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Stammeleer L, Xifra P, Serrano SI, Rishniw M, Daminet S, Peterson ME. Blood pressure in hyperthyroid cats before and after radioiodine treatment. J Vet Intern Med 2024; 38:1359-1369. [PMID: 38440934 PMCID: PMC11099771 DOI: 10.1111/jvim.17032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Hyperthyroid cats commonly have systemic hypertension, with a reported prevalence of 7% to 48%. Although hypertension might be expected to resolve once treatment restores euthyroidism, it can persist or only first develop after treatment. OBJECTIVES To determine the proportion of hyperthyroid cats with hypertension (systolic blood pressure [SBP] ≥160 mm Hg), persistence or first development of hypertension after successful radioiodine treatment, and correlation of post-treatment hypertension with azotemia or hypothyroidism. ANIMALS Four hundred one hyperthyroid nonazotemic cats were included in the study. METHODS Prospective, cross-sectional and before-and-after studies. All hyperthyroid cats had SBP measured by Doppler; 255 had SBP rechecked 6 months after successful radioiodine (131I) treatment. RESULTS Of untreated hyperthyroid cats, 108/401 (27%) were hypertensive. A higher proportion of hypertensive cats were nervous/excited compared with normotensive cats (47% vs 12%; P < .001). Of the initially hypertensive cats, 87/108 cats were reexamined after 131I treatment; 43/87 (49%) cats normalized SBP, whereas 44/87 (51%) remained hypertensive. Of the initially normotensive cats, 16/168 (9.5%) first developed hypertension after successful 131I treatment. 7/60 (12%) of the 131I-treated hypertensive cats were azotemic and 9/60 (15%) were hypothyroid. A higher proportion of cats remaining hypertensive had nervous/excited demeanor than did normotensive cats (50% vs 17%; P < .001). CONCLUSIONS/CLINICAL IMPORTANCE Hypertension, when present, resolves in many hyperthyroid cats after successful treatment. Hyperthyroid cats uncommonly develop new hypertension after treatment. Persistent or newly detected hypertension was unrelated to azotemia or iatrogenic hypothyroidism. More frequently perceived nervousness/anxiety in radioiodine-treated hypertensive cats suggests that many of these cats might have "situational" hypertension, as hyperthyroid-induced hypertension should resolve after treatment.
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Affiliation(s)
- Lisa Stammeleer
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | | | | | | | - Sylvie Daminet
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Mark E. Peterson
- Cornell UniversityIthacaNew YorkUSA
- Animal Endocrine ClinicNew YorkNew YorkUSA
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Matsuura T, Yoshimura A, Fukushima R. Effects of Beraprost with or without NOS Inhibition on Plasma Aldosterone and Hemodynamics in Healthy Cats. Vet Sci 2024; 11:155. [PMID: 38668422 PMCID: PMC11054574 DOI: 10.3390/vetsci11040155] [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: 02/02/2024] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVES The aim of the study was to evaluate the hemodynamic and RA system effects of the oral administration of the clinical dose of beraprost for feline CKD in healthy cats, and also to examine whether NOS inhibition reversed them. METHODS A placebo-controlled pharmacological sequential design study was carried out to assess the plasma aldosterone and renin concentrations (PAC and PRC), blood pressure, heart rate, and exploratorily to estimate renal plasma flow (RPF) and renal vascular resistance (RVR) with simplified methods. RESULTS Beraprost reduced PAC when compared to the placebo (p < 0.05); this was reversed when NOS inhibitor NG-nitro-L-arginine methyl ester (L-NAME) was added to the beraprost treatment (p < 0.01). No differences in the PRC or hemodynamic parameters were detected between beraprost and the placebo. The correlation ratios (η2) showed opposite relationships between beraprost and the added L-NAME effects on PAC, mean blood pressure (MBP), heart rate, estimated RPF (p < 0.001), estimated RVR (p < 0.01), and PRC (p < 0.05). CONCLUSIONS In healthy cats, the clinical dose of beraprost suppresses PAC, which can be reversed by the inhibition of NOS.
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Affiliation(s)
| | - Aritada Yoshimura
- Animal Medical Center, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Ryuji Fukushima
- Animal Medical Center, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
- Animal Medical Emergency Center, Tokyo University of Agriculture and Technology, Tokyo 184-8588, Japan
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3
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Adin D, Atkins C, Domenig O, Glahn C, DeFrancesco T, Meurs K. Evaluation of Renin-Angiotensin-Aldosterone System Components and Enzymes in Systemically Hypertensive Cats Receiving Amlodipine. Animals (Basel) 2023; 13:3479. [PMID: 38003097 PMCID: PMC10668637 DOI: 10.3390/ani13223479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/23/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Chronic renin-angiotensin-aldosterone system (RAAS) activation is harmful. Amlodipine activates RAAS in humans and dogs, but contradictory data exist for systemically hypertensive (SHT) cats. HYPOTHESIS Cats with SHT and chronic kidney disease treated with amlodipine (SHT/CKD-A) are RAAS activated. ANIMALS Client-owned cats: unmedicated normotensive (NT) cats (n = 9); SHT/CKD-A cats (n = 5) with median systolic blood pressure of 170 mmHg (vs. 195 mmHg, pre-treatment), chronic kidney disease, and receiving no RAAS-suppressive therapy. METHODS Serum was frozen (-80 °C) until RAAS analysis via equilibrium analysis. The RAAS variables (reported as median (minimum-maximum)) were compared between groups, using Mann-Whitney U test. RESULTS Angiotensin 1, angiotensin 1,7, angiotensin III, and angiotensin 1,5, and angiotensin-converting enzyme (ACE)-2 activity were higher in SHT/CKD-A cats compared to NT cats, while ACE activity was lower in SHT/CKD-A cats compared to NT cats (p < 0.05 all). A marker for alternative RAAS influence (ALT-S) was significantly higher (69; 58-73 pmol/pmol) in SHT/CKD-A cats compared to NT cats (35; 14-63 pmol/pmol; p = 0.001). Aldosterone concentrations were significantly higher (393; 137-564 pmol/L) in SHT/CKD-A cats compared to NT cats (129; 28-206 pmol/L; p = 0.007). CONCLUSION AND CLINICAL IMPORTANCE Circulating RAAS is activated in systemically hypertensive cats receiving amlodipine. Although this study did not parse out the individual contributions of SHT, chronic kidney disease, and amlodipine, the findings suggest that the use of concurrent RAAS-suppressant therapy, specifically aldosterone antagonism, in amlodipine-treated SHT cats with chronic kidney disease might be indicated.
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Affiliation(s)
- Darcy Adin
- College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA
| | - Clarke Atkins
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA (K.M.)
| | | | | | - Teresa DeFrancesco
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA (K.M.)
| | - Kathryn Meurs
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA (K.M.)
