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Sarkar G, Gaikwad VB, Sharma A, Halder SK, Kumar DA, Anand J, Agrawal S, Kumbhar A, Kinholkar B, Mathur R, Doshi M, Bachani D, Mehta S. Fixed-dose Combination of Metoprolol, Telmisartan, and Chlorthalidone for Essential Hypertension in Adults with Stable Coronary Artery Disease: Phase III Study. Adv Ther 2022; 39:923-942. [PMID: 34918194 DOI: 10.1007/s12325-021-01971-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/19/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate the efficacy and safety of fixed-dose combination (FDC) of metoprolol, telmisartan, and chlorthalidone in patients with essential hypertension and stable coronary artery disease (CAD) who showed inadequate response to dual therapy. METHODS In this phase III, open-label, multicenter study, 254 adults with stable CAD having uncontrolled hypertension despite being treated with FDC of metoprolol (25/50 mg) and telmisartan (40 mg) were included. Patients received either of the following FDC for 24 weeks: metoprolol (25 mg), telmisartan (40 mg), and chlorthalidone (12.5 mg) (FDC1; n = 139) or metoprolol (50 mg), telmisartan (40 mg), and chlorthalidone (12.5 mg) (FDC2; n = 115) tablets once daily. The FDCs were developed using the novel Wrap Matrix™ platform technology. Primary endpoint assessed the mean change in seated diastolic blood pressure (SeDBP) and seated systolic blood pressure (SeSBP) from baseline to 24 weeks. Secondary efficacy endpoints included proportion of patients achieving < 90 mmHg SeDBP (SeDBP responder) and < 140 mmHg SeSBP (SeSBP responder) at weeks 12, 16, 20, and 24. Safety was assessed throughout the study. RESULTS A total of 243 (95.70%) patients completed study. The mean change in BP from baseline (FDC1, 155/96 mmHg; FDC2, 165/98 mmHg) to week 24 (FDC1, 128/82 mmHg; FDC2, 131/83 mmHg) was statistically significant (both groups p < 0.0001). Within FDC1 and FDC2, the mean change from baseline to week 24 in SeDBP (82.60 mmHg and 83.09 mmHg) and SeSBP (128.07 mmHg and 131.29 mmHg) was statistically significant (both groups p < 0.0001). At week 24, in FDC1, 80.15% and 84.73% were SeDBP and SeSBP responders, respectively; in FDC2, 79.46% and 74.11% were SeDBP and SeSBP responders, respectively. No serious adverse events or deaths were reported. CONCLUSION Triple FDCs of metoprolol, telmisartan, and chlorthalidone were considered effective and well tolerated in patients with hypertension who respond inadequately to dual therapy. CLINICAL TRIAL REGISTRATION CTRI/2016/11/007491.
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Naveja JJ, Stumpfe D, Medina-Franco JL, Bajorath J. Exploration of Target Synergy in Cancer Treatment by Cell-Based Screening Assay and Network Propagation Analysis. J Chem Inf Model 2019; 59:3072-3079. [PMID: 31013082 DOI: 10.1021/acs.jcim.9b00036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Computational approaches have previously been introduced to predict compounds with activity against multiple targets or compound combinations with synergistic functional effects. By contrast, there are no computational studies available that explore combinations of targets that might act synergistically upon small molecule treatment. Herein, we introduce an approach designed to identify synergistic target pairs on the basis of cell-based screening data and compounds with known target annotations. The targets involved in forming synergistic pairs were analyzed through a novel network propagation algorithm for rationalizing possible common synergy mechanisms. This algorithm enabled further analysis of each synergistic target pair and the identification of "interactors", i.e., proteins with higher propagation scores than would be expected by adding the individual contributions of each target in the synergistic pair. We detected 137 synergistic target pairs including 51 unique targets. A global network analysis of these 51 targets made it possible to derive a subnetwork of proteins with significant synergy. Furthermore, interactors were identified for 87 synergistic target pairs upon individual analysis of the network propagation of each pair. These interactors were associated with pathways related to cancer and apoptosis, membrane transport, and steroid metabolism and provided possible explanations of synergistic effects.
