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Wilmes N, van Luik EM, Vaes EWP, Vesseur MAM, Laven SAJS, Mohseni-Alsalhi Z, Meijs DAM, Dikovec CJR, de Haas S, Spaanderman MEA, Ghossein-Doha C. Exploring Sex Differences of Beta-Blockers in the Treatment of Hypertension: A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:biomedicines11051494. [PMID: 37239165 DOI: 10.3390/biomedicines11051494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
AIMS In the prevention of cardiovascular morbidity and mortality, early recognition and adequate treatment of hypertension are of leading importance. However, the efficacy of antihypertensives may be depending on sex disparities. Our objective was to evaluate and quantify the sex-diverse effects of beta-blockers (BB) on hypertension and cardiac function. We focussed on comparing hypertensive female versus male individuals. METHODS AND RESULTS A systematic search was performed for studies on BBs from inception to May 2020. A total of 66 studies were included that contained baseline and follow up measurements on blood pressure (BP), heart rate (HR), and cardiac function. Data also had to be stratified for sex. Mean differences were calculated using a random-effects model. In females as compared to males, BB treatment decreased systolic BP 11.1 mmHg (95% CI, -14.5; -7.8) vs. 11.1 mmHg (95% CI, -14.0; -8.2), diastolic BP 8.0 mmHg (95% CI, -10.6; -5.3) vs. 8.0 mmHg (95% CI, -10.1; -6.0), and HR 10.8 beats per minute (bpm) (95% CI, -17.4; -4.2) vs. 9.8 bpm (95% CI, -11.1; -8.4)), respectively, in both sexes' absolute and relative changes comparably. Left ventricular ejection fraction increased only in males (3.7% (95% CI, 0.6; 6.9)). Changes in left ventricular mass and cardiac output (CO) were only reported in males and changed -20.6 g (95% CI, -56.3; 15.1) and -0.1 L (95% CI, -0.5; 0.2), respectively. CONCLUSIONS BBs comparably lowered BP and HR in both sexes. The lack of change in CO in males suggests that the reduction in BP is primarily due to a decrease in vascular resistance. Furthermore, females were underrepresented compared to males. We recommend that future research should include more females and sex-stratified data when researching the treatment effects of antihypertensives.
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Affiliation(s)
- Nick Wilmes
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Eveline M van Luik
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Esmée W P Vaes
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Maud A M Vesseur
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Sophie A J S Laven
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Zenab Mohseni-Alsalhi
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Daniek A M Meijs
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Cédric J R Dikovec
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Sander de Haas
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Chahinda Ghossein-Doha
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
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Ali W, Bakris GL. How to Manage Hypertension in People With Diabetes. Am J Hypertens 2020; 33:935-943. [PMID: 32307510 DOI: 10.1093/ajh/hpaa067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/14/2022] Open
Abstract
Hypertension is a common condition that is often seen in patients with diabetes. Both diseases increase the risk of morbidity and mortality from CV events and kidney disease progression. Factors that influence blood pressure (BP) control in diabetes include the persons' genetic background for hypertension and kidney disease, level of obesity and insulin resistance, the magnitude of preexisting kidney disease, and lifestyle factors, such as level of sodium and potassium intake, sleep quality and exercise effort all of which can affect levels of sympathetic nerve activity and contribute to increased BP variability. Lifestyle intervention is a key component to the effective management of diabetes and hypertension and can markedly reduce event rates of both heart and kidney outcomes. The approach to pharmacologic treatment of BP in diabetes is crucial since certain classes of agents for both BP and diabetes confer significant benefits to reduce cardiorenal outcomes.
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Affiliation(s)
- Waleed Ali
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, Illinois, USA
| | - George L Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and Metabolism, The University of Chicago Medicine, Chicago, Illinois, USA
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3
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Abstract
Blood pressure management in hypertensive patients with metabolic abnormalities is challenging, since many of the antihypertensive drugs adversely affect metabolism. Besides effective control of blood pressure in patients with hypertension, third-generation beta-blockers such as nebivolol offer additional benefits for central hemodynamics and neutral or beneficial effects on metabolism. Emerging clinical data suggest that nebivolol also has similar effects on metabolism in obese hypertensive and hypertensive diabetic patients. The present article will provide a systematic analysis of the pathophysiological links among hypertension, insulin resistance, and metabolic syndrome. We will also summarize the available clinical evidence regarding the metabolic effects of beta-blockers in hypertensive patients, with an emphasis on nebivolol. Nebivolol exerts neutral or beneficial effects on insulin sensitivity and lipid metabolism in hypertensive patients, owing to its nitric oxide-mediated vasodilatory and antioxidative properties. Thus, nebivolol could be a favorable therapeutic option for the treatment of hypertension in patients with impaired glucose and lipid metabolism.
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4
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Sarafidis PA, Alexandrou ME, Ruilope LM. A review of chemical therapies for treating diabetic hypertension. Expert Opin Pharmacother 2017; 18:909-923. [DOI: 10.1080/14656566.2017.1328054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Pantelis A. Sarafidis
- Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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5
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Abstract
The prevalence of obesity-related hypertension is high worldwide and has become a major health issue. The mechanisms by which obesity relates to hypertensive disease are still under intense research scrutiny, and include altered hemodynamics, impaired sodium homeostasis, renal dysfunction, autonomic nervous system imbalance, endocrine alterations, oxidative stress and inflammation, and vascular injury. Most of these contributing factors interact with each other at multiple levels. Thus, as a multifactorial and complex disease, obesity-related hypertension should be recognized as a distinctive form of hypertension, and specific considerations should apply in planning therapeutic approaches to treat obese individuals with high blood pressure.
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Affiliation(s)
- Dinko Susic
- Hypertension Research Laboratory, Ochsner Clinic Foundation, 1514 Jefferson Highway New Orleans, Louisiana 70121, USA
| | - Jasmina Varagic
- Hypertension & Vascular Research, Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA; Department of Physiology and Pharmacology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA.
