thiazide diuretics, cardioselective β-blockers, and ACE inhibitors declined (T3: 3.0%, 4.2%, and 0.8%). Dihydropyridine use was steady during pregnancy, but preference shifted from amlodipine to nifedipine in T3 (2.2.% vs.10.8%). Central α2-agonists increased during pregnancy (up to 15.2% in T3) compared to both pre- (9.8%) and post-pregnancy (5.7%). ARBs mirrored ACE inhibitors, with less than 1% utilization in later trimesters. Combination agents dropped from 10.8% pre-pregnancy to 0.8% in T3, then rebounded to 7.3% post-pregnancy. CONCLUSION Research is warranted to evaluate the choice of antihypertensives and optimal timing to switch to safer alternatives, considering maternal and fetal outcomes.
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Affiliation(s)
- Yanning Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States of America
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, United States of America
| | - Nicole E. Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, United States of America
| | - Celeste Ewig
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, United States of America
| | - Thuy Nhu Thai
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Tony S. Wen
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, United States of America
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
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Cheng N, Wang L, Liu Y, Song B, Ding C. HANSynergy: Heterogeneous Graph Attention Network for Drug Synergy Prediction. J Chem Inf Model 2024; 64:4334-4347. [PMID: 38709204 PMCID: PMC11135324 DOI: 10.1021/acs.jcim.4c00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
Drug synergy therapy is a promising strategy for cancer treatment. However, the extensive variety of available drugs and the time-intensive process of determining effective drug combinations through clinical trials pose significant challenges. It requires a reliable method for the rapid and precise selection of drug synergies. In response, various computational strategies have been developed for predicting drug synergies, yet the exploitation of heterogeneous biological network features remains underexplored. In this study, we construct a heterogeneous graph that encompasses diverse biological entities and interactions, utilizing rich data sets from sources, such as DrugCombDB, PubChem, UniProt, and cancer cell line encyclopedia (CCLE). We initialize node feature representations and introduce a novel virtual node to enhance drug representation. Our proposed method, the heterogeneous graph attention network for drug-drug synergy prediction (HANSynergy), has been experimentally validated to demonstrate that the heterogeneous graph attention network can extract key node features, efficiently harness the diversity of information, and further enhance network functionality through the incorporation of a multihead attention mechanism. In the comparative experiment, the highest accuracy (Acc) and area under the curve (AUC) are 0.877 and 0.947, respectively, in DrugCombDB_early data set, demonstrating the superiority of HANSynergy over the competing methods. Moreover, protein-protein interactions are important in understanding the mechanism of action of drugs. The heterogeneous attention mechanism facilitates protein-protein interaction analysis. By analyzing the changes of attention weight before and after heterogeneous network training, we investigated proteins that may be associated with drug combinations. Additionally, case studies align our findings with existing research, underscoring the potential of HANSynergy in drug synergy prediction. This advancement not only contributes to the burgeoning field of drug synergy prediction but also holds the potential to provide valuable insights and uncover new drug synergies for combating cancer.