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Affiliation(s)
- J Jesús Naveja
- Department of Life Science Informatics, B-IT, LIMES Program Unit Chemical Biology and Medicinal Chemistry , Rheinische Friedrich-Wilhelms-Universität , Endenicher Allee 19c , D-53115 Bonn , Germany.,PECEM, Faculty of Medicine , Universidad Nacional Autónoma de México , Mexico City , 04510 , Mexico.,Department of Pharmacy, School of Chemistry , Universidad Nacional Autónoma de México , Mexico City , 04510 , Mexico
| | - Dagmar Stumpfe
- Department of Life Science Informatics, B-IT, LIMES Program Unit Chemical Biology and Medicinal Chemistry , Rheinische Friedrich-Wilhelms-Universität , Endenicher Allee 19c , D-53115 Bonn , Germany
| | - José L Medina-Franco
- Department of Pharmacy, School of Chemistry , Universidad Nacional Autónoma de México , Mexico City , 04510 , Mexico
| | - Jürgen Bajorath
- Department of Life Science Informatics, B-IT, LIMES Program Unit Chemical Biology and Medicinal Chemistry , Rheinische Friedrich-Wilhelms-Universität , Endenicher Allee 19c , D-53115 Bonn , Germany
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KANG SEOKBONG, SHON HOSANG, PARK SOOJIN, SONG CHANGHYUN, KU SAEKWANG. Effects of Chungsinoryungsan, a polyherbal complex, on the pharmacokinetic profiles of perindopril in rats. Biomed Rep 2014; 2:855-860. [DOI: 10.3892/br.2014.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/30/2014] [Indexed: 11/06/2022] Open
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Redón J, Trenkwalder PRA, Barrios V. Efficacy of combination therapy with angiotensin-converting enzyme inhibitor and calcium channel blocker in hypertension. Expert Opin Pharmacother 2012. [DOI: 10.1517/14656566.2013.748037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Borghi C, Cicero AFG. Rationale for the Use of a Fixed-Dose Combination in the Management of Hypertension. Clin Drug Investig 2012; 30:843-54. [DOI: 10.1007/bf03256912] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Barrios V, Escobar C. Valsartan-amlodipine-hydrochlorothiazide: the definitive fixed combination? Expert Rev Cardiovasc Ther 2011; 8:1609-18. [PMID: 21090936 DOI: 10.1586/erc.10.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A significant proportion of patients with hypertension will need three or more antihypertensive agents to achieve blood pressure goals, particularly those at higher risk. On the other hand, fixed combinations provide an extra beneficial effect, as they improve medication adherence and, secondarily, the attainment of blood pressure goals during follow-up. Triple therapy is recommended in the treatment of hypertension in those patients not adequately controlled with two antihypertensive drugs. In this context, guidelines recommend the combination of a renin-angiotensin system inhibitor, a calcium channel blocker and a diuretic. The triple fixed combination of valsartan-amlodipine-hydrochlorothiazide has been shown to be an effective and safe therapy for treating hypertension and seems a logical approach for those patients uncontrolled with two antihypertensive agents as well as in those patients already treated with three drugs to improve treatment compliance. In this article, available evidence about the efficacy and tolerability of the triple fixed combined therapy valsartan-amlodipine-hydrochlorothiazide for the treatment of hypertension is updated.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain.
