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Li Y, Huang Y, Fu X, Xia J, Su J, Gu W, Liu W, Jian J, Xu Z. Bioequivalence Study of Atenolol Tablets in Healthy Chinese Subjects Under Fasting and Fed Conditions. Clin Pharmacol Drug Dev 2024. [PMID: 38742472 DOI: 10.1002/cpdd.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/16/2024] [Indexed: 05/16/2024]
Abstract
Atenolol, a cardioselective β1-blocker, exhibits efficacy in treating cardiovascular diseases. We conducted a single-center, randomized, open, single-dose, 2-preparation, 2-cycle, 2-sequence, double-crossover trial with a 7-day washout period to investigate the pharmacokinetics, bioequivalence (BE), and safety of test and reference atenolol tablets (25 mg) in healthy Chinese volunteers. Forty-eight healthy participants were randomized into the fasting and fed arms. After administering a single oral dose of the test or reference formulation (25 mg), plasma atenolol concentrations were measured using liquid chromatography-tandem mass spectrometry. Pharmacokinetic parameters were obtained from concentration-time profiles. In total, 23 and 24 individuals were included in the fasting and fed arms, respectively. The mean concentration-time profiles for both formulations were similar, and Cmax, AUC0-t, and AUC0-∞ were within the BE range of 80%-125%. Thirteen adverse events (AEs) were observed in 7 participants in the fasting arm; 1 withdrew from the trial early owing to an AE. In the fed arm, 20 AEs were observed in 8 participants, and none withdrew from the trial. All adverse reactions were grade I, with no serious AEs or deaths. Therefore, the 2 tablets are bioequivalent in healthy Chinese individuals under fasting and fed conditions, supporting their further clinical development.
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Affiliation(s)
- Yongtao Li
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingying Huang
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xihua Fu
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
- Infection Medicine Research Institute of Panyu District, Guangzhou, China
| | - Jiajing Xia
- College of Pharmacy, Jinan University, Guangzhou, China
| | - Jianfen Su
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenzhao Gu
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weixiong Liu
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianqing Jian
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zuoheng Xu
- The Affiliated Panyu Central Hospital of Guangzhou Medical University, Guangzhou, China
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Anjani QK, Sabri AHB, Hamid KA, Moreno-Castellanos N, Li H, Donnelly RF. Tip loaded cyclodextrin-carvedilol complexes microarray patches. Carbohydr Polym 2023; 320:121194. [PMID: 37659788 DOI: 10.1016/j.carbpol.2023.121194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/27/2023] [Accepted: 07/09/2023] [Indexed: 09/04/2023]
Abstract
Carvedilol, a β-blocker prescribed for chronic heart failure, suffers from poor bioavailability and rapid first pass metabolism when administered orally. Herein, we present the development of tip microarray patches (MAPs) composed of ternary cyclodextrin (CD) complexes of carvedilol for transdermal delivery. The ternary complex with hydroxypropyl γ-cyclodextrin (HPγCD) and poly(vinyl pyrrolidone) (PVP) reduced the crystallinity of carvedilol, as evidenced by DSC, XRD, NMR, and SEM analysis. MAPs were fabricated using a two-step process with the ternary complex as the needle layer. The resulting MAPs were capable of breaching ex vivo neonatal porcine skin to a depth ≈600 μm with minimal impact to needle height. Upon insertion, the needle dissolved within 2 h, leading to the transdermal delivery of carvedilol. The MAPs displayed minimal toxicity and acceptable biocompatibility in cell assays. In rats, MAPs achieved significantly higher AUC levels of carvedilol than oral administration, with a delayed Tmax and sustained plasma levels over several days. These findings suggest that the carvedilol-loaded dissolving MAPs have the potential to revolutionise the treatment of chronic heart failure.
