1
|
Érszegi A, Viola R, Bahar MA, Tóth B, Fejes I, Vágvölgyi A, Csupor D. Not first-line antihypertensive agents, but still effective-The efficacy and safety of imidazoline receptor agonists: A network meta-analysis. Pharmacol Res Perspect 2024; 12:e1215. [PMID: 38807350 PMCID: PMC11133783 DOI: 10.1002/prp2.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/22/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024] Open
Abstract
Cardiovascular disorders are the leading cause of death in the world. Many organ diseases (kidney, heart, and brain) are substantially more prone to develop in people with hypertension. In the treatment of hypertension, first-line medications are recommended, while imidazoline receptor agonists are not first-line antihypertensives. Our goal was to conduct a network meta-analysis to assess the efficacy and safety of imidazoline receptor agonists. The meta-analysis was performed following the PRISMA guidelines using the PICOS format, considering the CONSORT recommendations. Studies were collected from four databases: PubMed, Cochrane Library, Web of Science, and Embase. A total of 5960 articles were found. After filtering, 27 studies remained eligible for network meta-analysis. Moxonidine reduced blood pressure in sitting position statistically significantly after 8 weeks of treatment (SBP MD: 23.80; 95% CI: 17.45-30.15; DBP MD: 10.90; 95% CI: 8.45-13.35) compared to placebo. Moreover, moxonidine reduced blood pressure more effectively than enalapril; however, this difference was not significant (SBP MD: 3.10; 95% CI: -2.60-8.80; DBP MD: 1.30; 95% CI: -1.25-3.85). Dry mouth was experienced as a side effect in the case of all imidazoline receptor agonists. After 8 weeks of treatment, the appearance of dry mouth was highest with clonidine (OR: 9.27 95% CI: 4.70-18.29) and lowest with rilmenidine (OR: 6.46 95% CI: 0.85-49.13) compared to placebo. Somnolence was less frequent with moxonidine compared to rilmenidine (OR: 0.63 95% CI: 0.17-2.31). Imidazoline receptor agonists were nearly as effective as the first-line drugs in the examined studies. However, their utility as antihypertensives is limited due to their side effects. As a result, they are not first-line antihypertensives and should not be used in monotherapy. However, in the case of resistant hypertension, they are a viable option. According to our findings, from the point of view of safety and efficacy, moxonidine appears to be the best choice among imidazoline receptor agonists.
Collapse
Affiliation(s)
- András Érszegi
- Faculty of Pharmacy, Institute of Clinical PharmacyUniversity of SzegedSzegedHungary
- Albert Szent‐Györgyi Medical CentreCentral Pharmacy, University of SzegedSzegedHungary
| | - Réka Viola
- Faculty of Pharmacy, Institute of Clinical PharmacyUniversity of SzegedSzegedHungary
- Albert Szent‐Györgyi Medical CentreCentral Pharmacy, University of SzegedSzegedHungary
| | - Muh Akbar Bahar
- Faculty of Pharmacy, Institute of Clinical PharmacyUniversity of SzegedSzegedHungary
- Department of Pharmacy, Faculty of PharmacyUniversitas HasanuddinMakassarIndonesia
| | - Barbara Tóth
- Faculty of Pharmacy, Institute of Clinical PharmacyUniversity of SzegedSzegedHungary
| | - Imola Fejes
- Department of Medicine, Albert Szent‐Györgyi Medical CentreUniversity of SzegedSzegedHungary
| | - Anna Vágvölgyi
- Department of Medicine, Albert Szent‐Györgyi Medical CentreUniversity of SzegedSzegedHungary
| | - Dezső Csupor
- Faculty of Pharmacy, Institute of Clinical PharmacyUniversity of SzegedSzegedHungary
- Institute for Translational MedicineUniversity of PécsPécsHungary
| |
Collapse
|
2
|
Chakraborty S, Verma A, Garg R, Singh J, Verma H. Cardiometabolic Risk Factors Associated With Type 2 Diabetes Mellitus: A Mechanistic Insight. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231220780. [PMID: 38148756 PMCID: PMC10750528 DOI: 10.1177/11795514231220780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