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4
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Kurtz M, Fabrès V, Dumont R, Chetboul V, Chahory S, Saponaro V, Trehiou E, Poissonnier C, Passavin P, Jondeau C, Bott M, Buronfosse T, Benchekroun G. Prospective evaluation of a telmisartan suppression test as a diagnostic tool for primary hyperaldosteronism in cats. J Vet Intern Med 2023; 37:1348-1357. [PMID: 37246725 PMCID: PMC10365049 DOI: 10.1111/jvim.16741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND In a previous study, telmisartan suppressed aldosterone secretion in healthy cats but not in cats with primary hyperaldosteronism (PHA). HYPOTHESES Telmisartan suppresses aldosterone secretion in middle-aged healthy cat and cats with diseases that may result in secondary hyperaldosteronism, but not in those with PHA. ANIMALS Thirty-eight cats: 5 with PHA; 16 with chronic kidney disease (CKD), subclassified as hypertensive (CKD-H) or non-hypertensive (CKD-NH); 9 with hyperthyroidism (HTH); 2 with idiopathic systemic arterial hypertension (ISH); and 6 healthy middle-aged cats. METHODS Prospective, cross-sectional study. Serum aldosterone concentration, potassium concentration, and systolic blood pressure were measured before and 1 and 1.5 hours after PO administration of 2 mg/kg of telmisartan. The aldosterone variation rate (AVR) was calculated for each cat. RESULTS No significant difference in the minimum AVR was observed among groups (median [quartile 1 (Q1); quartile 3 (Q3)]: 25 [0; 30]; 5 [-27; -75]; 10 [-6; -95]; 53 [19; 86]; 29 [5; 78]) for PHA, CKD, HTH, ISH, and healthy cats, respectively (P = .05). Basal serum aldosterone concentration (pmol/L) was significantly higher in PHA cats (median [Q1; Q3]: 2914 [2789; 4600]) than in CKD-H cats (median [Q1; Q3]: 239 [189; 577], corrected P value = .003) and CKD-NH cats (median [Q1; Q3]: 353 [136; 1371], corrected P value = .004). CONCLUSIONS AND CLINICAL IMPORTANCE The oral telmisartan suppression test using a single dose of 2 mg/kg telmisartan did not discriminate cats with PHA from healthy middle-aged cats or cats with diseases that may result in secondary hyperaldosteronism.
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Affiliation(s)
- Maxime Kurtz
- Ecole Nationale Vétérinaire d'Alfort - CHUVA, Service de Médecine Interne, Maisons-Alfort, France
| | - Virginie Fabrès
- Ecole Nationale Vétérinaire d'Alfort - CHUVA, Service de Médecine Interne, Maisons-Alfort, France
- Aquivet Clinique Veterinaire - Service de Médecine Interne, Eysines, France
| | - Renaud Dumont
- Centre Hospitalier Veterinaire Fregis, Arcueil, France
| | - Valérie Chetboul
- École Nationale Vétérinaire d'Alfort - CHUVA, Unité de Cardiologie d'Alfort, Maisons-Alfort, France
| | - Sabine Chahory
- Ecole Nationale Vétérinaire d'Alfort - CHUVA, Unité d'Ophtalmologie, Maisons-Alfort, France
| | - Vittorio Saponaro
- École Nationale Vétérinaire d'Alfort - CHUVA, Unité de Cardiologie d'Alfort, Maisons-Alfort, France
| | - Emilie Trehiou
- École Nationale Vétérinaire d'Alfort - CHUVA, Unité de Cardiologie d'Alfort, Maisons-Alfort, France
| | - Camille Poissonnier
- École Nationale Vétérinaire d'Alfort - CHUVA, Unité de Cardiologie d'Alfort, Maisons-Alfort, France
| | - Peggy Passavin
- École Nationale Vétérinaire d'Alfort - CHUVA, Unité de Cardiologie d'Alfort, Maisons-Alfort, France
| | - Coline Jondeau
- Ecole Nationale Vétérinaire d'Alfort - CHUVA, Unité d'Ophtalmologie, Maisons-Alfort, France
| | - Matthieu Bott
- Ecole Nationale Vétérinaire d'Alfort - CHUVA, Unité d'Ophtalmologie, Maisons-Alfort, France
| | | | - Ghita Benchekroun
- Ecole Nationale Vétérinaire d'Alfort - CHUVA, Service de Médecine Interne, Maisons-Alfort, France
- Ecole Nationale Vétérinaire d'Alfort - University Paris-Est Créteil, INSERM, IMRB, Maisons-Alfort, France
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Beeston D, Jepson R, Cortellini S. Evaluation of presentation, treatment and outcome in hypertensive emergency in dogs and cats: 15 cases (2003-2019). J Small Anim Pract 2022; 63:784-791. [PMID: 35811381 PMCID: PMC9796549 DOI: 10.1111/jsap.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Hypertensive emergency is well recognised in human medicine, yet there is limited veterinary evidence. This study aimed to determine the presentation, treatment and outcome in dogs and cats with hypertensive emergency. MATERIALS AND METHODS A retrospective case series of dogs and cats with hypertensive emergency identified as follows: acute history with non-invasive Doppler systolic blood pressure greater than 180 mmHg and target organ damage including acute onset seizures, altered mentation with or without lateral recumbency or blindness. Data collected included signalment, history, physical examination and clinicopathological findings, systolic blood pressure, antihypertensive treatment and outcome. RESULTS Seven dogs and eight cats were included presenting with seizures (n=9), blindness (n=4), altered mentation with (n=2) or without (n=2) lateral recumbency. Median age was 9 years (range 1 to 15) and duration of clinical signs before presentation was 1.5 days (range 1 to 15). Median systolic blood pressure on presentation was 230 mmHg (range 190 to 300). Amlodipine was the most common first-line agent (n=10), followed by hydralazine (n=4) and hypertonic saline (n=1). Aetiology of hypertensive emergency was acute kidney injury (n=9), idiopathic hypertension (n=3), hyperthyroidism (n=1), lymphoma (n=1) and suspected cutaneous and renal glomerular vasculopathy (n=1). Five cats and three dogs survived to discharge with an overall survival of 53.3%. CLINICAL SIGNIFICANCE Hypertensive emergencies had various presenting signs in this series. AKI was considered to be the cause of hypertension in the majority of patients. Further evaluation of treatment for hypertensive emergencies is warranted, considering almost half of the cases did not survive to discharge.
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Affiliation(s)
- D. Beeston
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
| | - R. Jepson
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
| | - S. Cortellini
- Queen Mother Hospital for AnimalsRoyal Veterinary CollegeBrookmans ParkAL9 7TAUK
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Yu L, Lacorcia L, Johnstone T. Hyperthyroid cats and their kidneys: a literature review. Aust Vet J 2022; 100:415-432. [PMID: 35711100 PMCID: PMC9543258 DOI: 10.1111/avj.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
Hyperthyroidism and chronic kidney disease (CKD) are common diseases of geriatric cats, and often occur concurrently. Thus, a thorough understanding of the influence of thyroid function on renal function is of significant value for all feline practitioners. Among other effects, hyperthyroidism causes protein catabolism and increases renal blood flow and glomerular filtration rate (GFR). These effects render traditional renal markers insensitive for the detection of CKD in cats with uncontrolled hyperthyroidism. Furthermore, the development of iatrogenic hypothyroidism with over treatment of hyperthyroidism can be detrimental to renal function and may negatively affect long-term survival. This review discusses important diagnostic considerations of feline hyperthyroidism, as well as key treatment modalities, with an emphasis on the use of radioiodine and the importance of post treatment monitoring of thyroid and renal parameters. In Australia, a common curative treatment for cats with benign hyperthyroidism (i.e. thyroid hyperplasia or adenoma) is a fixed dose of orally administered radioiodine, regardless of the serum total thyroxine concentration at the time of diagnosis. This review discusses the long term outcomes of this standard of care in comparison with current, relevant research literature from around the world. Finally, this review explores the use of symmetric dimethylarginine (SDMA) in assessing renal function before and after treatment in hyperthyroid cats. SDMA correlates well with GFR and creatinine in non-hyperthyroid cats, but our understanding of its performance in hyperthyroid cats remains in its infancy.