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Affiliation(s)
- Ning Cheng
- School
of Informatics, Hunan University of Chinese
Medicine, Changsha, Hunan 410208, China
| | - Li Wang
- Degree
Programs in Systems and information Engineering, University of Tsukuba, Tsukuba, Ibaraki 305-8577, Japan
| | - Yiping Liu
- College
of Information Science and Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Bosheng Song
- College
of Information Science and Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Changsong Ding
- School
of Informatics, Hunan University of Chinese
Medicine, Changsha, Hunan 410208, China
- Big
Data Analysis Laboratory of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
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Hypertension in Cancer Survivors. Curr Hypertens Rep 2022; 24:435-443. [PMID: 35852781 DOI: 10.1007/s11906-022-01208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
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Hawlitschek C, Brendel J, Gabriel P, Schierle K, Salameh A, Zimmer HG, Rassler B. Antihypertensive and cardioprotective effects of different monotherapies and combination therapies in young spontaneously hypertensive rats - A pilot study. Saudi J Biol Sci 2022; 29:339-345. [PMID: 35002427 PMCID: PMC8716903 DOI: 10.1016/j.sjbs.2021.08.093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 11/03/2022] Open
Abstract
Spontaneously hypertensive rats (SHR) are an established animal model for antihypertensive treatment. The aim of this pilot study was a systematic search for two lines of antihypertensive treatment - a monotherapy and a combination of two drugs - to be applied in a future study on old SHR. Originally, representatives of three drug classes recommended for antihypertensive therapy in humans should be applied, namely captopril (CAP) as an antagonist of the renin-angiotensin-aldosterone system, nifedipine (NIF) as calcium channel blocker and propranolol (PROP) as β-adrenergic blocker. As we observed that PROP had been poorly ingested, all groups with PROP therapy were excluded from the study. CAP (60 mg kg-1 d-1), NIF (10 mg kg-1 d-1) or both were administered orally to seven-week-old SHR over 3 weeks. A further group of SHR received no treatment (SHR/CTRL). Age-matched normotensive Wistar-Kyoto rats served as normotensive controls. We examined the effect of the antihypertensive therapies on systolic blood pressure, heart weight and on histological and biochemical markers of cardiac hypertrophy and fibrosis. CAP proved to be the most effective treatment reducing blood pressure and relative heart weight significantly compared to SHR/CTRL without reaching normotensive values. Beginning cardiac fibrosis observed in SHR/CTRL was completely abrogated with CAP treatment. Similar effects were achieved with a combination of CAP and NIF. CAP as monotherapy and CAP + NIF as combination therapy were chosen for the forthcoming study on old SHR.
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Affiliation(s)
- Christina Hawlitschek
- University of Leipzig, Faculty of Medicine, Carl-Ludwig-Institute of Physiology, Liebigstrasse 27, Leipzig, Germany
| | - Julia Brendel
- University of Leipzig, Faculty of Medicine, Carl-Ludwig-Institute of Physiology, Liebigstrasse 27, Leipzig, Germany
| | - Philipp Gabriel
- University of Leipzig, Faculty of Medicine, Carl-Ludwig-Institute of Physiology, Liebigstrasse 27, Leipzig, Germany
| | - Katrin Schierle
- University of Leipzig, Faculty of Medicine, Institute of Pathology, Liebigstrasse 26, Leipzig, Germany
| | - Aida Salameh
- University of Leipzig, Faculty of Medicine, Heart Centre, Department of Pediatric Cardiology, Strümpellstrasse 39, Leipzig, Germany
| | - Heinz-Gerd Zimmer
- University of Leipzig, Faculty of Medicine, Carl-Ludwig-Institute of Physiology, Liebigstrasse 27, Leipzig, Germany
| | - Beate Rassler
- University of Leipzig, Faculty of Medicine, Carl-Ludwig-Institute of Physiology, Liebigstrasse 27, Leipzig, Germany
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Dhungana RR, Pedisic Z, Pandey AR, Shrestha N, de Courten M. Barriers, Enablers and Strategies for the Treatment and Control of Hypertension in Nepal: A Systematic Review. Front Cardiovasc Med 2021; 8:716080. [PMID: 34708082 PMCID: PMC8542767 DOI: 10.3389/fcvm.2021.716080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Understanding country-specific factors influencing hypertension care is critical to address the gaps in the management of hypertension. However, no systematic investigation of factors influencing hypertension treatment and control in Nepal is available. This study aimed to systematically review the published literature and synthesise the findings on barriers, enablers, and strategies for hypertension treatment and control in Nepal. Methods: Embase, PubMed, Web of Science, CINAHL, ProQuest and WorldCat, and Nepali journals and government websites were searched for qualitative, quantitative, and mixed-methods studies on factors or strategies related to hypertension treatment and control in Nepal. Information from qualitative studies was analysed using template analysis, while results from quantitative studies were narratively synthesised. Summary findings were framed under “health system”, “provider”, and “patient” domains. The protocol was registered in PROSPERO (registration number: CRD42020145823). Results: We identified 15 studies; ten related to barriers and enablers and five to strategies. The identified barriers associated with the health system were: lack of affordable services and lack of resources. The barriers at the provider's level were: communication gaps, inadequate counselling, long waiting hours for appointments, lack of national guidelines for hypertension treatment, and provider's unsupportive behaviours. Non-adherence to medication, irregular follow-up visits, lack of awareness on blood pressure target, poor help-seeking behaviours, reluctance to change behaviours, perceived side-effects of anti-hypertensive medication, self-medication, lack of family support, financial hardship, lack of awareness on blood pressure complications, and comorbidity were barriers identified at patient level. The following enablers were identified: free essential health care services, family support, positive illness perception, and drug reminders. Strategies implemented at the health system, provider and patient levels were: establishing digital health records at health centres, health worker's capacity development, and health education. Conclusion: There is a range of barriers for hypertension treatment and control in Nepal pertaining to the health system, health providers, and patients. Comprehensive interventions are needed at all three levels to further improve management and control of hypertension in Nepal.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | | | - Nipun Shrestha
