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Takami T, Hoshide S, Kario K. Differential impact of antihypertensive drugs on cardiovascular remodeling: a review of findings and perspectives for HFpEF prevention. Hypertens Res 2022; 45:53-60. [PMID: 34621033 DOI: 10.1038/s41440-021-00771-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 12/24/2022]
Abstract
Heart failure (HF) is an important health problem worldwide whose stages have traditionally been classified from A to D. In addition, HF can be categorized as that with preserved ejection fraction (HFpEF) and that with reduced ejection fraction (HFrEF). Hypertension and arterial stiffness in stage A HF are major drivers of the progression to left ventricular hypertrophy (LVH), a criterion of stage B HF. Although the pathogenesis of HFpEF is heterogeneous, affected patients tend to be older than HFrEF patients and have a greater prevalence of hypertension, which is closely associated with arterial stiffness and LVH. Thus, to treat HFpEF, the optimal intervention for improving prognosis is an aggressive approach to early-stage, i.e., Stage A and B, HF. This paper reviews the findings on arterial stiffness and LVH using conventional antihypertensive drugs such as angiotensin receptor II blockers (ARBs) and a new drug class for HF, ARB/neprilysin inhibitor (ARNi). Previous studies have suggested that the combination of an ARB with an L-T-type calcium channel blocker might be recommended for the improvement of arterial stiffness and regression of LVH. More recent research has shown that ARNi also improves central BP, which leads to a reduced afterload and a significant reduction in LVH. For optimal treatment of HFpEF, drug therapy should directly address arterial stiffness as well as hypertension.
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Affiliation(s)
- Takeshi Takami
- Department of Internal Medicine, Clinic Jingumae, Nara, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
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Nemska S, Gassmann M, Bang ML, Frossard N, Tavakoli R. Antagonizing the CX3CR1 Receptor Markedly Reduces Development of Cardiac Hypertrophy After Transverse Aortic Constriction in Mice. J Cardiovasc Pharmacol 2021; 78:792-801. [PMID: 34882111 DOI: 10.1097/fjc.0000000000001130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/01/2021] [Indexed: 12/12/2022]
Abstract
ABSTRACT Left-ventricular hypertrophy, characterized by cardiomyocyte hypertrophy, interstitial cell proliferation, and immune cell infiltration, is a high risk factor for heart failure and death. Chemokines interacting with G protein-coupled chemokine receptors probably play a role in left-ventricular hypertrophy development by promoting recruitment of activated leukocytes and modulating left-ventricular remodeling. Using the minimally invasive model of transverse aortic constriction in mice, we demonstrated that a variety of chemokine and chemokine receptor messenger Ribonucleic Acid are overexpressed in the early and late phase of hypertrophy progression. Among the chemokine receptors, Cx3cr1 and Ccr2 were most strongly overexpressed and were significantly upregulated at 3, 7, and 14 days after transverse aortic constriction. Ligands of CX3CR1 (Cx3cl1) and CCR2 (Ccl2, Ccl7, Ccl12) were significantly overexpressed in the left ventricle at the early stages after mechanical pressure overload. Pharmacological inhibition of CX3CR1 signaling using the antagonist AZD8797 led to a significant reduction of hypertrophy, whereas inhibition of CCR2 with the RS504393 antagonist did not show any effect. Furthermore, AZD8797 treatment reduced the expression of the hypertrophic marker genes Nppa and Nppb as well as the profibrotic genes Tgfb1 and Col1a1 at 14 days after transverse aortic constriction. These findings strongly suggest the involvement of the CX3CR1/CX3CL1 pathway in the pathogenesis of left-ventricular hypertrophy.