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Affiliation(s)
- L Yu
- Veterinary Referral HospitalDandenongVictoriaAustralia
| | - L Lacorcia
- Veterinary Referral HospitalDandenongVictoriaAustralia
| | - T Johnstone
- Animal Referral Hospital, Essendon Fields72 Hargrave AvenueEssendon FieldsVictoria3041Australia
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Geddes R, Aguiar J. Feline Comorbidities: Balancing hyperthyroidism and concurrent chronic kidney disease. J Feline Med Surg 2022; 24:641-650. [PMID: 35481810 PMCID: PMC11107990 DOI: 10.1177/1098612x221090390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Both hyperthyroidism and chronic kidney disease (CKD) are common long-term conditions in older cats, which might be diagnosed concurrently or develop at different times. Hyperthyroidism may mask the presence of CKD, and vice versa, by various mechanisms that are described in this review. Hyperthyroidism treatment options should be carefully considered when CKD has also been diagnosed. CLINICAL CHALLENGES Although it can be difficult to diagnose hyperthyroidism and CKD simultaneously, given that one condition may mask the other, it is important to consider the presence of both diseases when examining an older cat presenting with vomiting, weight loss, polyuria/ polydipsia, anorexia or sarcopenia. The concurrent presence of hyperthyroidism and CKD requires careful monitoring of glomerular filtration rate biomarkers, and adequate and prompt support of kidney function when normal thyroid function is re-established. Iatrogenic hypothyroidism is a recognised complication of all of the treatment options for hyperthyroidism, and increases the risk of azotaemia. Therapy with levothyroxine is recommended for cats that are hypothyroid and azotaemic. EVIDENCE BASE The information in this review draws on current literature and guidelines related to the pathophysiology, diagnosis and treatment recommendations for feline hyperthyroidism and CKD.
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Affiliation(s)
- Rebecca Geddes
- Clinical Sciences and Services, Royal Veterinary College, University of London, London, UK
| | - Joana Aguiar
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, UK
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8
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Sparkes A, Garelli-Paar C, Blondel T, Guillot E. 'The Mercury Challenge': feline systolic blood pressure in primary care practice - a European survey. J Feline Med Surg 2022; 24:e310-e323. [PMID: 35757930 PMCID: PMC9511504 DOI: 10.1177/1098612x221105844] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to collect data from a substantial number of older cats having their systolic blood pressure (SBP) measured in a variety of clinical practices, to describe the findings and assess variables that affected the duration of assessment and the values obtained. METHODS An international (European-based) multicentre convenience sample survey of cats ⩾7 years of age attending veterinary clinics and having SBP measured as part of their clinical assessment. Information gathered included details of the cat, concomitant disease(s) or therapies, SBP results, device used, time taken to assess SBP and the demeanor of the cat. RESULTS Useable data were available from 8884 cats aged 7-26 years, from 811 clinics across 16 countries. The device used to measure SBP was Doppler in 47.4% and oscillometry in 48.5%. The demeanor of the cat was reported to be calm in 45.7%, anxious in 41.9% and nervous in 8.9%; and the duration of assessment was reported to be <5 mins in 50.4%, 5-10 minutes in 41.7% and >10 mins in 7.9%. Concomitant chronic kidney disease (CKD) was reported in 21.8%, hyperthyroidism in 12.0% or both in 3.1%. The median SBP was 150 mmHg (range 80-310), with 18.6% classified as hypertensive (SBP 160-179 mmHg) and 21.1% as severely hypertensive (SBP ⩾180 mmHg). The measured SBP was significantly affected by the cat's demeanor, duration of SBP assessment, presence of CKD and/or hyperthyroidism, the cat's sex and age, and the presence of concomitant therapy. The duration of SBP assessment was significantly affected by the cat's demeanor. CONCLUSIONS AND RELEVANCE In veterinary clinics, SBP can be measured in most cats within a short period of time using either Doppler or oscillometric equipment. The presence of CKD or hyperthyroidism was associated with significantly higher SBP values, and anxious or nervous cats had higher SBP values and took longer to obtain SBP assessments.
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Affiliation(s)
- Andrew Sparkes
- Simply Feline Veterinary Consultancy, Shaftesbury, Dorset, UK
| | | | - Thomas Blondel
- Innovation and Development, Ceva Santé Animale, Libourne, France
| | - Emilie Guillot
- Companion Animal Franchise, Ceva Santé Animale, Libourne, France
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Ward JL, Guillot E, Domenig O, Ware WA, Yuan L, Mochel JP. Circulating renin‐angiotensin‐aldosterone system activity in cats with systemic hypertension or cardiomyopathy. J Vet Intern Med 2022; 36:897-909. [PMID: 35285549 PMCID: PMC9151484 DOI: 10.1111/jvim.16401] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 12/22/2022] Open
Abstract
Background Activity of the circulating renin‐angiotensin‐aldosterone system (RAAS) has not been comprehensively characterized in cats with systemic hypertension (SH) or cardiomyopathy (CM), and the effects of furosemide or amlodipine treatment on the RAAS have not been fully evaluated in cats. Hypothesis/Objectives To document RAAS activity in cats with SH or CM compared to healthy cats and determine how RAAS profiles change with furosemide or amlodipine treatment. Animals Sixty‐six client‐owned cats: 15 with SH (7 amlodipine‐treated, 8 untreated), 17 with advanced CM (7 furosemide‐treated, 10 not furosemide‐treated), and 34 healthy cats. Methods Equilibrium concentrations of RAAS peptides and aldosterone were quantified in serum samples by liquid chromatography‐mass spectrometry. Variables were compared between groups using Kruskal‐Wallis analysis with post hoc Holms‐corrected Dunn's testing. Results Compared with healthy cats, cats with CM had higher concentrations of angiotensin I, aldosterone, and plasma renin activity (all P < .01), and these differences remained significant (P < .03) after considering subgroups of untreated or furosemide‐treated cats. Compared with healthy cats, untreated cats with SH showed no differences in RAAS biomarkers, whereas amlodipine‐treated cats had higher concentrations of angiotensins I, II, III, IV, and 1‐7, aldosterone, and plasma renin activity (all P < .03). Multivariable analysis determined that furosemide and amlodipine treatments were independent predictors of increased RAAS biomarker concentrations. Conclusions and Clinical Importance Cats with CM had increased RAAS activity, whereas cats with untreated SH did not. Furosemide and amlodipine both led to nonspecific activation of both classical and alternative RAAS pathways in cats.