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Affiliation(s)
- Qonita Kurnia Anjani
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK; Fakultas Farmasi, Universitas Megarezky, Jl. Antang Raya No. 43, Makassar 90234, Indonesia
| | - Akmal Hidayat Bin Sabri
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Khuriah Abdul Hamid
- Department of Pharmaceutics, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, 42300 Puncak Alam, Malaysia
| | - Natalia Moreno-Castellanos
- Basic Science Department, Faculty of Health, Universidad Industrial de Santander, Bucaramanga 680001, Colombia
| | - Huanhuan Li
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK.
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Fici F, Robles NR, Tengiz I, Grassi G. Beta-Blockers and Hypertension: Some Questions and Answers. High Blood Press Cardiovasc Prev 2023; 30:191-198. [PMID: 37166681 DOI: 10.1007/s40292-023-00576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/17/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION International guidelines have removed b-blockers from first-line treatment of hypertension, limiting their use to patients with compelling indications. The position of guidelines stems from the results of studies performed with the 1st and 2nd generation of b-blockers, which concluded that these drugs have lower cardiovascular protection, compared with other antihypertensive agents. AIM The aim of our mini review is to answer to some questions about the effect of b-blockers on hypertension and cardiovascular protection and if these effects are different from those of other antihypertensive drugs, particularly in young and elderly patients. METHODS We evaluated the relevant systematic reviews and meta-analyses, which reported the effectiveness of b-blockers on blood pressure and cardiovascular outcomes, compared with placebo/no treatment and with other antihypertensive agents. RESULTS Beta-blockers, decreased high blood pressure with no significant difference from other common antihypertensive agents. Moreover b-blockers, compared with placebo, lowered the risk of major cardiovascular outcomes, while, compared with other drug classes, the reported results are very heterogeneous. Therefore it is difficult, globally, to find a difference between b-blockers and other drug classes. CONCLUSIONS Rather than looking for differences in the cardiovascular protective effect between b-blockers and other antihypertensive agents, we have to consider the different pathophysiology of hypertension in young [sympathetic hyperactivity] and elderly patients [arterial stiffness, high aortic systolic pressure]. Considering these aspects, non-vasodilating b-blockers are preferred, as first-line, in young/middle aged hypertensive subjects, while vasodilating b-blockers, are most appropriate, in elderly patients, for the favourable hemodynamic profile.
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Affiliation(s)
- Francesco Fici
- Department of Cardiovascular Risk, Salamanca University, Salamanca, Spain
- Milano-Bicocca University, Milan, Italy
| | | | - Istemihan Tengiz
- Cardiology and Hypertension Department, Medical Park Hospital, Izmir University, Izmir, Turkey
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Reduction of blood pressure variability: an additional protective cardiovascular effect of vasodilating beta-blockers? J Hypertens 2020; 38:405-407. [DOI: 10.1097/hjh.0000000000002334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Kotecha D, Flather MD, Atar D, Collins P, Pepper J, Jenkins E, Reid CM, Eccleston D. B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease. BMC Med 2019; 17:72. [PMID: 30943979 PMCID: PMC6448253 DOI: 10.1186/s12916-019-1306-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Risk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust 'real-world' evidence for their use. METHODS Prospective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression. RESULTS Five hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45-3.19; p = 0.0001) and 1.27 for composite events (1.04-1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years after risk modification and treatment of coronary disease. CONCLUSIONS Conventional risk factors and other markers of arterial compliance, inflammation and autonomic function have limited value for prediction of outcomes in risk-modified patients assessed for coronary disease. BNP can independently identify patients with subtle impairment of cardiac function that might benefit from more intensive management. TRIAL REGISTRATION Clinicaltrials.gov, NCT00403351 Registered on 22 November 2006.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK. .,Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia.
