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Xia T, Xu L, Guo P, Shi W, Cheng Y, Liu A. Synergism of amlodipine and telmisartan or candesartan on blood pressure reduction by using SynergyFinder 3.0 and probability sum test in vivo. Pharmacol Res Perspect 2023; 11:e01064. [PMID: 36810974 PMCID: PMC9944853 DOI: 10.1002/prp2.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
This study was designed to evaluate the synergism of two couples of antihypertensive drugs (amlodipine + telmisartan and amlodipine + candesartan) on blood pressure reduction in vivo by both SynergyFinder 3.0 and probability sum test. Spontaneously hypertensive rats were treated with intragastric administration of amlodipine (0.5, 1, 2, and 4 mg/kg), telmisartan (4, 8, and 16 mg/kg), candesartan (1, 2, and 4 mg/kg), nine combinations for amlodipine and telmisartan, and nine combinations for amlodipine and candesartan. The control rats were treated by 0.5% carboxymethylcellulose sodium. Blood pressure was recorded continuously up to 6 h after administration. Both SynergyFinder 3.0 and the probability sum test were used to evaluate the synergistic action. The synergisms calculated by SynergyFinder 3.0 are consistent with the probability sum test both in two different combinations. There is an obviously synergistic interaction between amlodipine and telmisartan or candesartan. The combinations of amlodipine and telmisartan (2 + 4 and 1 + 4 mg/kg) and amlodipine and candesartan (0.5 + 4 and 2 + 1 mg/kg) might exert an optimum synergism against hypertension. Compared with the probability sum test, SynergyFinder 3.0 is more stable and reliable to analyze the synergism.
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Affiliation(s)
- Tian Xia
- Department of Pharmacology, School of PharmacyNaval Medical UniversityShanghaiChina
- Institute of PharmacyYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Lu‐Lu Xu
- Department of Pharmacology, School of PharmacyNaval Medical UniversityShanghaiChina
- Institute of PharmacyYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Peng‐Yue Guo
- Department of Clinical PharmacyNaval Medical UniversityShanghaiChina
| | - Wan‐Ting Shi
- Department of Pharmacology, School of PharmacyNaval Medical UniversityShanghaiChina
- Institute of PharmacyYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yan‐Qiong Cheng
- Department of Pharmacology, School of PharmacyNaval Medical UniversityShanghaiChina
- Institute of PharmacyYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Ai‐Jun Liu
- Department of Pharmacology, School of PharmacyNaval Medical UniversityShanghaiChina
- Institute of PharmacyYueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese MedicineShanghaiChina
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Cheng YQ, Tan BY, Yu XH, Dong WZ, Su DF, Zhu DQ, Liu AJ. Synergism of amlodipine and candesartan on blood pressure reduction and organ protection in hypertensive rats. Clin Exp Pharmacol Physiol 2018; 45:514-524. [PMID: 29193272 DOI: 10.1111/1440-1681.12901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 01/18/2023]
Abstract
This study was designed to investigate the possible synergism of amlodipine and candesartan on the reduction of blood pressure (BP) in hypertensive rats. The end organ protection was also observed. In acute experiment, spontaneously hypertensive rats (SHRs) were treated with intragastric administration of amlodipine (0.5, 1, 2, 3 mg/kg), candesartan (1, 2, 3, 4, 6, 8 mg/kg), and 14 different combinations to find the possible ratio of synergistic interaction. In two kidneys, one clip (2K1C) rats, the effects of amlodipine (1 mg/kg), canderastan (2 mg/kg) and their combination on BP reduction were also observed. In chronic study, SHRs were treated with amlodipine (1 mg/kg), candesartan (2 mg/kg), and their combination for 5 months. Organ damage evaluation was performed after BP recording. The probability sum test (q test) was used to evaluate the synergistic action. There is a synergistic interaction between amlodipine and candesartan on BP reduction. The optimal dose ratio is 1:2. The synergistic effect was also confirmed by 2K1C hypertensive rats. In chronic study, this combination (1:2) possessed an obvious synergism on the reduction of BP and BP variability (BPV) and protection on end organs. Multiple regression analysis showed that heart and aortic hypertrophy indexes and glomerular damage parameters were positively related to BP and BPV. In conclusion, combination of amlodipine and candesartan exhibited a potent antihypertensive effect and possessed an obvious synergism on BP reduction and organ protection in hypertension. The optimal proportion was 1:2. BP and BPV reduction may both importantly contribute to end organ protection.