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Affiliation(s)
- Jessica L. Ward
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University Ames Iowa USA
| | - Emilie Guillot
- Ceva Santé Animale Companion Animal Franchise Libourne France
| | | | - Wendy A. Ware
- Department of Veterinary Clinical Sciences College of Veterinary Medicine, Iowa State University Ames Iowa USA
| | - Lingnan Yuan
- Department of Veterinary Biomedical Sciences, SMART Pharmacology College of Veterinary Medicine, Iowa State University Ames Iowa USA
| | - Jonathan P. Mochel
- Department of Veterinary Biomedical Sciences, SMART Pharmacology College of Veterinary Medicine, Iowa State University Ames Iowa USA
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Mayyas FA, Aljohmani AI, Alzoubi KH. The Impact of Spironolactone on Markers of Myocardial Oxidative Status, Inflammation and Remodeling in Hyperthyroid Rats. Curr Mol Pharmacol 2021; 13:206-215. [PMID: 31729306 DOI: 10.2174/1874467212666191113150553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/23/2019] [Accepted: 11/01/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hyperthyroidism promotes the development and progression of cardiovascular diseases (CVD). Aldosterone, a key mediator of myocardial inflammation, oxidative stress and fibrosis, may be activated in hyperthyroidism. OBJECTIVE To assess the impact of hyperthyroidism on aldosterone levels and myocardial oxidative status, inflammatory and fibrotic markers in hyperthyroid rats, and to test if the use of spironolactone (an aldosterone antagonist) attenuates these changes. METHODS Adult Wistar rats were randomly distributed into 4 groups; controls, spironolactone treated rats (Spir, 50mg/kg/day), hyperthyroid rats (Hyper, daily intraperitoneal levothyroxine 0.3mg/kg/day), and spironolactone treated hyperthyroid rats (Hyper+Spir) for 4 weeks. Blood pressure (Bp), and levels of serum and myocardial aldosterone, oxidants/antioxidants, inflammatory and fibrotic markers were measured. RESULTS Levothyroxine increased serum thyroid hormones and increased Bp, heart rate and heart to bodyweight ratio. Relative to control, serum aldosterone levels were increased in Hyper and Hyper+ Spir groups. In parallel, cardiac lipid peroxides and serum endothelin-1 were increased whereas cardiac superoxide dismutase, catalase, glutathione, and matrix metalloproteinase -2 were reduced in the Hyper group. Spironolactone decreased serum thyroid hormones and improved cardiac lipid peroxides and metalloproteinase -2 levels. The use of spironolactone decreased serum nitrite levels and increased cardiac SOD and glutathione. Cardiac levels of aldosterone, endothelin-1, transforming growth factor-beta and nitrite were similar among all groups. CONCLUSION Hyperthyroid status was associated with an increase in aldosterone and oxidant/ inflammatory biomarkers. The use of spironolactone enhanced antioxidant defenses. Aldosterone antagonists may serve as potential drugs to attenuate the development of cardiac disease in hyperthyroidism.
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Affiliation(s)
- Fadia A Mayyas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Ahmad I Aljohmani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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11
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Wakeling J, Hall T, Williams TL. Correlation of thyroid hormone measurements with thyroid stimulating hormone stimulation test results in radioiodine-treated cats. J Vet Intern Med 2020; 34:2265-2275. [PMID: 33044029 PMCID: PMC7694841 DOI: 10.1111/jvim.15909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 09/02/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Iatrogenic hypothyroidism can develop after radioiodine‐I131 (RAI) treatment of hyperthyroid cats and can be diagnosed using the thyroid stimulating hormone (TSH) stimulation test. Objectives To assess the effect of noncritical illness on TSH stimulation test results in euthyroid and RAI‐treated cats. To assess the correlation of low total‐thyroxine (tT4), low free‐thyroxine (fT4), and high TSH concentrations with TSH stimulation test results. Animals Thirty‐three euthyroid adult cats and 118 client‐owned cats previously treated with RAI. Methods Total‐thyroxine, fT4, and TSH were measured, and a TSH stimulation test was performed in all cats. Euthyroid control cats were divided into apparently healthy and noncritical illness groups. RAI‐treated cats were divided into RAI‐hypothyroid (after‐stimulation tT4 ≤ 1.5 μg/dL), RAI‐euthyroid (after‐stimulation tT4 ≥ 2.3 μg/dL OR after‐stimulation tT4 1.5‐2.3 μg/dL and before : after tT4 ratio > 1.5), and RAI‐equivocal (after stimulation tT4 1.5‐2.3 μg/dL and tT4 ratio < 1.5) groups. Results Noncritical illness did not significantly affect the tT4 following TSH stimulation in euthyroid (P = .38) or RAI‐treated cats (P = .54). There were 21 cats in the RAI‐equivocal group. Twenty‐two (85%) RAI‐hypothyroid cats (n = 26) and 10/71 (14%) of RAI‐euthyroid cats had high TSH (≥0.3 ng/mL). Twenty‐three (88%) RAI‐hypothyroid cats had low fT4 (<0.70 ng/dL). Of the 5 (7%) RAI‐euthyroid cats with low fT4, only one also had high TSH. Only 5/26 (19%) RAI‐hypothyroid cats had tT4 below the laboratory reference interval (<0.78 μg/dL). Conclusions and Clinical Relevance The veterinary‐specific chemiluminescent fT4 immunoassay and canine‐specific TSH immunoassay can be used to aid in the diagnosis of iatrogenic hypothyroidism in cats.
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Affiliation(s)
| | - Teresa Hall
- North West Nuclear Medicine, Vancouver, British Columbia, Canada
| | - Timothy L Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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12
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Abstract
Hypertension is a common problem, particularly in older cats. Hypertension secondary to a concurrent disease is the most common form of hypertension in cats, particularly in association with chronic kidney disease or hyperthyroidism. However, idiopathic hypertension may account for up to 24% of cases. Any form of persistent hypertension risks target organ damage (TOD), therefore measurement of blood pressure is vital in at-risk cats to identify occult hypertension before TOD occurs. This article addresses when and how to perform blood pressure measurement in cats, TOD that has been documented in this species, and our evidence basis for treating hypertension.
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Affiliation(s)
- Rebecca F Geddes
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire AL9 7TA, UK.