| | - Marcus D Flather
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway
| | - Peter Collins
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - John Pepper
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Christopher M Reid
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia.,Faculty of Health Sciences, School of Public Health, Curtin University, Perth, Australia
| | - David Eccleston
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia
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Suojanen L, Haring A, Tikkakoski A, Koskela JK, Tahvanainen AM, Huhtala H, Kähönen M, Sipilä K, Eräranta A, Mustonen JT, Kivistö K, Pörsti IH. Haemodynamic Influences of Bisoprolol in Hypertensive Middle-Aged Men: A Double-Blind, Randomized, Placebo-Controlled Cross-Over Study. Basic Clin Pharmacol Toxicol 2017; 121:130-137. [DOI: 10.1111/bcpt.12771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Lauri Suojanen
- School of Medicine; University of Tampere; Tampere Finland
| | - Antti Haring
- School of Medicine; University of Tampere; Tampere Finland
| | | | | | | | - Heini Huhtala
- School of Health Sciences; University of Tampere; Tampere Finland
| | - Mika Kähönen
- School of Medicine; University of Tampere; Tampere Finland
- Department of Clinical Physiology; Tampere University Hospital; Tampere Finland
| | - Kalle Sipilä
- Department of Clinical Physiology; Tampere University Hospital; Tampere Finland
| | - Arttu Eräranta
- School of Medicine; University of Tampere; Tampere Finland
| | - Jukka T. Mustonen
- School of Medicine; University of Tampere; Tampere Finland
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - Kari Kivistö
- School of Medicine; University of Tampere; Tampere Finland
| | - Ilkka H. Pörsti
- School of Medicine; University of Tampere; Tampere Finland
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
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Brandão AA, Amodeo C, Alcântara C, Barbosa E, Nobre F, Pinto F, Vilela-Martin JF, Bastos JM, Yugar-Toledo JC, Mota-Gomes MA, Neves MFT, Malachias MVB, Rodrigues MDC, Passarelli O, Jardim PCBV, Cunha PG, Póvoa R, Fonseca T, Dias VP, Barroso WS, Oigman W. I Luso-Brazilian Positioning on Central Arterial Pressure. Arq Bras Cardiol 2017; 108:100-108. [PMID: 28327876 PMCID: PMC5344653 DOI: 10.5935/abc.20170011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/10/2016] [Indexed: 01/30/2023] Open
Affiliation(s)
- Andréa A Brandão
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Celso Amodeo
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | - Eduardo Barbosa
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Fernando Nobre
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | | | - Juan Carlos Yugar-Toledo
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Marco Antônio Mota-Gomes
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Mario Fritsch Toros Neves
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | - Oswaldo Passarelli
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Paulo César B Veiga Jardim
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | - Rui Póvoa
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | | | | | - Weimar Sebba Barroso
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
| | - Wille Oigman
- Departamento de Hipertensão Arterial da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brazil
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Mann SJ. Redefining beta-blocker use in hypertension: selecting the right beta-blocker and the right patient. ACTA ACUST UNITED AC 2017; 11:54-65. [DOI: 10.1016/j.jash.2016.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 01/13/2023]
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9
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Niu W, Qi Y. A meta-analysis of randomized controlled trials assessing the impact of beta-blockers on arterial stiffness, peripheral blood pressure and heart rate. Int J Cardiol 2016; 218:109-117. [DOI: 10.1016/j.ijcard.2016.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/12/2016] [Indexed: 11/24/2022]
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10
