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Moke EG, Omogbai EKI, Osagie-Eweka SE, Uchendu AP, Obayuwana OM, Okoro-Akpandu E, Ben-Azu B. Antihypertensive and antihyperglycemic effects of combinations of losartan with metformin and/or glibenclamide in desoxycorticosterone acetate and streptozotocin-induced hypertensive diabetic rats. Lab Anim Res 2023; 39:7. [PMID: 37055870 PMCID: PMC10103437 DOI: 10.1186/s42826-023-00159-2] [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: 01/03/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Hypertension is a medical condition that often comorbidly exist in patients with type II diabetes. Therefore, it is very important to manage both conditions simultaneously to mitigate the complications and mortality connected with this comorbidity. Hence, this study investigated the antihypertensive and antihyperglycemic effects of combinations of losartan (LOS) with metformin (MET) and/or glibenclamide (GLB) in hypertensive diabetic rats. Hypertensive diabetic state was induced with desoxycorticosterone acetate (DOCA) and streptozotocin (STZ) in adult Wistar rats. The rats were divided into 5 groups (n = 5): control group (group 1), hypertensive diabetic (HD) control (group 2), treatment groups receiving LOS + MET (group 3), LOS + GLB (group 4), and LOS + MET + GLB (group 5). Group 1 comprised healthy rats while groups 2-5 were HD rats. The rats were treated orally once daily for 8 weeks. Fasted blood glucose (FBS) level, haemodynamic parameters, and some biochemical indices were thereafter assessed. RESULTS FBS level and blood pressure measurements were significantly (P < 0.05) increased following induction by DOCA/STZ. The drug treatment combinations, particularly combination of LOS + MET + GLB, significantly (P < 0.05) reduced the induced hyperglycemia and remarkably decreased systolic blood pressure and heart rate. There was significant (P < 0.05) reduction in raised lactate dehydrogenase and creatinine kinase levels by all drug treatment combinations except LOS + GLB. CONCLUSIONS Our findings suggest that LOS combinations with MET and/or GLB exhibited significant antidiabetic and antihypertensive effects against DOCA/STZ-induced hypertensive diabetic state in rats.
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Affiliation(s)
- Emuesiri Goodies Moke
- Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria.
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Nigeria.
| | - Eric Kelly Inanemo Omogbai
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | | | - Adaeze Phina Uchendu
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Odion Martha Obayuwana
- Department of Physiology, School of Basic Medical Sciences, University of Benin, Benin City, Nigeria
| | - Elizabeth Okoro-Akpandu
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
| | - Benneth Ben-Azu
- Department of Pharmacology, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria
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Koca TT, Aykan D, Berk E, Koçyiğit BF, Güçmen B. EFFECT OF HYPERTENSION ON PAIN THRESHOLD IN PATIENTS WITH CHRONIC PAIN. CENTRAL ASIAN JOURNAL OF MEDICAL HYPOTHESES AND ETHICS 2022. [DOI: 10.47316/cajmhe.2022.3.4.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Introduction: Little is known about the relationship between pain and hypertension (HT). This study aimed to analyze the effect of HT on pain sensitivity in patients with chronic musculoskeletal pain complaints.
Methods: This analytical, cross-sectional study included 45 patients aged 29–75 years with HT. The control group comprised 44 normo/hypotensive patients aged 19–66 (P = 0.107). Education status, age, gender, height, weight, smoking, presence of diabetes mellitus, physical activity level, blood pressure measurement, anti-HT drug use, vital parameters, including heart rate, respiratory rate, and body temperature, were recorded for all participants.
Results: The pain score was significantly higher in the HT group, with a mean of 72.1 ± 30.2 points (P = 0.008). Also, the HT group’s systolic blood pressure and pain score were significantly positively correlated (rho = 0.245, P = 0.02). The pulse rate was found to be significantly related to the pain score and pain threshold (P < 0.001); it was negatively correlated with algometer values (rho = –0.286, P = 0.015). Systolic pressure (P = 0.033) and BMI ( P < 0.001) were significantly different among the groups according to physical activity level. The Spearman correlation analysis showed a positive correlation of diastolic blood pressure with the body mass index (rho = 0.224, P = 0.036) and pain score (rho = 0.456, P < 0.001).
Conclusion: The present study showed that the pain complaint increases as the blood pressure and weight increase. Also, the pain threshold decreases as the heart rate increases. The pain threshold was lower in women than in men, independent of tension.