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13
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Yu L, Lacorcia L, Finch S, Johnstone T. Assessment of serum symmetric dimethylarginine and creatinine concentrations in hyperthyroid cats before and after a fixed dose of orally administered radioiodine. J Vet Intern Med 2020; 34:1423-1431. [PMID: 32506701 PMCID: PMC7379014 DOI: 10.1111/jvim.15831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/22/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Serum symmetric dimethylarginine (SDMA) is a sensitive renal biomarker for detecting early chronic kidney disease (CKD) in nonhyperthyroid cats, but knowledge regarding its performance in hyperthyroid cats remains limited. Objectives To determine the relationship between serum SDMA, creatinine and total thyroxine (TT4) concentrations in hyperthyroid cats before (T0) and 3 months after (T1) receiving a PO fixed dose of radioiodine. Animals Eighty client‐owned hyperthyroid cats. Methods Prospective cohort study. Serum TT4, and SDMA, creatinine concentrations, and urine specific gravity were measured at T0 and T1. Nonparametric tests were used to determine the relationship among SDMA, and creatinine and TT4 concentrations. Agreement between SDMA and creatinine regarding CKD staging at both time points was assessed using Goodman and Kruskal's gamma statistic. Results Mean serum SDMA concentration increased after treatment of hyperthyroidism. However, 21 of 75 cats experienced a decrease in SDMA between T0 and T1, whereas creatinine decreased in only 2 cats. A moderate correlation between SDMA and creatinine was seen at T1 (r = 0.53; P < .001) but not at T0 (r = 0.13; P = .25). Where assessable at T1, poor agreement was observed between SDMA and creatinine and CKD stage (Goodman and Kruskal's gamma 0.20; P = .29). Conclusions and clinical importance Discordant outcomes between SDMA and creatinine after radioiodine treatment in cats with hyperthyroidism suggest extrarenal factors may interfere with the reliability of SDMA to adequately reflect renal function. As a result, SDMA should not be interpreted in isolation in hyperthyroid cats treated with radioiodine.
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Affiliation(s)
- Lucia Yu
- Translational Research and Small Animal Clinical Trial Study Group, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia
| | - Lauren Lacorcia
- Translational Research and Small Animal Clinical Trial Study Group, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia
| | - Sue Finch
- Statistical Consulting Centre and Melbourne Statistical Consulting Centre, The University of Melbourne, Victoria, Australia
| | - Thurid Johnstone
- Translational Research and Small Animal Clinical Trial Study Group, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Victoria, Australia
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14
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Scherk M. Complex Disease Management: Managing a Cat with Comorbidities. Vet Clin North Am Small Anim Pract 2020; 50:811-822. [PMID: 32389353 DOI: 10.1016/j.cvsm.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many older cats often suffer concurrently from multiple conditions. By focusing on the common concerns, rather than conflicting requirements, a management program can be devised. Optimize hydration, nutrition, and ensure comfort though providing analgesia and a low-stress environment in which the patient's feline-specific nature is respected both in the clinic and at home. Additional requirements, such as hyperphosphatemia or hypokalemia, can be met using treatments outside of diet, if necessary.
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15
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Coleman AE, Brown SA, Traas AM, Bryson L, Zimmering T, Zimmerman A. Safety and efficacy of orally administered telmisartan for the treatment of systemic hypertension in cats: Results of a double-blind, placebo-controlled, randomized clinical trial. J Vet Intern Med 2019; 33:478-488. [PMID: 30851066 PMCID: PMC6430933 DOI: 10.1111/jvim.15429] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/16/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Information regarding the efficacy of telmisartan for feline systemic arterial hypertension is limited. OBJECTIVES To evaluate the safety and efficacy of PO administered telmisartan solution in hypertensive cats. ANIMALS Client-owned cats with indirect systolic arterial blood pressure (SBP) of 160-200 mm Hg, based on multiple measurements. METHODS This multicenter trial consisted a 28-day, prospective, randomized, double-blind, placebo-controlled, parallel group, efficacy phase and a 154-day extended-use telmisartan phase. Hypertensive cats were randomly assigned to receive 1.5 mg telmisartan/kg PO q12h for 14 days, followed by 2 mg telmisartan/kg PO q24h, or equivalent volume of placebo. Systolic blood pressure was measured on days 0, 14, and 28. Change in SBP compared to baseline was calculated for days 14 and 28. Telmisartan efficacy was defined as significant decrease in SBP at day 14 compared to placebo and a clinically relevant (>20 mm Hg) decrease in SBP at day 28. RESULTS Two-hundred twenty-one cats were included. On day 14, least squares mean (95% confidence interval) SBP decrease was significantly larger in telmisartan-treated (-23.3 mm Hg [-28.2 to -18.3]) versus placebo-treated (-7.5 mm Hg [-13.6 to -1.5]) cats (P = .0005). On day 28, telmisartan treatment resulted in a clinically relevant SBP decrease (-23.9 mm Hg [-27.8 to -20.0]), whereas placebo did not (-11.6 mm Hg [-17.4 to -5.9 mm Hg]). The decrease in SBP persisted over the 6-month trial in telmisartan-treated cats. CONCLUSIONS AND CLINICAL IMPORTANCE Telmisartan significantly decreased SBP to a clinically relevant extent and was well tolerated in hypertensive cats.
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Affiliation(s)
- Amanda E. Coleman
- Department of Small Animal Medicine and SurgeryUniversity of Georgia College of Veterinary MedicineAthensGeorgia
| | - Scott A. Brown
- Department of Small Animal Medicine and SurgeryUniversity of Georgia College of Veterinary MedicineAthensGeorgia
- Department of Physiology and PharmacologyUniversity of Georgia College of Veterinary MedicineAthensGeorgia
| | - Anne M. Traas
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
| | - Lawrence Bryson
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
| | - Tanja Zimmering
- Global PetVet Business Unit, Boehringer Ingelheim Vetmedica GmbHIngelheim am RheinGermany
| | - Alicia Zimmerman
- Pharmaceutical Clinical Research and Development, Boehringer Ingelheim Vetmedica, Inc.St. JosephMissouri
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16
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Ames MK, Atkins CE, Pitt B. The renin-angiotensin-aldosterone system and its suppression. J Vet Intern Med 2019; 33:363-382. [PMID: 30806496 PMCID: PMC6430926 DOI: 10.1111/jvim.15454] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic activation of the renin-angiotensin-aldosterone system (RAAS) promotes and perpetuates the syndromes of congestive heart failure, systemic hypertension, and chronic kidney disease. Excessive circulating and tissue angiotensin II (AngII) and aldosterone levels lead to a pro-fibrotic, -inflammatory, and -hypertrophic milieu that causes remodeling and dysfunction in cardiovascular and renal tissues. Understanding of the role of the RAAS in this abnormal pathologic remodeling has grown over the past few decades and numerous medical therapies aimed at suppressing the RAAS have been developed. Despite this, morbidity from these diseases remains high. Continued investigation into the complexities of the RAAS should help clinicians modulate (suppress or enhance) components of this system and improve quality of life and survival. This review focuses on updates in our understanding of the RAAS and the pathophysiology of AngII and aldosterone excess, reviewing what is known about its suppression in cardiovascular and renal diseases, especially in the cat and dog.
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Affiliation(s)
- Marisa K Ames
- Department of Clinical Sciences, College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - Clarke E Atkins
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
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17
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Hori Y, Heishima Y, Yamashita Y, Iguchi M, Nakamura K, Isayama N, Onodera H, Kitade A, Kanno N, Hirakawa A, Katagi M, Ibaragi T, Yamano S, Aramaki Y, Sawada T. Epidemiological study of indirect blood pressure measured using oscillometry in clinically healthy cats at initial evaluation. J Vet Med Sci 2019; 81:513-516. [PMID: 30745524 PMCID: PMC6483917 DOI: 10.1292/jvms.18-0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We investigated the clinical characteristics of healthy cats in accordance with the target organ damage (TOD) risk category, on the basis of systolic blood pressure (SBP). This prospective multi-center study included 137 healthy cats. Indirect blood pressure was measured using an oscillometric technique. The median SBP in all cats was 147 mmHg (interquartile range: 134-158). On the basis of the TOD risk category, 57.7, 19.7, 21.9, and 0.7% of the cats were classified into categories I-IV, respectively. Age, sex, and body weight did not affect the SBP. This study provides basic information on the distribution of TOD risk categories in clinically healthy cats.