A complex metabolic condition referred to as Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance (IR) and decreased insulin production. Obesity, dyslipidemia, hypertension, and chronic inflammation are just a few of the cardiometabolic illnesses that people with T2DM are more likely to acquire and results in cardiovascular issues. It is essential to comprehend the mechanistic insights into these risk variables in order to prevent and manage cardiovascular problems in T2DM effectively. Impaired glycemic control leads to upregulation of De novo lipogenesis (DNL), promote hepatic triglyceride (TG) synthesis, worsening dyslipidemia that is accompanied by low levels of high density lipoprotein cholesterol (HDL-C) and high amounts of small, dense low-density lipoprotein cholesterol (LDL-C) further developing atherosclerosis. By causing endothelial dysfunction, oxidative stress, and chronic inflammation, chronic hyperglycemia worsens already existing cardiometabolic risk factors. Vasoconstriction, inflammation, and platelet aggregation are caused by endothelial dysfunction, which is characterized by decreased nitric oxide production, increased release of vasoconstrictors, proinflammatory cytokines, and adhesion molecules. The loop of IR and endothelial dysfunction is sustained by chronic inflammation fueled by inflammatory mediators produced in adipose tissue. Infiltrating inflammatory cells exacerbate inflammation and the development of plaque in the artery wall. In addition, the combination of chronic inflammation, dyslipidemia, and IR contributes to the emergence of hypertension, a prevalent comorbidity in T2DM. The ability to target therapies and management techniques is made possible by improvements in our knowledge of these mechanistic insights. Aim of present review is to enhance our current understanding of the mechanistic insights into the cardiometabolic risk factors related to T2DM provides important details into the interaction of pathophysiological processes resulting in cardiovascular problems. Understanding these pathways will enable us to create efficient plans for the prevention, detection, and treatment of cardiovascular problems in T2DM patients, ultimately leading to better overall health outcomes.
Collapse
Affiliation(s)
- Snigdha Chakraborty
- Overseas R & D Centre, Overseas HealthCare Pvt Ltd., Phillaur, Punjab, India
| | - Anjali Verma
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Rajeev Garg
- IKG Punjab Technical University, Kapurthala, India
- Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India
- Guru Nanak Institute of Pharmacy, Dalewal, Hoshiarpur, Punjab, India
| | - Jyoti Singh
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Hitesh Verma
- Overseas R & D Centre, Overseas HealthCare Pvt Ltd., Phillaur, Punjab, India
- IKG Punjab Technical University, Kapurthala, India
- Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Bela, Ropar, Punjab, India
- Biofern Life Sciences Pvt Ltd, Karnataka, India
| |
Collapse
|
3
|
Masenga SK, Kirabo A. Hypertensive heart disease: risk factors, complications and mechanisms. Front Cardiovasc Med 2023; 10:1205475. [PMID: 37342440 PMCID: PMC10277698 DOI: 10.3389/fcvm.2023.1205475] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023] Open
Abstract
Hypertensive heart disease constitutes functional and structural dysfunction and pathogenesis occurring primarily in the left ventricle, the left atrium and the coronary arteries due to chronic uncontrolled hypertension. Hypertensive heart disease is underreported and the mechanisms underlying its correlates and complications are not well elaborated. In this review, we summarize the current understanding of hypertensive heart disease, we discuss in detail the mechanisms associated with development and complications of hypertensive heart disease especially left ventricular hypertrophy, atrial fibrillation, heart failure and coronary artery disease. We also briefly highlight the role of dietary salt, immunity and genetic predisposition in hypertensive heart disease pathogenesis.