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McGaughey TJ, Fletcher EA, Shah SA. Impact of Antihypertensive Agents on Central Systolic Blood Pressure and Augmentation Index: A Meta-Analysis. Am J Hypertens 2016; 29:448-57. [PMID: 26289583 PMCID: PMC4886490 DOI: 10.1093/ajh/hpv134] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/09/2015] [Accepted: 07/20/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND New evidence suggests that central systolic blood pressure (cSBP) and augmentation index (AI) are superior predictors of adverse cardiovascular outcomes compared to peripheral systolic BP (pSBP). We performed a meta-analysis assessing the impact of antihypertensives on cSBP and AI. METHODS PubMed, Cochrane Library, and CINAHL were searched until September 2014 to identify eligible articles. A DerSimonian and Laird random-effects model was used to calculate the weighted mean difference (WMD) and its 95% confidence interval (CI). Fifty-two and 58 studies incorporating 4,381 and 3,716 unique subjects were included for cSBP and AI analysis, respectively. RESULTS Overall, antihypertensives reduced pSBP more than cSBP (WMD 2.52 mm Hg, 95% CI 1.35 to 3.69; I (2) = 21.9%). β-Blockers (BBs) posed a significantly greater reduction in pSBP as compared to cSBP (WMD 5.19 mm Hg, 95% CI 3.21 to 7.18). α-Blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, renin-angiotensin aldosterone system inhibitors and nicorandil reduced cSBP and pSBP in a similar manner. The overall reduction in AI from baseline was 3.09% (95% CI 2.28 to 3.90; I (2) = 84.5%). A significant reduction in AI was seen with angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, renin-angiotensin aldosterone system inhibitors, BBs, α-blockers (ABs), nicorandil, and moxonidine reduced AI nonsignificantly. CONCLUSIONS BBs are not as beneficial as the other antihypertensives in reducing cSBP and AI.
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Affiliation(s)
- Tracey J McGaughey
- Department of Pharmacy, David Grant Medical Center, Travis Air Force Base Fairfield, California, USA
| | - Emily A Fletcher
- Department of Pharmacy, David Grant Medical Center, Travis Air Force Base Fairfield, California, USA
| | - Sachin A Shah
- Department of Pharmacy, David Grant Medical Center, Travis Air Force Base Fairfield, California, USA; Department of Pharmacy Practice, Thomas J Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California, USA.
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Lee YYL, Reidler P, Jelinek H, Lee YS, Zhou Y, Hambly BD, McCabe J, Matthews S, Ke H, Assareh H, McLachlan CS. Electrocardiogram derived QRS duration associations with elevated central aortic systolic pressure (CASP) in a rural Australian population. Clin Hypertens 2016; 22:6. [PMID: 26893940 PMCID: PMC4754924 DOI: 10.1186/s40885-016-0039-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background Prolonged electrocardiogram QRS durations are often present in hypertensive patients. Small increases in QRS duration serve as independent risk factors for both increased cardiovascular and all-cause mortality. Aortic stiffness is associated with increases in central aortic systolic blood pressure (CASP). However CASP and ECG QRS duration interactions have not been established in rural community populations. Our aims are to determine if QRS duration > 100 msec is associated with an elevated CASP measure in an Australian rural population. Methods A retrospective cross sectional population was obtained from the CSU Diabetes Screening Research Initiative data base where 68 participants had both central aortic pressure recorded and ECG derived QRS duration. Central aortic pressure was determined by directly recording radial arterial tonometry and brachial cuff pressure (HealthStats, Singapore). Resting 12-lead electrocardiograms were obtained from each subject using a Welch Allyn PC-Based ECG system. Results The population had a mean CASP of 137.8 mmHg, higher than previously reported in other population studies. In 8/68 subjects with a prolonged cardiac QRS duration >120 msec, CASP ranged from 129 mmHg – 182 mmHg. When subgroup analysis was stratified on the basis QRS duration <100 msec and ≥100 msec significant differences (p = 0.036) were observed for mean CASP, 130.6 mmHg ± 15.6 (SD) versus 140.6 mmHg ± 16.8 (SD), respectively. Conclusions Our results suggest that an arbitrary CASP reading greater than a value 140 mmHg raises suspicion of a prolonged QRS duration. QRS durations ≥100 msec in an aging rural population are associated with higher CASP measures. Our results also suggest in aging Australian rural populations CASP is likely to be elevated, possibly due to age related aortic stiffening.
