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Ferrara F, Zovi A, Nava E, Langella R, Vitiello A. Great Sustainability Results From Appropriate Antihypertensive Therapy. Curr Probl Cardiol 2023; 48:101857. [PMID: 37301491 DOI: 10.1016/j.cpcardiol.2023.101857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases are emerging as a major cause of death and hospitalization in the Western world. For many years, a number of medicines have been placed on the market, in well-established and safe use for antihypertensive therapy. The various classes of antihypertensives in established use include, ACE inhibitors, as monotherapy or in combination with diuretics or calcium antagonists, sartans, calcium antagonists, beta blockers, and diuretics. Among these medicines classes there are differences in mechanism of action, efficacy in reducing blood pression, tolerability, and cost. In fact, there are wide differences in the monthly cost of therapy within each class and among the classes themselves. In this analysis we describe an example about the prescribing trends of antihypertensive drugs at a European sample represented by an Italian health care company of about 1 million inhabitants. Aspects of pharmacoeconomics, pharmacoutilization, and pharmacological differences are described.
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Affiliation(s)
- Francesco Ferrara
- Pharmaceutical Department, Hospital Pharmacist Manager, ASL Napoli 3 Sud, Naples, Italy.
| | - Andrea Zovi
- Pharmaceutical Department, Hospital Pharmacist, Ministry of Health, Rome, Italy
| | - Eduardo Nava
- Pharmaceutical Department, Director Pharmaceutical, Coordination Area, ASL Napoli 3 Sud, Naples, Italy
| | - Roberto Langella
- Pharmaceutical Department, Italian Society of Hospital Pharmacy (SIFO), SIFO Secretariat of the Lombardy Region, Milan, Italy
| | - Antonio Vitiello
- Pharmaceutical Department, Clinical Pharmacologist, Ministry of Health, Rome, Italy
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2
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Liu CW, Wu FH, Hu YL, Pan RH, Lin CH, Chen YF, Tseng GS, Chan YK, Wang CL. Left ventricular hypertrophy detection using electrocardiographic signal. Sci Rep 2023; 13:2556. [PMID: 36781924 PMCID: PMC9924839 DOI: 10.1038/s41598-023-28325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
Left ventricular hypertrophy (LVH) indicates subclinical organ damage, associating with the incidence of cardiovascular diseases. From the medical perspective, electrocardiogram (ECG) is a low-cost, non-invasive, and easily reproducible tool that is often used as a preliminary diagnosis for the detection of heart disease. Nowadays, there are many criteria for assessing LVH by ECG. These criteria usually include that voltage combination of RS peaks in multi-lead ECG must be greater than one or more thresholds for diagnosis. We developed a system for detecting LVH using ECG signals by two steps: firstly, the R-peak and S-valley amplitudes of the 12-lead ECG were extracted to automatically obtain a total of 24 features and ECG beats of each case (LVH or non-LVH) were segmented; secondly, a back propagation neural network (BPN) was trained using a dataset with these features. Echocardiography (ECHO) was used as the gold standard for diagnosing LVH. The number of LVH cases (of a Taiwanese population) identified was 173. As each ECG sequence generally included 8 to 13 cycles (heartbeats) due to differences in heart rate, etc., we identified 1466 ECG cycles of LVH patients after beat segmentation. Results showed that our BPN model for detecting LVH reached the testing accuracy, precision, sensitivity, and specificity of 0.961, 0.958, 0.966 and 0.956, respectively. Detection performances of our BPN model, on the whole, outperform 7 methods using ECG criteria and many ECG-based artificial intelligence (AI) models reported previously for detecting LVH.
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Affiliation(s)
- Cheng-Wei Liu
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Hsing Wu
- Bachelor Degree Program of Artificial Intelligence, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Yu-Lun Hu
- Department of Management Information Systems, National Chung-Hsing University, Taichung, Taiwan
| | - Ren-Hao Pan
- La Vida Tec. Co. Ltd., Taichung, Taiwan
- Preventive Medicine Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Information Management, Tunghai University, Taichung, Taiwan
| | - Chuen-Horng Lin
- Department of Computer Science and Information Engineering, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Yung-Fu Chen
- Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Guo-Shiang Tseng
- Division of Cardiology, Department of Internal Medicine, Taoyuan Armed Force General Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Yung-Kuan Chan
- Department of Management Information Systems, National Chung-Hsing University, Taichung, Taiwan.
| | - Ching-Lin Wang
- Department of Information Management, National Chin-Yi University of Technology, Taichung, Taiwan.