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.,Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Maximilian de Courten
- Mitchell Institute for Education and Health Policy, Victoria University, Melbourne, VIC, Australia
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Wu T, Zheng L, Zhang S, Duan L, Ma J, Zha L, Li L. Left ventricular long-axis ultrasound strain (GLS) is an ideal indicator for patients with anti-hypertension treatment. Clin Exp Hypertens 2021; 44:20-25. [PMID: 34523366 DOI: 10.1080/10641963.2021.1969663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Primary hypertension is one of the most well-known risk factors for cardiovascular disease. Currently, there is still no ideal indicator for left ventricular end-diastolic pressure. METHODS 73 hypertension patients and 37 healthy people were enrolled in this study. Each member was examined with conventional echocardiography including multiple indicators such as Peak mitral valve flow velocity (E, A), E/A, left atrial volume index (LAVl), tissue Doppler (PW-TDI) peak velocities during early and late diastolic mitral valve flow (e '), E/e ', and GLS. We have collected clinical data from all enrolled members. The above cardiac ultrasound indicators were obtained before the antihypertensive treatment, one month and three months after treatment. RESULTS Left ventricular end-diastolic pressure (LVEDP) was positively correlated and negatively correlated with GLS (r = 0.638, P < .01) and E/e' (r = -0.578, P < .05), respectively. The hypertensives had lower e' value and higher values of GLS, E/e', and LAVI than the control group (P < .05). GLS and E/e' were significantly lower in hypertension group than those in the Control group after one month and three months of treatment (P < .05). The improvement rate of GLS was significantly higher than those in the improvement rate of e', E/e', LAVI after treatment (p < .05). CONCLUSION The GLS improvement rate was significantly higher than those of e', E/e' after one and three-month treatment. Therefore, GLS might be a potential ideal index for patients with anti-hypertension treatment. The results obtained in this study provide useful information for further study.
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Affiliation(s)
- Tingting Wu
- Department of Cardiovascular, Xiangya Hospital of Central South University, Changsha, China
| | - Lulu Zheng
- Department of Cardiovascular, Xiangya Hospital of Central South University, Changsha, China
| | - Saidan Zhang
- Department of Cardiovascular, Xiangya Hospital of Central South University, Changsha, China
| | - Lan Duan
- Department of Cardiovascular, Xiangya Hospital of Central South University, Changsha, China
| | - Jing Ma
- Department of Cardiovascular, Xiangya Hospital of Central South University, Changsha, China
| | - Lihuang Zha
- Department of Cardiovascular, Xiangya Hospital of Central South University, Changsha, China
| | - Lingfang Li
- Department of Cardiovascular, Xiangya Hospital of Central South University, Changsha, China
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7
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Mazurek P, Yuusuf NA, Silau H, Mordhorst H, Pamp SJ, Brook MA, Skov AL. Simultaneous delivery of several antimicrobial drugs from multi‐compartment glycerol‐silicone membranes. J Appl Polym Sci 2021. [DOI: 10.1002/app.50780] [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)
- Piotr Mazurek
- Danish Polymer Centre, Department of Chemical Engineering Technical University of Denmark Kongens Lyngby Denmark
| | - Nuura A. Yuusuf
- Research Group for Genomic Epidemiology National Food Institute, Technical University of Denmark Kongens Lyngby Denmark
| | - Harald Silau
- Danish Polymer Centre, Department of Chemical Engineering Technical University of Denmark Kongens Lyngby Denmark
| | - Hanne Mordhorst
- Research Group for Genomic Epidemiology National Food Institute, Technical University of Denmark Kongens Lyngby Denmark
| | - Sünje J. Pamp
- Research Group for Genomic Epidemiology National Food Institute, Technical University of Denmark Kongens Lyngby Denmark
| | - Michael A. Brook
- Department of Chemistry and Chemical Biology McMaster University Hamilton Ontario Canada
| | - Anne L. Skov
- Danish Polymer Centre, Department of Chemical Engineering Technical University of Denmark Kongens Lyngby Denmark
- Glysious, R&D Kongens Lyngby Denmark
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Loganathan L, Gopinath K, Sankaranarayanan VM, Kukreti R, Rajendran K, Lee JK, Muthusamy K. Computational and Pharmacogenomic Insights on Hypertension Treatment: Rational Drug Design and Optimization Strategies. Curr Drug Targets 2019; 21:18-33. [DOI: 10.2174/1389450120666190808101356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
Background::
Hypertension is a prevalent cardiovascular complication caused by genetic
and nongenetic factors. Blood pressure (BP) management is difficult because most patients become
resistant to monotherapy soon after treatment initiation. Although many antihypertensive drugs are
available, some patients do not respond to multiple drugs. Identification of personalized antihypertensive
treatments is a key for better BP management.
