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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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Garcia Marrero TM, Ward JL, Tropf MA, Bourgois‐Mochel A, Guillot E, Domenig O, Yuan L, Kundu D, Mochel JP. Effect of amlodipine on the circulating renin-angiotensin-aldosterone system in healthy cats. J Vet Intern Med 2024; 38:913-921. [PMID: 38334012 PMCID: PMC10937479 DOI: 10.1111/jvim.17006] [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: 07/06/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Systemic hypertension (SH) is a common cardiovascular disease in older cats that is treated primarily with the calcium channel blocker amlodipine besylate (AML). The systemic effect of AML on the classical and alterative arms of the renin-angiotensin-aldosterone system (RAAS) in cats is incompletely characterized. HYPOTHESIS/OBJECTIVES To determine the effect of AML compared to placebo on circulating RAAS biomarkers in healthy cats using RAAS fingerprinting. ANIMALS Twenty healthy client-owned cats. METHODS Cats were administered amlodipine besylate (0.625 mg in toto) or placebo by mouth once daily for 14 days in a crossover design with a 4-week washout period. Plasma AML concentrations and RAAS biomarker concentrations were measured at multiple timepoints after the final dose in each treatment period. Time-weighted averages for RAAS biomarkers over 24 hours after dosing were compared between treatment groups using Wilcoxon rank-sum testing. RESULTS Compared to placebo, AML treatment was associated with increases in markers of plasma renin concentration (median 44% increase; interquartile range [IQR] 19%-86%; P = .009), angiotensin I (59% increase; IQR 27-101%; P = .006), angiotensin II (56% increase; IQR 5-70%; P = .023), angiotensin IV (42% increase; -19% to 89%; P = .013); and angiotensin 1-7 (38% increase; IQR 9-118%; P = .015). CONCLUSIONS AND CLINICAL IMPORTANCE In healthy cats, administration of AML resulted in nonspecific activation of both classical and alternative RAAS pathways.
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Affiliation(s)
- Tatiana M. Garcia Marrero
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
| | - Jessica L. Ward
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
| | - Melissa A. Tropf
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
| | - Agnes Bourgois‐Mochel
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
| | - Emilie Guillot
- Ceva Santé Animale, Companion Animal FranchiseLibourneFrance
| | | | - Lingnan Yuan
- Department of Veterinary Biomedical SciencesSMART Pharmacology, College of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
| | - Debosmita Kundu
- Department of StatisticsCollege of Liberal Arts and Sciences, Iowa State UniversityAmesIowaUSA
| | - Jonathan P. Mochel
- Department of Veterinary Biomedical SciencesSMART Pharmacology, College of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
- Department of Veterinary PathologySMART Pharmacology, College of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
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Magalhães TR, Lourenço AL, Corbee RJ, Queiroga FL. Clinical management of feline chronic kidney disease in Portugal: a questionnaire-based study. J Feline Med Surg 2023; 25:1098612X231206125. [PMID: 37987623 PMCID: PMC10811999 DOI: 10.1177/1098612x231206125] [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] [Indexed: 11/22/2023]
Abstract
OBJECTIVES The aim of the study was to characterise the clinical management of feline chronic kidney disease (CKD) by veterinary practitioners in Portugal. METHODS A questionnaire-based study was designed to be completed by all veterinarians who had diagnosed and treated at least one case of feline CKD in the previous year. RESULTS A total of 409 veterinary practitioners responded to the questionnaire, with approximately half of them diagnosing 2-5 cases of feline CKD per month (n = 219, 53.5%). Although a high proportion of these reported using the guidelines published by the International Renal Interest Society (n = 379, 92.7%), only 19.1% (n = 78) systematically performed systolic blood pressure (SBP) measurements in all of their patients. A renal diet was advised by almost all respondents (n = 406, 99.3%), but 36.9% (n = 150) of them considered that it represented less than 75% of the daily food intake for most of their patients. This dietary intervention was often prescribed regardless of stage (n = 298, 73.4%) and without a proper gradual diet transition. Appetite stimulants were frequently prescribed (n = 366, 89.5%), as well as a calcium channel blocker (n = 171, 41.8%) and an angiotensin-converting enzyme inhibitor (n = 245, 59.9%) to control systemic hypertension and proteinuria, respectively. Prescription of a phosphate binder was also common (n = 311, 76.0%). Regarding monitoring, 70.9% (n = 290) recommended that stable patients be reassessed every 2-3 months or more frequently, but only 35.7% (n = 146) were able to comply with this periodicity due to owners' constraints. CONCLUSIONS AND RELEVANCE The findings showed that although most survey respondents are aware of international guidelines for the clinical management of cats with CKD, the SBP measurement still needs to be more systematic to allow proper substaging and detection of systemic hypertension. The monitoring frequency was lower than recommended. Furthermore, the introduction of a renal therapeutic diet should be refined to improve its acceptance rate.