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6
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Niu W, Qi Y. A meta-analysis of randomized controlled trials assessing the impact of beta-blockers on arterial stiffness, peripheral blood pressure and heart rate. Int J Cardiol 2016; 218:109-117. [DOI: 10.1016/j.ijcard.2016.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 11/24/2022]
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Maranta F, Spoladore R, Fragasso G. Pathophysiological Mechanisms and Correlates of Therapeutic Pharmacological Interventions in Essential Arterial Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:37-59. [PMID: 27864806 DOI: 10.1007/5584_2016_169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Treating arterial hypertension (HT) remains a hard task. The hypertensive patient is often a subject with several comorbidities and metabolic abnormalities. Clinicians everyday have to choose the right drug for the single patient among the different classes of antihypertensives. Apart from lowering blood pressure, a main therapeutic target should be that of counteracting all the possible pathophysiological mechanisms involved in HT itself and in existing/potential comorbidities. All the ancillary positive and negative effects of the administered drugs should be considered: in particular, since hypertensive patients are often glucose intolerant/diabetic, carrier of serum lipids disorder, have already developed atherosclerotic diseases and endothelial dysfunction, they should not be treated with drugs negatively interfering with these conditions but with molecules that, if possible, improve them. The main pathophysiological mechanisms and correlates of therapeutic pharmacological interventions in essential HT are reviewed here.
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Affiliation(s)
- Francesco Maranta
- Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Spoladore
- Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Fragasso
- Clinical Cardiology, Heart Failure Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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8
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Harmon L, Chilton RJ, Spellman C. Reducing Cardiovascular Events and End-Organ Damage in Patients with Hypertension: New Considerations. Postgrad Med 2015; 123:7-17. [DOI: 10.3810/pgm.2011.03.2258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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9
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Varagic J, Punzi H, Ferrario CM. Clinical utility of fixed-dose combinations in hypertension: evidence for the potential of nebivolol/valsartan. Integr Blood Press Control 2014; 7:61-70. [PMID: 25473311 PMCID: PMC4251532 DOI: 10.2147/ibpc.s50954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Despite significant advances in pharmacologic approaches to treat hypertension during the last decades, hypertension- and hypertension-related organ damage are still a high health and economic burden because a large proportion of patients with hypertension do not achieve optimal blood pressure control. There is now general agreement that combination therapy with two or more antihypertensive drugs is required for targeted blood pressure accomplishment and reduction of global cardiovascular risk. The goals of combination therapies are to reduce long-term cardiovascular events by targeting different mechanism underlying hypertension and target organ disease, to block the counterregulatory pathways activated by monotherapies, to improve tolerability and decrease the adverse effects of up-titrated single agents, and to increase persistence and adherence with antihypertensive therapy. Multiple clinical trials provide evidence that fixed-dose combinations in a single pill offer several advantages when compared with loose-dose combinations. This review discusses the advances in hypertension control and associated cardiovascular disease as they relate to the prospect of combination therapy targeting a third-generation beta (β) 1-adrenergic receptor (nebivolol) and an angiotensin II receptor blocker (valsartan) in fixed-dose single-pill formulations.
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Affiliation(s)
- Jasmina Varagic
- Hypertension and Vascular Research Center, Wake Forest University, Winston-Salem, NC USA ; Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA
| | - Henry Punzi
- Trinity Hypertension and Diagnostic Research Center, Carrollton, TX, USA ; Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos M Ferrario
- Division of Surgical Sciences, Wake Forest University, Winston-Salem, NC USA ; Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, NC USA ; Department of Internal Medicine and Nephrology, Wake Forest University, Winston-Salem, NC, USA
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Arterial stiffness and cardiovascular therapy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:621437. [PMID: 25170513 PMCID: PMC4142148 DOI: 10.1155/2014/621437] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
The world population is aging and the number of old people is continuously increasing. Arterial structure and function change with age, progressively leading to arterial stiffening. Arterial stiffness is best characterized by measurement of pulse wave velocity (PWV), which is its surrogate marker. It has been shown that PWV could improve cardiovascular event prediction in models that included standard risk factors. Consequently, it might therefore enable better identification of populations at high-risk of cardiovascular morbidity and mortality. The present review is focused on a survey of different pharmacological therapeutic options for decreasing arterial stiffness. The influence of several groups of drugs is described: antihypertensive drugs (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, diuretics, and nitrates), statins, peroral antidiabetics, advanced glycation end-products (AGE) cross-link breakers, anti-inflammatory drugs, endothelin-A receptor antagonists, and vasopeptidase inhibitors. All of these have shown some effect in decreasing arterial stiffness. Nevertheless, further studies are needed which should address the influence of arterial stiffness diminishment on major adverse cardiovascular and cerebrovascular events (MACCE).
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11
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Koumaras C, Tziomalos K, Stavrinou E, Katsiki N, Athyros VG, Mikhailidis DP, Karagiannis A. Effects of renin-angiotensin-aldosterone system inhibitors and beta-blockers on markers of arterial stiffness. ACTA ACUST UNITED AC 2013; 8:74-82. [PMID: 24139833 DOI: 10.1016/j.jash.2013.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/23/2013] [Accepted: 09/11/2013] [Indexed: 01/29/2023]
Abstract
Antihypertensive agents may, even within the same class, exert variable effects on arterial stiffness variables. Nebivolol could have a better impact than atenolol on arterial stiffness, by increasing the bioavailability of endothelium-derived nitric oxide. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) increase plasma renin activity (enhancing the production of angiotensin II via non-ACE-related pathways) whereas aliskiren does not, potentially affecting central hemodynamics differently. We compared the effects of two renin-angiotensin-aldosterone system (RAAS) inhibitors (quinapril and aliskiren) and 2 beta-blockers (atenolol and nebivolol) on arterial stiffness variables. Treatment-naïve patients (n = 72; 68.1% males; age, 47.6 ± 10.6 years) with uncomplicated stage I-II essential hypertension were randomly assigned to quinapril, aliskiren, atenolol, or nebivolol for 10 weeks. Central systolic and diastolic blood pressure (BP), central pulse pressure (PP), augmentation index (AIx), and pulse wave velocity (PWV) were measured at baseline, 2, and 10 weeks. The same measurements were performed in 20 normotensive subjects (65.0% males; age, 40.0 ± 8.9 years). Peripheral and central systolic and diastolic BP, peripheral PP, and PWV were significantly and similarly reduced by all agents. However, PWV continued to decline between the second and last visit in patients on quinapril and aliskiren but did not change in those on nebivolol or atenolol. Central PP and AIx decreased in patients on quinapril, aliskiren, and nebivolol but did not change in those taking atenolol. The decrease in central PP and AIx did not differ between patients on quinapril, aliskiren, and nebivolol. Despite similar reductions in peripheral BP, atenolol is less effective than nebivolol and RAAS inhibitors in improving central pulsatile hemodynamics. Aliskiren exerts similar effects on markers of arterial stiffness as quinapril. The clinical relevance of these differences remains to be established.