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Yan P, Luo Y, Zhang J, Liu H, Chen J, Wang J, Dong G, Ge M. Effect of administration of low-dose irbesartan and hydrochlorothiazide combined with levamlodipine at different times on the circadian rhythm of blood pressure and the levels of MMPs and TIMPs in non-dipper patients with grade 1 and 2 hypertension. J Clin Hypertens (Greenwich) 2023; 25:137-145. [PMID: 36639984 PMCID: PMC9903188 DOI: 10.1111/jch.14630] [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] [Received: 09/27/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
This study aimed to probe the effects of low-dose irbesartan and hydrochlorothiazide in combination with levamlodipine at different times on the circadian rhythm of blood pressure, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs) levels in patients with non-dipper hypertension (NDH). In this prospective randomized controlled trial, 124 patients with NDH who visited our hospital between August 2018 and July 2021 were enrolled and divided into morning (62 patients) and night (62 patients) medication groups according to the random number table method. All patients received low-dose irbesartan and hydrochlorothiazide combined with levamlodipine, with the morning medication group taking the medication between 7:00 and 10:00 and the night medication group taking the medication between 19:00 and 22:00 for 24 weeks. The effect of antihypertensive medication in both groups was measured, and changes in ambulatory blood pressure, blood pressure circadian rhythm, left ventricular structure, vascular endothelial function, MMPs, and TIMPs levels were observed before treatment initiation and after 24 weeks of treatment in both groups. The percentage of the dipper type was higher in the night medication group than in the morning medication group, while the percentage of the non-dipper type was lower in the morning medication group (p < .05). Low-dose irbesartan and hydrochlorothiazide combined with levamlodipine at different times can effectively treat NDH, but bedtime dosing is more beneficial in reducing nocturnal blood pressure, reversing NDH, improving the circadian rhythm of blood pressure, left ventricular structure, regulating vascular endothelial function, increasing MMPs levels, and reducing TIMP levels.
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Affiliation(s)
- Peiling Yan
- Department of General PracticeZhenhai District People's HospitalNingboChina
| | - Yongjian Luo
- Department of General PracticeZhenhai District People's HospitalNingboChina
| | - Jiancheng Zhang
- Department of General PracticeZhenhai District People's HospitalNingboChina
| | - Haifeng Liu
- Department of GastroenterologyZhenhai District People's HospitalNingboChina
| | - Jiashi Chen
- Department of General PracticeZhenhai District People's HospitalNingboChina
| | - Jing Wang
- Emergency Department of Ningbo Zhenhai District People's HospitalNingboChina
| | - Guofeng Dong
- Department of General PracticeZhenhai District People's HospitalNingboChina
| | - Minghao Ge
- Department of General PracticeCommunity Health Service Center of Luotuo Street, Zhenhai DistrictNingboChina
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Hypertension and cardiomyopathy associated with chronic kidney disease: epidemiology, pathogenesis and treatment considerations. J Hum Hypertens 2023; 37:1-19. [PMID: 36138105 PMCID: PMC9831930 DOI: 10.1038/s41371-022-00751-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Chronic kidney disease (CKD) is a complex condition with a prevalence of 10-15% worldwide. An inverse-graded relationship exists between cardiovascular events and mortality with kidney function which is independent of age, sex, and other risk factors. The proportion of deaths due to heart failure and sudden cardiac death increase with progression of chronic kidney disease with relatively fewer deaths from atheromatous, vasculo-occlusive processes. This phenomenon can largely be explained by the increased prevalence of CKD-associated cardiomyopathy with worsening kidney function. The key features of CKD-associated cardiomyopathy are increased left ventricular mass and left ventricular hypertrophy, diastolic and systolic left ventricular dysfunction, and profound cardiac fibrosis on histology. While these features have predominantly been described in patients with advanced kidney disease on dialysis treatment, patients with only mild to moderate renal impairment already exhibit structural and functional changes consistent with CKD-associated cardiomyopathy. In this review we discuss the key drivers of CKD-associated cardiomyopathy and the key role of hypertension in its pathogenesis. We also evaluate existing, as well as developing therapies in the treatment of CKD-associated cardiomyopathy.