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Affiliation(s)
- Tomás Rodrigues Magalhães
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Ana Luísa Lourenço
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Department of Animal Science, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Ronald Jan Corbee
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Felisbina Luísa Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
- Centre for the Study of Animal Science, CECA-ICETA, University of Porto, Porto, Portugal
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Moretto L, Beckmann K, Günther C, Herzig R, Rampazzo A, Suter A, Steffen F, Glaus T. Manifestations of hypertensive encephalopathy in cats. J Feline Med Surg 2023; 25:1098612X231153357. [PMID: 36802953 PMCID: PMC10812077 DOI: 10.1177/1098612x231153357] [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] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Hypertensive encephalopathy in cats is an important entity but is underestimated in clinical practice. This could be explained, in part, by non-specific clinical signs. The objective of this study was to characterise the clinical manifestations of hypertensive encephalopathy in cats. METHODS Cats with systemic hypertension (SHT) recognised by routine screening, associated with underlying predisposing disease or a clinical presentation suggestive of SHT (neurological or non-neurological), were prospectively enrolled over a 2-year period. Confirmation of SHT was based on at least two sets of measurements of systolic blood pressure >160 mmHg by Doppler sphygmomanometry. RESULTS Fifty-six hypertensive cats with a median age of 16.5 years were identified; 31 had neurological signs. In 16/31 cats, neurological abnormalities were the primary complaint. The other 15 cats were first presented to the medicine or ophthalmology service, and neurological disease was recognised based on the cat's history. The most common neurological signs were ataxia, various manifestations of seizures and altered behaviour. Individual cats also showed paresis, pleurothotonus, cervical ventroflexion, stupor and facial nerve paralysis. In 28/30 cats, retinal lesions were detected. Of these 28 cats, six presented with a primary complaint of visual deficits, and neurological signs were not the primary complaint; nine presented with non-specific medical issues, without suspicion of SHT-induced organ damage; in 13 cats, neurological issues were the primary complaint and fundic abnormalities were detected subsequently. CONCLUSIONS AND RELEVANCE SHT is common in older cats and the brain is an important target organ; however, neurological deficits are commonly ignored in cats with SHT. Gait abnormalities, (partial) seizures and even mild behavioural changes should prompt clinicians to consider the presence of SHT. A fundic examination in cats with suspected hypertensive encephalopathy is a sensitive test to support the diagnosis.
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Affiliation(s)
- Laura Moretto
- Department of Cardiology, University of Zurich, Zürich, Switzerland
| | - Katrin Beckmann
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | | | - Robert Herzig
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | - Antonella Rampazzo
- Department of Ophthalmology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Anja Suter
- Department of Ophthalmology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Frank Steffen
- Department of Neurology, University of Zurich, Zürich, Switzerland
| | - Tony Glaus
- Department of Cardiology, University of Zurich, Zürich, Switzerland
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First genome-wide association study investigating blood pressure and renal traits in domestic cats. Sci Rep 2022; 12:1899. [PMID: 35115544 PMCID: PMC8813908 DOI: 10.1038/s41598-022-05494-3] [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: 03/05/2021] [Accepted: 12/28/2021] [Indexed: 11/08/2022] Open
Abstract
Hypertension (HTN) and chronic kidney disease (CKD) are common in ageing cats. In humans, blood pressure (BP) and renal function are complex heritable traits. We performed the first feline genome-wide association study (GWAS) of quantitative traits systolic BP and creatinine and binary outcomes HTN and CKD, testing 1022 domestic cats with a discovery, replication and meta-analysis design. No variants reached experimental significance level in the discovery stage for any phenotype. Follow up of the top 9 variants for creatinine and 5 for systolic BP, one SNP reached experimental-wide significance for association with creatinine in the combined meta-analysis (chrD1.10258177; P = 1.34 × 10–6). Exploratory genetic risk score (GRS) analyses were performed. Within the discovery sample, GRS of top SNPs from the BP and creatinine GWAS show strong association with HTN and CKD but did not validate in independent replication samples. A GRS including SNPs corresponding to human CKD genes was not significant in an independent subset of cats. Gene-set enrichment and pathway-based analysis (GSEA) was performed for both quantitative phenotypes, with 30 enriched pathways with creatinine. Our results support the utility of GWASs and GSEA for genetic discovery of complex traits in cats, with the caveat of our findings requiring validation.