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Affiliation(s)
- Charalambos Koumaras
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Eirini Stavrinou
- Department of Nephrology, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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12
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Liu M, Li GL, Li Y, Wang JG. Effects of Various Antihypertensive Drugs on Arterial Stiffness and Wave Reflections. ACTA ACUST UNITED AC 2013; 1:97-107. [PMID: 26587429 PMCID: PMC4315340 DOI: 10.1159/000354108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We reviewed trials that tested the efficacy of antihypertensive drugs in reducing arterial stiffness and wave reflections as assessed by pulse wave velocity and augmentation index, respectively. Regardless of cross-over or parallel-group comparison design, placebo-controlled trials demonstrated that antihypertensive drugs were effective in reducing pulse wave velocity. In actively-controlled parallel-group comparison studies, this effect on arterial stiffness was more evident for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers than other classes of antihypertensive drugs, particularly when brachial-ankle pulse wave velocity was measured. Regardless of cross-over or parallel-group comparison or placebo- or actively-controlled design, the reviewed trials showed that β-blockers were inferior to all the other classes of antihypertensive drugs in reducing augmentation index. However, these studies had a small sample size and a short follow-up time and did not link the changes in measurements of arterial function with cardiovascular events. Whether the superiority or inferiority is clinically relevant for cardiovascular protection and prevention remains to be investigated.
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Affiliation(s)
- Ming Liu
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ge-Le Li
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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13
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Increased night heart rate is associated with worse large artery elasticity in chronic kidney disease patients. Int Urol Nephrol 2013; 45:1621-7. [PMID: 23575951 DOI: 10.1007/s11255-013-0431-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 03/27/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with high overall and cardiovascular mortality. Numerous studies have reported that increased heart rate is a risk factor for all-cause mortality. We investigated the link between sleep heart rate and artery stiffness in CKD patients. METHODS In a cross-sectional study, we enrolled 100 prevalent Chinese CKD patients (55 males, aged 52.5 ± 16.40 years). Heart rate was measured with an automatic system. Arterial stiffness was evaluated by using a calibrated tonometer. RESULTS Large artery elasticity index (LAEI) was positively correlated with body mass index and hemoglobin but negatively associated with age and systolic blood pressure. Furthermore, LAEI was negatively associated with glomerular filtration rate (GFR) and sleep heart rate. In multivariate regression, LAEI was independently predicted by SBP, BMI, age, sleep heart rate, and gender. Adjusted R (2) of the model was 0.486. CONCLUSION Elevated sleep heart rate is significantly associated with increased arterial stiffness in CKD patients. Further investigation is needed to explore the potential benefits of sleep heart rate lowering therapy in this patient group.
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Abstract
Haemodynamic factors influence all forms of vascular growth (vasculogenesis, angiogenesis, arteriogenesis). Because of its prominent role in atherosclerosis, shear stress has gained particular attention, but other factors such as circumferential stretch are equally important to maintain the integrity and to (re)model the vascular network. While these haemodynamic forces are crucial determinants of the appearance and the structure of the vasculature, they are in turn subjected to structural changes in the blood vessels, such as an increased arterial stiffness in chronic arterial hypertension and ageing. This results in an interplay between the various forces (biomechanical forces) and the involved vascular elements. Although many molecular mediators of biomechanical forces still need to be identified, there is plenty of evidence for the causal role of these forces in vascular growth processes, which will be summarized in this review. In addition, we will discuss the effects of concomitant diseases and disorders on these processes by altering either the biomechanics or their transduction into biological signals. Particularly endothelial dysfunction, diabetes, hypercholesterolaemia, and age affect mechanosensing and -transduction of flow signals, thereby underpinning their influence on cardiovascular health. Finally, current approaches to modify biomechanical forces to therapeutically modulate vascular growth in humans will be described.
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Affiliation(s)
- Imo E Hoefer
- Laboratory of Experimental Cardiology, University Medical Center, G02.523, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands.