Objective::
This review aimed to elucidate aspects of rational drug design and other methods to develop
better hypertension management.
Results::
Among hypertension-related signaling mechanisms, the renin-angiotensin-aldosterone system
is the leading genetic target for hypertension treatment. Identifying a single drug that acts on multiple
targets is an emerging strategy for hypertension treatment, and could be achieved by discovering new
drug targets with less mutated and highly conserved regions. Extending pharmacogenomics research
to include patients with hypertension receiving multiple antihypertensive drugs could help identify the
genetic markers of hypertension. However, available evidence on the role of pharmacogenomics in
hypertension is limited and primarily focused on candidate genes. Studies on hypertension pharmacogenomics
aim to identify the genetic causes of response variations to antihypertensive drugs. Genetic
association studies have identified single nucleotide polymorphisms affecting drug responses. To understand
how genetic traits alter drug responses, computational screening of mutagenesis can be utilized
to observe drug response variations at the protein level, which can help identify new inhibitors
and drug targets to manage hypertension.
Conclusions::
Rational drug design facilitates the discovery and design of potent inhibitors. However,
further research and clinical validation are required before novel inhibitors can be clinically used as
antihypertensive therapies.
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Affiliation(s)
| | - Krishnasamy Gopinath
- Department of Chemical Engineering, Konkuk University, 1 Hwayang-Dong, Gwangjin-Gu, Seoul, Korea
| | | | - Ritushree Kukreti
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, New Delhi, India
| | - Kannan Rajendran
- Department of General Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Jung-Kul Lee
- Department of Chemical Engineering, Konkuk University, 1 Hwayang-Dong, Gwangjin-Gu, Seoul, Korea
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Du Z, Bian W, Wu S, Gao B, Sun Y, Kang Z, Zhang X. Effects of blood pressure goals on cardiovascular outcomes in hypertensive patients. Arch Med Sci 2019; 15:1381-1387. [PMID: 31749865 PMCID: PMC6855153 DOI: 10.5114/aoms.2018.80013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 11/02/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The aim of the study was to evaluate the effects of blood pressure (BP) goals on cardiovascular outcomes in hypertensive patients. MATERIAL AND METHODS Primary hypertensive patients were retrospectively enrolled from outpatient clinics. The demographics, comorbidities, laboratory parameters and glomerular filtration rate (GFR) were collected. All participants were followed for 1 year. Cardiovascular outcomes included composite of all-cause mortality, non-fatal myocardial infarction, and non-fatal ischemic stroke/transient ischemic attack. Adverse event was defined as falling down and GFR decrease at follow-up. RESULTS A total of 1226 patients were included. Based on therapeutic BP goals, participants were divided into low (< 130/80 mm Hg) and high (< 140/90 mm Hg) therapeutic goal groups and an uncontrolled hypertension (≥ 140/90 mm Hg) group. Compared to the low therapeutic goal group, patients in the uncontrolled group were older and more likely to be smokers, have longer duration of hypertension, diabetes mellitus, lower GFR and higher prevalent ischemic stroke (p < 0.05). Patients in the uncontrolled hypertension group had higher incidence of composite endpoints than low and high therapeutic goal groups. Two cases of falling down were observed in the low therapeutic goal group and no significant changes in GFR were observed. With adjustment for confounding factors, the uncontrolled hypertension group had higher risk of composite endpoints compared to low and high therapeutic goal groups, and these benefits were more prominent in the low versus high therapeutic goal group. CONCLUSIONS In hypertension patients, when compared to uncontrolled hypertension patients, low therapeutic BP goal is associated with better cardiovascular outcomes than high therapeutic BP goal.