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Moretto L, Herzig R, Beckmann K, Wolfer N, Dennler M, Glaus TM. Reversible facial nerve paralysis in a cat suspected to be associated with systemic hypertension. JFMS Open Rep 2021; 7:20551169211063454. [PMID: 34925872 PMCID: PMC8679037 DOI: 10.1177/20551169211063454] [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] [Indexed: 11/16/2022] Open
Abstract
Case summary This report describes the appearance of facial nerve paralysis in a 16-year-old hypertensive cat. MRI was helpful in visualising and characterising mesencephalic and facial nerve lesions thought to be induced by hypertension. Neurological signs rapidly resolved under antihypertensive therapy. Relevance and novel information Systemic hypertension is an important medical condition in geriatric cats causing damage in various target organs, including the brain. Hypertensive encephalopathy is an umbrella term for a multitude of different clinical manifestations of cerebral target organ damage. Facial nerve paralysis secondary to hypertension is recognised in human medicine, particularly in children, but so far has not been reported in veterinary medicine.
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Affiliation(s)
- Laura Moretto
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Robert Herzig
- Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Katrin Beckmann
- Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Nadja Wolfer
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Matthias Dennler
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Tony M Glaus
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Lawson JS, Jepson RE. Feline comorbidities: The intermingled relationship between chronic kidney disease and hypertension. J Feline Med Surg 2021; 23:812-822. [PMID: 34428941 PMCID: PMC10812150 DOI: 10.1177/1098612x211037872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PRACTICAL RELEVANCE Chronic kidney disease (CKD) is a highly prevalent disorder of senior cats. CKD is frequently diagnosed in association with hypertension, and the two conditions have an intermingled cause-and-effect relationship. Hypertensive target organ damage (TOD) to the eye, brain, heart and kidney significantly impacts the welfare of cats suffering from this comorbidity. Hypertension also drives proteinuria, which is an independent risk factor for progression and mortality in cats with CKD. Blood pressure monitoring and institution of effective antihypertensive treatment, where indicated, is therefore crucial in effective management of the feline CKD patient. Current guidelines recommend a target systolic blood pressure of <160 mmHg to minimise risk of TOD. Both amlodipine besylate and telmisartan are effective antihypertensive agents for use in these patients. CLINICAL CHALLENGES Clinical signs of hypertension may not be apparent to owners of affected cats until severe hypertensive TOD is present. Despite this, blood pressure monitoring in cats with CKD is still infrequently performed, and hypertension likely remains underdiagnosed in this population. EVIDENCE BASE This review is based upon evaluation of the currently available published literature, including relevant consensus statements. There is a large body of evidence supporting the association between hypertension and CKD in cats. However, significant aspects, such as the mechanisms behind this association, and effect of hypertension and antihypertensive treatment on mortality and progression of CKD, remain unclear. Further research is therefore required in order to improve understanding of these conditions.