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Affiliation(s)
- Yasutomo Hori
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan
| | - Yasuhiro Heishima
- School of Veterinary Medicine, Rakuno Gakuen University, 582 Midori-machi, Bunkyodai, Ebetsu, Hokkaido 069-8501, Japan.,Heisei Animal Hospital, 2-1-1 Futago-cho, Kasugai, Aichi 486-0955, Japan
| | - Yohei Yamashita
- Ebisu Animal Hospital, 3-3-43 Nishitaga, Taihaku, Sendai, Miyagi 982-0034, Japan
| | - Masayuki Iguchi
- Iguchi Animal Hospital, 6-2-34 Kamijima, Naka, Hamamatsu, Shizuoka 433-8122, Japan
| | - Kensuke Nakamura
- University of Miyazaki, 1-1 Gakuenkibanadai-nishi, Miyazaki 889-2192 Japan
| | - Noriko Isayama
- Uenonomori Animal Clinic, 1-5-11 Yanaka Taito, Tokyo 110-0001, Japan
| | - Hideyuki Onodera
- Onodera Animal Hospital, 1-10-4 Chuou, Rifu-cho, Miyagi, Miyagi 981-0104, Japan
| | - Akihito Kitade
- Kitade Animal Hospital, 2 Ichishichotajiri, Tsu, Mie 515-2516, Japan
| | - Nobuyuki Kanno
- Veterinary Internal Medicine, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-8510, Japan
| | - Atsushi Hirakawa
- Pet Clinic Hallelujah, 2544-1 Nakabaru, Kasuya-machi, Kasuya, Fukuoka 811-2304, Japan
| | - Michio Katagi
- Katagi Animal Hospital, 565-5 Matoba, Kawagoe, Saitama 350-1101, Japan
| | - Toshiki Ibaragi
- Miyoshi Inter Animal Hospital, 27-103 Neura Fukuya-cho, Miyoshi, Aichi 470-0217, Japan
| | - Shigeki Yamano
- Ueda Animal Clinic, 2-202 Ueda, Tenpaku, Nagoya, Aichi 465-0081, Japan
| | - Yoshitaka Aramaki
- Bay Veterinary Hospital, 5-6-7 Ujinanishi, Minami, Hiroshima, Hiroshima 734-0014, Japan
| | - Tamotsu Sawada
- Kitanomori Animal Hospital, 17-1-35 11-Jyou, Shin-kotoni, Kita, Sapporo, Hokkaido 001-0911, Japan
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18
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Glaus TM, Elliott J, Herberich E, Zimmering T, Albrecht B. Efficacy of long-term oral telmisartan treatment in cats with hypertension: Results of a prospective European clinical trial. J Vet Intern Med 2018; 33:413-422. [PMID: 30561059 PMCID: PMC6430888 DOI: 10.1111/jvim.15394] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 11/15/2018] [Indexed: 12/28/2022] Open
Abstract
Background Efficacy of telmisartan in treating hypertension (HT) in cats has not been largely investigated. Objective Telmisartan oral solution effectively controls systolic arterial blood pressure (SABP) in hypertensive cats. Animals Two‐hundred eighty‐five client‐owned cats with systemic HT. Methods Prospective, multicenter, placebo‐controlled, randomized, double‐blinded study. Hypertensive cats diagnosed with SABP ≥160 mmHg and ≤200 mmHg without target‐organ‐damage were randomized (2 : 1 ratio) to receive 2 mg/kg telmisartan or placebo q24 PO. A 28‐day efficacy phase was followed by a 120‐day extended use phase. Efficacy was defined as significant difference in mean SABP reduction between telmisartan and placebo on Day 14 and group mean reduction in SABP of > 20 mmHg by telmisartan on Day 28 compared to baseline. Results Two‐hundred fifty‐two cats completed the efficacy and 144 cats the extended use phases. Mean SABP reduction at Day 14 differed significantly between groups (P < .001). Telmisartan reduced baseline SABP of 179 mmHg by 19.2 (95% confidence interval [CI]: 15.92‐22.52) and 24.6 (95% CI: 21.11‐28.14) mmHg at Days 14 and 28. The placebo group baseline SABP of 177 mmHg was reduced by 9.0 (95% CI: 5.30‐12.80) and 11.4 (95% CI: 7.94‐14.95) mmHg, respectively. Of note, 52% of telmisartan‐treated cats had SABP <150 mmHg at Day 28. Mean SABP reduction by telmisartan in severe (≥180 mmHg) and moderate HT (160‐179 mmHg) was comparable and persistent over time. Conclusions and Clinical Importance Telmisartan solution (PO) was effective in reducing SABP in hypertensive cats with SABP ≥160 mmHg and ≤200 mmHg.
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Affiliation(s)
| | - Jonathan Elliott
- The Department of Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
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19
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Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM. ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2018; 32:1803-1822. [PMID: 30353952 PMCID: PMC6271319 DOI: 10.1111/jvim.15331] [Citation(s) in RCA: 265] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022] Open
Abstract
An update to the 2007 American College of Veterinary Internal Medicine (ACVIM) consensus statement on the identification, evaluation, and management of systemic hypertension in dogs and cats was presented at the 2017 ACVIM Forum in National Harbor, MD. The updated consensus statement is presented here. The consensus statement aims to provide guidance on appropriate diagnosis and treatment of hypertension in dogs and cats.
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Affiliation(s)
- Mark J Acierno
- Department of Medicine, College of Veterinary Medicine, Midwestern University, 5715 W. Utopia Rd, Glendale Arizona 85308
| | - Scott Brown
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Amanda E Coleman
- College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
| | - Mark Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Rebecca L Stepien
- Department of Medical Sciences, University of Wisconsin School of Veterinary Medicine, Madison, Wisconsin
| | - Harriet M Syme
- Department of Clinical Science and Services, Royal Veterinary College, London, United Kingdom
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20
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Conroy M, Chang YM, Brodbelt D, Elliott J. Survival after diagnosis of hypertension in cats attending primary care practice in the United Kingdom. J Vet Intern Med 2018; 32:1846-1855. [PMID: 30315661 PMCID: PMC6271307 DOI: 10.1111/jvim.15307] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/28/2018] [Accepted: 07/24/2018] [Indexed: 12/01/2022] Open
Abstract
Background Hypertension is common in older cats. There is limited evidence for predictors of survival after diagnosis. Hypothesis/Objectives Investigate blood pressure assessment (BPA) and hypertension diagnosis in cats attending UK primary care practices (PCPs) and factors that influence survival. Animals Cats (347 889) attending 244 UK PCPs enrolled in the VetCompass program between January 1, 2012, and December 31, 2013. Cats identified as hypertensive (282) were included in descriptive and survival analyses. Methods All electronic patient records (EPRs) were searched to identify cats that potentially had received BPA. EPRs were read in detail to identify those that had BPA. The proportion that received BPA was evaluated using a stratified analysis and the incidence of hypertension estimated. A retrospective cohort study was used to investigate survival after diagnosis (Cox proportional hazard model). Results Estimated incidence risk was 19.5% (95% confidence interval [CI], 17.5‐21.6) from the estimated 1.34% (1.30%‐1.38%) of cats that received BPA. Few cats had BPA more than once after diagnosis (median, 1; interquartile range [IQR], 0‐3), with only 9.9% of diagnosed hypertensive cats having urine protein:creatinine ratio determined. Cats diagnosed as a result of monitoring of pre‐existing disease had improved survival (hazard ratio [HR], 0.58; 95% CI, 0.37‐0.89; P = .01) compared to cats diagnosed after clinical signs were recognized. Cats that had an amlodipine dose change had improved survival (HR, 0.56; 95% CI, 0.36‐0.87; P = .01) compared to those with no dose change. Conclusions and clinical importance These data suggest improved blood pressure monitoring in clinical practice may decrease the morbidity associated with hypertension.