Collapse
Affiliation(s)
- Sepiso K. Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Cam-Pus, Livingstone, Zambia
- School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN, United States
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, TN, United States
| |
Collapse
|
4
|
Liu Y, Lin Y, Zhang MM, Li XH, Liu YY, Zhao J, Shi L. The relationship of plasma renin, angiotensin, and aldosterone levels to blood pressure variability and target organ damage in children with essential hypertension. BMC Cardiovasc Disord 2020; 20:296. [PMID: 32546130 PMCID: PMC7298948 DOI: 10.1186/s12872-020-01579-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To investigate the relationships of plasma renin, angiotensin, and aldosterone levels to blood pressure variability and target organ damage in children with essential hypertension. METHODS A case-control study was conducted on 132 children diagnosed with essential hypertension (103 males and 29 females with the mean age of 11.8 ± 2.4 years). The plasma RAAS levels were measured using the enhanced chemiluminescence method, the ambulatory blood pressure was monitored for 24 h, and then the average real variability (ARV) was calculated. Data on indicators were used for assessing cardiac and renal damages. The correlations of plasma renin, angiotensin, and aldosterone (RAAS) levels to blood pressure variability (BPV) and target organ damage (TOD) were studied. A comparison between the groups was conducted using SPSS 20. RESULTS Among the 132 children, 55 cases had target organ damage. The 24-h ARV and the daytime ARV of the systolic blood pressure of the high angiotensin II (AT II) group was significantly higher than that of the normal AT II group (t = 2.175, P = 0.031; t = 2.672, P = 0.009). Plasma AT II and aldosterone levels were significantly associated with the left ventricular mass index (r = 0.329, P = 0.0001; r = 0.175, P = 0.045). Linear regression analysis showed that AT II [β ± s.e. = 0.025 ± 0.006, 95% CI (0.013-0.038), P = 0.0001] and aldosterone [β ± s.e. = 0.021 ± 0.007, 95% CI (0.008-0.034), P = 0.002] were risk factors for LVH. CONCLUSIONS The AT II level in children with essential hypertension affected the variability of the 24-h and the daytime SBP. Plasma AT II and aldosterone levels were associated with cardiac damage. Results from this study indicated that AT II and aldosterone are risk factors for LVH in childhood hypertension and are of great significance for improving the clinical prognosis of pediatric patients with hypertension.
Collapse
Affiliation(s)
- Yang Liu
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, 100191, China
| | - Yao Lin
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Ming-Ming Zhang
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Xiao-Hui Li
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Yan-Yan Liu
- Department of Cardiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, 100020, China
| | - Jing Zhao
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, 100191, China.
| | - Lin Shi
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, 100191, China.
| |
Collapse
|
5
|
Niu J, Zeng M, Wang Y, Liu J, Li H, Wang S, Zhou X, Wang J, Li Y, Hou F, Zhu J. Sensitive marker for evaluation of hypertensive heart disease: extracellular volume and myocardial strain. BMC Cardiovasc Disord 2020; 20:292. [PMID: 32539749 PMCID: PMC7294608 DOI: 10.1186/s12872-020-01553-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/26/2020] [Indexed: 01/19/2023] Open
Abstract
Background Evaluation of tissue fibrosis and myocardial hypertrophy in left ventricular (LV) remodeling is the basis of post-treatment evaluation of hypertensive heart disease (HHD). Extracellular volume (ECV) and myocardial strain parameters can indirectly reflect the changes of both. Our objective was to analyze the characteristics of ECV and strain parameters in LV myocardium of HHD with varying degrees of systolic dysfunction, and to explore the changes of both after treatment for hypertension. Methods A total of 62 HHD patients were divided into 3 groups according to ejection fraction (EF < 30, 30%≦EF < 50%, EF≧50%). Twenty-one of these patients underwent cardiac magnetic resonance (CMR) reexamination more than six months after receiving antihypertensive medication. The initial T1 time and post-enhancement T1 time of each segment were measured, and the ECV was calculated. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) of LV were measured by cvi42 software, and the differences in CMR parameters between different groups and before and after treatment were compared. Results ①The mean, basal and middle ECV value of HHD groups with different EF were all higher than that of the control group (P < 0.05), but the difference between HHD groups was not statistically significant. ②With the decrease of EF, the absolute value of both the global or local strain decreased. Strain is related to LVMI and ECV. ③In general, ECV, global RS (GRS) and global CS (GCS) improved after treatment, but the improvement of LS impairment in HHD patients is difficult. Conclusions ECV and myocardial strain parameters are more sensitive to myocardial abnormalities, and ECV, GRS and GCS are more sensitive to treatment. However it is difficult to improve longitudinal strain impairment in HHD patients. ECV and myocardial strain parameters can be used as good makers for long-term monitoring of the efficacy of HHD patients.
Collapse
Affiliation(s)
- Junqiao Niu
- Radiological imaging Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - Mu Zeng
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Wang
- Radiological imaging Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China.