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Affiliation(s)
- Jack S Lawson
- Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - Rosanne E Jepson
- Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
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8
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Fink DM, Mans C. Use of Amlodipine in Psittacine Birds: 5 Cases (2010-2018). J Avian Med Surg 2021; 35:155-160. [PMID: 34256545 DOI: 10.1647/19-00016] [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: 11/11/2022]
Abstract
Amlodipine is a calcium channel blocker shown to be effective in lowering blood pressure with minimal adverse effects in mammals. To provide a retrospective evaluation of amlodipine use in psittacine birds, medical records were reviewed for all avian patients prescribed amlodipine for treatment for the presumptive diagnosis of hypertension, based on clinical signs and indirect blood pressure measurements. Five birds were treated with amlodipine between 2010 and 2018. The median age was 33 years (range, 22-37 years) and 3/5 birds presented for ataxia or seizures. The median indirect systolic blood pressure at diagnosis was 243 mm Hg (range, 200-275 mm Hg). In 3/5 birds, amlodipine was the only drug prescribed, whereas, in 2/5 birds, enalapril was also prescribed in addition to amlodipine. In addition to the prescription of enalapril, blood pressure measurements were obtained indirectly, which are variables to be considered in this report. The initial median dose of amlodipine prescribed was 0.4 mg/kg (range, 0.1-0.4 mg/kg) PO q24h. In 3/5 birds, amlodipine administration was increased either in dose or frequency. Median follow-up time was 25 months (range, 2-55 months) after the initiation of amlodipine treatment. Owners in all 5 cases reported improvement of clinical signs by a median time of 2 months (range, 1-15 months). Three of 5 birds (60%) demonstrated a decreasing trend in blood pressure during the first 6 months after treatment with amlodipine was started (average, ≥20% decrease). Prospective, controlled studies are needed to investigate the efficacy of amlodipine in psittacine birds.
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Affiliation(s)
- Dustin M Fink
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Christoph Mans
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA,
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Moretto L, Lavaud A, Suter A, Günther C, Pot S, Glaus T. Reliability of detecting fundus abnormalities associated with systemic hypertension in cats assessed by veterinarians with and without ophthalmology specialty training. J Feline Med Surg 2021; 23:921-927. [PMID: 33438504 DOI: 10.1177/1098612x20983265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Systemic hypertension (SHT) causes severe target organ damage (TOD) and blood pressure (BP) measurement should be routine in at-risk populations. Fundoscopy is a tool to corroborate acute clinical relevance of high BP results and to decide on immediate therapy. Not every cat with a high BP result can be examined by an ophthalmologist. The study objective was to determine the reliability of fundoscopy in cats with SHT performed by a veterinarian without ophthalmology specialty training. METHODS Cats with suspicion of hypertensive TOD or belonging to a risk population for SHT with a first measurement of elevated BP >160 mmHg were enrolled. Indirect ophthalmoscopy was performed by a recent graduate veterinarian followed by a veterinary ophthalmologist. Confirmation of SHT was based on two additional sets of systolic BP measurements >160 mmHg by Doppler sphygmomanometry. RESULTS Thirty-three cats were included. SHT was confirmed in 27 cats. SHT was detected on routine examinations in 12/27 cats; fundoscopic lesions were observed in 9/12 by the non-trained veterinarian and in 11/12 by an ophthalmologist. Nine of 27 cats were neurological patients; fundoscopic lesions were detected in 4/9 by the non-trained veterinarian and in 7/9 by an ophthalmologist. Six of 27 cats were presented for acute blindness; fundus lesions were detected in all six cats by the non-trained veterinarian and ophthalmologist. SHT was not confirmed and fundoscopic lesions were not detected by either examiner in 6/33 cats. Compared with a veterinary ophthalmologist, reliability of detecting fundus abnormalities by the non-trained veterinarian was 72% (13/18) for cats with, and 100% (6/6) for cats without, vision. CONCLUSIONS AND RELEVANCE Fundus examination by a non-specialty trained veterinarian has reasonably high reliability for the detection of ocular TOD. Private practice veterinarians are encouraged to perform an initial fundic examination in suspected hypertensive cats.