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MESH Headings
- Animals
- Aorta/physiopathology
- Aorta/surgery
- Atrial Natriuretic Factor/genetics
- Atrial Natriuretic Factor/metabolism
- CX3C Chemokine Receptor 1/antagonists & inhibitors
- CX3C Chemokine Receptor 1/genetics
- CX3C Chemokine Receptor 1/metabolism
- Chemokine CX3CL1/genetics
- Chemokine CX3CL1/metabolism
- Collagen Type I, alpha 1 Chain/genetics
- Collagen Type I, alpha 1 Chain/metabolism
- Constriction
- Disease Models, Animal
- Fibrosis
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/metabolism
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Left Ventricular/prevention & control
- Male
- Mice, Inbred C57BL
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Natriuretic Peptide, Brain/genetics
- Natriuretic Peptide, Brain/metabolism
- Pyrimidines/pharmacology
- Signal Transduction
- Thiazoles/pharmacology
- Time Factors
- Transforming Growth Factor beta1/genetics
- Transforming Growth Factor beta1/metabolism
- Ventricular Function, Left/drug effects
- Ventricular Remodeling/drug effects
- Mice
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Affiliation(s)
- Simona Nemska
- Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
- Laboratoire d'Innovation Thérapeutique UMR 7200, LabEx Medalis, CNRS, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Max Gassmann
- Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Marie-Louise Bang
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; and
- Institute of Genetic and Biomedical Research (IRGB) - National Research Council (CNR), Milan Unit, Milan, Italy
| | - Nelly Frossard
- Laboratoire d'Innovation Thérapeutique UMR 7200, LabEx Medalis, CNRS, Faculté de Pharmacie, Université de Strasbourg, Illkirch, France
| | - Reza Tavakoli
- Institute of Veterinary Physiology and Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
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Impact of Arterial Hypertension on Left Atrial Size and Function. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2587530. [PMID: 33015158 PMCID: PMC7512039 DOI: 10.1155/2020/2587530] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022]
Abstract
An increase in left atrial (LA) size in patients with arterial hypertension (AHT) has long been known to be associated with worse cardiovascular morbidity and mortality contributes to various complications, including atrial arrhythmias, stroke, and heart failure. The aim of our study was to evaluate the impact of arterial hypertension (AHT) on the LA size and function. This cross-sectional investigation included one hundred patients with essential hypertension without valvular or structural heart disease and atrial fibrillation. All recruits had a transthoracic echocardiography. LA volumes were measured by area-length method in transthoracic echocardiography at different cardiac cycle times. The indices of LA function were calculated: the reservoir function (total emptying fraction, total emptying volume, and expansion index), the conduit function (passive emptying fraction and passive emptying volume), and the pump function (active emptying fraction and active emptying volume). For all statistical tests, a p value ≤0.05 (represents the degree of significance) is considered statistically significant. In univariate analysis, LA was dilated in 9% of patients. The LA reservoir function and the pump function were increased, respectively, in 85% and 82% of patients. LA conduit function was impaired in 80% of patients. In bivariate analysis, the most powerful factors for this repercussion were diabetes (LA volume MAX dilated in nondiabetic patients (p = 0.037)), obesity (the reservoir function was impaired in obese patients (p = 0.015)), and antihypertensive drugs (the reservoir function was impaired in patients who take beta blockers (p = 0.023); the LA pump function was significantly impaired in patients treated with calcium antagonists (p = 0.012)). This study proved the impact of AHT on the LA size and function. Further investigations are necessary to evaluate the potential predictive value of LA remodeling in hypertensive patients like speckle tracking imaging.