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Affiliation(s)
- Megan Conroy
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, London, United Kingdom
| | - Dave Brodbelt
- Veterinary Epidemiology, Economics and Public Health, Royal Veterinary College, Hatfield, United Kingdom
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, London, United Kingdom
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21
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Whittemore JC, Nystrom MR, Mawby DI. Effects of various factors on Doppler ultrasonographic measurements of radial and coccygeal arterial blood pressure in privately owned, conscious cats. J Am Vet Med Assoc 2017; 250:763-769. [PMID: 28306487 DOI: 10.2460/javma.250.7.763] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the effects of age, body condition score (BCS), and muscle condition score (MCS) on radial and coccygeal systolic arterial blood pressure (SAP) in cats. DESIGN Prospective randomized trial. ANIMALS 66 privately owned cats enrolled between May and December 2010. PROCEDURES BCS and MCS of cats were assessed by 2 investigators; SAP was measured via Doppler ultrasonic flow detector, with cats positioned in right lateral or sternal recumbency for measurements at the radial or coccygeal artery, respectively, with order of site randomized. Associations among variables were assessed through correlation coefficients, partial correlation coefficients, and ANCOVA. RESULTS Interrater reliability for BCS and MCS assessment was high (correlation coefficients, 0.95 and 0.83, respectively). No significant effect was identified for order of SAP measurement sites. Coccygeal and radial SAP were positively correlated (ρ = 0.45). The median difference in coccygeal versus radial SAP was 19 mm Hg, but differences were not consistently positive or negative. Radial SAP was positively correlated with age (ρ = 0.48) and negatively correlated with MCS (ρ = -0.30). On the basis of the correlation analysis, the association between radial SAP and MCS reflected the confounding influence of age. Coccygeal SAP was not significantly correlated with age, BCS, or MCS. CONCLUSIONS AND CLINICAL RELEVANCE Use of the coccygeal artery is recommended to reduce the confounding effects of age and sarcopenia on Doppler ultrasonographic SAP measurements in cats. Additionally, monitoring for changes in MCS is recommended for cats undergoing serial SAP measurement.
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22
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Taylor SS, Sparkes AH, Briscoe K, Carter J, Sala SC, Jepson RE, Reynolds BS, Scansen BA. ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats. J Feline Med Surg 2017; 19:288-303. [PMID: 28245741 PMCID: PMC11119534 DOI: 10.1177/1098612x17693500] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Practical relevance: Feline hypertension is a common disease in older cats that is frequently diagnosed in association with other diseases such as chronic kidney disease and hyperthyroidism (so-called secondary hypertension), although some cases of apparent primary hypertension are also reported. The clinical consequences of hypertension can be severe, related to 'target organ damage' (eye, heart and vasculature, brain and kidneys), and early diagnosis followed by appropriate therapeutic management should help reduce the morbidity associated with this condition. Clinical challenges: Despite being a common disease, routine blood pressure (BP) monitoring is generally performed infrequently, probably leading to underdiagnosis of feline hypertension in clinical practice. There is a need to: (i) ensure BP is measured as accurately as possible with a reproducible technique; (ii) identify and monitor patients at risk of developing hypertension; (iii) establish appropriate criteria for therapeutic intervention; and (iv) establish appropriate therapeutic targets. Based on current data, amlodipine besylate is the treatment of choice to manage feline hypertension and is effective in the majority of cats, but the dose needed to successfully manage hypertension varies between individuals. Some cats require long-term adjuvant therapy and, occasionally, additional therapy is necessary for emergency management of hypertensive crises. Evidence base: These Guidelines from the International Society of Feline Medicine (ISFM) are based on a comprehensive review of the currently available literature, and are aimed at providing practical recommendations to address the challenges of feline hypertension for veterinarians. There are many areas where more data is required which, in the future, will serve to confirm or modify some of the recommendations in these Guidelines.
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Affiliation(s)
| | | | - Katherine Briscoe
- Animal Referral Hospital, 250 Parramatta Road, Homebush, Sydney, NSW 2140, Australia
| | - Jenny Carter
- PO Box 128209, Remuera, Auckland 1541, New Zealand
| | | | - Rosanne E Jepson
- Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
| | | | - Brian A Scansen
- Associate Professor, Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO 80523, USA
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23
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Jepson RE, Warren HR, Syme HM, Elliott J, Munroe PB. Uromodulin gene variants and their association with renal function and blood pressure in cats: a pilot study. J Small Anim Pract 2016; 57:580-588. [DOI: 10.1111/jsap.12582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/19/2016] [Accepted: 07/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R. E. Jepson
- Department of Clinical Sciences and Services; Royal Veterinary College; Nr Hatfield Herts AL9 7TA
| | - H. R. Warren
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London EC1M 6BQ
| | - H. M. Syme
- Department of Clinical Sciences and Services; Royal Veterinary College; Nr Hatfield Herts AL9 7TA
| | - J. Elliott
- Department of Comparative Biomedical Sciences; Royal Veterinary College; London NW1 0TU
| | - P. B. Munroe
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London EC1M 6BQ
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24
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Vaske HH, Schermerhorn T, Grauer GF. Effects of feline hyperthyroidism on kidney function: a review. J Feline Med Surg 2016; 18:55-9. [PMID: 25749888 PMCID: PMC11149009 DOI: 10.1177/1098612x15575385] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Chronic kidney disease and hyperthyroidism are two commonly diagnosed conditions in the geriatric feline population, and are often seen concurrently. Management of both diseases is recommended; however, the physiologic implications of both diseases must be understood to ensure the most favorable outcome for each patient. This report reviews the complex interplay between hyperthyroidism and kidney function, as well as the effects of hyperthyroid therapy on kidney function.