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Affiliation(s)
- Yan-Qiong Cheng
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China.,Department of Urinary Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bing-Yi Tan
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Xu-Hong Yu
- Department of Pharmacy, People Liberation Army 305 Hospital, Beijing, China
| | - Wen-Zhe Dong
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China.,Department of Pharmacology, Shanghai Institute of Health Sciences, Shanghai, China
| | - Ding-Feng Su
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China
| | - De-Qiu Zhu
- Division of Pharmacy, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ai-Jun Liu
- Department of Pharmacology, School of Pharmacy, Second Military Medical University, Shanghai, China
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Skrzypecki J, Gawlak M, Huc T, Szulczyk P, Ufnal M. Renal denervation decreases blood pressure and renal tyrosine hydroxylase but does not augment the effect of hypotensive drugs. Clin Exp Hypertens 2017; 39:290-294. [DOI: 10.1080/10641963.2016.1267191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shirakura T, Nomura J, Matsui C, Kobayashi T, Tamura M, Masuzaki H. Febuxostat, a novel xanthine oxidoreductase inhibitor, improves hypertension and endothelial dysfunction in spontaneously hypertensive rats. Naunyn Schmiedebergs Arch Pharmacol 2016; 389:831-8. [PMID: 27198514 PMCID: PMC4939152 DOI: 10.1007/s00210-016-1239-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 03/28/2016] [Indexed: 02/07/2023]
Abstract
Xanthine oxidase (XO) is an enzyme responsible for the production of uric acid. XO produces considerable amount of oxidative stress throughout the body. To date, however, its pathophysiologic role in hypertension and endothelial dysfunction still remains controversial. To explore the possible involvement of XO-derived oxidative stress in the pathophysiology of vascular dysfunction, by use of a selective XO inhibitor, febuxostat, we investigated the impact of pharmacological inhibition of XO on hypertension and vascular endothelial dysfunction in spontaneously hypertensive rats (SHRs). Sixteen-week-old SHR and normotensive Wistar-Kyoto (WKY) rats were treated with tap water (control) or water containing febuxostat (3 mg/kg/day) for 6 weeks. Systolic blood pressure (SBP) in febuxostat-treated SHR (220 ± 3 mmHg) was significantly (P < 0.05) decreased compared with the control SHR (236 ± 4 mmHg) while SBP in febuxostat-treated WKY was constant. Acetylcholine-induced endothelium-dependent relaxation in aortas from febuxostat-treated SHR was significantly (P < 0.05) improved compared with the control SHR, whereas relaxation in response to sodium nitroprusside was not changed. Vascular XO activity and tissue nitrotyrosine level, a representative indicator of local oxidative stress, were considerably elevated in the control SHR compared with the control WKY, and this increment was abolished by febuxostat. Our results suggest that exaggerated XO activity and resultant increase in oxidative stress in this experimental model contribute to the hypertension and endothelial dysfunction, thereby supporting a notion that pharmacological inhibition of XO is valuable not only for hyperuricemia but also for treating hypertension and related endothelial dysfunction in human clinics.
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Affiliation(s)
- Takashi Shirakura
- Pharmaceutical Development Research Laboratories, Teijin Institute for Bio-Medical Research, Teijin Pharma Ltd., 4-3-2, Asahigaoka, Hino, 191-852, Tokyo, Japan.