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Saqib F, Arif Aslam M, Mujahid K, Marceanu L, Moga M, Ahmedah HT, Chicea L. Studies to Elucidate the Mechanism of Cardio Protective and Hypotensive Activities of Anogeissus acuminata (Roxb. ex DC.) in Rodents. Molecules 2020; 25:molecules25153471. [PMID: 32751601 PMCID: PMC7436098 DOI: 10.3390/molecules25153471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 01/03/2023] Open
Abstract
Anogeissus acuminata (Roxb. ex DC.) is a folkloric medicinal plant in Asia; including Pakistan; used as a traditional remedy for cardiovascular disorders. This study was planned to establish a pharmacological basis for the trivial uses of Anogeissus acuminata in certain medical conditions related to cardiovascular systems and to explore the underlying mechanisms. Mechanistic studies suggested that crude extract of Anogeissus acuminata (Aa.Cr) produced in vitro cardio-relaxant and vasorelaxant effects in isolated paired atria and aorta coupled with in vivo decrease in blood pressure by invasive method; using pressure and force transducers connected to Power Lab Data Acquisition System. Moreover; Aa.Cr showed positive effects in left ventricular hypertrophy in Sprague Dawley rats observed hemodynamically by a decrease in cardiac cell size and fibrosis; along with absence of inflammatory cells; coupled with reduced levels of angiotensin converting enzyme (ACE) and renin concentration along with increased concentrations of nitric oxide (NO) and cyclic guanosine monophosphate (cGMP). In Acute Myocardial Infarction (AMI) model; creatine kinase (CK), creatine kinase-MB (CK-MB) and lactic acid dehydrogenase (LDH levels) were found to be decreased; along with decreased necrosis; edema and recruitment of inflammatory cells histologically. In vivo and ex vivo studies of Anogeissus acuminata provided evidence of vasorelaxant; hypotensive and cardioprotective properties facilitated through blockage of voltage-gated Ca++ ion channel; validating its use in cardiovascular diseases.
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Affiliation(s)
- Fatima Saqib
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (F.S.); (M.A.A.); (K.M.)
| | - Muhammad Arif Aslam
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (F.S.); (M.A.A.); (K.M.)
| | - Khizra Mujahid
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (F.S.); (M.A.A.); (K.M.)
| | - Luigi Marceanu
- Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
- Correspondence: (L.M.); (H.T.A.); Tel.: +40-744674478 (L.M.); +966-541417822 (H.T.A.)
| | - Marius Moga
- Faculty of Medicine, Transilvania University of Brasov, 500019 Brasov, Romania;
| | - Hanadi Talal Ahmedah
- Radiological Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
- Correspondence: (L.M.); (H.T.A.); Tel.: +40-744674478 (L.M.); +966-541417822 (H.T.A.)
| | - Liana Chicea
- “Victor Papilian” Medical School, “Lucian Blaga” University of Sibiu, 550024 Sibiu, Romania;
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Saqib F, Mujahid K, Aslam MA, Modhi A, Moga MA, Bobescu E, Marceanu L. Ex vivo and in vivo studies of Viola tricolor Linn. as potential cardio protective and hypotensive agent: Inhibition of voltage-gated Ca ++ ion channels. FASEB J 2020; 34:9102-9119. [PMID: 32475023 DOI: 10.1096/fj.202000658r] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/12/2020] [Accepted: 04/20/2020] [Indexed: 11/11/2022]
Abstract
Viola tricolor Linn. is used as cardio-protective and anti-hypertensive agent in traditional medicine. Current study objective was to evaluate cardio-protective and hypotensive effects of Viola tricolor L. in vitro and in vivo studies. Viola tricolor L. crude extract (Vt.Cr) and its fractions (Aqueous and organic) were tested at rabbit atria and aorta coupled to Power Lab Data Acquisition System for cardio depressant and vasorelaxant effects in vitro whereas in vivo Blood Pressure was checked by invasive method in normotensive ketamine-diazepam anesthetized rats. Isoproterenol was employed for acute myocardial infarction (AMI) and left ventricular hypertrophy (LVH) development and cardioprotective effects of Vt.Cr were evaluated hemodynamically and histopathologically. Vt.Cr and its fractions decreased heart rate and contractile force in paired atria and relaxed Phenylephrine (1 µM) and K+ (80 mM) stimulated contractions in aorta possibly mediated through Voltage dependent L-type calcium channels blockage supported by in vivo hypotensive action. In LVH, Vt.Cr lowered Angiotensin Converting Enzymes and renin, increased cyclic Guanosine Monophosphate and nitric oxide levels, decreased cardiomyocytes size and fibrosis attributed to Gallic acid as detected by High Performance Liquid Chromatography. Partial positive results were seen hemodynamically and histologically in AMI Viola tricolor L. showed vasorelaxant, cardio-relaxant, hypotensive, and cardio protective effect validating traditional practice in cardiovascular disorders.
