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Russell T, Gangotia D, Barry G. Assessing the potential of repurposing ion channel inhibitors to treat emerging viral diseases and the role of this host factor in virus replication. Biomed Pharmacother 2022; 156:113850. [DOI: 10.1016/j.biopha.2022.113850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/25/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022] Open
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Iatridi F, Theodorakopoulou MP, Papagianni A, Sarafidis P. Management of intradialytic hypertension: current evidence and future perspectives. J Hypertens 2022; 40:2120-2129. [PMID: 35950992 DOI: 10.1097/hjh.0000000000003247] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intradialytic hypertension (IDH), that is, a paradoxical rise in blood pressure (BP) during or immediately after a hemodialysis session, affects approximately 10-15% of the hemodialysis population. It is currently recognized as a phenomenon of major clinical significance as recent studies have shown that BP elevation extends to the whole interdialytic interval and associates with increased cardiovascular and all-cause mortality. The pathophysiology of IDH is complex involving volume and sodium overload, endothelial dysfunction, excess renin-angiotensin-aldosterone system and sympathetic nervous system activation, and other mechanisms. For several years, there was a scarcity of studies regarding IDH treatment; recently, however, several attempts to examine the effect of nonpharmacological and pharmacological measures on BP levels in IDH are made. This review attempts to summarize this latest evidence in the field of management of IDH and discuss areas for future research.
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Affiliation(s)
- Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
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Chakraborty RN, Langade D, More S, Revandkar V, Birla A. Efficacy of Cilnidipine (L/N-type Calcium Channel Blocker) in Treatment of Hypertension: A Meta-Analysis of Randomized and Non-randomized Controlled Trials. Cureus 2021; 13:e19822. [PMID: 34963839 PMCID: PMC8695827 DOI: 10.7759/cureus.19822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Hypertension is one of the most common cardiovascular diseases, and the prevalence of hypertension continues to rise across the globe. National and international guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), diuretics, and beta-blockers for the management of hypertension. CCBs are among the most used antihypertensive medications and Cilnidipine is a newer dihydropyridine CCB shown to have a prolonged antihypertensive property. OBJECTIVE This meta-analysis of comparative randomized and non-randomized clinical trials evaluated the effect of Cilnidipine monotherapy or combination therapy on systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate (PR) over 48 weeks of therapy. STUDY DESIGN PubMed (MEDLINE) and Google scholar databases were searched to identify studies designed to evaluate the effects of Cilnidipine in the treatment of hypertensive patients. The study criteria for inclusion into the meta-analysis were all prospective, randomized, and non-randomized clinical studies published till March 2021, studies published in a peer-reviewed journal, the inclusion of patients with hypertension, assessment of blood pressure and heart rate, and a follow-up of four weeks or longer. The initial search identified 82 potential articles; of these, 24 met the inclusion criteria. Studies with <4 weeks treatment period and those not having a CCB were excluded. OUTCOMES Change in SBP, DBP, and PR from baseline at the end of therapy compared between the Cilnidipine and other CCB's. RESULTS Cilnidipine caused a significant reduction (p<0.05) in SBP, DBP, and PR at end of therapy, whereas the reduction in SBP, DBP, and PR with Cilnidipine was similar to other CCB's (p>0.05). The results of this meta-analysis revealed that there were no significant differences in the efficacy in the treatment of hypertensive patients with Cilnidipine and the other therapies. CONCLUSION Cilnidipine has similar anti-hypertensive effects compared with other first-line antihypertensive drugs commonly used in practice. We recommend Cilnidipine as a novel first-line CCB for the management of hypertension either as a monotherapy or as a combination therapy.