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Hui Li
- Radiological imaging Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - Shanshan Wang
- Radiological imaging Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd, Shanghai, China
| | - Jia Wang
- Radiological imaging Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - Yanyu Li
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Hou
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Junwen Zhu
- Cardiopulmonary function department, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, China
| |
Collapse
|
6
|
Upadhya B, Rocco MV, Pajewski NM, Morgan T, Blackshear J, Hundley WG, Oparil S, Soliman EZ, Cohen DL, Hamilton CA, Cho ME, Kostis WJ, Papademetriou V, Rodriguez CJ, Raj DS, Townsend R, Vasu S, Zamanian S, Kitzman DW. Effect of Intensive Blood Pressure Reduction on Left Ventricular Mass, Structure, Function, and Fibrosis in the SPRINT-HEART. Hypertension 2019; 74:276-284. [PMID: 31256724 PMCID: PMC7098010 DOI: 10.1161/hypertensionaha.119.13073] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In observational studies, left ventricular mass (LVM) and structure are strong predictors of mortality and cardiovascular events. However, the effect of hypertension treatment on LVM reduction and its relation to subsequent outcomes is unclear, particularly at lower blood pressure (BP) targets. In an ancillary study of SPRINT (Systolic Blood Pressure Intervention Trial), where participants were randomly assigned to intensive BP control (target systolic BP target <120 mm Hg) versus standard BP control (<140 mm Hg), cardiac magnetic resonance imaging was performed at baseline and 18-month follow-up to measure: LVM, volumes, ejection fraction, and native T1 mapping for myocardial fibrosis. At baseline, 337 participants were examined (age: 64±9 years, 45% women); 300 completed the 18-month exam (153 intensive control and 147 standard control). In the intensive versus standard BP control group at 18 months, there was no difference in change in LVM (mean±SE =-2.7±0.5 g versus -2.3±0.7 g; P=0.368), ejection fraction, or native T1 (P=0.79), but there was a larger decrease in LVM/end-diastolic volume ratio (-0.04±0.01 versus -0.01±0.01; P=0.002) a measure of concentric LV remodeling. There were fewer cardiovascular events in the intensive control group, but no significant association between the reduced events and change in LVM or any other cardiac magnetic resonance imaging measure. In SPRINT-HEART, contrary to our hypothesis, there were no significant between-group differences in LVM, function, or myocardial T1 at 18-month follow-up. These results suggests that mediators other than these LV measures contribute to the improved cardiovascular outcomes with intensive BP control.
Collapse
Affiliation(s)
- Bharathi Upadhya
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael V Rocco
- Nephrology Section (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Nicholas M Pajewski
- Department of Internal Medicine, Department of Biostatistics and Data Science (N.M.P., T.M.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Tim Morgan
- Department of Internal Medicine, Department of Biostatistics and Data Science (N.M.P., T.M.), Wake Forest School of Medicine, Winston-Salem, NC
| | | | - William Greg Hundley
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama, Birmingham (S.O.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Division of Public Health Sciences (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Debbie L Cohen
- Medicine-Nephrology, University of Pennsylvania, Philadelphia (D.L.C., R.T.)
| | - Craig A Hamilton
- Biomedical Engineering (C.A.H.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Monique E Cho
- Division of Hypertension and Nephrology, University of Utah, Salt Lake City (M.E.C.)
| | | | | | - Carlos J Rodriguez
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Dominic S Raj
- Medicine-Nephrology, George Washington University School of Medicine, District of Columbia (D.S.R.)
| | - Ray Townsend
- Medicine-Nephrology, University of Pennsylvania, Philadelphia (D.L.C., R.T.)
| | - Sujethra Vasu
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sara Zamanian
- Department of Medicine, Case Western Reserve University, Cleveland, OH (S.Z.)
| | - Dalane W Kitzman
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | | |
Collapse
|
7
|
Lambert EA, Esler MD, Schlaich MP, Dixon J, Eikelis N, Lambert GW. Obesity-Associated Organ Damage and Sympathetic Nervous Activity. Hypertension 2019; 73:1150-1159. [DOI: 10.1161/hypertensionaha.118.11676] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Elisabeth A. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Murray D. Esler
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| | - Markus P. Schlaich
- Dobney Hypertension Centre, School of Medicine–Royal Perth Hospital Unit, University of Western Australia (M.P.S.)
| | - John Dixon
- Clinical Obesity Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.D.)
| | - Nina Eikelis
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
| | - Gavin W. Lambert
- From the Iverson Health Innovation Research Institute and School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia (E.A.L., N.E., G.W.L.)