| | - Johji Nomura
- Pharmaceutical Development Research Laboratories, Teijin Institute for Bio-Medical Research, Teijin Pharma Ltd., 4-3-2, Asahigaoka, Hino, 191-852, Tokyo, Japan
| | - Chieko Matsui
- Pharmaceutical Development Research Laboratories, Teijin Institute for Bio-Medical Research, Teijin Pharma Ltd., 4-3-2, Asahigaoka, Hino, 191-852, Tokyo, Japan
| | - Tsunefumi Kobayashi
- Pharmaceutical Development Research Laboratories, Teijin Institute for Bio-Medical Research, Teijin Pharma Ltd., 4-3-2, Asahigaoka, Hino, 191-852, Tokyo, Japan
| | - Mizuho Tamura
- Pharmaceutical Development Research Laboratories, Teijin Institute for Bio-Medical Research, Teijin Pharma Ltd., 4-3-2, Asahigaoka, Hino, 191-852, Tokyo, Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
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Michel MC, Brunner HR, Foster C, Huo Y. Angiotensin II type 1 receptor antagonists in animal models of vascular, cardiac, metabolic and renal disease. Pharmacol Ther 2016; 164:1-81. [PMID: 27130806 DOI: 10.1016/j.pharmthera.2016.03.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 02/07/2023]
Abstract
We have reviewed the effects of angiotensin II type 1 receptor antagonists (ARBs) in various animal models of hypertension, atherosclerosis, cardiac function, hypertrophy and fibrosis, glucose and lipid metabolism, and renal function and morphology. Those of azilsartan and telmisartan have been included comprehensively whereas those of other ARBs have been included systematically but without intention of completeness. ARBs as a class lower blood pressure in established hypertension and prevent hypertension development in all applicable animal models except those with a markedly suppressed renin-angiotensin system; blood pressure lowering even persists for a considerable time after discontinuation of treatment. This translates into a reduced mortality, particularly in models exhibiting marked hypertension. The retrieved data on vascular, cardiac and renal function and morphology as well as on glucose and lipid metabolism are discussed to address three main questions: 1. Can ARB effects on blood vessels, heart, kidney and metabolic function be explained by blood pressure lowering alone or are they additionally directly related to blockade of the renin-angiotensin system? 2. Are they shared by other inhibitors of the renin-angiotensin system, e.g. angiotensin converting enzyme inhibitors? 3. Are some effects specific for one or more compounds within the ARB class? Taken together these data profile ARBs as a drug class with unique properties that have beneficial effects far beyond those on blood pressure reduction and, in some cases distinct from those of angiotensin converting enzyme inhibitors. The clinical relevance of angiotensin receptor-independent effects of some ARBs remains to be determined.
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Affiliation(s)
- Martin C Michel
- Dept. Pharmacology, Johannes Gutenberg University, Mainz, Germany; Dept. Translational Medicine & Clinical Pharmacology, Boehringer Ingelheim, Ingelheim, Germany.
| | | | - Carolyn Foster
- Retiree from Dept. of Research Networking, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Yong Huo
- Dept. Cardiology & Heart Center, Peking University First Hospital, Beijing, PR China
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Ley L, Schumacher H. Telmisartan plus amlodipine single-pill combination for the management of hypertensive patients with a metabolic risk profile (added-risk patients). Curr Med Res Opin 2013; 29:41-53. [PMID: 23157465 DOI: 10.1185/03007995.2012.750601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Hypertensive patients with metabolic risk factors, including obesity, diabetes, and metabolic syndrome, often require a combination of antihypertensive agents to achieve blood pressure (BP) targets. This article considers the evidence supporting telmisartan/amlodipine combination therapy for the treatment of hypertension in patients with metabolic risk factors. METHODS Clinical trials of telmisartan/amlodipine at doses of 40-80 mg/5-10 mg (T40-80/A5-10) in free, fixed-dose and single-pill combinations were identified through electronic searches (MEDLINE and congress abstracts) up to and including June 2012, and from the Boehringer Ingelheim (BI) trial database. All identified trials were reviewed for data on hypertensive patients with obesity, diabetes, or both. Post-hoc subgroup analyses were carried out using the BI database to determine the relevant information if it was not previously reported. RESULTS Thirteen clinical trials including 6886 patients were identified with data relevant for inclusion in this review. The telmisartan/amlodipine combination allowed a high proportion of hypertensive patients with metabolic conditions to achieve BP targets, particularly among patients who had previously failed to achieve BP targets with monotherapy. BP reductions and goal rate achievement were similarly high among patients with and without the presence of metabolic risk factors. BP reductions were maintained throughout the 24 h dosing period, and 24 h goal rates were obtained in a high proportion of patients. Particularly large reductions in BP with telmisartan/amlodipine were recorded among patients with severe hypertension (systolic BP ≥180 mmHg). CONCLUSIONS The results of this post-hoc analysis further support the ability of the telmisartan/amlodipine combination to effectively reduce BP in hypertensive patients with obesity, diabetes, or metabolic syndrome, enabling the majority of patients to achieve target BP. This combination is also well tolerated, and may be considered a suitable option for these added-risk hypertensive patients.
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Affiliation(s)
- Ludwin Ley
- Boehringer Ingelheim International GmbH & Co. KG, Ingelheim, Germany.
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