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Deedwania P, Shea J, Chen W, Brener L. Effects of Add-On Nebivolol on Blood Pressure and Glucose Parameters in Hypertensive Patients With Prediabetes. J Clin Hypertens (Greenwich) 2013; 15:270-8. [DOI: 10.1111/jch.12071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 11/16/2012] [Accepted: 12/20/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Prakash Deedwania
- Department of Medicine; UCSF School of Medicine; San Francisco CA
- Department of Cardiovascular; Cardiology section; UCSF Program; Fresno CA
| | - John Shea
- Forest Research Institute; Jersey City NJ
| | - Wei Chen
- Forest Research Institute; Jersey City NJ
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Bakris GL, Sowers JR. Treatment of hypertension in patients with diabetes-an update. ACTA ACUST UNITED AC 2012; 3:150-5. [PMID: 20409955 DOI: 10.1016/j.jash.2009.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- George L Bakris
- Hypertensive Diseases and Diabetes Center, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Koumaras C, Tzimou M, Stavrinou E, Griva T, Gossios TD, Katsiki N, Athyros VG, Mikhailidis DP, Karagiannis A. Role of Antihypertensive Drugs in Arterial ‘De-Stiffening’ and Central Pulsatile Hemodynamics. Am J Cardiovasc Drugs 2012; 12:143-56. [DOI: 10.2165/11599040-000000000-00000] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Wang J, Xu J, Zhou C, Zhang Y, Xu D, Guo Y, Yang Z. Improvement of Arterial Stiffness by Reducing Oxidative Stress Damage in Elderly Hypertensive Patients After 6 Months of Atorvastatin Therapy. J Clin Hypertens (Greenwich) 2012; 14:245-9. [DOI: 10.1111/j.1751-7176.2012.00600.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fragasso G, Maranta F, Montanaro C, Salerno A, Torlasco C, Margonato A. Pathophysiologic therapeutic targets in hypertension: a cardiological point of view. Expert Opin Ther Targets 2012; 16:179-93. [DOI: 10.1517/14728222.2012.655724] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Shahin Y, Khan JA, Chetter I. Angiotensin converting enzyme inhibitors effect on arterial stiffness and wave reflections: a meta-analysis and meta-regression of randomised controlled trials. Atherosclerosis 2011; 221:18-33. [PMID: 22209214 DOI: 10.1016/j.atherosclerosis.2011.12.005] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 11/25/2011] [Accepted: 12/05/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Several studies have assessed the effect of angiotensin converting enzyme inhibitors (ACEIs) on arterial stiffness and wave reflections as measured by pulse wave velocity (PWV) and augmentation index (AIx), respectively. We conducted a meta-analysis to investigate this effect in comparison to placebo and to other antihypertensive agents. Additionally, we investigated this effect when ACEIs are combined with other antihypertensive agents and in comparison to a combination of antihypertensive agents. METHODS MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to May 2011 on randomised controlled trials (RCTs) which assessed the effect of ACEIs on arterial stiffness vs. placebo or no treatment and ACEIs vs. angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), β-blockers and diuretics. RCTs which assessed the effect of ACEIs combined with other antihypertensives or compared ACEIs with a combination of antihypertensives were also sought. Data from included RCTs were pooled with use of fixed and random effects meta-analysis of the weighted mean change differences between the comparator groups. Heterogeneity across studies was assessed with the I(2) statistic. RESULTS In 5 trials including 469 patients, treatment with ACEIs (n=227) vs. placebo (n=216) significantly reduced PWV (pooled mean change difference -1.69, 95% C.I. -2.05, -1.33, p<0.00001 with insignificant heterogeneity). In 9 trials which included 378 patients, treatment with ACEIs (n=178) insignificantly reduced PWV when compared with other antihypertensives (ARBs, CCBs, β-blockers, diuretics and a combination of ACEI and ARB) (n=220) (pooled mean change difference -0.19, 95% C.I. -0.59, 0.21, p=0.36, I(2)=0%). ACEI effect on AIx in comparison to placebo was assessed in 7 trials. Treatment with ACEIs significantly reduced AIx (pooled mean change difference -3.79, 95% C.I. -5.96, -1.63, p=0.0006) with significant heterogeneity. In 7 trials, treatment with ACEIs significantly reduced AIx when compared with other antihypertensives (pooled mean change difference -1.84, 95% C.I. -3, -0.68, p=0.002, I(2)=32%, p for heterogeneity=0.11). However, this effect was only significant when compared with β-blockers (pooled mean change difference -1.6, 95% C.I. -2.84, -0.36, p=0.01). Mean BP differences between baseline and end of treatment did not predict the treatment (ACEI) induced changes in PWV. CONCLUSIONS ACEIs reduce PWV and AIx which are markers of arterial stiffness and wave reflections in patients with different pathological conditions. However, due to the lack of high quality and properly powered RCTs, it is not clear whether ACEIs are superior to other antihypertensive agents in their effect on arterial stiffness. The ability of ACEIs to reduce arterial stiffness (PWV) seems to be independent of its ability to reduce BP.
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Affiliation(s)
- Yousef Shahin
- Academic Vascular Surgical Unit, Hull York Medical School & University of Hull, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, UK.
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Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2010; 27:2121-58. [PMID: 19838131 DOI: 10.1097/hjh.0b013e328333146d] [Citation(s) in RCA: 999] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-induced hypertension. Hypertens Res 2010; 33:386-93. [PMID: 20442753 DOI: 10.1038/hr.2010.9] [Citation(s) in RCA: 356] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The relationship between obesity and hypertension is well established both in children and adults. The mechanisms through which obesity directly causes hypertension are still an area of research. Activation of the sympathetic nervous system has been considered to have an important function in the pathogenesis of obesity-related hypertension. The arterial-pressure control mechanism of diuresis and natriuresis, according to the principle of infinite feedback gain, seems to be shifted toward higher blood-pressure levels in obese individuals. During the early phases of obesity, primary sodium retention exists as a result of increase in renal tubular reabsorption. Extracellular-fluid volume is expanded and the kidney-fluid apparatus is resetted to a hypertensive level, consistent with a model of hypertension because of volume overload. Plasma renin activity, angiotensinogen, angiotensin II and aldosterone values display significant increase during obesity. Insulin resistance and inflammation may promote an altered profile of vascular function and consequently hypertension. Leptin and other neuropeptides are possible links between obesity and the development of hypertension. Obesity should be considered as a chronic medical condition, which is likely to require long-term treatment. Understanding of the mechanisms associated with obesity-related hypertension is essential for successful treatment strategies.
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Affiliation(s)
- Vasilios Kotsis
- 3rd Department of Medicine, Hypertension Center, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Bakris GL, Sowers JR, Glies TD, Black HR, Izzo JL, Materson BJ, Oparil S, Weber MA. Treatment of hypertension in patients with diabetes--an update. ACTA ACUST UNITED AC 2010; 4:62-7. [PMID: 20400050 DOI: 10.1016/j.jash.2010.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- George L Bakris
- Hypertensive Diseases and Diabetes Center, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Taylor AA, Bakris GL. The role of vasodilating beta-blockers in patients with hypertension and the cardiometabolic syndrome. Am J Med 2010; 123:S21-6. [PMID: 20609696 DOI: 10.1016/j.amjmed.2010.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the United States, a vast segment of the adult population is classified as having the cardiometabolic syndrome, and currently there are epidemic rates of both type 2 diabetes mellitus and obesity. Hypertension is closely linked with these metabolic disorders and is a strong independent predictor of incident type 2 diabetes. In addition, hypertension is an important contributor to increasing cardiovascular disease risk in patients with the cardiometabolic syndrome. Lowering elevated blood pressure in patients with the cardiometabolic syndrome or diabetes is a critical component of reducing global cardiovascular risk. However, aggressive management of hypertension in these patients is often challenging, and the presence of these conditions is associated with poor blood pressure control. The utility of beta-blockers in patients with these conditions continues to be a subject of intense debate, given the adverse metabolic effects associated with conventional beta-blockers. Data on vasodilating beta-blockers, however, suggest that these agents have favorable or neutral metabolic effects and generally more favorable effects when compared with nonvasodilating members of this class. These agents may expand the utility of beta-blockers to patient populations traditionally considered not to be optimal candidates for beta-blocker therapy-a fact which has important clinical implications, because more antihypertensive agents are needed to diversify the therapeutic options available for clinicians treating hypertension in patients with the cardiometabolic syndrome or type 2 diabetes.