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Affiliation(s)
- Fatima Saqib
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Khizra Mujahid
- Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | | | - Alotaibi Modhi
- Department of Biology, College of Science, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Elena Bobescu
- Faculty of Medicine, Transilvania University Brasov, Brasov, Romania
| | - Luigi Marceanu
- Faculty of Medicine, Transilvania University Brasov, Brasov, Romania
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Abstract
Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality. The left ventricle (LV) is a primary target for HTN end-organ damage. In addition to being a marker of HTN, LV geometrical changes: concentric remodeling, concentric or eccentric LV hypertrophy (LVH) are major independent risk factors for not only CVD morbidity and mortality but also for all-cause mortality and neurological pathologies. Blood pressure control with lifestyle changes and antihypertensive agents has been demonstrated to prevent and regress LVH. Herein, we provide a comprehensive review of literature on the relationship between HTN and LV geometry abnormalities with a focus on diagnosis, prognosis, pathophysiological mechanisms, and treatment approaches.
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7
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Testosterone may influence left ventricular diastolic function depending on previous myocardial infarction and smoking. Int J Cardiol 2015; 186:67-71. [PMID: 25814347 DOI: 10.1016/j.ijcard.2015.03.238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 12/16/2022]
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8
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Modulation of the QT interval duration in hypertension with antihypertensive treatment. Hypertens Res 2015; 38:447-54. [DOI: 10.1038/hr.2015.30] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 11/08/2022]
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Zhang K, Huang F, Chen J, Cai Q, Wang T, Zou R, Zuo Z, Wang J, Huang H. Independent influence of overweight and obesity on the regression of left ventricular hypertrophy in hypertensive patients: a meta-analysis. Medicine (Baltimore) 2014; 93:e130. [PMID: 25437025 PMCID: PMC4616382 DOI: 10.1097/md.0000000000000130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Overweight and obesity are associated with adverse cardiovascular outcomes. However, the role of overweight and obesity in left ventricular hypertrophy (LVH) of hypertensive patients is controversial. The aim of the current meta-analysis was to evaluate the influence of overweight and obesity on LVH regression in the hypertensive population.Twenty-eight randomized controlled trials comprising 2403 hypertensive patients (mean age range: 43.8-66.7 years) were identified. Three groups were divided according to body mass index: normal weight, overweight, and obesity groups.Compared with the normal-weight group, LVH regression in the overweight and obesity groups was more obvious with less reduction of systolic blood pressure after antihypertensive therapies (P < 0.001). The renin-angiotensin system inhibitor was the most effective in regressing LVH in overweight and obese hypertensive patients (19.27 g/m, 95% confidence interval [15.25, 23.29], P < 0.001), followed by β-blockers, calcium channel blockers, and diuretics. In the stratified analysis based on blood pressure measurement methods and age, more significant LVH regression was found in 24-h ambulatory blood pressure monitoring (ABPM) group and in relatively young patients (40-60 years' old) group (P < 0.01).Overweight and obesity are independent risk factors for LVH in hypertensive patients. Intervention at an early age and monitoring by ABPM may facilitate therapy-induced LVH regression in overweight and obese hypertensive patients.