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Affiliation(s)
- Zonglei Du
- Department of Cardiovascular Medicine, Zouchen People’s Hospital, Zouchen, China
| | - Weishi Bian
- Department of Cardiovascular Medicine, The Third People’s Hospital of Linyi, Linyi, China
| | - Shanxia Wu
- Department of Cardiovascular Medicine, The Third People’s Hospital of Linyi, Linyi, China
| | - Bingfeng Gao
- Department of Cardiovascular Medicine, The Third People’s Hospital of Linyi, Linyi, China
| | - Yanfang Sun
- Department of Cardiovascular Medicine, The Third People’s Hospital of Linyi, Linyi, China
| | - Zhenxing Kang
- Department of Cardiovascular Medicine, The Third People’s Hospital of Linyi, Linyi, China
| | - Xianchao Zhang
- Department of Cardiovascular Medicine, Linyi People’s Hospital, Linyi, China
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Wang T, Liu XH, Guan J, Ge S, Wu MB, Lin JP, Yang LR. Advancement of multi-target drug discoveries and promising applications in the field of Alzheimer's disease. Eur J Med Chem 2019; 169:200-223. [PMID: 30884327 DOI: 10.1016/j.ejmech.2019.02.076] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/12/2019] [Accepted: 02/28/2019] [Indexed: 12/22/2022]
Abstract
Complex diseases (e.g., Alzheimer's disease) or infectious diseases are usually caused by complicated and varied factors, including environmental and genetic factors. Multi-target (polypharmacology) drugs have been suggested and have emerged as powerful and promising alternative paradigms in modern medicinal chemistry for the development of versatile chemotherapeutic agents to solve these medical challenges. The multifunctional agents capable of modulating multiple biological targets simultaneously display great advantages of higher efficacy, improved safety profile, and simpler administration compared to single-targeted agents. Therefore, multifunctional agents would certainly open novel avenues to rationally design the next generation of more effective but less toxic therapeutic agents. Herein, the authors review the recent progress made in the discovery and design processes of selective multi-targeted agents, especially the successful application of multi-target drugs for the treatment of Alzheimer's disease.
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Affiliation(s)
- Tao Wang
- School of Biological Science, Jining Medical University, Jining, China; Key Laboratory of Biomass Chemical Engineering of Ministry of Education, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China.
| | - Xiao-Huan Liu
- School of Biological Science, Jining Medical University, Jining, China
| | - Jing Guan
- School of Biological Science, Jining Medical University, Jining, China
| | - Shun Ge
- School of Biological Science, Jining Medical University, Jining, China.