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (E.A.L., M.D.E., N.E., G.W.L.)
| |
Collapse
|
8
|
|
9
|
Fan Z, Wu G, Yue M, Ye J, Chen Y, Xu B, Shu Z, Zhu J, Lu N, Tan X. Hypertension and hypertensive left ventricular hypertrophy are associated with ACE2 genetic polymorphism. Life Sci 2019; 225:39-45. [PMID: 30917908 DOI: 10.1016/j.lfs.2019.03.059] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/19/2019] [Accepted: 03/23/2019] [Indexed: 02/05/2023]
Abstract
AIMS Renin-angiotensin system modulates cardiac structure independent of blood pressure. The present study aimed at investigating whether single nucleotide polymorphism (SNP) and haplotype of angiotensin converting enzyme 2 (ACE2) could influence blood pressure and the susceptibility to hypertensive left ventricular hypertrophy (LVH). SUBJECTS AND METHODS A total of 647 patients (347 females and 300 males) with newly diagnosed mild to moderate essential hypertension were enrolled in a blood pressure matched, case-control study. Four ACE2 tagSNPs (rs2074192, rs4646176, rs4646155 and rs2106809) were genotyped and major haplotypes consisting of these four SNPs were reconstructed for all subjects. KEY FINDINGS In females, minor alleles of ACE2 rs2074192 and rs2106809 respectively conferred a 2.1 and 2.0 fold risk for LVH. ACE2 haplotype TCGT increased the risk for LVH while another haplotype CCGC decreased the risk in females. The covariates-adjusted mean left ventricular mass index was 11% greater in TCGT haplotype carriers than in noncarriers in women. In females, the covariates-adjusted mean systolic blood pressure was 3.4 mm Hg lower in CCGC haplotype carriers than in noncarriers. In males, the covariates-adjusted mean systolic blood pressure was 2.4 mm Hg lower in CCGC haplotype carriers than in noncarriers. SIGNIFICANCE ACE2 tagSNPs rs2074192 and rs2106809 as well as major haplotypes CCGC and TCGT may serve as novel risk markers for LVH in hypertensive patients.
Collapse
Affiliation(s)
- Zhimin Fan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Guihai Wu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Minghui Yue
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Jianfeng Ye
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Yequn Chen
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Bayi Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Zhouwu Shu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Jinxiu Zhu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Nan Lu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China
| | - Xuerui Tan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong, China.
| |
Collapse
|
10
|
Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Erhayiem B, Foley J, Garg P, Haaf P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. Acute Reverse Remodelling After Transcatheter Aortic Valve Implantation: A Link Between Myocardial Fibrosis and Left Ventricular Mass Regression. Can J Cardiol 2016; 32:1411-1418. [DOI: 10.1016/j.cjca.2016.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022] Open
|
11
|
Impact of Renal Sympathetic Denervation on Left Ventricular Structure and Function at 1-Year Follow-Up. PLoS One 2016; 11:e0149855. [PMID: 26934735 PMCID: PMC4774915 DOI: 10.1371/journal.pone.0149855] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/05/2016] [Indexed: 01/19/2023] Open
Abstract
Background Catheter-based sympathetic renal denervation (RDN) is a recent therapeutic option for patients with resistant hypertension. However, the impact of RDN in left ventricular (LV) mass and function is not completely established. Our aim was to evaluate the effects of RDN on LV structure and function (systolic and diastolic) in patients with resistant hypertension (HTN). Methods and Results From a single centre prospective registry including 65 consecutive patients with resistant HTN submitted to RDN between July-2011 and April-2015, 31 patients with baseline and 1-year follow-up echocardiogram were included in this analysis. Mean age was 65±7 years, 48% were males, 71% had type 2 diabetes. Most had hypertension lasting for more than 10 years (90%), and were being treated with a median number of 6 anti-hypertensive drugs, including 74% on spironolactone. At 1-year, there was a significant decrease both on office SBP (176±24 to 149±13mmHg, p<0.001) and DBP (90±14 to 79±11mmHg, p<0.001), and also in 24h ABPM SBP (150±20 to 132±14mmhg, p<0.001) and DBP (83±10 to 74±9mmHg, p<0.001). There was also a significant decrease in LV mass from 152±32 to 136±34g/m2 (p<0.001), an increase in LV end diastolic volume (93±18 to 111±27 mL, p = 0.004), an increase in LV ejection fraction (65±9 to 68±9%, p = 0.001) and mitral valve E deceleration time (225±49 to 247±51ms, p = 0.015) at 1-year follow up. There were no significant changes in left atrium volume index or in the distribution of patients among the different left ventricle geometric patterns and diastolic function subgroups. Conclusions In this single centre registry of patients with resistant hypertension, renal denervation was associated with significant reduction in both office and ABPM blood pressure and a significant decrease in left ventricle mass evaluated by transthoracic echocardiogram at 1 year follow-up.