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Ingelfinger JR. Thiazide-like versus Thiazide Diuretics - Finally, an Answer? N Engl J Med 2022; 387:2462-2463. [PMID: 36516077 DOI: 10.1056/nejme2215744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Chanduluru HK, Sugumaran A, Kannaiah KP. Multiple spectrophotometric determinations of Chlorthalidone and Cilnidipine using propylene carbonate - As a step towards greenness. Anal Biochem 2022; 657:114890. [PMID: 36096183 DOI: 10.1016/j.ab.2022.114890] [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: 04/27/2022] [Revised: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 12/30/2022]
Abstract
Analyzing a drug based on its overlapping spectra requires the use of sophisticated equipment and more hazardous solvents, which is detrimental to ecological sustainability. There is a critical need to create a simple, unique, and cost-effective approach for detecting a mixture of compounds in a safer environment. The aim was to develop an eco-friendly, stability-indicating assay method to determine Chlorthalidone (CLD) and Cilnidipine (CIL) in bulk and tablet dosage form using four different Ultra-Violet (UV) spectrophotometric methods. The ratio difference method showed absorbance peaks at 256.01 nm, 220.87 nm, first ratio difference spectra at 267.21 nm, 288.03 nm, and second ratio difference spectra at 309.2 nm, 280.03 nm. The area under curve techniques showed an absorbance range of around 224-232 nm for CIL and 218-227 nm for CLD. Further, the spectral changes have been assessed at various conditions like acid, base, oxidation, and UV radiation, and it has been found that CLD tends to lose its spectral property by more than 45%. The method developed for two drugs has obeyed Beers law with the selected concentration range of 7-13 μg/mL for CLD and 8.75-16.25 μg/mL for CIL. The developed method was finally evaluated using four tools, and the results showed green pictographically representation in the GAPI and score near to 100 for AES and closer to 1 for AGREE indicated that the method was found to be most eco-friendly. The findings were easy to replicate, adoptive with major regulatory requirements, environmentally friendly, fast, and inexpensive to perform. This approach does not require any specific expensive equipment, and it might be inexpensive to use in the future to assess laboratory and commercial mixtures.
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Affiliation(s)
| | - Abimanyu Sugumaran
- SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, 603203, India.
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Kolkenbeck-Ruh A, Soepnel LM, Crouch SH, Naidoo S, Smith W, Norris SA, Davies J, Ware LJ. Obesity, hypertension, and tobacco use associated with left ventricular remodeling and hypertrophy in South African women: Birth to Twenty Plus Cohort. BMC Cardiovasc Disord 2022; 22:403. [PMID: 36085014 PMCID: PMC9463769 DOI: 10.1186/s12872-022-02837-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Left ventricular hypertrophy (LVH) is a marker of increased risk in developing future life-threatening cardiovascular disease (CVD), however, it is unclear how CVD risk factors, such as obesity, blood pressure (BP), and tobacco use, are associated with left ventricular (LV) remodeling and LVH in urban African populations. Therefore, we aimed to identify the prevalence of LVH as well as the health factors associated with LV remodeling and LVH, within black South African adult women and their pre-pubescent children.
Methods
Black female adults (n = 123; age: 29–68 years) and their children (n = 64; age: 4–10; 55% female) were recruited from the Birth to Twenty Plus Cohort in Soweto, South Africa. Tobacco and alcohol use, physical activity, presence of diabetes mellitus, heart disease, and medication were self-reported. Height, weight, and blood pressure were measured in triplicate to determine the prevalence of obesity and hypertension respectively. Echocardiography was used to assess LV mass at end-diastole, based on linear measurements, and indexed to body surface area to determine LVH.
Results
Hypertension and obesity prevalences were 35.8% and 59.3% for adults and 45.3% and 6.3% for children. Self-reported tobacco use in adults was 22.8%. LVH prevalence was 35.8% in adults (75% eccentric: 25% concentric), and 6.3% in children. Concentric remodeling was observed in 15.4% of adults, however, concentric remodeling was only found in one child. In adults, obesity [OR: 2.54 (1.07–6.02; p = 0.02)] and hypertension [3.39 (1.08–10.62; p = 0.04)] significantly increased the odds of LVH, specifically eccentric LVH, while concentric LVH was associated with self-reported tobacco use [OR: 4.58 (1.18–17.73; p = 0.03)]. Although no logistic regression was run within children, of the four children LVH, three had elevated blood pressure and the child with normal blood pressure was overweight.
Conclusions
The association between obesity, hypertension, tobacco use, and LVH in adults, and the 6% prevalence of LVH in children, calls for stronger public health efforts to control risk factors and monitor children who are at risk.