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Affiliation(s)
- Yvonne Yin Leng Lee
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Paul Reidler
- School of Health Sciences, Charles Stuart University, Albury, Australia
| | - Herbert Jelinek
- School of Health Sciences, Charles Stuart University, Albury, Australia
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Singapore Institute for Clinical Sciences, ASTAR, Singapore, Singapore
| | - Yuling Zhou
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Brett D Hambly
- Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Joel McCabe
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Slade Matthews
- Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Honghong Ke
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hassan Assareh
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
| | - Craig S McLachlan
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Room 327, Samuels Building, Sydney, NSW 2052 Australia
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Pucci G, Ranalli MG, Battista F, Schillaci G. Effects of β-Blockers With and Without Vasodilating Properties on Central Blood Pressure. Hypertension 2016; 67:316-24. [DOI: 10.1161/hypertensionaha.115.06467] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 11/05/2015] [Indexed: 01/30/2023]
Abstract
β-Blockers are less effective than other antihypertensive drug classes in reducing central systolic blood pressure (cSBP) as compared with peripheral SBP (pSBP). Whether this effect is less pronounced with vasodilating β-blockers (VBB) when compared with nonvasodilating β-blockers (NVBB) remains unsettled. We conducted a systematic review and meta-analysis of randomized trials exploring the effects of β-blockers on both pSBP and cSBP in hypertension. We selected 20 studies, for a total of 32 treatment arms (n=21 for NVBB, n=11 for VBB) and 1263 participants (n=962 for NVBB, n=301 for VBB). pSBP decreased from 150 to 133 mm Hg for NVBB and from 145 to 134 mm Hg for VBB. cSBP decreased from 137 to 126 mm Hg for NVBB and from 132 to 123 mm Hg for VBB. SBP amplification (pSBP–cSBP) decreased significantly under VBB (−5.6 mm Hg; 95% confidence interval, −7.8, −3.4 mm Hg), but not under NVBB (−1.1 mm Hg; 95% confidence interval, −3.4, +1.2 mm Hg;
P
<0.01 versus NVBB). There was high heterogeneity both within and between β-blockers subclasses. In a meta-regression model, the weighted difference in treatment-induced changes in SBP amplification between NVBB and VBB lost its significance after adjustment for mean age and baseline pSBP and heart rate (−2.9±2.3 mm Hg;
P
=0.22) and was almost abolished after adjustment for treatment-induced heart rate changes (−0.1±0.5 mm Hg;
P
=0.78). In conclusion, NVBBs, but not VBBs, determine a lower reduction in cSBP than in pSBP. However, the difference in treatment-induced SBP amplification changes between NVBB and VBB is nearly abolished after accounting for differences in heart rate changes.
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Affiliation(s)
- Giacomo Pucci
- From the Dipartimento di Medicina (G.P., F.B., G.S.) and Dipartimento di Scienze Politiche (M.G.R.), Università di Perugia, Perugia, Italy; and Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy (G.P., F.B., G.S.)
| | - Maria Giovanna Ranalli
- From the Dipartimento di Medicina (G.P., F.B., G.S.) and Dipartimento di Scienze Politiche (M.G.R.), Università di Perugia, Perugia, Italy; and Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy (G.P., F.B., G.S.)
| | - Francesca Battista
- From the Dipartimento di Medicina (G.P., F.B., G.S.) and Dipartimento di Scienze Politiche (M.G.R.), Università di Perugia, Perugia, Italy; and Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy (G.P., F.B., G.S.)
| | - Giuseppe Schillaci
- From the Dipartimento di Medicina (G.P., F.B., G.S.) and Dipartimento di Scienze Politiche (M.G.R.), Università di Perugia, Perugia, Italy; and Struttura Complessa di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy (G.P., F.B., G.S.)