Collapse
|
12
|
A Single Nucleotide Polymorphism near the CYP17A1 Gene Is Associated with Left Ventricular Mass in Hypertensive Patients under Pharmacotherapy. Int J Mol Sci 2015; 16:17456-68. [PMID: 26263970 PMCID: PMC4581202 DOI: 10.3390/ijms160817456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/16/2015] [Accepted: 07/23/2015] [Indexed: 01/11/2023] Open
Abstract
Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 ± 9.8 years, 83% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) ≥ 40% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7%) and myocardial infarction (n = 545; 54.1%) with a mean LVEF of 59.9% ± 9.3%. The mean left ventricular mass index (LVMI) was 52.1 ± 21.2 g/m2.7 and 485 (48.2%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7% increase in LVMI (95% CI: 1%-12%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.
Collapse
|
13
|
Lambert EA, Straznicky NE, Dixon JB, Lambert GW. Should the sympathetic nervous system be a target to improve cardiometabolic risk in obesity? Am J Physiol Heart Circ Physiol 2015; 309:H244-58. [DOI: 10.1152/ajpheart.00096.2015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/11/2015] [Indexed: 02/03/2023]
Abstract
The sympathetic nervous system (SNS) plays a key role in both cardiovascular and metabolic regulation; hence, disturbances in SNS regulation are likely to impact on both cardiovascular and metabolic health. With excess adiposity, in particular when visceral fat accumulation is present, sympathetic activation commonly occurs. Experimental investigations have shown that adipose tissue releases a large number of adipokines, cytokines, and bioactive mediators capable of stimulating the SNS. Activation of the SNS and its interaction with adipose tissue may lead to the development of hypertension and end-organ damage including vascular, cardiac, and renal impairment and in addition lead to metabolic abnormalities, especially insulin resistance. Lifestyle changes such as weight loss and exercise programs considerably improve the cardiovascular and metabolic profile of subjects with obesity and decrease their cardiovascular risk, but unfortunately weight loss is often difficult to achieve and sustain. Pharmacological and device-based approaches to directly or indirectly target the activation of the SNS may offer some benefit in reducing the cardiometabolic consequences of obesity. Preliminary evidence is encouraging, but more trials are needed to investigate whether sympathetic inhibition could be used in obesity to reverse or prevent cardiometabolic disease development. The purpose of this review article is to highlight the current knowledge of the role that SNS plays in obesity and its associated metabolic disorders and to review the potential benefits of sympathoinhibition on metabolic and cardiovascular functions.