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Ernst ME, Fravel MA. Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. Am J Hypertens 2022; 35:573-586. [PMID: 35404993 DOI: 10.1093/ajh/hpac048] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/27/2023] Open
Abstract
The term thiazide is universally understood to refer to diuretics that exert their principal action in the distal tubule. The thiazide class is heterogenous and can be further subdivided into compounds containing the benzothiadiazine ring structure-the thiazide-type (e.g., hydrochlorothiazide)-and those lacking the benzothiadiazine ring-the thiazide-like (e.g., chlorthalidone and indapamide) drugs. Thiazide-like agents are longer acting and constitute the diuretics used in most of the cardiovascular outcome trials that established benefits of treatment with diuretics, but pragmatic aspects, such as lack of availability in convenient formulations, limit their use. Regardless of class heterogeneity, thiazides have retained importance in the management of hypertension for over 60 years. They are reliably effective as monotherapy in a majority of hypertensive patients, and augment the efficacy of other classes of antihypertensives when used in combination. Importantly, a thiazide-based treatment regimen lowers cardiovascular events, and their sturdy effect reinforces their place among the recommended first-line agents to treat hypertension in major domestic and international hypertension guidelines. There are few head-to-head comparisons within the class, but potential differences have been explored indirectly as well as in non-blood pressure mechanisms and potential pleiotropic properties. Until proven otherwise, the importance of these differences remains speculative, and clinicians should assume that cardiovascular events will be lowered similarly across agents when equivalent blood pressure reduction occurs. Thiazides remain underutilized, with only about one-third of hypertensive patients receiving them. For many patients, however, a thiazide is an indispensable component of their regimen to achieve adequate blood pressure control.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
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Bays HE, Kulkarni A, German C, Satish P, Iluyomade A, Dudum R, Thakkar A, Rifai MA, Mehta A, Thobani A, Al-Saiegh Y, Nelson AJ, Sheth S, Toth PP. Ten things to know about ten cardiovascular disease risk factors - 2022. Am J Prev Cardiol 2022; 10:100342. [PMID: 35517870 PMCID: PMC9061634 DOI: 10.1016/j.ajpc.2022.100342] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
The American Society for Preventive Cardiology (ASPC) "Ten things to know about ten cardiovascular disease risk factors - 2022" is a summary document regarding cardiovascular disease (CVD) risk factors. This 2022 update provides summary tables of ten things to know about 10 CVD risk factors and builds upon the foundation of prior annual versions of "Ten things to know about ten cardiovascular disease risk factors" published since 2020. This 2022 version provides the perspective of ASPC members and includes updated sentinel references (i.e., applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful dietary intake, physical inactivity, dyslipidemia, pre-diabetes/diabetes, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis (with smoking as a potential contributor to thrombosis), kidney dysfunction and genetics/familial hypercholesterolemia. Other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the ASPC "Ten things to know about ten cardiovascular disease risk factors - 2022" to provide a tabular overview of things to know about ten of the most common CVD risk factors applicable to preventive cardiology and provide ready access to applicable guidelines and sentinel reviews.
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Affiliation(s)
- Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville KY 40213
| | - Anandita Kulkarni
- Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701
| | - Charles German
- University of Chicago, Section of Cardiology, 5841 South Maryland Ave, MC 6080, Chicago, IL 60637
| | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA 77030
| | - Adedapo Iluyomade
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL 33176
| | - Ramzi Dudum
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Aarti Thakkar
- Osler Medicine Program, Johns Hopkins Hospital, Baltimore MD
| | | | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Aneesha Thobani
- Emory University School of Medicine | Department of Cardiology, 101 Woodruff Circle, WMB 2125, Atlanta, GA 30322
| | - Yousif Al-Saiegh
- Lankenau Medical Center – Mainline Health, Department of Cardiovascular Disease, 100 E Lancaster Ave, Wynnewood, PA 19096
| | - Adam J Nelson
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX 75093
| | - Samip Sheth
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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Llamas-Molina J, Navarro-Triviño F, Ruiz-Villaverde R. Tiazidas: lo que el dermatólogo debería saber. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:498-504. [DOI: 10.1016/j.ad.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