| | - Mian-Bin Wu
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China; Zhejiang Key Laboratory of Antifungal Drugs, Taizhou, 318000, China
| | - Jian-Ping Lin
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Li-Rong Yang
- Key Laboratory of Biomass Chemical Engineering of Ministry of Education, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, 310027, China
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Moya L, Moreno J, Lombo M, Guerrero C, Aristizábal D, Vera A, Melgarejo E, Conta J, Gómez C, Valenzuela D, Ángel M, Achury H, Duque R, Triana Á, Gelves J, Pinzón A, Caicedo A, Cuéllar C, Sandoval J, Pérez J, Rico-Mendoza A, Porras-Ramírez A. Consenso de expertos sobre el manejo clínico de la hipertensión arterial en Colombia. Sociedad Colombiana de Cardiología y Cirugía. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Lopatowska P, Mlodawska E, Tomaszuk-Kazberuk A, Banach M, Malyszko J. Adhering to the principles of clinical pharmacology - the correct fixed combinations of antihypertensive drugs. Expert Rev Clin Pharmacol 2017; 11:165-170. [PMID: 29192802 DOI: 10.1080/17512433.2018.1412826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Hypertension is one of the primary modifiable risk factor for cardiac and renal diseases with the prevalence around 30-45% of the general population, with a steep increase with ageing. The administration of blood pressure-lowering drugs is to reduce the risk of major clinical cardiovascular outcomes. Hypertension guidelines recommend combination therapy in patients with high cardiovascular risk and with subclinical organ damage as well as when monotherapy fails. Areas covered: As the etiology of essential hypertension is multifactorial, combination therapy using different classes of antihypertensive agents have greater effect than each on its own (synergistic effect), may have better tolerability (two components minimizing each other's side effects) and lead to improved patient compliance. Several studies assess the hypotensive efficacy on drug combination; there are also studies on triple drug combination. Expert commentary: At present, dual and triple combination therapy is available to hypertensive patients with good clinical outcomes, compliance and low profile of side effects. It is critical as patients' adherence to the pharmacological therapy significantly decreases the risk of long-term adverse events including mortality. It appears that combinations not only of hypotensive drugs but also with statins (as well as antidiabetics) will be widely used.
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Affiliation(s)
- Paulina Lopatowska
- a Department of Cardiology , Medical University in Bialystok , Bialystok , Poland
| | - Elzbieta Mlodawska
- a Department of Cardiology , Medical University in Bialystok , Bialystok , Poland
| | | | - Maciej Banach
- b Department of Hypertension , WAM University Hospital in Lodz, Medical University of Lodz (MUL) , Lodz , Poland.,c Polish Mother's Memorial Hospital Research Institute (PMMHRI) , Lodz , Poland.,d Cardiovascular Research Centre , University of Zielona Gora , Zielona Gora , Poland
| | - Jolanta Malyszko
- e 2nd Department of Nephrology and Hypertension with Dialysis Unit , Medical University in Bialystok , Bialystok , Poland
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14
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Li D, Xu S, Wang Y, Li D, Li X, Pan J, Xu P. Pharmacokinetics and drug-drug interaction between enalapril, enalaprilat and felodipine extended release (ER) in healthy subjects. Oncotarget 2017; 8:70752-70760. [PMID: 29050316 PMCID: PMC5642591 DOI: 10.18632/oncotarget.19984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Since angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists have complimentary mechanisms of action, enalapril, an ACE inhibitor, is used in combination with felodipine, a vascular selective dihydropyridine calcium antagonist, for the treatment of hypertension. The present study was designed to investigate the possible drug-drug interaction between these two agents in Chinese healthy subjects. A randomized, open-label, multiple-dose, 3-treatment, 3-period, 6-sequence cross-over study enrolling 12 healthy subjects (six male and six female subjects) was performed. Plasma pharmacokinetic studies were performed after 5 mg of enalapril and 5 mg of felodipine were administered alone or concomitantly twice per day for six days, and once in the morning of day seven. All 12 healthy subjects (mean [SD] age, 24.3 [2.8] years; body weight, 57.3 [5.7] kg; height, 163.2 [5.2] cm) completed all scheduled pharmacokinetic studies. Geometric mean ratios (with 90% CIs) of AUCτ,ss and Cmax,ss for enalapril administered concomitantly with felodipine vs. enalapril administered alone were 1.025 (0.80-1.25) and 1.065 (0.70-1.43), respectively. Geometric mean ratios (with 90% CIs) of AUCτ,ss and Cmax,ss for felodipine administered concomitantly with enalapril vs. felodipine administered alone were 1.14 (0.97-1.31) and 0.80 (0.65-0.95), respectively. There were no severe or serious drug-related adverse events observed during the study. Our results revealed that the co-administration of enalapril and felodipine affected the pharmacokinetics of felodipine, but not that of enalapril. Although the difference in PK parameters was statistically significant, its clinical significance may be limited, considering safety profile observed in the present study.
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Affiliation(s)
- Dai Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Sumei Xu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yulu Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Dan Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaomin Li
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jing Pan
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Pingsheng Xu
- National Institution of Drug Clinical Trial, Xiangya Hospital, Central South University, Changsha 410008, China
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