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Yehya YM, Hussein AM, Ezam K, Eid EA, Ibrahim EM, Sarhan MAFE, Elsayed A, Sarhan ME. Blockade of Renin Angiotensin System Ameliorates the Cardiac Arrhythmias and Sympathetic Neural Remodeling in Hearts of Type 2 DM Rat Model. Endocr Metab Immune Disord Drug Targets 2021; 20:464-478. [PMID: 31544705 DOI: 10.2174/1871530319666190809150921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/16/2019] [Accepted: 07/04/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The present study was designed to investigate the effects of renin angiotensin system (RAS) blockade on cardiac arrhythmias and sympathetic nerve remodelling in heart tissues of type 2 diabetic rats. METHODS Thirty-two male Sprague Dawley rats were randomly allocated into 4 equal groups; a) normal control group: normal rats, b) DM group; after type 2 diabetes induction, rats received 2ml oral saline daily for 4 weeks, c) DM+ ACEi: after type 2 diabetes induction, rats were treated with enalapril (10 mg/kg, orally for 4 weeks) and d) DM+ ARBs: after type 2 diabetes induction, rats were treated with losartan (30 mg/kg, orally for 4 weeks). RESULTS In type 2 diabetic rats, the results demonstrated significant prolongation in Q-T interval and elevation of blood sugar, HOMA-IR index, TC, TGs, LDL, serum CK-MB, myocardial damage, myocardial MDA, myocardial norepinephrine and tyrosine hydroxylase (TH) density with significant reduction in serum HDL, serum insulin and myocardial GSH and CAT. On the other hand, blockade of RAS at the level of either ACE by enalapril or angiotensin (Ag) receptors by losartan resulted in significant improvement in ECG parameters (Q-T), cardiac enzymes (CK-MB), cardiac morphology, myocardial oxidative stress (low MDA, high CAT and GSH) and myocardial TH density. CONCLUSION RAS plays a role in the cardiac sympathetic nerve sprouting and cardiac arrhythmias induced by type 2 DM and its blockade might have a cardioprotective effect via attenuation of sympathetic nerve fibres remodelling, myocardial norepinephrine contents and oxidative stress.
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Affiliation(s)
- Yomna M Yehya
- Medical Physiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abdelaziz M Hussein
- Medical Physiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khaled Ezam
- Medical Physiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Elsayed A Eid
- Department of internal Medicine and endocrinology, Delta University, Gamasa, Egypt
| | - Eman M Ibrahim
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed A F E Sarhan
- Medical Biochemistry Department, Faculty of Medicine, Mansoura, University, Mansoura, Egypt
| | - Aya Elsayed
- Medical Experimental Research Centre, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed E Sarhan
- Medical Physiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Pantzaris ND, Karanikolas E, Tsiotsios K, Velissaris D. Renin Inhibition with Aliskiren: A Decade of Clinical Experience. J Clin Med 2017; 6:jcm6060061. [PMID: 28598381 PMCID: PMC5483871 DOI: 10.3390/jcm6060061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/24/2017] [Accepted: 06/03/2017] [Indexed: 11/29/2022] Open
Abstract
The renin-angiotensin-aldosterone system (RAAS) plays a key role in the pathophysiology of arterial hypertension as well as in more complex mechanisms of cardiovascular and renal diseases. RAAS-blocking agents like angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers, have long been key components in the treatment of essential hypertension, heart failure, diabetic nephropathy, and chronic kidney disease, showing benefits well beyond blood pressure reduction. Renin blockade as the first step of the RAAS cascade finally became possible in 2007 with the approval of aliskiren, the first orally active direct renin inhibitor available for clinical use and the newest antihypertensive agent on the market. In the last decade, many clinical trials and meta-analyses have been conducted concerning the efficacy and safety of aliskiren in comparison to other antihypertensive agents, as well as the efficacy and potential clinical use of various combinations. Large trials with cardiovascular and renal endpoints attempted to show potential benefits of aliskiren beyond blood pressure lowering, as well as morbidity and mortality outcomes in specific populations such as diabetics, heart failure patients, and post-myocardial infarction individuals. The purpose of this review is to present the currently available data regarding established and future potential clinical uses of aliskiren.
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Affiliation(s)
| | - Evangelos Karanikolas
- Department of Medicine, Schools of Health Sciences, University of Athens75 Mikras Asias str., Athens 11527, Greece.
| | | | - Dimitrios Velissaris
- Internal Medicine Department, University Hospital of Patras, Rio Achaia 26504, Greece.