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Ruilope LM, Segura J. ARBs and ACEis together in the treatment of hypertension and its complications? current practical recommendations. Expert Opin Pharmacother 2010; 11:2619-23. [DOI: 10.1517/14656566.2010.522992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Borghi C, Cicero AFG. Rationale for the use of a fixed-dose combination in the management of hypertension: efficacy and tolerability of lercanidipine/enalapril. Clin Drug Investig 2010. [PMID: 20923243 DOI: 10.2165/11584470-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Hypertension, a significant factor in the development of cerebrovascular disorders, heart disease and renal failure, is a common disorder worldwide. Despite the availability of a wide range of antihypertensive agents, almost two-thirds of hypertensive patients have poorly controlled blood pressure (BP). Numerous clinical trials have shown that most patients require at least two antihypertensive agents to achieve adequate BP control and associated significant reductions in cardiovascular morbidity and mortality. Combination therapy using two drugs with different, complementary mechanisms of action achieves better efficacy and tolerability outcomes than treatment with either component drug alone. When such a combination is administered as a fixed-dose formulation, other benefits, such as improved compliance and potentially lower costs, are also likely. The good efficacy and tolerability of the combination of a calcium channel antagonist and an angiotensin-converting enzyme inhibitor is well established, and this combination is recommended by European Society of Hypertension/European Society of Cardiology guidelines as a first choice in high-risk hypertensive patients, including those with type 2 diabetes mellitus. Lercanidipine/enalapril is a promising example of a fixed-dose combination of these drug classes. In clinical trials in hypertensive patients, including those with type 2 diabetes, lercanidipine/enalapril improved BP to a greater extent than either drug as monotherapy (in patients who were previous non-responders to lercanidipine or enalapril) or the combination of lercanidipine/hydrochlorothiazide, and was equally well tolerated. Further studies are required to evaluate the cardiovascular protective effects of lercanidipine/enalapril.
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Affiliation(s)
- Claudio Borghi
- Hypertension Research Unit, Internal Medicine, Aging and Kidney Disease Department, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.
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Lackland DT. The Role of Combination Therapy for Hypertension After ACCOMPLISH. CURRENT CARDIOVASCULAR RISK REPORTS 2010. [DOI: 10.1007/s12170-010-0101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A study of fluid intake from beverages in a sample of healthy French children, adolescents and adults. Eur J Clin Nutr 2010; 64:350-5. [PMID: 20160751 PMCID: PMC2857162 DOI: 10.1038/ejcn.2010.4] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background/Objectives: To assess the intake of fluid in healthy French children, adolescents, adults and seniors, considering amounts, types of beverages, time and place of consumption. Subjects/Methods: Data regarding fluid intake were extracted and analyzed from the National Intake Survey, which was conducted in quota samples of the French population (Comportement et Consommations Alimentaires en France study). Seven-day questionnaires were administered to free-living individuals in 2002–2003. A total of 566 children (aged 6–11 years), 333 adolescents (aged 12–19 years), 831 adults (aged 20–54 years) and 443 seniors (aged ⩾55 years) were included in this study. Results: The average total intake of fluid was 1–1.3 l per day depending on age groups. Water accounted for about one-half of daily fluid intake. The contribution of other types of beverages varied with age (for example, dairy drinks in children and adolescents; alcoholic drinks in adults and seniors). Intake of sodas (including regular and light) was highest in adolescents (169 ml a day). Beverages were mainly consumed at home during meals. Conclusions: This is the first description of fluid intake in French children, adolescents, adults and seniors, considering amounts, types of beverages, time and place of intake. It shows that water is the main source of fluid in all age groups. Selection of various types of beverages is different according to age.