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Affiliation(s)
- Laura Moretto
- Division of Cardiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Arnold Lavaud
- Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Anja Suter
- Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Christian Günther
- Division of Neurology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Simon Pot
- Division of Ophthalmology Section, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Tony Glaus
- Division of Cardiology, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
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Ekweremadu CS, Abdelhakim HE, Craig DQM, Barker SA. Development and Evaluation of Feline Tailored Amlodipine Besylate Mini-Tablets Using L-lysine as a Candidate Flavouring Agent. Pharmaceutics 2020; 12:E917. [PMID: 32987962 PMCID: PMC7600910 DOI: 10.3390/pharmaceutics12100917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
Felines may find orally administered medicines unpalatable, thus presenting a problem in the treatment of chronic conditions such as hypertension, a commonly diagnosed condition in felines requiring daily administration of medication. A pertinent example is amlodipine besylate, formulations of which are known to be poorly tolerated by cats. There is therefore a need to develop feline-specific delivery approaches that are both simple to administer and mask the taste of the drug, thereby enhancing the owner's commitment to treatment and the associated therapeutic outcome for the companion animal. In addition, it is helpful to develop accessible and reproducible means of assessing taste for pre-clinical selection, hence the use of recently developed taste biosensor systems for veterinary applications is an area of interest. This study focuses on developing feline-specific amlodipine besylate formulations by improving the taste using a suitable flavouring agent while reducing dosage form size to a 2 mm diameter mini-tablet. The choice of L-lysine as a flavouring agent was based on the dietary and taste preference of cats. The impact of L-lysine on the taste perception of the formulation was evaluated using a biosensor system (E-tongue) fitted with sensors sensitive to bitter tastes. The results showed L-lysine successfully masked bitterness, while the drug release studies suggest that it has no impact on drug dissolution. In addition, tableting parameters such as tablet mass uniformity, content uniformity, tablet diameter, thickness and hardness were all satisfactory. The present study suggests that amlodipine besylate mini-tablets containing L-lysine could improve the palatability and in turn support product acceptability and ease of administration. These data could have an impact on orally administered medicines for cats and other veterinary species through product differentiation and competitive advantage in the companion animal market sector. The study also outlines the use of the electronic tongue as a tool for formulation selection in the veterinary field.
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Affiliation(s)
- Chinedu S. Ekweremadu
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (C.S.E.); (H.E.A.); (D.Q.M.C.)
| | - Hend E. Abdelhakim
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (C.S.E.); (H.E.A.); (D.Q.M.C.)
| | - Duncan Q. M. Craig
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (C.S.E.); (H.E.A.); (D.Q.M.C.)
| | - Susan A. Barker
- Department of Pharmaceutics, University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK; (C.S.E.); (H.E.A.); (D.Q.M.C.)
- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Chatham, Kent ME4 4TB, UK
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11
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Miyagawa Y, Akabane R, Sakatani A, Ogawa M, Nagakawa M, Miyakawa H, Takemura N. Effects of telmisartan on proteinuria and systolic blood pressure in dogs with chronic kidney disease. Res Vet Sci 2020; 133:150-156. [PMID: 32992126 DOI: 10.1016/j.rvsc.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Renal proteinuria is associated with promoted renal dysfunction and a shorter survival period in dogs with chronic kidney disease (CKD). Renin angiotensin- aldosterone system inhibitors are primarily used to treat renal proteinuria. In this retrospective, open-label study, we aimed to evaluate the anti-proteinuric and anti-hypertensive effects of telmisartan (angiotensin II receptor blocker) in dogs with proteinuric CKD. A total of 28 dogs with proteinuric CKD were included in the study, all dogs received telmisartan 1 mg/kg q24h, PO. The urine protein-to-creatinine ratio (UPC), urine albumin-to-creatinine ratio (UAC) and systolic blood pressure (SBP) decreased significantly after telmisartan administration (P < 0.05). The median rate of change in UPC, UAC and SBP at Day 120 were - 65.1%, -75.9% and - 9.7%. Ten dogs (36.7%) achieved UPC < 1.0 at Day 120, of which six dogs had UPC < 0.5. A reduction of UPC to ≥50% was achieved in 10 dogs (36%) at Day 45 and 17 dogs (61%) at Day 120. Seventeen dogs (61%) had hypertension at baseline, of which 10 dogs (59%) had SBP < 160 mmHg at Day 120. Two-way repeated measures analysis of variance did not attribute the observed changes in SBP, UPC or UAC to feeding with a renal diet. In conclusion, telmisartan therapy provides anti-proteinuric and anti-hypertensive effects in dogs with proteinuric CKD.