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Affiliation(s)
| | - Deepak Langade
- Pharmacology, School of Medicine, D Y Patil University, Navi Mumbai, IND
| | - Shyam More
- Community Medicine, School of Medicine, D Y Patil University, Navi Mumbai, IND
| | - Vaibhav Revandkar
- Medical Affairs, J. B. Chemicals and Pharmaceutical Limited, Mumbai, IND
| | - Ashish Birla
- Medical Affairs, J. B. Chemicals and Pharmaceutical Limited, Mumbai, IND
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Fujiwara T, Hoshide S, Tomitani N, Kanegae H, Kario K. Comparative effects of valsartan plus cilnidipine or hydrochlorothiazide on nocturnal home blood pressure. J Clin Hypertens (Greenwich) 2021; 23:687-691. [PMID: 33497537 PMCID: PMC8029519 DOI: 10.1111/jch.14199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
We tested our hypothesis that, in hypertensive patients with higher nocturnal home systolic blood pressure (HSBP) at baseline, a valsartan/cilnidipine (80/10 mg) combination would reduce nocturnal HSBP more markedly than a valsartan/hydrochlorothiazide (80/12.5 mg) combination. Patients measured their nocturnal HSBP over three nights prior to study randomization and at the end of treatment. Sixty-three and 66 patients comprised the valsartan/cilnidipine and valsartan/hydrochlorothiazide groups; their respective baseline nocturnal HSBP values were 124.3 ± 15.6 and 125.8 ± 15.2 mm Hg (P = .597). Nocturnal HSBPs were significantly reduced from baseline in both groups. Although the valsartan/hydrochlorothiazide group exhibited a significantly greater reduction in nocturnal HSBP compared to the valsartan/cilnidipine group (-5.0 vs. -10.0 mm Hg, P = .035), interaction between the treatment groups and the baseline nocturnal HSBP levels for the changes in nocturnal HSBP after the treatment periods was significant (P = .047). The BP-lowering effect of valsartan/cilnidipine was more dependent on baseline nocturnal HSBP than that of valsartan/hydrochlorothiazide.
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Affiliation(s)
- Takeshi Fujiwara
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.,Genkiplaza Medical Center for Health Care, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
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Yun WJ, Zhang XY, Liu TT, Liang JH, Sun CP, Yan JK, Huo XK, Tian XG, Zhang BJ, Huang HL, Ma XC. The inhibition effect of uncarialin A on voltage-dependent L-type calcium channel subunit alpha-1C: Inhibition potential and molecular stimulation. Int J Biol Macromol 2020; 159:1022-1030. [DOI: 10.1016/j.ijbiomac.2020.05.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/09/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022]
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Matsuda S, Nagahama S, Kurose Y, Wakabayashi M, Sugii H, Teshima T, Suzuki N, Kario K. A post-marketing survey evaluating the safety and efficacy of a fixed-dose single-pill combination of cilnidipine and valsartan in patients with hypertension: Real-world JSH 2014 and 2019 implementations. Clin Exp Hypertens 2020; 42:502-511. [PMID: 31964180 DOI: 10.1080/10641963.2020.1714641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
METHODS : The home blood pressure control by a single-pill combination of cilnidipine and valsartan (HOPE-Combi) survey sought to evaluate the safety and efficacy of cilnidipine 10 mg/valsartan 80 mg single-pill combination (SPC of Cil/Val) treatment in patients with hypertension for over 12 months. Of 2622 subjects' data; we analyzed 2572 cases for safety and 2372 cases for efficacy. RESULTS Adverse drug reaction (ADR) incidence rate was 3.77% (97 of 2572 patients). The frequency of ADRs did not differ between patients aged <75 years and those aged ≥75 years (3.70% vs. 3.93%, respectively); between patients with and without chronic liver disease (CLD; 6.44% vs. 3.54%, respectively); and between patients with and without chronic kidney disease (CKD; 5.26% vs. 3.59%, respectively). Office systolic blood pressure (BP) was reduced from 149.5 ± 19.6 mmHg to 133.5 ± 14.8 mmHg (-15.8 mmHg, P < .01); pulse rate was also reduced 75.5 ± 12.2 bpm to 73.5 ± 11.3 bpm (-1.8 bpm, P < .01) after 12 months. CONCLUSIONS : The SPC of Cil/Val was safe and effective in treating BP of hypertensive patients in real-world settings.