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McEniery CM, Cockcroft JR, Roman MJ, Franklin SS, Wilkinson IB. Central blood pressure: current evidence and clinical importance. Eur Heart J 2014; 35:1719-25. [PMID: 24459197 PMCID: PMC4155427 DOI: 10.1093/eurheartj/eht565] [Citation(s) in RCA: 418] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 11/27/2013] [Accepted: 12/17/2013] [Indexed: 01/09/2023] Open
Abstract
Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.
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Affiliation(s)
- Carmel M McEniery
- Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Box 110, Cambridge CB2 2QQ, UK
| | - John R Cockcroft
- Department of Cardiology, Wales Heart Research Institute, Cardiff CF14 4XN, UK
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medical College, New York, NY 10021, USA
| | - Stanley S Franklin
- University of California, UCI School of Medicine, Irvine, CA 92697-4101, USA
| | - Ian B Wilkinson
- Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Box 110, Cambridge CB2 2QQ, UK
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15
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Trudeau L. Central Blood Pressure as an Index of Antihypertensive Control: Determinants and Potential Value. Can J Cardiol 2014; 30:S23-8. [DOI: 10.1016/j.cjca.2014.03.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/09/2014] [Accepted: 03/09/2014] [Indexed: 11/17/2022] Open
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16
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Shupenina EY, Vasyuk YA, Khadzegova AB, Ivanova SV, Nadina EV, Khuchinaeva AM. A COMPARISON OF THE MAIN ANTIHYPERTENSIVE DRUGS FROM THE VIEWPOINT OF AORTIC STIFFNESS MODIFICATION IN ARTERIAL HYPERTENSION. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2014. [DOI: 10.15829/1728-8800-2014-2-76-79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A plenty of trials confirm the importance of aortic wall stiffness evaluation during estimation of the cardiovascular risk and the need for novel drugs influencing this parameter. Most of hypotensive medications modify arterial wall siffness by one or another way. So the usage of drug combination might be more effective. Insufficient impact of betaadrenoblockers on central artrial pressure is linked to peripheral vasoconstriction. The drugs within this class having vasodilatory properties significantly reduce central aortic pressure.
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Affiliation(s)
- E. Yu. Shupenina
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - Yu. A. Vasyuk
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - A. B. Khadzegova
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - S. V. Ivanova
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - E. V. Nadina
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
| | - A. M. Khuchinaeva
- Moscow State Medical and Stomatology University n. a. Evdokimov; Moscow, Russia
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17
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Abstract
Objective: To review the pharmacology, pharmacokinetics, and pharmacodynamic properties of commonly used β-blockers (atenolol, carvedilol, metoprolol succinate, metoprolol tartrate, and nebivolol). Data Sources: A MEDLINE literature search (1966-May 2013) was performed using the following key terms: hypertension, β-blockers, atenolol, carvedilol, metoprolol tartrate, metoprolol succinate, nebivolol, pharmacology, pharmacodynamics, pharmacokinetics, blood pressure, metabolic, lipid, central aortic pressure, diabetes, and insulin resistance. References from publications reviewed were included. Study Selection and Data Extraction: English-language articles identified were reviewed. Animal studies and studies in patients for a primary diagnosis of coronary artery disease were excluded. Data Synthesis: β-Blockers are no longer recommended first-line therapy for primary hypertension, based on data showing that β-blockers are inferior to other antihypertensives and no better than placebo, in spite of provision of blood pressure reduction. Because atenolol is the β-blocker used in 75% of these studies, uncertainty about widespread application to all β-blockers exists. Different pharmacological and physiological properties, both within β-blockers and compared with other antihypertensives, may explain divergent effects. Evidence shows that β-blockers have a truncated effect on central aortic pressure, an independent predictor of cardiovascular events, compared with other antihypertensive classes; differences within the class may exist, but the evidence is inconclusive. Metabolic effects differ within the β-blocker class, with evidence that carvedilol causes less metabolic dysregulation. Conclusion: Emerging evidence reveals physiological differences within the β-blocker class and in comparison to other antihypertensives. These differences provide insight into the diverse clinical effects β-blockers provide in cardiovascular disease.