Collapse
Affiliation(s)
- Elisabeth A. Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Physiology, Monash University, Clayton, Australia
| | - Nora E. Straznicky
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - John B. Dixon
- Clinical Obesity Research Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia; and
| | - Gavin W. Lambert
- Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| |
Collapse
|
14
|
Cuspidi C, Tadic M, Sala C. Aldosterone and abnormal left ventricular geometry in chronic kidney disease. Hypertens Res 2015; 38:314-6. [PMID: 25787043 DOI: 10.1038/hr.2015.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Cesare Cuspidi
- 1] Department of Health Science, University of Milano-Bicocca, Milano, Italy [2] Istituto Auxologico Italiano, Milano, Italy
| | - Marijana Tadic
- University Clinical Hospital Centre "Dragisa Misovic", Belgrade, Serbia
| | - Carla Sala
- 1] Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy [2] Fondazione Policlinico di Milano, Milano, Italy
| |
Collapse
|
15
|
Ripley DP, Negrou K, Oliver JJ, Worthy G, Struthers AD, Plein S, Greenwood JP. Aortic remodelling following the treatment and regression of hypertensive left ventricular hypertrophy: a cardiovascular magnetic resonance study. Clin Exp Hypertens 2014; 37:308-16. [PMID: 25271354 DOI: 10.3109/10641963.2014.960974] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Increased arterial stiffness independently predicts adverse prognosis. While different antihypertensive strategies produce different magnitudes of left ventricular hypertrophy (LVH) regression, there are no comparative data on how these strategies affect arterial stiffness. The aim was to determine the longitudinal change in aortic stiffness following the treatment of essential hypertension with two mechanistically different antihypertensive treatment strategies. METHODS AND RESULTS Forty-two patients with essential hypertension and CMR confirmed with LVH were randomly assigned to antihypertensive regimes for 6 months. Treatment strategies were designed either to inhibit the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS) (valsartan and moxonidine, group VM) or to have neutral effect on these systems (bendroflumethiazide and amlodipine, group BA). Both treatment groups underwent identical baseline and a 6-month follow-up CMR and were compared with a healthy age-matched control group. Baseline aortic distensibility (AD) was lower in both hypertensive groups compared with controls (2.8 × 10(-3 )mmHg(-1) in group VM (p = 0.001) and 3.3 × 10(-3 )mmHg(-1) group BA (p = 0.039) compared with 4.5 × 10(-3 )mmHg(-1) in the control group). AD increased after antihypertensive therapy (VM: 2.8 × 10(-3 )mmHg(-1)-4.2 × 10(-3 )mmHg(-1) (p = 0.001); BA 3.3 × 10(-3 )mmHg(-1)-4.6 × 10(-3 )mmHg(-1) (p < 0.01)). In both treatment groups AD returned to a level comparable with the normal control group (p = 0.81) after 6 months. CONCLUSIONS In patients with essential hypertension and LVH, AD was lower than in matched normal controls. Despite the opposing pharmacological mechanisms utilised across the treatment groups, the improvement in AD was similar, suggesting that blood pressure reduction per se may be more important than RAAS and SNS inhibition for the improvement of aortic remodelling.
Collapse
Affiliation(s)
- David P Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds , UK
| | | | | | | | | | | | | |
Collapse
|
16
|
Schirmer SH, Sayed MM, Reil JC, Ukena C, Linz D, Kindermann M, Laufs U, Mahfoud F, Böhm M. Improvements in Left Ventricular Hypertrophy and Diastolic Function Following Renal Denervation. J Am Coll Cardiol 2014; 63:1916-23. [DOI: 10.1016/j.jacc.2013.10.073] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/07/2013] [Accepted: 10/17/2013] [Indexed: 11/30/2022]
|
17
|
Gavina C, Falcão-Pires I, Rodrigues J, Marinho B, Gonçalves N, Lopes R, Amorim MJ, Almeida J, Pinho P, Gonçalves A, Rocha-Gonçalves F, Leite-Moreira A. Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients. Int J Cardiol 2013; 170:324-30. [PMID: 24268509 DOI: 10.1016/j.ijcard.2013.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 08/16/2013] [Accepted: 11/02/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated the impact of hypertension on the left ventricular mass regression in aortic stenosis after aortic valve replacement. METHODS We prospectively studied 135 patients with severe aortic stenosis at baseline and 1 year after surgery. In 32 patients we analyzed myocardial gene expression of collagen types I and III, connective tissue growth factor, transforming growth factor-β1, metalloproteinase-2 and its tissue inhibitor and compared its levels vs controls. RESULTS Seventy-six patients (56.3%) had a history of hypertension. Hypertensive patients were older, had higher Euroscore-II and NYHA class, with no differences in stenosis severity. At 1 year follow-up there was a median decrease of mass index of 14.2% (P25-75: -4.3%-30.4%; p<0.001). Mass regression was significantly higher in patients without hypertension, with a median decrease of 25.9% (P25-75: 12.0%-38.7%) vs 5.4% (P25-75: -12.5%-20.1%; p=0.001), despite similar increase in effective orifice area and no differences in valvuloarterial impedance. After 1 year, higher baseline left ventricular mass index (p=0.005) and the absence of hypertension (p=0.002) or diabetes (p=0.041) were the only independent predictors of mass regression higher than the median. Comparing with controls, aortic stenosis patients had an increased expression of collagen types I and III, but only hypertensive patients had higher relative expression of collagen type I vs III. In hypertensive patients TIMP2 expression was up-regulated and correlated with higher baseline left ventricular mass index (r=0.61; p=0.020). CONCLUSIONS In aortic stenosis, hypertension impairs mass regression one year after valve replacement, independently of total afterload. Differences in the expression of extracellular matrix remodeling genes might contribute to this finding.