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Affiliation(s)
- Addison A Taylor
- Departments of Medicine, Pharmacology, and Molecular Physiology, Baylor College of Medicine, Houston, Texas 77030, USA.
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Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, Cifkova R, Clément D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HAJ, Van Zwieten PA, Viigimaa M, Zanchetti A. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2010; 18:308-47. [PMID: 20001654 DOI: 10.3109/08037050903450468] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, 20052 Monza, Milan, Italy.
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Domanski D, Schwarz ER. Clinical Review: Is the Perioperative Use of β-Blockers Still Recommended? A Critical Review of Recent Controversies. J Cardiovasc Pharmacol Ther 2009; 14:258-68. [DOI: 10.1177/1074248409343934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The optimal role of β-adrenergic receptor blockade in the perioperative period remains unclear in patients at risk for cardiovascular events. Cardiovascular complications continue to be the most common cause of perioperative morbidity and mortality, and cardioprotective properties of β-blockers are widely recognized, yet the results of the clinical trials investigating the use of different β-blockers in the perioperative period are controversial. The discrepancy might be related to differences in the design of studies, use of different agents, administration by different routes, and continuation for different time intervals. Evidently, perioperative mortality and morbidity seem to be related to heart rate, and the majority of complications are related to β-blockers’ side effects. Based on the observations from different studies, we propose an algorithm for perioperative β blockade.
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Affiliation(s)
- Damian Domanski
- Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Ernst R. Schwarz
- Cedars Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California,
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Nebivolol decreases endothelial cell stiffness via the estrogen receptor beta: a nano-imaging study. J Hypertens 2009; 27:517-26. [PMID: 19330906 DOI: 10.1097/hjh.0b013e32831fb389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nebivolol (NEB) is a [beta]1-receptor blocker with nitric oxide-dependent vasodilating properties. NEB-induced nitric oxide release is mediated through the estrogen receptor. METHOD Here, we tested the hypothesis that NEB decreases endothelial cell stiffness and that these effects can be abolished by both endothelial nitric oxide synthase and estrogen receptor blockade. Human endothelial cells (EAHy-926) were incubated with vehicle, NEB 0.7 nmol/l, metoprolol 200 nmol/l, 17[beta]-estradiol (E2) 15 nmol/l, the estrogen receptor antagonists tamoxifen 100 nmol/l and ICI 182780 (ICI) 100 nmol/l, the nitric oxide synthase inhibitor N[omega]-nitro-L-arginine methyl ester 1 mmol/l and combinations of NEB and E2 with either tamoxifen, ICI or N[omega]-nitro-L-arginine methyl ester as well as metoprolol and ICI. Atomic force microscopy was performed to measure cellular stiffness, cell volume and apical surface. Presence of estrogen receptor protein in EAHy-926 was confirmed by western blot analysis; quantification of ER[alpha] and ER[beta] total RNA was performed by semiquantitative PCR. RESULTS Both NEB as well as E2 decreased cellular stiffness to a similar extent (NEB: 0.83 +/- 0.03 pN/nm, E2: 0.87 +/- 0.03 pN/nm, vehicle: 2.19 +/- 0.07 pN/nm), whereas metoprolol had no effect on endothelial stiffness (2.07 +/- 0.04 pN/nm, all n = 60, P < 0.01). The decrease in stiffness occurred as soon as 5 min after starting NEB incubation. The effects are mediated through nongenomic ER[beta] pathways, as ER[alpha] is not translated into measurable protein levels in EAHy-926. Furthermore, NEB increased cell volume by 48 +/- 4% and apical surface by 34 +/- 3%. E2 had comparable effects. Tamoxifen, ICI and N[omega]-nitro-L-arginine methyl ester substantially diminished the effects of NEB and E2. CONCLUSION NEB decreases cellular stiffness and causes endothelial cell growth. These effects are nitric oxide-dependent and mediated through nongenomic ER[beta] pathways. The morphological and functional alterations observed in endothelial cells may explain improved endothelial function with NEB treatment.
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Mansia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A. 2007 ESH‐ESC Guidelines for the management of arterial hypertension. Blood Press 2009; 16:135-232. [PMID: 17846925 DOI: 10.1080/08037050701461084] [Citation(s) in RCA: 238] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Giuseppe Mansia
- Clinica Medica, Ospedale San Gerardo, Universita Milano-Bicocca, Via Pergolesi, 33 - 20052 MONZA (Milano), Italy.
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Mytas DZ, Stougiannos PN, Zairis MN, Foussas SG, Pyrgakis VN, Kyriazis IA. Diabetic myocardial disease: pathophysiology, early diagnosis and therapeutic options. J Diabetes Complications 2009; 23:273-82. [PMID: 18413201 DOI: 10.1016/j.jdiacomp.2007.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Accepted: 12/07/2007] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus is a powerful risk factor for cardiovascular disease associated with high morbidity and mortality rates. Diabetic patients also have an increased incidence of heart failure which has been traditionally attributed to the concurrent presence of ischemic or hypertensive heart disease. Yet, nowadays, according to recent scientific evidence, diabetic myocardial disease (DMD) is more and more being considered as a distinct nosologic entity, independent of the co-existence of coronary artery disease, arterial hypertension or other risk factors, with the potential to lead to a self-existent progressive development of heart failure. In this article, we review the possible pathophysiologic mechanisms involved in the development of DMD as well as the structural and functional changes in the diabetic heart. We emphasize the importance of early detection of the syndrome, especially by novel echocardiographic techniques. Finally, we refer to the various therapeutic options for the optimal management of DMD according to the recent literature.