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[Translated article] What Dermatologists Should Know About Thiazides. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Roush GC, Messerli FH. Chlorthalidone versus hydrochlorothiazide: major cardiovascular events, blood pressure, left ventricular mass, and adverse effects. J Hypertens 2021; 39:1254-1260. [PMID: 33470735 DOI: 10.1097/hjh.0000000000002771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is continuous debate whether chlorthalidone (CTD) and hydrochlorothiazide (HCTZ) differ in reducing major cardiovascular events (MACE). HCTZ is prescribed 10 times more commonly than CTD. METHOD A systematic literature search yielded 14 references, including two network meta-analyses of randomized trials with MACE and left ventricular mass as outcomes. RESULTS The network meta-analysis of randomized trials showed CTD reducing MACE more than HCTZ, hazard ratio = 0.79 (0.72-0.88), P < 0.0001, and an observational cohort study gave an identical point estimate: hazard ratio = 0.79 (0.68-0.92), P = 0.002. In contrast, two observational cohort studies reported no differences between CTD and HCTZ. However, in the studies showing the superiority of CTD median follow-up was 4.3 and 7.0 years, respectively, whereas in the latter studies showing no difference between the two drugs follow-up was only 0.95 and 0.25 years. As differences in outcomes for MACE in hypertension trials with various interventions only emerge after prolonged (>1 year) therapy, differences in follow-up explain these discrepant results. CTD also more effectively reduced left ventricular mass in observational data and network analysis of trials. These advantages of CTD over HCTZ are consistent with greater reductions in night-time blood pressure, greater reductions in oxidative stress and platelet aggregation, and greater improvements in endothelial function. CONCLUSION Over the short-term there were no differences in the net clinical benefit between HCTZ and CTD. However, long-term available data document CTD to be significantly more effective in reducing MACE than HCTZ. The Veterans Administration's trial in progress may provide definitive answer to these questions.
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Affiliation(s)
| | - Franz H Messerli
- Swiss Cardiovascular Center, Bern, Switzerland
- Mount Sinai Icahn School of Medicine, New York City, New York, USA
- Jagiellonian University Krakow, Poland
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Empagliflozin Disrupts a Tnfrsf12a-Mediated Feed Forward Loop That Promotes Left Ventricular Hypertrophy. Cardiovasc Drugs Ther 2021; 36:619-632. [PMID: 33886003 DOI: 10.1007/s10557-021-07190-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Although the cardioprotective benefits of sodium-glucose cotransporter 2 (SGLT2) inhibitors are now widely appreciated, the mechanisms underlying these benefits remain unresolved. Tumor necrosis factor receptor superfamily member 12a (Tnfrsf12a) is a receptor for tumor necrosis factor superfamily member 12 (Tnfsf12). Tnfrsf12a is highly inducible and plays a key role in the development of cardiac hypertrophy and heart failure. Here we set out to determine if SGLT2 inhibition affects the Tnfsf12/Tnfrsf12a system in the stressed myocardium. METHODS C57BL/6N mice that had undergone sham or transverse aortic constriction (TAC) surgery were treated with either the SGLT2 inhibitor empagliflozin (400 mg/kg diet; 60-65 mg/kg/day) or standard chow alone and were followed for 8 weeks. Tnfrsf12a expression in mouse hearts was assessed by in situ hybridization, qRT-PCR, and immunoblotting. RESULTS Left ventricular (LV) mass, end-systolic volume, and end-diastolic volume were all increased in TAC mice and were significantly lower with empagliflozin. Myocyte hypertrophy and interstitial fibrosis in TAC hearts were similarly attenuated with empagliflozin. Tnfrsf12a expression was upregulated in mouse hearts following TAC surgery but not in the hearts of empagliflozin-treated mice. In cultured cardiomyocytes, Tnfrsf12a antagonism attenuated the increase in cardiomyocyte size that was induced by phenylephrine. CONCLUSION Empagliflozin attenuates LV enlargement in mice with hypertrophic heart failure. This effect may be mediated, at least in part, by a reduction in loading conditions which limits upregulation of the inducible, proinflammatory, and prohypertrophic TNF superfamily receptor, Tnfrsf12a. Disruption of the Tnfsf12/Tnfrsf12a feed forward system may contribute to the cardioprotective benefits of SGLT2 inhibition.
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14
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Dineva S, Uzunova K, Pavlova V, Filipova E, Kalinov K, Vekov T. Network meta-analysis of efficacy and safety of chlorthalidone and hydrochlorothiazide in hypertensive patients. Blood Press Monit 2021; 26:160-168. [PMID: 32909966 PMCID: PMC7932752 DOI: 10.1097/mbp.0000000000000486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/10/2020] [Indexed: 12/03/2022]
Abstract
Hypertension is a chronic condition leading to increased stress on the heart and blood vessels, a critical risk factor for clinically significant events such as myocardial infarction heart failure, stroke and death. Chlorthalidone and hydrochlorothiazide are first-line antihypertensive agents for most patients with hypertension. The aim of our meta-analysis was to compare the efficacy and safety of both therapies in patients with hypertension. Searches of electronic databases PubMed, MEDLINE, Scopus, PsycInfo and eLIBRARY.ru, were performed. We used network meta-analysis to combine direct and indirect evidence. Forest plots and closed loops depict estimated results from studies included in our meta-analysis. Of 1289 identified sources, only 37 were included in our meta-analysis. Our analysis has demonstrated a slight superiority for chlorthalidone regarding SBP and not statistically significant differences regarding DBP. Simultaneously, hydrochlorothiazide seems to be a safer choice of therapy, as evidenced by the levels of serum potassium. The two diuretics can be used interchangeably.