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Affiliation(s)
- Saori Matsuda
- Medical Department, Post-Marketing Medical Research Group, EA Pharma Co., Ltd ., Tokyo, Japan
| | - Shinobu Nagahama
- Medical Department, Post-Marketing Medical Research Group, EA Pharma Co., Ltd ., Tokyo, Japan
| | - Yoshiki Kurose
- Medical Department, Post-Marketing Medical Research Group, EA Pharma Co., Ltd ., Tokyo, Japan
| | - Maki Wakabayashi
- Quality & Compliance Department, Pharmacovigilance Group, EA Pharma Co., Ltd ., Tokyo, Japan
| | - Hitoshi Sugii
- Post-Marketing Surveillance, MOCHIDA PHARMACEUTICAL CO., LTD , Tokyo, Japan
| | - Tsukasa Teshima
- Post-Marketing Surveillance, MOCHIDA PHARMACEUTICAL CO., LTD , Tokyo, Japan
| | - Noriyuki Suzuki
- Medical Affairs Department, MOCHIDA PHARMACEUTICAL CO., LTD , Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Tochigi, Japan
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Kario K, Matsuda S, Nagahama S, Kurose Y, Sugii H, Teshima T, Suzuki N. Single-pill combination of cilnidipine, an L-/N-type calcium channel blocker, and valsartan effectively reduces home pulse pressure in patients with uncontrolled hypertension and sympathetic hyperactivity: The HOPE-Combi survey. J Clin Hypertens (Greenwich) 2020; 22:457-464. [PMID: 32311215 DOI: 10.1111/jch.13771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 12/25/2022]
Abstract
The home blood pressure (BP) control by a single-pill combination of cilnidipine (an L-/N-type calcium channel blocker; CCB) and valsartan (HOPE-Combi) survey is a multicenter, post-marketing, prospective observational study of a single-pill combination of cilnidipine 10 mg and valsartan 80 mg (SPC of Cil/Val) in patients with uncontrolled hypertension. We examined the effects of the SPC of Cil/Val on morning home systolic BP (MHSBP) and morning home pulse pressure (MHPP) of 1036 patients with hypertension over 12 months. MHSBP decreased by 14.0 mm Hg (P < .01), and MHPP decreased by 6.6 mm Hg (P < .01). Moreover, morning home pulse rate (MHPR) decreased by 2.1 bpm (P < .01). A more progressive and greater decrease in MHSBP (-17.2 vs -10.3 mm Hg, P < .01) and MHPP (-7.6 vs -4.9 mm Hg, P < .01) was observed in patients with higher MHPR (≥70 bpm) than in those with lower MHPR (<70 bpm) over the treatment period. In particular, in patients with a wide MHPP (≥70 mm Hg), the difference in the MHPP reduction was greater in patients with higher MHPR than in those with lower MHPR (-17.9 vs -13.6 mm Hg, P < .01). These results suggested that the SPC of Cil/Val, which possesses the unique sympatholytic characteristics of an L-/N-type CCB, was particularly effective in patients with uncontrolled hypertension and sympathetic hyperactivity.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Saori Matsuda
- Post-Marketing Medical Research Group, Medical Department, EA Pharma Co., Ltd., Tokyo, Japan
| | - Shinobu Nagahama
- Post-Marketing Medical Research Group, Medical Department, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yoshiki Kurose
- Post-Marketing Medical Research Group, Medical Department, EA Pharma Co., Ltd., Tokyo, Japan
| | - Hitoshi Sugii
- Post-Marketing Surveillance, MOCHIDA PHARMACEUTICAL Co., Ltd., Tokyo, Japan
| | - Tsukasa Teshima
- Post-Marketing Surveillance, MOCHIDA PHARMACEUTICAL Co., Ltd., Tokyo, Japan
| | - Noriyuki Suzuki
- Medical Affairs Department, MOCHIDA PHARMACEUTICAL Co., Ltd., Tokyo, Japan
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Ito T, Fujimoto N, Ishikawa E, Dohi K, Fujimoto M, Murata T, Kiyohara M, Takeuchi H, Koyabu S, Nishimura H, Takeuchi T, Ito M. The effect of an L/N-type calcium channel blocker on intradialytic blood pressure in intradialytic hypertensive patients. Clin Exp Hypertens 2018; 41:92-99. [PMID: 29584458 DOI: 10.1080/10641963.2018.1445753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Intradialytic hypertension (HTN), which is one of the poor prognostic markers in patients undergoing hemodialysis, may be associated with sympathetic overactivity. The L/N-type calcium channel blocker, cilnidipine, has been reported to suppress sympathetic nerves activity in vivo. Therefore, we hypothesized that cilnidipine could attenuate intradialytic systolic blood pressure (SBP) elevation. METHODS Fifty-one patients on chronic hemodialysis who had intradialytic-HTN (SBP elevation ≥10 mmHg during hemodialysis) and no fluid overload were prospectively randomized into two groups: control and cilnidipine groups. Cilnidipine group patients took cilnidipine (10 mg/day) for 12 weeks. The primary endpoint was the change in the intradialytic SBP elevation before and after the 12-week intervention. RESULTS Before the intervention, no differences were observed in age, sex or pre-dialytic SBP (148.5 ± 12.9 vs. 148.3 ± 19.3 mmHg) between the two groups. Intradialytic SBP elevation was unchanged in the control group. Cilnidipine significantly lowered the post-dialytic SBP with an attenuation of the intradialytic SBP elevation from 12.0 ± 15.4 mmHg to 4.8 ± 10.1 mmHg. However, the observed difference in the intradialytic SBP elevation by cilnidipine did not reach statistical significance (group×time interaction effect p = 0.25). Cathecolamine levels were unaffected by the intervention in both groups. CONCLUSION Cilnidipine lowers both the pre- and post-dialytic SBP and might attenuate intradialytic SBP elevation. Therefore, cilnidipine may be effective in lowering SBP during HD in patients with intradialytic-HTN.