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Agabiti-Rosei E, Porteri E, Rizzoni D. Arterial stiffness, hypertension, and rational use of nebivolol. Vasc Health Risk Manag 2009; 5:353-60. [PMID: 19475771 PMCID: PMC2686253 DOI: 10.2147/vhrm.s3056] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Arterial stiffness plays a key role in the pathophysiology of the cardiovascular system. Some indices of arterial stiffness (pulse wave velocity, augmentation index, characteristics of central blood pressure waveform) may be presently calculated and evaluated in the clinical setting. Age and blood pressure are the two major clinical determinants of increased arterial stiffness, while molecular determinants of arterial stiffness are related to fibrotic components of the extracellular matrix, mainly elastin, collagen and fibronectin. Increased arterial stiffness has been consistently observed in conditions such as hypertension, dyslipidemia and diabetes. Arterial stiffness evaluated by means of carotid-femoral pulse wave velocity yielded prognostic significance beyond and above traditional risk factors. A more favorable effect of calcium channel blockers, diuretics and ACE inhibitors compared with β-blockers on indices of arterial stiffness was observed in several studies. It is conceivable that newer β-blockers with additional vasodilating properties, such as nebivolol, which has favorable effects on carbohydrate and lipid metabolism, as well as on endothelial function and on oxidative stress, may have favorable effects on arterial stiffness, compared with atenolol. In fact, in recent studies, nebivolol was demonstrated to improve artery stiffness to a greater extent than older β-blockers. Because endothelial dysfunction and increased arterial stiffness play an important role in the early atherosclerotic processes and are associated with poor outcomes and increased mortality, independently of blood pressure, the ability of nebivolol to enhance release of endothelium-derived nitric oxide, and consequently improve endothelial function and arterial stiffness, may have significant clinical implications for the use of this agent in the treatment of hypertension and cardiovascular diseases.
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Affiliation(s)
- Enrico Agabiti-Rosei
- Department of Medical and Surgical Sciences, Clinica Medica, University of Brescia, Brescia, Italy.
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Makaryus AN, Akhrass P, McFarlane SI. Treatment of hypertension in metabolic syndrome: implications of recent clinical trials. Curr Diab Rep 2009; 9:229-37. [PMID: 19490825 DOI: 10.1007/s11892-009-0037-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Metabolic syndrome represents a constellation of hypertension, abdominal obesity, impaired fasting glucose, and dyslipidemia, and it has been shown to be a risk factor for cardiovascular disease. The components of metabolic syndrome are rapidly emerging as epidemics of the twenty-first century, and reduction of these underlying causes, such as obesity, physical inactivity, and atherogenic diet, is first-line therapy. Treatment of hypertension and other cardiometabolic risk factors of the syndrome is also required. Evidence demonstrates a relationship between hypertension, type 2 diabetes mellitus, and several vascular and metabolic abnormalities that are components of metabolic syndrome. Hypertension associated with metabolic syndrome has pathophysiologic characteristics that provide clinical challenges as well as opportunities for successful therapeutic interventions. This article reviews the treatment of hypertension as a metabolic and vascular disease and also opens a new paradigm for the treatment of metabolic syndrome, which affects nearly one quarter of the world's population.
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Affiliation(s)
- Amgad N Makaryus
- Department of Cardiology, North Shore University Hospital, Manhasset, NY 11030, USA.
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Ladage D, Reidenbach C, Lichtenthal A, Schwinger R, Brixius K. Betablocker der 3. Generation: Stand der Forschung zu den Betablockern mit vasodilatierenden Zusatzeigenschaften. Wien Med Wochenschr 2009; 159:211-8. [DOI: 10.1007/s10354-009-0650-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 10/07/2008] [Indexed: 10/20/2022]
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Bakris GL, Sowers JR. ASH position paper: treatment of hypertension in patients with diabetes-an update. J Clin Hypertens (Greenwich) 2009; 10:707-13; discussion 714-5. [PMID: 18844766 DOI: 10.1111/j.1751-7176.2008.00012.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This report updates concepts on hypertension management in patients with diabetes. It focuses on clinical outcomes literature published within the last 3 years and incorporates these observations into modifications of established guidelines. While the fundamentals of treatment and goal blood pressures remain unchanged, approaches to specific patient-related issues has changed. This update focuses on questions such as what to do when a patient has an elevated potassium level when therapy is initiated and whether combinations of agents that block the renin-angiotensin system still be used. In addition, there are updates from trials, just published and in press, that focus on related management issues influencing cardiovascular outcomes in persons with diabetes. Last, an updated algorithm is provided that incorporates many of the new findings and is suggested as a starting point to achieve blood pressure goals.
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Affiliation(s)
- George L Bakris
- Hypertensive Diseases and Diabetes Center, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA.
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The metabolic syndrome in hypertension: European society of hypertension position statement. J Hypertens 2008; 26:1891-900. [PMID: 18806611 DOI: 10.1097/hjh.0b013e328302ca38] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The metabolic syndrome considerably increases the risk of cardiovascular and renal events in hypertension. It has been associated with a wide range of classical and new cardiovascular risk factors as well as with early signs of subclinical cardiovascular and renal damage. Obesity and insulin resistance, beside a constellation of independent factors, which include molecules of hepatic, vascular, and immunologic origin with proinflammatory properties, have been implicated in the pathogenesis. The close relationships among the different components of the syndrome and their associated disturbances make it difficult to understand what the underlying causes and consequences are. At each of these key points, insulin resistance and obesity/proinflammatory molecules, interaction of demographics, lifestyle, genetic factors, and environmental fetal programming results in the final phenotype. High prevalence of end-organ damage and poor prognosis has been demonstrated in a large number of cross-sectional and a few number of prospective studies. The objective of treatment is both to reduce the high risk of a cardiovascular or a renal event and to prevent the much greater chance that metabolic syndrome patients have to develop type 2 diabetes or hypertension. Treatment consists in the opposition to the underlying mechanisms of the metabolic syndrome, adopting lifestyle interventions that effectively reduce visceral obesity with or without the use of drugs that oppose the development of insulin resistance or body weight gain. Treatment of the individual components of the syndrome is also necessary. Concerning blood pressure control, it should be based on lifestyle changes, diet, and physical exercise, which allows for weight reduction and improves muscular blood flow. When antihypertensive drugs are necessary, angiotensin-converting enzyme inhibitors, angiotensin II-AT1 receptor blockers, or even calcium channel blockers are preferable over diuretics and classical beta-blockers in monotherapy, if no compelling indications are present for its use. If a combination of drugs is required, low-dose diuretics can be used. A combination of thiazide diuretics and beta-blockers should be avoided.