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Affiliation(s)
- Stela Dineva
- Department of Science, Tchaikapharma High Quality Medicines, Dimitrov Blvd
| | - Katya Uzunova
- Department of Science, Tchaikapharma High Quality Medicines, Dimitrov Blvd
| | - Velichka Pavlova
- Department of Science, Tchaikapharma High Quality Medicines, Dimitrov Blvd
| | - Elena Filipova
- Department of Science, Tchaikapharma High Quality Medicines, Dimitrov Blvd
| | - Krassimir Kalinov
- Department of Informatics, New Bulgarian University, 21 Montevideo St, Sofia
| | - Toni Vekov
- Department of Pharmacy, Medical University, Dean, Pleven, Bulgaria
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Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, Kelli HM, Ferdinand KC, Echols MR, Weintraub H, Bostrom J, Johnson HM, Hoppe KK, Shapiro MD, German CA, Virani SS, Hussain A, Ballantyne CM, Agha AM, Toth PP. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol 2021; 5:100149. [PMID: 34327491 PMCID: PMC8315386 DOI: 10.1016/j.ajpc.2021.100149] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The “American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update” is a summary document (updated yearly) regarding CVD risk factors. This “ASPC Top Ten CVD Risk Factors 2021 Update” summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten CVD Risk Factors 2021 Update” to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Medical Director / President, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
- Corresponding author.
| | - Pam R. Taub
- University of California San Diego Health, San Diego, CA USA
| | | | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A. Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison L. Bailey
- Chief, Cardiology, Centennial Heart at Parkridge, Chattanooga, TN USA
| | - Heval M. Kelli
- Northside Hospital Cardiovascular Institute, Lawrenceville, GA USA
| | - Keith C. Ferdinand
- Professor of Medicine, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Melvin R. Echols
- Assistant Professor of Medicine, Department of Medicine, Cardiology Division, Morehouse School of Medicine, New Orleans, LA USA
| | - Howard Weintraub
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - John Bostrom
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Clinical Affiliate Associate Professor, Florida Atlantic University, Boca Raton, FL USA
| | - Kara K. Hoppe
- Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Charles A. German
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Aliza Hussain
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Christie M. Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Ali M. Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Bourdillon MT, Vasan RS. A Contemporary Approach to Hypertensive Cardiomyopathy: Reversing Left Ventricular Hypertrophy. Curr Hypertens Rep 2020; 22:85. [DOI: 10.1007/s11906-020-01092-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Hypertension (HTN) is a major modifiable risk factor for cardiovascular disease (CVD) morbidity and mortality. The left ventricle (LV) is a primary target for HTN end-organ damage. In addition to being a marker of HTN, LV geometrical changes: concentric remodeling, concentric or eccentric LV hypertrophy (LVH) are major independent risk factors for not only CVD morbidity and mortality but also for all-cause mortality and neurological pathologies. Blood pressure control with lifestyle changes and antihypertensive agents has been demonstrated to prevent and regress LVH. Herein, we provide a comprehensive review of literature on the relationship between HTN and LV geometry abnormalities with a focus on diagnosis, prognosis, pathophysiological mechanisms, and treatment approaches.
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Karimi R, Gholivand MB, Amiri M. Monitoring of triamterene and hydrochlorothiazide at carbonic materials modified electrode. J Electroanal Chem (Lausanne) 2019. [DOI: 10.1016/j.jelechem.2019.05.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kuusela PJ. Interventricular vessel of the heart and diuretics. J Clin Hypertens (Greenwich) 2019; 21:141. [DOI: 10.1111/jch.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Tadic M, Cuspidi C. Diuretics and left ventricular hypertrophy regression: The relationship that we commonly forget. J Clin Hypertens (Greenwich) 2018; 20:1516-1518. [PMID: 30251479 DOI: 10.1111/jch.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
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