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Alves TC, Pugliesi Abdalla P, Bohn L, Da Silva LSL, dos Santos AP, Tasinafo Júnior MF, Rossini Venturini AC, Mota J, Lopes Machado DR. Acute and chronic cardiometabolic responses induced by resistance training with blood flow restriction in HIV patients. Sci Rep 2022; 12:16989. [PMID: 36216952 PMCID: PMC9550823 DOI: 10.1038/s41598-022-19857-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 09/06/2022] [Indexed: 12/29/2022] Open
Abstract
Resistance training with blood flow restriction (RTBFR) allows physically impaired people living with HIV (PWH) to exercise at lower intensities than traditional resistance training (TRT). But the acute and chronic cardiac and metabolic responses of PWH following an RTBFR protocol are unknown. The objective was to compare the safety of acute and chronic effects on hemodynamic and lipid profiles between TRT or RTBFR in PWH. In this randomized control trial, 14 PWH were allocated in RTBFR (GRTBFR; n = 7) or TRT (GTRT; n = 7). Both resistance training protocols had 36 sessions (12 weeks, three times per week). Protocol intensity was 30% (GRTBFR) and 80% (GTRT). Hemodynamic (heart rate, blood pressure) and lipid profile were acutely (rest and post exercise 7th, 22nd, and 35th sessions) and chronically (pre and post-program) recorded. General linear models were applied to determine group * time interaction. In the comparisons between groups, the resistance training program showed acute adaptations: hemodynamic responses were not different (p > 0.05), regardless of the assessment session; and chronicles: changes in lipidic profile favors GRTBFR, which significantly lower level of total cholesterol (p = 0.024), triglycerides (p = 0.002) and LDL (p = 0.030) compared to GTRT. RTBFR and TRT induced a similar hemodynamic adaptation in PWH, with no significant risks of increased cardiovascular stress. Additionally, RTBFR promoted better chronic adequacy of lipid profile than TRT. Therefore, RTBFR presents a safe resistance training alternative for PWH.Trial registration: ClinicalTrials.gov ID: NCT02783417; Date of registration: 26/05/2016.
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Affiliation(s)
- Thiago Cândido Alves
- grid.11899.380000 0004 1937 0722Universidade de São Paulo, Avenue of Bandeirantes no 3900, University Campus-Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - Pedro Pugliesi Abdalla
- grid.11899.380000 0004 1937 0722Universidade de São Paulo, Avenue of Bandeirantes no 3900, University Campus-Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil ,grid.5808.50000 0001 1503 7226Universidade do Porto, Porto, Portugal
| | - Lucimere Bohn
- grid.5808.50000 0001 1503 7226Universidade do Porto, Porto, Portugal ,grid.410936.90000 0001 2199 9085Universidade Lusófona do Porto, Porto, Portugal
| | - Leonardo Santos Lopes Da Silva
- grid.11899.380000 0004 1937 0722Universidade de São Paulo, Avenue of Bandeirantes no 3900, University Campus-Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - André Pereira dos Santos
- grid.11899.380000 0004 1937 0722Universidade de São Paulo, Avenue of Bandeirantes no 3900, University Campus-Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - Márcio Fernando Tasinafo Júnior
- grid.11899.380000 0004 1937 0722Universidade de São Paulo, Avenue of Bandeirantes no 3900, University Campus-Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - Ana Cláudia Rossini Venturini
- grid.11899.380000 0004 1937 0722Universidade de São Paulo, Avenue of Bandeirantes no 3900, University Campus-Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil
| | - Jorge Mota
- grid.5808.50000 0001 1503 7226Universidade do Porto, Porto, Portugal
| | - Dalmo Roberto Lopes Machado
- grid.11899.380000 0004 1937 0722Universidade de São Paulo, Avenue of Bandeirantes no 3900, University Campus-Monte Alegre, Ribeirão Preto, SP 14040-902 Brazil ,grid.5808.50000 0001 1503 7226Universidade do Porto, Porto, Portugal
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Lai X, Dong Z, Wu S, Zhou X, Zhang G, Xiong S, Wu W, Cao R, Wang X, Hua Q, Du J, Fan J, Mao J, Jiang W, Yuan H, Chen Y, Xu Y, Li Z, Zhang J, Dong G, Zhen H, Ding R, Wu Z, Gao Y. Efficacy and Safety of Chinese Herbal Medicine Compared With Losartan for Mild Essential Hypertension: A Randomized, Multicenter, Double-Blind, Noninferiority Trial. Circ Cardiovasc Qual Outcomes 2022; 15:e007923. [PMID: 35105177 DOI: 10.1161/circoutcomes.121.007923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hypertension is one of the most challenging public health problems worldwide. Previous studies suggested that the Songling Xuemaikang capsule (SXC)-a Chinese herbal formula-was effective for essential hypertension. However, the efficacy of SXC monotherapy for hypertension remains unclear. We aimed to compare the blood pressure (BP)-lowering efficacy and safety of SXC versus losartan in patients with essential hypertension. METHODS In this multicenter, randomized, double-blind, noninferiority trial in China, patients 18 to 65 years of age with mild essential hypertension were randomly allocated to receive either SXC or losartan for 8 weeks. The primary