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Choice of antihypertensive drugs in the European Society of Hypertension–European Society of Cardiology guidelines: specific indications rather than ranking for general usage. J Hypertens 2008; 26:164-8. [DOI: 10.1097/hjh.0b013e3282f52fa8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guías de práctica clínica sobre prevención de la enfermedad cardiovascular: versión resumida. Rev Esp Cardiol 2008. [DOI: 10.1157/13114961] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Op Reimer WS, Weissberg P, Wood D, Yarnell J, Zamorano JL, Walma E, Fitzgerald T, Cooney MT, Dudina A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Funck-Brentano C, Filippatos G, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Altiner A, Bonora E, Durrington PN, Fagard R, Giampaoli S, Hemingway H, Hakansson J, Kjeldsen SE, Larsen ML, Mancia G, Manolis AJ, Orth-Gomer K, Pedersen T, Rayner M, Ryden L, Sammut M, Schneiderman N, Stalenhoef AF, Tokgözoglu L, Wiklund O, Zampelas A. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). ACTA ACUST UNITED AC 2007; 14 Suppl 2:E1-40. [PMID: 17726406 DOI: 10.1097/01.hjr.0000277984.31558.c4] [Citation(s) in RCA: 259] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Other experts who contributed to parts of the guidelines: Edmond Walma, Schoonhoven (The Netherlands), Tony Fitzgerald, Dublin (Ireland), Marie Therese Cooney, Dublin (Ireland), Alexandra Dudina, Dublin (Ireland) European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG):, Alec Vahanian (Chairperson) (France), John Camm (UK), Raffaele De Caterina (Italy), Veronica Dean (France), Kenneth Dickstein (Norway), Christian Funck-Brentano (France), Gerasimos Filippatos (Greece), Irene Hellemans (The Netherlands), Steen Dalby Kristensen (Denmark), Keith McGregor (France), Udo Sechtem (Germany), Sigmund Silber (Germany), Michal Tendera (Poland), Petr Widimsky (Czech Republic), José Luis Zamorano (Spain) Document reviewers: Irene Hellemans (CPG Review Coordinator) (The Netherlands), Attila Altiner (Germany), Enzo Bonora (Italy), Paul N. Durrington (UK), Robert Fagard (Belgium), Simona Giampaoli(Italy), Harry Hemingway (UK), Jan Hakansson (Sweden), Sverre Erik Kjeldsen (Norway), Mogens Lytken Larsen (Denmark), Giuseppe Mancia (Italy), Athanasios J. Manolis (Greece), Kristina Orth-Gomer (Sweden), Terje Pedersen (Norway), Mike Rayner (UK), Lars Ryden (Sweden), Mario Sammut (Malta), Neil Schneiderman (USA), Anton F. Stalenhoef (The Netherlands), Lale Tokgözoglu (Turkey), Olov Wiklund (Sweden), Antonis Zampelas (Greece)
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Affiliation(s)
- Ian Graham
- Department of Cardiology, The Adelaide and Meath Hospital, Tallaght, Doublin, Ireland.
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Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HAJS, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Erdine S, Kiowski W, Agabiti-Rosei E, Ambrosion E, Fagard R, Lindholm LH, Manolis A, Nilsson PM, Redon J, Viigimaa M, Adamopoulos S, Agabiti-Rosei E, Bertomeu V, Clement D, Farsang C, Gaita D, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL. [ESH/ESC 2007 Guidelines for the management of arterial hypertension]. Rev Esp Cardiol 2007; 60:968.e1-94. [PMID: 17915153 DOI: 10.1157/13109650] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Op Reimer WS, Weissberg P, Wood D, Yarnell J, Zamorano JL. European guidelines on cardiovascular disease prevention in clinical practice: Executive summary. Atherosclerosis 2007; 194:1-45. [PMID: 17880983 DOI: 10.1016/j.atherosclerosis.2007.08.024] [Citation(s) in RCA: 168] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Ian Graham
- Department of Cardiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
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Kearney-Schwartz A, Virion JM, Stoltz JF, Drouin P, Zannad F. Haemorheological disturbances in hypertensive type 2 diabetic patients ? influence of antihypertensive therapy. Fundam Clin Pharmacol 2007; 21:387-96. [PMID: 17635177 DOI: 10.1111/j.1472-8206.2007.00496.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Haemorheological changes have been described in hypertension as well as in diabetes mellitus. Antihypertensive treatment improves rheology in hypertensive patients. The aim of this study was to describe the haemorheological profile and its impact on shear stress in hypertensive type 2 diabetes mellitus patients (HT + DM) and to investigate the effect of antihypertensive therapy on blood rheology using a double-blind randomized protocol, comparing the calcium antagonist amlodipine with the angiotensin-converting enzyme (ACE) inhibitor enalapril. A total of 144 patients with hypertension and type 2 diabetes (64 of transversal study and 80 of randomized clinical trial) were compared with 92 controls belonging to a transversal study. Secondarily, in a separate analysis, therapeutic effects of calcium antagonist amlodipine and ACE inhibitor enalapril were compared in a longitudinal, randomized trial in the patients. We assessed whole-blood viscosity, plasma viscosity, partial and total disaggregation times, haematocrit and fibrinogen. Radial artery systolic flow velocity was measured by pulsed Doppler. Shear stress was calculated as the product of flow velocity x whole-blood viscosity. Compared with controls, patients had significantly higher whole-blood viscosity for all shear rates (P < 0.001) as well as higher arterial diameter and systolic blood flow velocity (2.8 +/- 0.3 vs. 2.6 +/- 0.3 mm, P < 0.001; and 50.8 +/- 11.6 vs. 45.6 +/- 9.8 cm/s, P = 0.01, respectively). Whole-blood viscosity at shear rate gamma = 128/s tended to increase with amlodipine (+1.13%) and decrease with enalapril (-2.47%) (P = 0.028 for inter-group difference). In hypertensive diabetic patients, hyperviscosity contributes to increased shear stress. Haemorheological disturbances in these patients are not significantly influenced by blood pressure lowering with antihypertensive therapy by ACE inhibitor enalapril or calcium antagonist amlodipine. Other factors potentially contributing to rheology and arterial changes may be more critical in HT + DM patients and need further investigation.