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Modulation of the QT interval duration in hypertension with antihypertensive treatment. Hypertens Res 2015; 38:447-54. [DOI: 10.1038/hr.2015.30] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/27/2014] [Accepted: 11/12/2014] [Indexed: 11/08/2022]
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Miki T, Tobisawa T, Sato T, Tanno M, Yano T, Akasaka H, Kuno A, Ogasawara M, Murase H, Saitoh S, Miura T. Does glycemic control reverse dispersion of ventricular repolarization in type 2 diabetes? Cardiovasc Diabetol 2014; 13:125. [PMID: 25142437 PMCID: PMC4243814 DOI: 10.1186/s12933-014-0125-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/07/2014] [Indexed: 02/23/2023] Open
Abstract
Background Abnormal ventricular repolarization is a predictor of cardiovascular mortality. In this study, we tested the hypothesis that glycemic control reverses abnormal ventricular repolarization in patients with type 2 diabetes. Methods We analyzed longitudinal changes in repolarization indices of electrocardiograms in retrospectively enrolled 44 patients with type 2 diabetes and 44 age-matched healthy subjects. Results In the diabetic group, BMI was greater, levels of HbA1c (10.0 ± 1.6 vs. 5.6 ± 0.3%) and triglyceride were higher and level of HDL cholesterol was lower than those in the control group. Although mean QTc intervals were similar (413.6 ± 18.5 vs. 408.3 ± 22.7 ms), QT dispersion (41.8 ± 15.4 vs. 28.7 ± 7.7 ms) and Tpeak-Tend in lead V5 (83.6 ± 13.6 vs. 71.3 ± 10.3 ms) were significantly longer in the diabetic group than in the control group, indicating increased heterogeneity of ventricular repolarization in type 2 diabetes. During follow-up of 36 patients in the diabetic group for 787 ± 301 days, HbA1c level decreased to 7.3 ± 1.6%, while BMI did not significantly change. In contrast to HbA1c, QT dispersion (45.8 ± 15.0 ms) and Tpeak-Tend in lead V5 (83.6 ± 10.6 ms) were not significantly reduced during the follow-up period. There was no correlation between the change in HbA1c and the change in QT dispersion or Tpeak-Tend. Conclusions Increased heterogeneity of ventricular repolarization in type 2 diabetic patients was not reduced during the relatively short follow-up period despite significantly improved glycemic control.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1 West-16, Sapporo 060-8543, Chuo-ku, Japan.
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Antonakis V, Tsioufis C, Tsiachris D, Andrikou I, Fantaki M, Dagres N, Vrachnis N, Stefanadis C. Associations of Hemodynamic Load and Ventricular Repolarization in Patients With Newly Diagnosed Essential Hypertension: A Long-Term Follow-Up Study. J Clin Hypertens (Greenwich) 2014; 16:219-24. [DOI: 10.1111/jch.12275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Velissaris Antonakis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Costas Tsioufis
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Dimitris Tsiachris
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Ioannis Andrikou
- First Cardiology Clinic; University of Athens; Hippokration Hospital; Athens Greece
| | - Maria Fantaki
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
| | - Nikos Dagres
- Second Cardiology Department; University of Athens; Attikon University Hospital; Athens Greece
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Furuya M, Masuda Y, Sato K, Nishibe T, Yana K, Ono T. Long and short term QT-RR interval co-variability in type 2 diabetes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:38-41. [PMID: 25569891 DOI: 10.1109/embc.2014.6943523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper examines the long and short term co-variability of QT and RR intervals for diabetic patients to explore if the QT-RR co-variability could yield a noble index for the stratification of clinical severity of the disease. Twenty four hour Holter ECG recordings are made for 19 type 2 diabetic (T2DM) patients and 25 normal subjects. RR and QT intervals are extracted from ECG signals sampled at 200 Hz and their co-variability has been examined. To see the long term QT-RR co-variability, correlation coefficients and mutual entropies between QT and RR intervals have been estimated for original beat to beat intervals and smoothed median interval series of successive one hundred beats. Mutual entropy for both beat-to-beat and smoothed median QT and RR interval series showed statistically significant differences between T2DM and control subjects whereas differences in correlation coefficients showed significant difference only for beat-to-beat intervals. Mutual entropy between both beat-to-beat and smoothed median QT-RR interval sequences showed the equally well separation between T2DM patients and control subjects: Mutual entropy and serial correlation coefficients for beat to beat intervals are respectively 1.42 ± 0.33 (bits), 0.856 ± 0.055 for control and 0.752 ± 0.23 (bits), 0.756 ± 0.10 for T2DM patients. Scatter diagram between RR and QT intervals show apparent nonlinearity which validate this result. Short term QT-RR co-variability has been examined by spline smoothed QTc series and sporadic changes have been observed for the control subjects whereas no such changes are found in diabetic patients. This new phenomenon could be a mean for the clinical characterization of diabetes.