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Affiliation(s)
- Yuichi Miyagawa
- The Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan Cho, Musashino-shi, 180-8602 Tokyo, Japan.
| | - Ryota Akabane
- The Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan Cho, Musashino-shi, 180-8602 Tokyo, Japan
| | - Atsushi Sakatani
- The Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan Cho, Musashino-shi, 180-8602 Tokyo, Japan
| | - Mizuki Ogawa
- The Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan Cho, Musashino-shi, 180-8602 Tokyo, Japan
| | - Masayoshi Nagakawa
- The Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan Cho, Musashino-shi, 180-8602 Tokyo, Japan
| | - Hirosumi Miyakawa
- The Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan Cho, Musashino-shi, 180-8602 Tokyo, Japan
| | - Naoyuki Takemura
- The Laboratory of Veterinary Internal Medicine II, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, 1-7-1 Kyonan Cho, Musashino-shi, 180-8602 Tokyo, Japan
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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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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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14
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Savolainen S, Hautala J, Junnila J, Airaksinen S, Juppo AM, Raekallio M, Vainio O. Acceptability of flavoured pharmaceutically non-active mini-tablets in pet cats tested with a rapid 3-portal acceptance test with and without food. Vet Anim Sci 2019; 7:100054. [PMID: 32734075 PMCID: PMC7386771 DOI: 10.1016/j.vas.2019.100054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/22/2019] [Accepted: 02/28/2019] [Indexed: 01/19/2023] Open
Abstract
The palatability of synthetically flavoured mini-tablets in cats was investigated. 3-portal acceptance tests were carried out on 10–19 pet cats in their homes. The mini-tablets were not accepted voluntarily without food by most of the cats. Amino acids were not palatable to cats, which did not support the earlier studies. Most of the cats ate the mini-tablets concealed inside a palatable food item.
Palatable oral pharmaceuticals are crucial for feline medication. The pharmaceutical industry prefers synthetic flavours over organic ones because of hygiene and regulatory issues. The aim of this study was to find a palatable synthetic flavour for future taste-masking of feline pharmaceuticals. The hypothesis was that synthetic meat aromas and free amino acids would be palatable to cats. The palatability of 18 synthetically flavoured mini-tablets was screened with 10–19 pet cats using a rapid 3-portal acceptance test with and without food. The tested flavours were synthetic amino acids (L-carnitine, l-glutamic acid monosodium salt hydrate, l-leucine, l-methionine, l-phenylalanine, l-proline, and taurine), d-(+)-Maltose monohydrate and thiamine hydrochloride. Furthermore, thiamine hydrochloride was combined with amino acids (l-cysteine, l-leucine, l-methionine and l-proline) and synthetic meat flavours (2-acetylpyridine, 2-acetylthiazole, 2-pentylpyridine and 4-hydroxy-5-methyl-3(2H)-furanone). The negative control was a non-flavoured placebo mini-tablet, while positive controls were an organic yeast-flavoured mini-tablet and a yeast- and fish-based commercial vitamin tablet in mini-tablet form. No significant differences were detected between palatable synthetic flavours and the placebo, nor between the synthetic flavours and the yeast flavour. In general, the mini-tablet seemed to be small enough to be accepted inside a food item. These results differ from the earlier literature about the taste preferences of cats for amino acids, and hence free amino acids should not be considered palatable to cats based purely on previous findings.
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Affiliation(s)
- S Savolainen
- Department of Equine and Small Animal Medicine, University of Helsinki, P.O. Box 57, 00014 University of Helsinki, Finland
| | - J Hautala
- Division of Pharmaceutical Chemistry and Technology, University of Helsinki, P.O. Box 56, 00014 University of Helsinki, Finland
| | - J Junnila
- 4Pharma Ltd, Arkadiankatu 7, 00100 Helsinki, Finland
| | - S Airaksinen
- Division of Pharmaceutical Chemistry and Technology, University of Helsinki, P.O. Box 56, 00014 University of Helsinki, Finland
| | - A M Juppo
- Division of Pharmaceutical Chemistry and Technology, University of Helsinki, P.O. Box 56, 00014 University of Helsinki, Finland
| | - M Raekallio
- Department of Equine and Small Animal Medicine, University of Helsinki, P.O. Box 57, 00014 University of Helsinki, Finland
| | - O Vainio
- Department of Equine and Small Animal Medicine, University of Helsinki, P.O. Box 57, 00014 University of Helsinki, Finland
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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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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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17