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Ohta Y, Matsumura K, Tsuchihashi T, Ohtsubo T, Arima H, Miwa Y, Goto K, Ohya Y, Fujii K, Uezono K, Abe I, Iida M. Improvement of Blood Pressure Control in a Hypertension Clinic in Japan: A 15-Year Follow-Up Study. Clin Exp Hypertens 2009; 31:553-9. [DOI: 10.3109/10641960902927960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kanno H, Iwai M, Inaba S, Senba I, Nakaoka H, Sone H, Mogi M, Horiuchi M. Improvement of glucose intolerance by combination of pravastatin and olmesartan in type II diabetic KK-A(y) mice. Hypertens Res 2009; 32:706-11. [PMID: 19478815 DOI: 10.1038/hr.2009.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The effects of the coadministration of pravastatin and an angiotensin type 1 (AT(1)) receptor blocker, olmesartan, on glucose intolerance were examined using type II diabetic mice. Male KK-A(y) mice (8 weeks of age) were treated with pravastatin and/or olmesartan for 2 weeks. An oral glucose tolerance test (OGTT) was performed with an administration of 2 g kg(-1) glucose. Tissue glucose uptake was determined using 2-[(3)H]deoxyglucose. The treatment of mice with pravastatin attenuated the increase in the plasma glucose level during OGTT in a dose-dependent manner, without affecting the plasma insulin level. Pravastatin increased glucose uptake in insulin-sensitive tissue such as the skeletal muscle and adipose tissue after treatment at 5-20 mg kg(-1) day(-1) for 2 weeks, but not at 1 mg kg(-1) day(-1). The combination of a noneffective dose of pravastatin (1 mg kg(-1) day(-1)) and a noneffective dose of olmesartan (0.5 mg kg(-1) day(-1)) synergistically improved OGTT without affecting the plasma insulin level. This combination also increased 2-[(3)H]deoxyglucose uptake in the skeletal muscle and adipose tissue. The effects of pravastatin or olmesartan on OGTT and tissue 2-[(3)H]deoxyglucose uptake were significantly enhanced by an antioxidant, tempol, whereas the effects of a pravastatin-olmesartan combination were not further enhanced by tempol. These results indicate that the combination of pravastatin and olmesartan synergistically improves glucose intolerance through an increase in tissue glucose uptake. The effects seem to be mediated by an increase in insulin sensitivity through the inhibition of oxidative stress.
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Affiliation(s)
- Harumi Kanno
- Department of Molecular Cardiovascular Biology and Pharmacology, Ehime University Graduate School of Medicine, Shitsukawa, Tohon, Ehime 791-0295, Japan
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Risk factors associated with hypertension awareness, treatment, and control in a multi-ethnic Asian population. J Hypertens 2009; 27:190-7. [PMID: 19145784 DOI: 10.1097/hjh.0b013e328317c8c3] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate demographic and cardiovascular disease risk factors associated with awareness, treatment and control of hypertension in a multi-ethnic Asian population. METHODS Participants from four previous cross-sectional studies were invited for a repeat examination (2004--2007). Information of demographic details and cardiovascular disease risk factors was obtained using questionnaire, physical examination and blood tests. Odds ratios and 95% confidence intervals were calculated using multiple logistic regression models. RESULTS The final number of respondents was 5022 (response rate 49.7%). Although hypertension treatment (84.4% of those aware of hypertension) was high, awareness (51.8% of those having hypertension) and control (27.1% of hypertension on treatment) were low. Reduced awareness and treatment were associated with being younger, never married, and working adults with a higher education level. Low socioeconomic status individuals were more likely to be treated but had poorer control. A similar relationship was found for treatment and control for individuals with coexisting cardiovascular disease risk factors. The use of multiple drug classes was not associated with better control. Diuretic use for treatment of hypertension, as recommended by local and international guidelines, was not common (15.0% of all hypertension medications used). CONCLUSIONS The awareness, treatment, and control of hypertension in Singapore can be improved. There is a need to improve awareness through education and target screening and treatment in younger, working adults with higher levels of education and higher economic status, as well as Malays. Control of hypertension could be improved among older or diabetic hypertensive individuals.