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Affiliation(s)
- Takayasu Ito
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Naoki Fujimoto
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Eiji Ishikawa
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Kaoru Dohi
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Mika Fujimoto
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Tomohiro Murata
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Michiyo Kiyohara
- b Department of Internal medicine , Takeuchi Hospital , Tsu , Japan
| | | | - Sukenari Koyabu
- c Department of Hemodialysis center , Owase General Hospital , Owase , Japan
| | | | | | - Masaaki Ito
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
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Fujiwara T, Tomitani N, Kanegae H, Kario K. Comparative effects of valsartan plus either cilnidipine or hydrochlorothiazide on home morning blood pressure surge evaluated by information and communication technology-based nocturnal home blood pressure monitoring. J Clin Hypertens (Greenwich) 2018; 20:159-167. [DOI: 10.1111/jch.13154] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Takeshi Fujiwara
- Jichi Medical University School of Medicine; Shimotsuke Japan
- Higashiagatsuma-machi National Health Insurance Clinic; Gunma Japan
| | - Naoko Tomitani
- Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Hiroshi Kanegae
- Jichi Medical University School of Medicine; Shimotsuke Japan
- Genkiplaza Medical Center for Health Care; Tokyo Japan
| | - Kazuomi Kario
- Jichi Medical University School of Medicine; Shimotsuke Japan
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Fujiwara T, Tomitani N, Sato K, Okura A, Suzuki N, Kario K. The relationship between a blunted morning surge and a reversed nocturnal blood pressure dipping or “riser” pattern. J Clin Hypertens (Greenwich) 2017; 19:1108-1114. [DOI: 10.1111/jch.13087] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 05/02/2017] [Accepted: 05/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Takeshi Fujiwara
- Jichi Medical University School of Medicine; Shimotsuke Japan
- Higashiagatsuma-machi National Health Insurance Clinic; Gunma Japan
| | - Naoko Tomitani
- Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Keiko Sato
- Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Ayako Okura
- Jichi Medical University School of Medicine; Shimotsuke Japan
| | | | - Kazuomi Kario
- Jichi Medical University School of Medicine; Shimotsuke Japan
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Aoki S, Hosomi N, Nezu T, Teshima T, Sugii H, Nagahama S, Kurose Y, Maruyama H, Matsumoto M. Blood pressure control with cilnidipine treatment in Japanese post-stroke hypertensive patients: The CA-ATTEND study. Clin Exp Hypertens 2017; 39:225-234. [PMID: 28448181 DOI: 10.1080/10641963.2016.1235183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Blood pressure control is important in post-stroke hypertensive patients and antihypertensive treatment is recommended for such patients. Ca-channel blockers are recommended as the medications of choice for the treatment of post-stroke patients. Here, we report the results of a large-scale prospective post-marketing surveillance study of post-stroke hypertensive patients (n = 2667, male 60.4%, 69.0 ± 10.9 years) treated with cilnidipine, with regard to blood pressure control and adverse reactions. Cilnidipine treatment caused a decrease in both clinic and home blood pressures 2 months after the beginning of treatment, and the decreased blood pressure was maintained until the end of 12 months' observation. The proportion of patients in whom clinic blood pressure was well controlled (<140/90 mmHg) increased from 21.5% to 65.3% in cilnidipine treatment, with no differences in effectiveness among the various clinical subtypes of stroke. In total, 346 adverse events occurred, with an overall incidence of 8.9% (238 of 2667 patients). In the elderly group, specifically, a fall and a hip fracture each occurred in 1 (0.1%) patient. These results indicate that cilnidipine was effective in treating uncontrolled blood pressure and was well tolerated in Japanese post-stroke hypertensive patients in a real-world clinical setting.