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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: 258] [Impact Index Per Article: 43.0] [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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18
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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: 16] [Impact Index Per Article: 2.7] [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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19
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Bijsmans ES, Doig M, Jepson RE, Syme HM, Elliott J, Pelligand L. Factors Influencing the Relationship Between the Dose of Amlodipine Required for Blood Pressure Control and Change in Blood Pressure in Hypertensive Cats. J Vet Intern Med 2018; 30:1630-1636. [PMID: 27717190 PMCID: PMC5032874 DOI: 10.1111/jvim.14562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/02/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background Hypertension is a common problem in elderly cats. In most cats, systolic blood pressure (SBP) of <160 mmHg is achieved in response to amlodipine besylate at either 0.625 or 1.25 mg q24h. The individual cat factors determining dose requirement dose have not been explored. Aims To determine whether individual cat factors influence the dose of amlodipine required to achieve adequate blood pressure control and to determine whether factors other than the prescribed dose of drug alter the achieved plasma amlodipine concentrations. Methods Fifty‐nine hypertensive cats that required 0.625 mg (A) and 41 cats that required 1.25 mg (B) amlodipine to reach a target SBP of <160 mmHg were identified, and plasma amlodipine concentrations were determined. Comparisons were made between groups, and multivariable linear regression models were performed to investigate predictors of antihypertensive response. Results Cats that required a greater dose of amlodipine had significantly higher SBP at diagnosis of hypertension (A: (median [25th, 75th percentile]) 182 [175,192] mmHg; B: 207 [194,217] mmHg, P < .001), but comparable blood pressure was achieved after treatment. Plasma amlodipine concentrations were directly related to the dose of amlodipine administered. At diagnosis, cats in group B had significantly lower plasma potassium concentration (A: 4.1 [3.8,4.5]; B: 3.8 [3.6,4.2] mEq/L, P < .01). Weight did not differ between groups. The decrease in SBP was directly and independently associated with the SBP at diagnosis and the plasma amlodipine concentration. Conclusions and Clinical Importance Cats with higher blood pressure at diagnosis might require a greater dose of amlodipine to control their blood pressure adequately. Differences in amlodipine pharmacokinetics between cats do not seem to play a role in the antihypertensive response.
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Affiliation(s)
- E S Bijsmans
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK.
| | - M Doig
- ABS Laboratories Ltd, Welwyn Garden City, Hertfordshire, UK
| | - R E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - H M Syme
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - J Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, University of London, London, UK
| | - L Pelligand
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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20
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Oyama MA, Ellenberg SS, Shaw PA. Clinical Trials in Veterinary Medicine: A New Era Brings New Challenges. J Vet Intern Med 2017; 31:970-978. [PMID: 28557000 PMCID: PMC5508340 DOI: 10.1111/jvim.14744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/17/2017] [Accepted: 04/20/2017] [Indexed: 12/27/2022] Open
Abstract
Randomized clinical trials (RCTs) are among the most rigorous ways to determine the causal relationship between an intervention and important clinical outcome. Their use in veterinary medicine has become increasingly common, and as is often the case, with progress comes new challenges. Randomized clinical trials yield important answers, but results from these studies can be unhelpful or even misleading unless the study design and reporting are carried out with care. Herein, we offer some perspective on several emerging challenges associated with RCTs, including use of composite endpoints, the reporting of different forms of risk, analysis in the presence of missing data, and issues of reporting and safety assessment. These topics are explored in the context of previously reported veterinary internal medicine studies as well as through illustrative examples with hypothetical data sets. Moreover, many insights germane to RCTs in veterinary internal medicine can be drawn from the wealth of experience with RCTs in the human medical field. A better understanding of the issues presented here can help improve the design, interpretation, and reporting of veterinary RCTs.