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Affiliation(s)
- Toni L. Ripley
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Joseph J. Saseen
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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18
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Studinger P, Tabák ÁG, Chen CH, Salvi P, Othmane TE, Torzsa P, Kapocsi J, Fekete BC, Tislér A. The Effect of Low-Dose Carvedilol, Nebivolol, and Metoprolol on Central Arterial Pressure and Its Determinants: A Randomized Clinical Trial. J Clin Hypertens (Greenwich) 2013; 15:910-7. [DOI: 10.1111/jch.12210] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/24/2013] [Accepted: 08/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Péter Studinger
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Ádám G. Tabák
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
- Department of Epidemiology and Public Health; University College London; London UK
| | - Chen-Huan Chen
- Department of Public Health; School of Medicine; National Yang-Ming University; Taipei Taiwan
- Department of Medical Research and Education; Taipei Veterans General Hospital; Taipei Taiwan
| | - Paolo Salvi
- Department of Cardiology; Istituto Auxologico Italiano; Milan Italy
| | - Taha E.H. Othmane
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Péter Torzsa
- Department of Family Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Judit Kapocsi
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - Bertalan C. Fekete
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
| | - András Tislér
- 1st Department of Medicine; Semmelweis University Faculty of Medicine; Budapest Hungary
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19
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Pucci G, Battista F, Schillaci G. Effects of antihypertensive drugs on central blood pressure: new evidence, more challenges. Hypertens Res 2013; 37:10-2. [DOI: 10.1038/hr.2013.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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20
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Heart rate and blood pressure: any possible implications for management of hypertension? Curr Hypertens Rep 2013; 14:478-84. [PMID: 22972532 DOI: 10.1007/s11906-012-0306-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hypertension is a common clinical problem and a major risk factor for cardiovascular disease and stroke. Elevated heart rate is associated with elevated blood pressure, increased risk for hypertension, and, among hypertensives, increased risk for cardiovascular disease. Despite these important relationships, heart rate is generally not a major consideration in choosing antihypertensive medications. In part, this is due to a lack of evidence supporting heart rate lowering as a therapeutic strategy in hypertension. Additionally, while there is a positive correlation between heart rate and peripheral blood pressure, there is an inverse relationship between heart rate and central blood pressure. The use of antihypertensive medications, specifically medications that affect heart rate, may not reliably reduce central blood pressure to a similar extent as observed peripherally. We review the relationship between heart rate and peripheral and central blood pressure, with a focus on the implications for chronotropic therapy in hypertension.
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21
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Casey DP, Curry TB, Charkoudian N, Joyner MJ, Hart EC. The effects of acute beta-adrenergic blockade on aortic wave reflection in postmenopausal women. Am J Hypertens 2013; 26:503-10. [PMID: 23467206 DOI: 10.1093/ajh/hps074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Acute beta-adrenergic blockade increases aortic-wave reflection in young women. However, it is not known whether this effect extends to postmenopausal women. We therefore examined the effect of systemic beta-adrenergic blockade on aortic wave reflection in 14 postmenopausal women with a mean age of 58±2 years. METHODS Aortic pressure waveforms were synthesized noninvasively from high-fidelity radial pressure waveforms obtained through applanation tonometry before and during systemic beta-blockade with propranolol given in a bolus dose of 0.25mg/kg, followed by a continuous infusion at 0.004mg/kg/min. To further examine the effects of acute beta-blockade on aortic-wave reflection in postmenopausal women, we compared the changes in hemodynamics and indices of aortic-wave reflection with published data from a previous study with a protocol identical to that in the present study but which involved young women. RESULTS Acute beta-blockade increased the aortic augmentation index (AIx) in postmenopausal women (32±2% vs. 35±2%, P < 0.01). However, AIx adjusted for a heart rate of 75 bpm (AIx75) was unchanged (25±2% vs. 24±2%, P > 0.05). The changes in AIx, AIx75, and the amplitude of reflected waves (augmented aortic pressure) during beta-blockade were all substantially smaller in postmenopausal women than in their younger counterparts (P < 0.05). Conclusions As compared with those in our previously published study involving young women, indices of aortic-wave reflection were significantly less affected by acute systemic beta-adrenergic blockade in the postmenopausal women in the present study. Taken together, our data suggest that the negative effects (i.e. increased aortic wave reflection) of nonselective beta-adrenergic blockade are less pronounced in postmenopausal than in young women.