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Affiliation(s)
- Shiro Aoki
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Naohisa Hosomi
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Tomohisa Nezu
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Tsukasa Teshima
- b Post-Marketing Surveillance , Mochida Pharmaceutical Co., Ltd. , Tokyo , Japan
| | - Hitoshi Sugii
- b Post-Marketing Surveillance , Mochida Pharmaceutical Co., Ltd. , Tokyo , Japan
| | - Shinobu Nagahama
- c Post-Marketing Medical Research Department , EA Pharma Co., Ltd. , Tokyo , Japan
| | - Yoshiki Kurose
- c Post-Marketing Medical Research Department , EA Pharma Co., Ltd. , Tokyo , Japan
| | - Hirofumi Maruyama
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Masayasu Matsumoto
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
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Tamargo J, Ruilope LM. Investigational calcium channel blockers for the treatment of hypertension. Expert Opin Investig Drugs 2016; 25:1295-1309. [DOI: 10.1080/13543784.2016.1241764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J Tamargo
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, Madrid, Spain. CIBER of Cardiovascular Diseases
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Kario K, Saito I, Kushiro T, Teramukai S, Yaginuma M, Mori Y, Okuda Y, Kobayashi F, Shimada K. Persistent olmesartan-based blood pressure-lowering effects on morning hypertension in Asians: the HONEST study. Hypertens Res 2016; 39:334-41. [PMID: 26739871 PMCID: PMC4865473 DOI: 10.1038/hr.2015.148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/12/2015] [Accepted: 10/26/2015] [Indexed: 11/23/2022]
Abstract
Using data from the large-scale HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) study, we investigated the characteristics of the effects of olmesartan-based treatment on morning hypertension in Asian hypertensive patients. Specifically, we investigated the relationship between baseline blood pressure (BP) and BP reduction after 16 weeks by linear regression analyses; determinants of BP reduction were also investigated. For both morning home BP (MHBP) and clinic BP (CBP), reduced systolic BP (SBP) after 16 weeks was associated with baseline SBP (P<0.001). The slope of the regression lines was similar for morning home SBP (MHSBP) (-0.744) and clinic SBP (-0.735). Although sex, concomitant diabetes mellitus and concomitant hepatic disease significantly influence the relationship between BP reduction and baseline BP for MHSBP, none were deemed clinically relevant. In conclusion, olmesartan-based treatment robustly reduced baseline high MHBP, similar to CBP, and the effect was associated with baseline BP but unaffected by patient background factors.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | | | | | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Zamponi GW, Striessnig J, Koschak A, Dolphin AC. The Physiology, Pathology, and Pharmacology of Voltage-Gated Calcium Channels and Their Future Therapeutic Potential. Pharmacol Rev 2015; 67:821-70. [PMID: 26362469 PMCID: PMC4630564 DOI: 10.1124/pr.114.009654] [Citation(s) in RCA: 719] [Impact Index Per Article: 79.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Voltage-gated calcium channels are required for many key functions in the body. In this review, the different subtypes of voltage-gated calcium channels are described and their physiologic roles and pharmacology are outlined. We describe the current uses of drugs interacting with the different calcium channel subtypes and subunits, as well as specific areas in which there is strong potential for future drug development. Current therapeutic agents include drugs targeting L-type Ca(V)1.2 calcium channels, particularly 1,4-dihydropyridines, which are widely used in the treatment of hypertension. T-type (Ca(V)3) channels are a target of ethosuximide, widely used in absence epilepsy. The auxiliary subunit α2δ-1 is the therapeutic target of the gabapentinoid drugs, which are of value in certain epilepsies and chronic neuropathic pain. The limited use of intrathecal ziconotide, a peptide blocker of N-type (Ca(V)2.2) calcium channels, as a treatment of intractable pain, gives an indication that these channels represent excellent drug targets for various pain conditions. We describe how selectivity for different subtypes of calcium channels (e.g., Ca(V)1.2 and Ca(V)1.3 L-type channels) may be achieved in the future by exploiting differences between channel isoforms in terms of sequence and biophysical properties, variation in splicing in different target tissues, and differences in the properties of the target tissues themselves in terms