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Affiliation(s)
- M A Oyama
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - S S Ellenberg
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Division of Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - P A Shaw
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Division of Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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21
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Leclerc A, Trehiou-Sechi E, Greunz EM, Damoiseaux C, Bouvard J, Chetboul V. Systemic arterial hypertension secondary to chronic kidney disease in two captive-born large felids. J Vet Cardiol 2017; 19:308-316. [PMID: 28435002 DOI: 10.1016/j.jvc.2017.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 10/20/2016] [Accepted: 02/23/2017] [Indexed: 01/18/2023]
Abstract
Systemic arterial hypertension (SHT) has been widely described in the domestic cat (Felis catus). In these feline patients, SHT is considered as the most common vascular disorder of middle-aged to older animals, and secondary SHT related to chronic kidney disease (CKD) represents the most common form of the disease. We describe here the first two cases of spontaneous SHT in large felids, i.e. one 18-year old, 34.4 kg, male North-Chinese leopard (Panthera pardus japonensis, case #1) and one 20-year old, 28.7 kg, female snow leopard (Panthera uncia, case #2), both captive-bred and previously diagnosed with CKD. Both animals underwent complete echocardiographic examination under general anesthesia due to abnormal cardiac auscultation (heart murmur and/or gallop sound), and recurrent lethargy in case #1. The combination of left ventricular remodeling with moderate aortic regurgitation of high velocity was highly suggestive of SHT, which was confirmed by indirect blood pressure measurement (systolic arterial blood pressure of 183 mmHg for case #1 and 180 mmHg for case #2). Amlodipine was prescribed (0.35-0.70 mg/kg/day orally) for 31 and 6 months respectively after the initial diagnosis. In case #1, concurrent amlodipine and benazepril treatment was associated with decreased heart murmur grade and reduced aortic insufficiency severity. These reports illustrate that, similarly to domestic cats, SHT should be suspected in old large felids with CKD and that amlodipine is a well-tolerated antihypertensive drug in these species.
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Affiliation(s)
- A Leclerc
- Parc Zoologique et de Loisirs de Thoiry, 78770, Thoiry, France.
| | - E Trehiou-Sechi
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - E M Greunz
- Parc Zoologique et de Loisirs de Thoiry, 78770, Thoiry, France
| | - C Damoiseaux
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - J Bouvard
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France
| | - V Chetboul
- Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), Ecole Nationale Vétérinaire d'Alfort, Université Paris-Est, 7 avenue Général de Gaulle, 94704, Maisons-Alfort Cedex, France; INSERM, U955, Equipe 03, 51 avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
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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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Quimby JM. Update on Medical Management of Clinical Manifestations of Chronic Kidney Disease. Vet Clin North Am Small Anim Pract 2016; 46:1163-81. [DOI: 10.1016/j.cvsm.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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24
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Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre HP, White J, Quimby J. ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease. J Feline Med Surg 2016; 18:219-39. [PMID: 26936494 PMCID: PMC11148907 DOI: 10.1177/1098612x16631234] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
PRACTICAL RELEVANCE Chronic kidney disease (CKD) is one of the most commonly diagnosed diseases in older cats. In most cats, CKD is also a progressive disease and can be accompanied by a wide range of clinical and clinicopathological changes. These ISFM Consensus Guidelines have been developed by an independent panel of clinicians and academics to provide practical advice on the diagnosis and management of this complex disease. CLINICAL CHALLENGES Although CKD is a common clinical problem in cats, the manifestations of disease vary between individuals. Thus there is a need for careful and repeat evaluation of cats with CKD and adjustment of therapy according to individual needs. In addition to addressing problems arising from CKD and improving quality of life (QoL) for the patient, therapy may also target slowing the underlying progression of disease and hence prolonging life. While maintaining QoL is of paramount importance in our patients, this can be challenging when multiple therapies are indicated. In some cases it is necessary to prioritise therapy, given an understanding of what is likely to most benefit the individual patient. EVIDENCE BASE In preparing these Guidelines, the Panel has carefully reviewed the existing published literature, and has also graded the quality of evidence for different interventions to help to provide practical recommendations on the therapeutic options for feline CKD. This is a field of veterinary medicine that has benefited from some excellent published clinical research and further research findings will undoubtedly modify the recommendations contained in these Guidelines in the future.
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Affiliation(s)
| | | | - Serge Chalhoub
- Faculty of Veterinary Medicine, University of Calgary, Canada
| | - Jonathan Elliott
- Department of Comparative Biomedical Sciences, Royal Veterinary College, UK
| | - Natalie Finch
- Bristol Renal, School of Clinical Sciences, University of Bristol, UK
| | | | | | - Hervé P Lefebvre
- Clinical Research Unit, National Veterinary School of Toulouse (ENVT), France
| | - Joanna White
- Small Animal Specialist Hospital, Sydney, Australia
| | - Jessica Quimby
- Department of Clinical Veterinary Sciences, Colorado State University, USA
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