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Affiliation(s)
- Heather H Vaske
- Department of Clinical Sciences, 106 Moiser Hall, Veterinary Health Center, Kansas State University, Manhattan, KS 66506-5606, USA
| | - Thomas Schermerhorn
- Department of Clinical Sciences, 106 Moiser Hall, Veterinary Health Center, Kansas State University, Manhattan, KS 66506-5606, USA
| | - Gregory F Grauer
- Department of Clinical Sciences, 106 Moiser Hall, Veterinary Health Center, Kansas State University, Manhattan, KS 66506-5606, USA
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25
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Ferreira A, Sottiaux J, Mandara MT, Motta L. Ascending haemorrhagic myelomalacia associated with systemic hypertension in a hyperthyroid cat. JFMS Open Rep 2015; 1:2055116915589840. [PMID: 28491365 PMCID: PMC5362925 DOI: 10.1177/2055116915589840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 12/30/2022] Open
Abstract
CASE SUMMARY An 8-year-old domestic shorthair neutered male cat was presented with acute onset of paraplegia, absent nociception on the pelvic limbs, tail and perianal area, and a previous history of uncontrolled hyperthyroidism (even after thyroidectomy) and chronic hypertension. The magnetic resonance findings (heterogeneous intramedullary ill-defined area, isointense on T1-weighted and hyperintense on short tau inversion recovery and T2-weighted scans between T12 and L5 spinal cord segments) were consistent with ascending haemorrhagic myelomalacia, which was confirmed by histopathology. It also revealed myelomalacia associated with diffuse arteriolar hyalinosis, similar to the reports found with hypertensive encephalopathy. RELEVANCE AND NOVEL INFORMATION Myelomalacia should be considered as a possible outcome in cats with hypertension. Considering that hypertension is a common consequence of hyperthyroidism, emphasis should be given to blood pressure monitoring, especially after treatment of this condition. We describe the histopathological changes occurring in the spinal cord associated with a state of hypertension.
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Affiliation(s)
| | - Jacques Sottiaux
- Cardiology Department, Grange Pierre, Saint Andre de Corcy, France
| | | | - Luca Motta
- ChesterGates Veterinary Specialists, Neurology Department, Chester, UK
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26
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Higgs P, Murray JK, Hibbert A. Medical management and monitoring of the hyperthyroid cat: a survey of UK general practitioners. J Feline Med Surg 2014; 16:788-95. [PMID: 24423813 PMCID: PMC11112222 DOI: 10.1177/1098612x13519633] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Feline hyperthyroidism is commonly diagnosed in general practice. This study assessed the opinions and experiences of UK general practitioners (GPs) regarding the management of feline hyperthyroidism. This included an evaluation of preferred treatment modalities and the monitoring of medically treated cats in relation to thyroxine (T4) level, co-morbid disease and adverse drug reactions. Six hundred and three GPs completed an online questionnaire comprising 34 questions. Oral medication was the most commonly preferred treatment option (65.7% of respondents), followed by thyroidectomy (27.5%) and then radioiodine (5.5%). When cost of treatment was eliminated as a consideration factor, significantly more respondents selected radioiodine (40.5%, P <0.001). Concerning target total T4 levels during medical management, 48.4% aimed for the lower half of the reference interval (RI), 32.3% anywhere within RI, 13.1% within the top half of RI and 0.5% above the RI; 3.4% evaluated efficacy by physical assessment only. In the presence of chronic kidney disease (CKD) respondents were significantly more likely to target total T4 levels within the upper half of the RI (40.3%) or above it (9.8%) when compared with targets for routine cases (P <0.001). Assessment for unmasking of CKD after initiating treatment or for hypertension was not consistently performed. Variability in monitoring strategies may result in CKD and hypertension remaining undetected, inadequate suppression of T4 levels in cats with concurrent CKD and delayed recognition of potentially significant haematological abnormalities.
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Affiliation(s)
- Paul Higgs
- School of Veterinary Sciences, University of Bristol, Langford, Bristol, UK
| | - Jane K Murray
- School of Veterinary Sciences, University of Bristol, Langford, Bristol, UK
| | - Angie Hibbert
- The Feline Centre, Langford Veterinary Services, Langford, Bristol, UK
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Peterson ME, Eirmann L. Dietary Management of Feline Endocrine Disease. Vet Clin North Am Small Anim Pract 2014; 44:775-88, vi-vii. [DOI: 10.1016/j.cvsm.2014.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Association between urinary vascular endothelial growth factor excretion and chronic kidney disease in hyperthyroid cats☆. Res Vet Sci 2014; 96:436-41. [DOI: 10.1016/j.rvsc.2014.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/17/2014] [Accepted: 02/15/2014] [Indexed: 11/18/2022]
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Jepson RE, Syme HM, Elliott J. Plasma renin activity and aldosterone concentrations in hypertensive cats with and without azotemia and in response to treatment with amlodipine besylate. J Vet Intern Med 2013; 28:144-53. [PMID: 24428319 PMCID: PMC4895535 DOI: 10.1111/jvim.12240] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/21/2013] [Accepted: 09/23/2013] [Indexed: 12/17/2022] Open
Abstract
Background Role of renin‐angiotensin aldosterone system (RAAS) in feline systemic hypertension is poorly understood. Objectives Examine plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) in normotensive and hypertensive cats with variable renal function and in response to antihypertensive therapy. Animals One hundred and ninety‐six cats >9 years from first opinion practice. Methods PRA, PAC, and aldosterone‐to‐renin ratio (ARR) were evaluated in cats recruited prospectively and grouped according to systolic blood pressure (SBP) and renal function (nonazotemic normotensive [Non‐Azo‐NT], nonazotemic hypertensive [Non‐Azo‐HT], azotemic normotensive [Azo‐NT], azotemic hypertensive [Azo‐HT]). Changes in PRA and PAC were evaluated with antihypertensive therapy (amlodipine besylate). Results Plasma renin activity (ng/mL/h; P = .0013), PAC (pg/mL; P < .001), and ARR (P = 0.0062) differed significantly among groups. PRA (ng/mL/h) was significantly lower in hypertensive (Non‐Azo‐HT; n = 25, median 0.22 [25th percentile 0.09, 75th percentile 0.39], Azo‐HT; n = 44, 0.33 [0.15, 0.48]) compared with Non‐Azo‐NT cats (n = 57, 0.52 [0.28, 1.02]). Azo‐HT cats had significantly higher PAC (n = 22, 149.8 [103.1, 228.7]) than normotensive cats (Non‐Azo‐NT; n = 26, 45.4 [19.6, 65.0], Azo‐NT; n = 18, 84.1 [38.6, 137.8]). ARR was significantly higher in Azo‐HT (n = 20, 503.8 [298.8, 1511]) than Azo‐NT cats (n = 16, 97.8 [77.0, 496.4]). Significant increase in PRA was documented with antihypertensive therapy (pretreatment [n = 20] 0.32 [0.15–0.46], posttreatment 0.54 [0.28, 1.51]), but PAC did not change. Conclusions and Clinical Importance Hypertensive cats demonstrate significantly increased PAC with decreased PRA. PRA significantly increases with antihypertensive therapy. Additional work is required to determine the role of plasma aldosterone concentration in the pathogenesis of hypertension and whether this relates to autonomous production or activation of RAAS without demonstrable increase in PRA.
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Affiliation(s)
- R E Jepson
- Department of Clinical Sciences and Services, Royal Veterinary College, Nr Hatfield, UK
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