of membrane potential or firing frequency. Thus, use-dependent blockers of the different isoforms could selectively block calcium channels in particular pathologies, such as nociceptive neurons in pain states or in epileptic brain circuits. Of important future potential are selective Ca(V)1.3 blockers for neuropsychiatric diseases, neuroprotection in Parkinson's disease, and resistant hypertension. In addition, selective or nonselective T-type channel blockers are considered potential therapeutic targets in epilepsy, pain, obesity, sleep, and anxiety. Use-dependent N-type calcium channel blockers are likely to be of therapeutic use in chronic pain conditions. Thus, more selective calcium channel blockers hold promise for therapeutic intervention.
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Affiliation(s)
- Gerald W Zamponi
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (G.W.Z.); Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences, University of Innsbruck, Innsbruck, Austria (J.S., A.K.); and Department of Neuroscience, Physiology, and Pharmacology, Division of Biosciences, University College London, London, United Kingdom (A.C.D.)
| | - Joerg Striessnig
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (G.W.Z.); Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences, University of Innsbruck, Innsbruck, Austria (J.S., A.K.); and Department of Neuroscience, Physiology, and Pharmacology, Division of Biosciences, University College London, London, United Kingdom (A.C.D.)
| | - Alexandra Koschak
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (G.W.Z.); Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences, University of Innsbruck, Innsbruck, Austria (J.S., A.K.); and Department of Neuroscience, Physiology, and Pharmacology, Division of Biosciences, University College London, London, United Kingdom (A.C.D.)
| | - Annette C Dolphin
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (G.W.Z.); Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences, University of Innsbruck, Innsbruck, Austria (J.S., A.K.); and Department of Neuroscience, Physiology, and Pharmacology, Division of Biosciences, University College London, London, United Kingdom (A.C.D.)
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15
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Abstract
Ion channels are critical for all aspects of cardiac function, including rhythmicity and contractility. Consequently, ion channels are key targets for therapeutics aimed at cardiac pathophysiologies such as atrial fibrillation or angina. At the same time, off-target interactions of drugs with cardiac ion channels can be the cause of unwanted side effects. This manuscript aims to review the physiology and pharmacology of key cardiac ion channels. The intent is to highlight recent developments for therapeutic development, as well as elucidate potential mechanisms for drug-induced cardiac side effects, rather than present an in-depth review of each channel subtype.
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16
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Uchida S, Takahashi M, Sugawara M, Saito T, Nakai K, Fujita M, Mochizuki K, Shin I, Morita T, Hikita T, Itakura H, Takahashi Y, Mizuno S, Ohno Y, Ito K, Ito T, Soma M. Effects of the N/L-type calcium channel blocker cilnidipine on nephropathy and uric acid metabolism in hypertensive patients with chronic kidney disease (J-CIRCLE study). J Clin Hypertens (Greenwich) 2014; 16:746-53. [PMID: 25264215 PMCID: PMC8031925 DOI: 10.1111/jch.12412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 12/16/2022]
Abstract
This study assessed the urinary albumin/creatinine ratio (ACR) and uric acid metabolism in 70 hypertensive patients with chronic kidney disease in whom urinary ACR had remained ≥30 mg/g under the treatment of the L-type calcium channel blocker amlodipine. Three months after switching to the N/L-type calcium channel blocker cilnidipine, blood pressure (BP) did not change; however, urinary ACR significantly decreased with cilnidipine. Serum uric acid levels showed no significant change. In cases where uric acid production had been high (urinary uric acid/creatinine ratio ≥0.5), the urinary uric acid/creatinine ratio decreased significantly after cilnidipine treatment, suggesting that cilnidipine can suppress excessive uric acid formation. These results suggest that switching from amlodipine to cilnidipine results in a significant reduction in urinary ACR as well as significant reduction in uric acid production. Thus, cilnidipine is more useful than amlodipine in improving albuminuria and uric acid metabolism in hypertensive patients with chronic kidney disease.