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Affiliation(s)
- Darren P Casey
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
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22
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Saul SM, Duprez DA, Zhong W, Grandits GA, Cohn JN. Effect of carvedilol, lisinopril and their combination on vascular and cardiac health in patients with borderline blood pressure: the DETECT Study. J Hum Hypertens 2012. [DOI: 10.1038/jhh.2012.54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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23
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Scali MC, Basso M, Gandolfo A, Bombardini T, Bellotti P, Sicari R. Real time 3D echocardiography (RT3D) for assessment of ventricular and vascular function in hypertensive and heart failure patients. Cardiovasc Ultrasound 2012; 10:27. [PMID: 22742054 PMCID: PMC3439359 DOI: 10.1186/1476-7120-10-27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/28/2012] [Indexed: 11/29/2022] Open
Abstract
Background Cardiac and systemic hemodynamics have been historically in the domain of invasive cardiology, but recent advances in real-time 3-Dimensional echocardiography (RT3D echo) provide a reliable measurement of ventricular volumes, allowing to measure a set of hemodynamic parameters previously difficult or impossible to obtain with standard 2D echo. Aim To assess the feasibility of a comprehensive hemodynamic study with RT-3D echo. Methods We enrolled 136 patients referred for routine echocardiography: 44 normal (N), 57 hypertensive (HYP), and 35 systolic heart failure patients (HF). All patients underwent standard 2D echo examination followed by RT3D echo examination, including measurement of left ventricular (LV) end-diastolic and end-systolic volumes and derived assessment of LV elastance (an index of LV contractility), arterial elastance (characterizing the distal impedance of the arterial system downstream of the aortic valve); ventricular-arterial coupling (a central determinant of net cardiovascular performance); systemic vascular resistances. Blood pressure was derived from cuff sphygmomanometer and heart rate from ECG. Results A complete 2D echo was performed in all 136 patients. 3D echo examination was obtained in 130 patients (feasibility = 95 %). Standard 2D echo examination was completed in 14.8 ± 2.2 min. Acquisition of 3D images required an average time of 5 ± 0.9 min (range 3.5-7.5 min) and image analysis was completed in 10.1 ± 2.8 min (range 6–12 min) per patient. Compared to N and HYP, HF patients showed reduced LV elastance (1.7 ± 1.5 mmHg mL-1 m-2, p <0.001 vs N = 3.8 ± 1.3 and HYP = 3.8 ± 1.3) and ventricular-arterial coupling (0.6 ± 0.5, p < 0.01 vs N = 1.4 ± 0.4 and HYP = 1.2 ± 0.4). Systemic vascular resistances were highest in HYP (2736 ± 720, p < .01 vs N = 1980 ± 432 and vs HF = 1855 ± 636 dyne*s/cm5). The LV elastance was related to EF (r = 0.73, p < 0.01) and arterial pressure was moderately related to vascular elastance (r = 0.54, p < 0.01). The ventricular-arterial coupling was unrelated to systemic vascular resistances (r = −0.04, p NS). Conclusion RT-3D echo allows a non invasive, comprehensive assessment of cardiac and systemic hemodynamics, offering insight access to key variables – such as increased systemic vascular resistances in hypertensives and reduced ventricular-arterial coupling in heart failure patients.
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