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Greater insulin resistance indicates decreased diurnal variation in the QT interval in patients with type 2 diabetes. Heart Vessels 2013; 29:256-62. [PMID: 23681273 DOI: 10.1007/s00380-013-0356-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
Circadian variations in the QT interval (QT) and QT dispersion are decreased in patients with type 2 diabetes because of cardioneuropathy. Insulin resistance has been recently identified as an independent determinant of QT prolongation in normoglycemic women. However, the relationship between QT prolongation and the degree of insulin resistance as well as circadian variation remains unclear in diabetic patients. This study was designed to assess the relationship between insulin resistance and the circadian variation in QT measurements in patients with type 2 diabetes. In 14 patients with diabetes, QT, corrected QT (QTc), QT dispersion, QTc dispersion, and RR interval (RR) were analyzed using 12-lead Holter monitoring and commercial software. The degree of diurnal variation in each measurement was defined as the amplitude between the maximum and mean values on curves fitted using the mean cosinor method (A_QT, A_QTc, A_QT dispersion, A_QTc dispersion, and A_RR). The cosine curve was fitted to all measured values in each QT measurement and RR for 24 h. Insulin resistance (glucose infusion rate (GIR)) was measured using the euglycemic hyperinsulinemic glucose clamp method. The maximum QT, QTc, QT dispersion, and QTc dispersion were >450 ms. GIR was significantly correlated with A_QT only (r = 0.59, P < 0.05). GIR was not correlated with other variables, and was dependent only on the circadian variation in QT.
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Ertaş F, Yavuz C, Kaya H, Karahan O, Demirtaş S, Acet H, Oylumlu M, Akıl MA, Bilik MZ, Alan S. The relationship between QT dispersion and exaggerated blood pressure response to exercise stress testing. Clin Exp Hypertens 2013; 35:470-4. [PMID: 23387821 DOI: 10.3109/10641963.2013.764891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study was aimed to investigate sensitivity and specificity of QT dispersion (QTd) as a predictor of hypertensive response to peak exercise stress testing (EST). Fifty-nine patients were divided in to two groups (32 patients with exaggerated blood pressure response (EBPR) to EST group and 27 patients for normotensive group) and the EST was monitored. The QTd and corrected QT (QTc) intervals were still found to be significant predictors of EBPR (P < 0.05). In receiver operating characteristic (ROC) analysis, a level of QTd ≥ 40 predicted EBPR with 84% sensitivity and 74% specificity. According to the present data, QTd might be an important predictive marker for EBPR.
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Affiliation(s)
- Faruk Ertaş
- Department of Cardiology, Dicle University Faculty of Medicine , Diyarbakir , Turkey
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Klimas J, Vaja V, Vercinska M, Kyselovic J, Krenek P. Discrepant regulation of QT (QTc) interval duration by calcium channel blockade and angiotensin converting enzyme inhibition in experimental hypertension. Basic Clin Pharmacol Toxicol 2012; 111:279-88. [PMID: 22626243 DOI: 10.1111/j.1742-7843.2012.00901.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 05/10/2012] [Indexed: 11/27/2022]
Abstract
Antihypertensive treatment may reduce prolonged QT duration in hypertension. Generally, the reductions of blood pressure and/or of cardiac mass are believed to be the responsible factors. However, drugs are not equivalent in QT modulation despite similar antihypertensive and antihypertrophic action. We investigated the effect of a calcium channel blocker, lacidipine and an angiotensin-converting enzyme inhibitor, enalapril on QT duration in rats. Normotensive Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were treated with lacidipine (at the dose of 1.5 mg/kg per day for WKY and 3 mg/kg per day for SHR) or enalapril (5 mg/kg per day for WKY and 10 mg/kg per day for SHR) during 8 weeks. Tail-cuff systolic blood pressure (sBP), left ventricular weight (LVW), vascular function of isolated aorta and mesenteric artery and duration of QT (and QTc) interval on Frank electrocardiograms were evaluated. As expected, untreated SHR showed elevated sBP, impaired vascular reactivity, increased LVW and prolonged QT when compared with WKY (p < 0.05). After treatment, both agents markedly improved vascular reactivity and reduced sBP in SHR (p < 0.05). Additionally, enalapril reduced LVW in both hypertensive (by 17%; p < 0.05) and normotensive rats (by 13%; p < 0.05) and, consequently, corrected QT duration in SHR. Interestingly, lacidipine also reduced LVW in SHR (by 9%; p < 0.05), but without influence on prolonged QT. Moreover, lacidipine had no effect on LVW in WKYs but prolonged their QT interval (by 10%; p < 0.05). In conclusion, lacidipine did not reverse a progressive prolongation of QT in SHR, despite sBP lowering and LVW reduction. Thus, the lowering of blood pressure and/or reduction of LVW are not sufficient per se to normalize ventricular repolarization in hypertensive cardiac disease. More likely, modulation of QT prolongation by antihypertensive drugs is a function of their complex action on blood pressure, vascular function, cardiac mass and on reflex neurohumoral activation.
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Affiliation(s)
- Jan Klimas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic.
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Barrios V, Escobar C, Calderon A. Aliskiren: A Potential Antiarrhythmic Drug? J Clin Hypertens (Greenwich) 2012; 14:189. [DOI: 10.1111/j.1751-7176.2011.00589.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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