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Barrios V, Escobar C, Echarri R. Fixed combinations in the management of hypertension: perspectives on lercanidipine-enalapril. Vasc Health Risk Manag 2009; 4:847-53. [PMID: 19066001 PMCID: PMC2597757 DOI: 10.2147/vhrm.s3421] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Although achieving blood pressure (BP) control is critical to improve cardiovascular prognosis in hypertensive patients, many of them fail to achieve BP goals. The majority of hypertensive patients need more than one antihypertensive agent to attain BP targets. Combination therapy is required when monotherapy fails to attain BP objectives and as a first-line treatment in certain situations, such as markedly elevated BP values, when lower targets are required in high or very high cardiovascular risk patients. The advantages of combination therapy are well documented, with an increased antihypertensive efficacy as a result of the simultaneous inhibition of different mechanisms of action and with a lesser incidence of adverse events, because of the possible compensatory responses and the lower doses used. Calcium channel blockers are effective drugs in the treatment of hypertension. The efficacy of lercanidipine has been evaluated in several noncomparative and in comparative studies showing a great efficacy with a good tolerability. On the other hand, the inhibition of the renin-angiotensin system appears to be very beneficial in the treatment of patients with hypertension. Enalapril is an effective and well tolerated angiotensin converting enzyme inhibitor. Although there are several fixed-combination drugs, the combination lercanidipine plus enalapril appears to be one of the most promising therapies in the treatment of hypertension. The aim of this manuscript is to update the published data about the efficacy and safety of this fixed combination.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, Hospital Ramón y Cajal, Madrid, Spain.
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Escobar C, Barrios V. Calcium channel blocker-based combination therapy. The best approach in the treatment of high-risk hypertension? Int J Clin Pract 2008; 62:670-2. [PMID: 18412928 DOI: 10.1111/j.1742-1241.2008.01728.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ferri C, Croce G, Desideri G. Role of combination therapy in the treatment of hypertension: focus on valsartan plus amlodipine. Adv Ther 2008; 25:300-20. [PMID: 18449492 DOI: 10.1007/s12325-008-0042-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension control is rare in clinical practice, particularly in high-risk patients. A large factor is therapeutic inertia deriving from poorly prescribed lifestyle changes, excess monotherapy use, and scarce on-treatment modifications. The use of drug combinations significantly improves blood pressure (BP) control; in particular, fixed combinations improve therapy without increasing daily pill intake, thereby favouring patient compliance and therapy continuation. The most widely used fixed combination is based on thiazide diuretics added to either angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). Several large-scale clinical trials have been conducted showing that these combinations are effective in lowering BP. However, thiazide diuretics can reduce the metabolic benefits derived from renin-angiotensin-aldosterone system (RAAS) inhibitors in high metabolic risk patients. In contrast, ACE inhibitors or ARBs combined with dihydropyridine calcium channel antagonists (DHPCAs) exert a marked antihypertensive effect without decreasing metabolic protection by RAAS blockade. In the recent JIKEI heart study, approximately 60% of patients affected by hypertension, heart failure, coronary heart disease or their combination in the valsartan arm were simultaneously treated with DHPCAs. Of note, a 39% reduction in the primary endpoint of combined morbidity and mortality was reported in the valsartan compared with the non-valsartan arm. Furthermore, in a recent multinational study, 83% of 3161 hypertensive patients treated with valsartan and the DHCPA amlodipine reported a concontrolled BP after 8 weeks of treatment. As expected, amlodipine did not negatively influence the metabolic profile of patients, thereby supporting the role of ARB+DHPCA combinations as effective and promising tools in hypertension treatment. In summary, the combination of ARBs with DHPCAs is an effective strategy in hypertension treatment through synergy between their antihypertensive and vascular protective actions, persistent metabolic benefits deriving from RAAS inhibition, and reduced incidence of side effects.
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Affiliation(s)
- Claudio Ferri
- Department of Internal Medicine and Public Health, University of L'Aquila, L'Aquila, Italy.
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Augoustides JG. Angiotensin Blockade and General Anesthesia: So Little Known, So Far to Go. J Cardiothorac Vasc Anesth 2008; 22:177-9. [DOI: 10.1053/j.jvca.2008.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Indexed: 01/13/2023]
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