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Affiliation(s)
- Shunya Uchida
- Internal MedicineTeikyo University School of MedicineTokyoJapan
| | | | | | | | | | | | | | - Isu Shin
- Sekimachi Internal Medicine ClinicTokyoJapan
| | | | | | | | | | | | | | - Kageki Ito
- Ito Internal Medicine & Pediatrics ClinicTokyoJapan
| | | | - Masayoshi Soma
- General MedicineNihon University School of MedicineTokyoJapan
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17
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Kanaoka T, Tamura K, Wakui H, Ohsawa M, Azushima K, Uneda K, Kobayashi R, Fujikawa T, Tsurumi-Ikeya Y, Maeda A, Yanagi M, Toya Y, Umemura S. L/N-type calcium channel blocker cilnidipine added to renin-angiotensin inhibition improves ambulatory blood pressure profile and suppresses cardiac hypertrophy in hypertension with chronic kidney disease. Int J Mol Sci 2013; 14:16866-81. [PMID: 23959116 PMCID: PMC3759940 DOI: 10.3390/ijms140816866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 01/22/2023] Open
Abstract
Ambulatory blood pressure (BP) and heart rate (HR) profile are proposed to be related to renal deterioration and cardiovascular complication in hypertension and chronic kidney disease (CKD). In this study, we examined the beneficial effects cilnidipine, a unique L/N-type calcium channel blocker (CCB), in addition to renin-angiotensin system inhibitors, on ambulatory BP and HR profile, as well as cardiorenal function in hypertensive CKD patients. Forty-five patients were randomly assigned to the cilnidipine replacement group (n = 21) or the control CCBs group (n = 24) during a 24-week active treatment period. Although clinical BP values were similar in the cilnidipine and control CCBs groups after the treatment period, the results of ambulatory BP monitoring showed that the 24-h and daytime systolic BP levels in the cilnidipine group were significantly lower compared with the control group after the study. Furthermore, the left ventricular mass index (LVMI) was significantly decreased in the cilnidipine group compared to the control group after the study (LVMI, 135.3 ± 26.4 versus 181.2 ± 88.4, p = 0.031), with a significant difference in the changes in the LVMI between the cilnidipine and control groups (change in LVMI, −12.4 ± 23.7 versus 26.2 ± 64.4, p = 0.007). These results indicate that cilnidipine is beneficial for the suppression of pathological cardiac remodeling, at least partly, via a superior improving effect on ambulatory BP profile compared with control CCBs in hypertensive CKD patients.
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Affiliation(s)
| | - Kouichi Tamura
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +81-45-787-2635 (ext. 6326); Fax: +81-45-701-3738
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18
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Diagnosis of true uncontrolled hypertension using both home and ambulatory blood pressure monitoring. J Hum Hypertens 2013; 28:176-9. [DOI: 10.1038/jhh.2013.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/21/2013] [Accepted: 06/28/2013] [Indexed: 11/09/2022]
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19
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Kario K, Saito I, Kushiro T, Teramukai S, Mori Y, Hiramatsu K, Kobayashi F, Shimada K. Enhanced blood pressure-lowering effect of olmesartan in hypertensive patients with chronic kidney disease-associated sympathetic hyperactivity: HONEST study. J Clin Hypertens (Greenwich) 2013; 15:555-61. [PMID: 23889717 PMCID: PMC3884768 DOI: 10.1111/jch.12132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/09/2013] [Accepted: 04/12/2013] [Indexed: 01/12/2023]
Abstract