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Affiliation(s)
- Kun Zhang
- From the Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University (KZ, FH, JW, HH); Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology (KZ, FH, JC, TW, RZ, JW, HH); Department of Radiation Oncology, Sun Yat-sen Memorial Hospital (JC); Department of Internal Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, China (QC); and Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA (ZZ)
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Cardioprotective effect of an L/N-type calcium channel blocker in patients with hypertensive heart disease. J Cardiol 2009; 54:262-72. [DOI: 10.1016/j.jjcc.2009.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 05/20/2009] [Accepted: 05/28/2009] [Indexed: 11/17/2022]
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Hassanein A, Desai A, Verma A, Oparil S, Izzo J, Rocha R, Hilkert R, Seifu Y, Pitt B, Solomon S. EXCEED: Exforge®-intensive control of hypertension to evaluate efficacy in diastolic dysfunction: study rationale, design, and participant characteristics. Ther Adv Cardiovasc Dis 2009; 3:429-39. [DOI: 10.1177/1753944709341301] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Both diastolic dysfunction and increased vascular stiffness represent important measures of target-organ damage in hypertension. Whether intensive blood pressure (BP) control can further improve these measures remains unknown. Methods: EXCEED is a prospective, randomized open-label blinded endpoint trial (PROBE) design, aiming to test the hypothesis that more aggressive BP lowering would result in greater improvement in diastolic function among patients with stage II hypertension, evidence of diastolic dysfunction and preserved systolic function (EF ≥ 50%). Patients were randomized to one of two treatment strategies, targeting systolic blood pressure (SBP) <140 mmHg or <130 mmHg using a combination of amlodipine/valsartan with additional antihypertensive medications as needed to achieve the prescribed targets. Diastolic function was assessed using Doppler tissue imaging of early diastolic velocity of lateral mitral annulus (E'), while vascular stiffness was assessed using radial augmentation index (RAI) derived from radial artery tonometry. The study primary endpoint will be the change in lateral E' velocity between baseline and 24 weeks. Results: Two hundred and twenty eight patients (50% female) with mean age of (59.6±9.7) years and mean BP of (162±14/92±13 mmHg) were randomized equally to either treatment strategies. Left ventricular hypertrophy was present among <4% of the enrolled patients. Inspite diastolic function was impaired, baseline lateral E' velocity (7.6±1.2 cm/s) was not related to baseline SBP while baseline RAI was weakly related ( r = 0.2, p <0.01) to SBP even after adjustment to age, gender and heart rate. Conclusion: EXCEED will determine whether intensive BP lowering will further improve diastolic dysfunction and vascular stiffness among patients with uncontrolled hypertension.
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Affiliation(s)
- Amira Hassanein
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA,
| | - Akshay Desai
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Anil Verma
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Suzanne Oparil
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Joseph Izzo
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Richardo Rocha
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Robert Hilkert
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Youdit Seifu
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Bertrand Pitt
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
| | - Scott Solomon
- Brigham and Women's Hospital, Cardiovascular Division, Echo. Core lab., 75 Francis St., Boston, MA 02115, USA
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Bakiler AR, Yavascan O, Harputluoglu N, Kara OD, Aksu N. Evaluation of aortic stiffness in children with chronic renal failure. Pediatr Nephrol 2007; 22:1911-9. [PMID: 17710441 DOI: 10.1007/s00467-007-0562-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 05/17/2007] [Accepted: 06/07/2007] [Indexed: 10/22/2022]
Abstract
The measurement of aortic stiffness (As) [aortic strain (S), pressure strain elastic modulus (Ep) and pressure strain normalized by diastolic pressure (Ep*)] is suggested as an excellent marker of subclinical arterial sclerosis. We aimed to investigate the presence of As and to determine the relationship between As and some risk factors in children with chronic renal failure (CRF). Twenty-six pre-dialysis (PreD) [female/male (F/M) 7/19] patients and 23 chronic peritoneal dialysis (CPD) (F/M 13/10) patients were assessed. Twenty-nine healthy children were selected as a control group (F/M 14/15). We determined anemia, abnormal calcium/phosphate metabolism, hypertension, diastolic dysfunction, increased left ventricular mass (LVM), hypertriglyceridemia, increased stiffness (Ep, Ep*), and decreased strain (S) in the CRF (PreD and CPD) group compared with the controls (P < 0.05). Presence of renal disease, LVM and usage of angiotensin-converting enzyme inhibitor (ACE-I) in all groups; female gender, duration of disease and the usage of anti-hypertensive drug therapy in CRF patients; and LVM and LVM index in healthy children were found to be independent predictors for aortic stiffness and/or strain. In conclusion, CRF is associated with significant arterial functional abnormalities in uremic children and not controlled by dialysis treatment. These results suggest that, even in young children, uremia has a profound impact on arterial function.