Collapse
Affiliation(s)
- Cristina Gavina
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
| | - Inês Falcão-Pires
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal
| | | | - Benjamim Marinho
- Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Nadia Gonçalves
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Ricardo Lopes
- Cardiology, Centro Hospitalar São João, Porto, Portugal
| | - Mário Jorge Amorim
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Jorge Almeida
- Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Pinho
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | | | | | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| |
Collapse
|
18
|
Kiel RG, Deedwania P. Medical treatment of hypertension in patients with heart failure with preserved ejection fraction. Curr Cardiol Rep 2013; 15:428. [PMID: 24162922 DOI: 10.1007/s11886-013-0428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Heart failure with preserved ejection fraction (HFPEF) has become an increasingly common problem, accounting for as many as half of all diagnoses of heart failure. Hypertension has been shown to be a major risk factor for the development of HPEF, and the treatment of hypertension is key to both preventing the development of HFPEF as well as mitigating its impact on our health care system. While numerous studies have looked at using various classes of antihypertensive medications to treat HFPEF, there are still no well validated treatment strategies which have shown a significant mortality benefit. As a result, when choosing an antihypertensive medication to treat or prevent HFPEF, it is important to tailor the choice of antihypertensive medication to an individual patient's specific symptoms and comorbidities.
Collapse
Affiliation(s)
- Richard G Kiel
- Veterans Affairs - Central California Health Care System, UCSF - Fresno Medical Education Program, 2615 E Clinton Ave, Fresno, CA, 93703, USA
| | | |
Collapse
|
19
|
Alhaj E, Alhaj N, Rahman I, Niazi TO, Berkowitz R, Klapholz M. Uremic Cardiomyopathy: An Underdiagnosed Disease. ACTA ACUST UNITED AC 2013; 19:E40-5. [DOI: 10.1111/chf.12030] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eyad Alhaj
- Department of Cardiology; UMDNJ; New Jersey Medical School, Newark; NJ
| | - Nehad Alhaj
- Department of Cardiology; UMDNJ; New Jersey Medical School, Newark; NJ
| | - Ifad Rahman
- Department of Cardiology; UMDNJ; New Jersey Medical School, Newark; NJ
| | - Tariq O. Niazi
- Department of Cardiology; UMDNJ; New Jersey Medical School, Newark; NJ
| | - Robert Berkowitz
- Department of Cardiology; UMDNJ; New Jersey Medical School, Newark; NJ
| | - Marc Klapholz
- Department of Cardiology; UMDNJ; New Jersey Medical School, Newark; NJ
| |
Collapse
|
20
|
Zhang K, Chen J, Liu Y, Wang T, Wang L, Wang J, Huang H. Diastolic blood pressure reduction contributes more to the regression of left ventricular hypertrophy: a meta-analysis of randomized controlled trials. J Hum Hypertens 2013; 27:698-706. [DOI: 10.1038/jhh.2013.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/21/2013] [Accepted: 02/11/2013] [Indexed: 11/09/2022]
|
21
|
Schneider MP, Schmieder RE. Role of neuroendocrine activation for left ventricular hypertrophy in hypertension. J Hypertens 2012; 30:1917-9. [DOI: 10.1097/hjh.0b013e328358223a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|