To investigate the blood pressure (BP)-lowering effect of olmesartan in relation to chronic kidney disease (CKD)-associated sympathetic nerve activity, a subanalysis was performed using data from the first 16 weeks of the Home BP Measurement With Olmesartan-Naive Patients to Establish Standard Target Blood Pressure (HONEST) study, a prospective observational study of hypertensive patients. Essential hypertensive patients who took no antihypertensive agent at baseline were classified based on baseline morning home systolic BP (MHSBP) in quartiles. In each class, patients were further classified based on baseline morning home pulse rate (MHPR). A subgroup analysis in patients with/without chronic kidney disease (CKD) was performed. A total of 5458 patients (mean age, 63.0 years; 51.6% women) were included. In the 4th quartile of baseline MHSBP (≥165 mm Hg), patients with MHPR ≥70 beats per minute had a greater BP reduction (by 3.2 mm Hg) than those with MHPR <70 beats per minute after 16 weeks of olmesartan-based treatment (P=.0005). An even greater BP reduction (by 6.6 mm Hg) was observed in patients with CKD than in patients without CKD in this group (P=.0084). Olmesartan was more effective in hypertensive patients with high MHSBP and MHPR ≥70 beats per minute, especially in patients with CKD. Olmesartan may have enhanced BP-lowering effects by improving renal ischemia in hypertensive CKD patients with potential increased sympathetic nerve activity.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
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20
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Iyer RP, Lindsey ML, Chilton RJ. A two-for-one bargain: using cilnidipine to treat hypertension and its comorbidities. J Clin Hypertens (Greenwich) 2013; 15:455-7. [PMID: 23815532 PMCID: PMC3815552 DOI: 10.1111/jch.12112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rugmani Padmanabhan Iyer
- San Antonio Cardiovascular Proteomics CenterThe University of Texas Health Science Center at San AntonioSan AntonioTX
- Jackson Center for Heart ResearchDepartment of Physiology and BiophysicsUniversity of Mississippi Medical CenterJacksonMS
| | - Merry L. Lindsey
- San Antonio Cardiovascular Proteomics CenterThe University of Texas Health Science Center at San AntonioSan AntonioTX
- Jackson Center for Heart ResearchDepartment of Physiology and BiophysicsUniversity of Mississippi Medical CenterJacksonMS
- Research ServicesG.V. (Sonny) Montgomery Veterans Affairs Medical CenterJacksonMS
| | - Robert J. Chilton
- San Antonio Cardiovascular Proteomics CenterThe University of Texas Health Science Center at San AntonioSan AntonioTX
- Division of CardiologyDepartment of MedicineThe University of Texas Health Science Center at San AntonioSan AntonioTX
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21
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Kario K, Nariyama J, Kido H, Ando SI, Takiuchi S, Eguchi K, Niijima Y, Ando T, Noda M. Effect of a novel calcium channel blocker on abnormal nocturnal blood pressure in hypertensive patients. J Clin Hypertens (Greenwich) 2013; 15:465-72. [PMID: 23815534 PMCID: PMC8033971 DOI: 10.1111/jch.12113] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/13/2013] [Accepted: 02/21/2013] [Indexed: 11/28/2022]
Abstract
The authors examined the effect of cilnidipine, a unique L/N-type calcium channel blocker, on abnormal nocturnal blood pressure (BP) dipping in Japanese hypertensive patients in the real world. The Ambulatory Blood Pressure Control and Home Blood Pressure (Morning and Evening) Lowering by N-Channel Blocker Cilnidipine (ACHIEVE-ONE), a large-scale clinical study, was designed to evaluate the effects of cilnidipine in daily medical practice. Among the study, 24-hour ambulatory BP data were obtained from 615 patients and classified according to their nocturnal dipping status as extreme dippers, dippers, nondippers, or risers. A 12-week treatment with cilnidipine significantly reduced 24-hour BP in all groups (P<.001). Changes in nocturnal systolic BP (SBP) from baseline were -17.9 mm Hg from 154.6 mm Hg in risers and -11.9 mm Hg from 142.1 mm Hg, -6.6 mm Hg from 128.5 mm Hg, and 0.1 mm Hg from 115.8 mm Hg in nondippers, dippers, and extreme dippers, respectively. Changes from baseline in nocturnal SBP reduction rate were 8.2% in risers (P<.001) but -7.0% in extreme dippers (P<.001), while no change was observed in the nighttime SBP reduction rate for the total patients (-0.2%±9.6%, P=.617). Cilnidipine partially, but significantly, restored abnormal nocturnal dipping status toward a normal dipping pattern in hypertensive patients.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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