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Affiliation(s)
- Ali Rahmi Bakiler
- Department of Pediatric Cardiology, Tepecik Training and Research Hospital, Yenisehir, Izmir, Turkey
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Tan HW, Li L, Zhang W, Ma ZY, Zhong XZ, Zhang Y. Effect of cilnidipine on left ventricular function in hypertensive patients as assessed by tissue Doppler Tei index. J Hum Hypertens 2006; 20:618-24. [PMID: 16625238 DOI: 10.1038/sj.jhh.1002030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Tissue Doppler Tei index is pointed to be more effective in the evaluation of global cardiac function than systolic and diastolic measurements alone in various heart diseases. This study was designed to assess the effect of cilnidipine on left ventricular function in hypertensive patients by using this index. A group of 40 hypertensives (mean age 55+/-8 years, range: 35-65) and 16 controls (mean age 52+/-9 years, range: 36-65) were included. Hypertensives were classified into non-left ventricular hypertrophy (NLVH) group (25 patients) and left ventricular hypertrophy (LVH) group (15 patients), and treated with cilnidipine for 2 months. Before and after treatment, the participants were examined by echocardiography. Tissue Doppler Tei index was calculated as diastolic time interval measured from end of late diastole to origin of early diastole (a') minus systolic Sm duration (b') divided by b', that is Tei index = (a'-b')/b'. Thirty-seven hypertensive patients finished the treatment. Tei index was significantly higher in NLVH and LVH groups than in control group, and in LVH group than in NLVH group (0.44+/-0.07 vs 0.28+/-0.06, P < 0.001; 0.51+/-0.13 vs 0.28+/-0.06, P < 0.001; 0.51+/-0.13 vs 0.44+/-0.07, P < 0.05). After treatment, Tei index was significantly decreased (0.40+/-0.11 vs 0.46+/-0.10, P < 0.0001); systolic blood pressure and diastolic blood pressure were also decreased significantly. In conclusion, Tei index is impaired in hypertensives before development of ventricular hypertrophy and impairment is more prominent in hypertrophy. Cilnidipine can improve left ventricular function. Tissue Doppler Tei index is gaining importance in evaluating LV function after drug intervention in hypertensive patients.
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Affiliation(s)
- H-W Tan
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Jinan, China
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Takemori K, Ishida H, Dote K, Yamamoto K, Ito H. Prophylactic effects of an N- and L-type Ca2+ antagonist, cilnidipine, against cardiac hypertrophy and dysfunction in stroke-prone, spontaneously hypertensive rats. Can J Physiol Pharmacol 2006; 83:785-90. [PMID: 16333380 DOI: 10.1139/y05-067] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To clarify the beneficial effects of cilnidipine, an L- and N-type calcium channel blocker, which were clinically observed against diastolic dysfunction in hypertrophied hearts of hypertensive patients, we investigated the effects of cilnidipine on cardiac remodeling and enhanced gene expression in stroke-prone, spontaneously hypertensive rats in comparison with that of captopril, a well-known angiotensin-converting enzyme inhibitor, at threshold doses with little blood pressure lowering effect. The expression of type III collagen and beta/alpha-myosin heavy chain as well as transforming growth factor-beta, and basic fibroblast growth factor were suppressed by both treatments, indicating the prevention or amelioration of cardiac dysfunction. Such beneficial effects were much more intense with cilnidipine treatment than in captopril. These results indicate that Ca2+ is a key factor in the pathogenesis of cardiac remodeling in hypertension. One possible beneficial effect of cilnidipine in the prevention of cardiac dysfunction may be due to the decreased amount of growth factors such as transforming growth factor-beta and basic fibroblast growth factor via direct action for Ca2+ influx and also via inhibition of local renin-angiotensin system in the myocardium.
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Affiliation(s)
- Kumiko Takemori
- Department of Pathology, Kinki University School of Medicine, Osaka, Japan
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