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Abstract
Nebivolol is a third generation beta-blocker. It is highly selective for the beta1-adrenoceptor, and has additional nitric oxide-mediated vasodilating and antioxidant properties, along with a favourable metabolic profile. Nebivolol is well tolerated by patients with hypertension and heart failure. Although several smaller studies were conducted with nebivolol in hypertensive patients, no large randomised clinical trials have been performed to prove efficacy on hard clinical end points. In patients with heart failure, a large mortality/morbidity trial was conducted, and nebivolol was shown to reduce the composite end point of mortality and hospitalisations. Nebivolol is registered, in Europe, for mild-to-moderate, uncomplicated hypertension and mild-to-moderate heart failure; and outside Europe, for hypertension. This review describes experimental and clinical data regarding this selective beta-blocker with vasodilating and antioxidant effects.
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Affiliation(s)
- Rudolf A de Boer
- University Medical Center Groningen, Thoraxcenter, Department of Cardiology, Groningen, The Netherlands
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Rahman S, Ismail AAS, Ismail SB, Naing NN, Abdul Rahman AR. Effect of rosiglitazone/ramipril on preclinical vasculopathy in newly diagnosed, untreated diabetes and IGT patients: 1-year randomised, double-blind, placebo-controlled study. Eur J Clin Pharmacol 2007; 63:733-41. [PMID: 17565489 DOI: 10.1007/s00228-007-0315-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 04/23/2007] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate whether pharmacological interventions with rosiglitazone/ramipril can reverse preclinical vasculopathy in newly diagnosed untreated patients with type 2 diabetes (T2DM) and impaired glucose tolerance (IGT). METHODS In this randomised, double-blind, placebo-controlled study, 33 T2DM and 33 IGT patients were randomised to 4 mg rosiglitazone or 5 mg ramipril or placebo for 1 year. The subjects were newly diagnosed, untreated, normotensive, nonobese, nonsmoker, and nonhyperlipidaemic. Haemodynamic variables were measured at three treatment phases and pulse wave velocity (PWV) and augmentation index (AI) were measured throughout the treatment period. RESULTS Rosiglitazone showed a significant reduction in PWV (p=0.039) and AI (p=0.031) and ramipril demonstrated a significant reduction of AI (p=0.025) in IGT in comparison to placebo on the 12th month of treatment. No significant difference was observed in PWV and AI in T2DM with rosiglitazone/ramipril in comparison to placebo during overall treatment period. CONCLUSIONS Rosiglitazone significantly reversed preclinical vasculopathy in IGT as evident by significant decrease in PWV and AI after 1 year of treatment. Ramipril also reduced large artery stiffness as shown by significant decrease of AI after 1 year of treatment in IGT. Further trials are needed for a longer period of time, maybe with higher doses, to show whether rosiglitazone/ramipril can reverse preclinical vasculopathy in T2DM.
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Affiliation(s)
- Sayeeda Rahman
- Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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45
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Abstract
The effects of the antihypertensive drugs on carbohydrate metabolism and the development of diabetes have been a major research field for more than two decades. Many clinical studies have investigated the effects of the antihypertensive classes on insulin sensitivity and glycemic control, whereas several observational studies and large outcome trials have examined associations of antihypertensive agents with diabetes incidence. In general, thiazide diuretics and conventional beta blockers decrease insulin sensitivity and increase new-onset diabetes, whereas angiotensin-converting enzyme inhibitors, calcium channel blockers, and angiotensin II receptor blockers have neutral or beneficial effects on these parameters. However, several issues in this field, such as the specific properties of newer agents and the relationship of adverse metabolic outcomes and cardiovascular risk, remain to be fully elucidated. This article presents and evaluates the current knowledge in this important area.
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Affiliation(s)
- Pantelis A Sarafidis
- 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, 546 36 Thessaloniki, Greece.
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Pfützner A, Forst T, März W, Jacob S. Evidenzbasierte Medizin. Internist (Berl) 2007; 48:426-35. [PMID: 17364168 DOI: 10.1007/s00108-007-1830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Founded on evidence based medicine (EBM), medical decisions should involve the best possible external scientific evidence as well as the expertise of the individual physician, while taking into consideration the subjective perspective of the patient. The Institute for Quality and Cost Effectiveness (Institut für Qualität und Wirtschaftlichkeit, IQWIG), which is financed through membership contributions to the statutory health insurance, deviates drastically in its evaluations for innovative medications from this concept. All publications on a medication are reduced to only a few "relevant" studies so that the statistics from the resulting meta-analysis are invalid. The resulting method dependent lack of statistical significance is considered by IQWIG authors to show the non-superiority of the test products, which are then speculatively discredited in terms of their safety. The "recommendations" of the IQWIG are accepted uncritically by the cost carriers. The aim of this article is to evaluate IQWIG-EBM in comparison with international standards on the basis of published IQWIG reports on metabolically active medications. The example of the reports on statins, short-term insulin analogues and inhaled insulin shows a methodology which suggests the misuse of study results and can best be characterized by the term "evidently biased medicine."
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Affiliation(s)
- A Pfützner
- IKFE Institut für Klinische Forschung und Entwicklung, Mainz, Deutschland
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47
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Metabolic effects of β-blockers: importance of dissociating newer from conventional agents. J Hypertens 2007. [DOI: 10.1097/hjh.0b013e328010c2c1] [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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Schmidt AC, Graf C, Brixius K, Scholze J. Blood Pressure-Lowering Effect of Nebivolol in Hypertensive Patients with Type 2 Diabetes Mellitus. Clin Drug Investig 2007; 27:841-9. [DOI: 10.2165/00044011-200727120-00006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Sarafidis PA, Bakris GL. Metabolic effects of β-blockers: importance of dissociating newer from conventional agents. J Hypertens 2007; 25:249-52; author reply 252-3. [PMID: 17143201 DOI: 10.1097/hjh.0b013e3280104fa5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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