outcome was the change in sitting diastolic BP from baseline to 8 weeks, with a predefined noninferiority margin of -2.5 mm Hg. RESULTS Of the 755 patients who entered a 2-week run-in period, 628 patients (327 women and 301 men; mean [SD] age, 52.6 [9.2] years) were randomly assigned to the SXC (n=314) or losartan (n=314) group. The primary analysis based on the intention-to-treat principle showed that the change in diastolic BP from baseline to 8 weeks was similar between the SXC and losartan groups (-7.9 [8.0] versus -8.1 [7.9]). The lower boundary of 95% CI (mean difference, -0.24 [95% CI, -1.51 to 1.03]) was above the margin of -2.5 mm Hg, showing noninferiority. Results were consistent with per-protocol analysis. SXC produced greater improvements in total hypertension symptom score (-5.7 [4.2] versus -5.0 [4.0]; P=0.020) and total cholesterol (-0.1 [1.0] versus 0.1 [1.2]; P=0.025). There were no differences between groups in the other BP and patient-reported outcomes. Incidence and severity of adverse events were similar between groups. CONCLUSIONS SXC was well tolerated and demonstrated noninferior to losartan in BP lowering in patients with mild hypertension. SXC might be an alternative for mild hypertension, particularly for patients with a preference for natural medicine. REGISTRATION URL: www.chictr.org.cn; Unique identifier: ChiCTR-IPR-16008108.
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Affiliation(s)
- Xinxing Lai
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China (X.L., Y.G.).,Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (X.L., S.W., G.Z., Y.G.).,Institute for TCM-X, MOE Key Laboratory of Bioinformatics/Bioinformatics Division, BNRIST, Department of Automation, Tsinghua University, Beijing, China. (X.L.)
| | - Zhenyu Dong
- Department of Traditional Chinese Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (Z.D., R.C.)
| | - Shengxian Wu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (X.L., S.W., G.Z., Y.G.)
| | - Xiaohua Zhou
- Department of Biostatistics, Beijing International Center for Mathematical Research, Peking University, China (X.Z.).,Department of Biostatistics, School of Public Health, Peking University, Beijing, China (X.Z.)
| | - Genming Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (X.L., S.W., G.Z., Y.G.)
| | - Shangquan Xiong
- Department of Cardiology, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China (S.X.)
| | - Wei Wu
- Department of Cardiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (W.W.)
| | - Rui Cao
- Department of Traditional Chinese Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (Z.D., R.C.)
| | - Xiaolong Wang
- Department of Cardiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China (X.W.)
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China (Qi Hua)
| | - Jinhang Du
- Department of Cardiology of Integrated Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China (J.D.)
| | - Jinying Fan
- Department of Cardiology, Yantaishan Hospital, Yantai, China (J.F.)
| | - Jingyuan Mao
- Department of Cardiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China (J.M.)
| | - Weimin Jiang
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China (X.L., Y.G.).,Department of Cardiology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China (W.J.)
| | - Huishu Yuan
- Department of Cardiology, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China (H.Y.)
| | - Yushan Chen
- Department of Cardiology, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China (Y.C.)
| | - Yong Xu
- Department of Cardiovascular Medicine, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China (Y.X.)
| | - Zhanquan Li
- Department of Cardiology, People's Hospital of Liaoning Province, Shenyang, China (Z.L.)
| | - Jun Zhang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, China (J.Z.)
| | - Guiying Dong
- Department of Hypertension, Jinan Hospital of Traditional Chinese Medicine, Jinan, China (Guiying Dong)
| | - Hui Zhen
- Technical Center for Drug Research and Evaluation, China Association of Traditional Chinese Medicine, Beijing, China (H.Z.)
| | - Ru Ding
- Department of Cardiology, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, China (R.D., Z.W.)
| | - Zonggui Wu
- Department of Cardiology, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, China (R.D., Z.W.)
| | - Ying Gao
- Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China (X.L., Y.G.).,Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (X.L., S.W., G.Z., Y.G.)
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5
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Zhou JG, Zhao HH, Chen AP, Zhang ZJ, Li JZ, Zuo L, Cheng YX, Deng D, Li XL, Ma XY, Man D, Zheng MH, Chen J, Wen B, Wang J. Mechanism of Wuweijiangyasan in the treatment of spontaneous hypertension based on network pharmacology. WORLD JOURNAL OF TRADITIONAL CHINESE MEDICINE 2022. [DOI: 10.4103/2311-8571.351793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Loganathan L, Gopinath K, Sankaranarayanan VM, Kukreti R, Rajendran K, Lee JK, Muthusamy K. Computational and Pharmacogenomic Insights on Hypertension Treatment: Rational Drug Design and Optimization Strategies. Curr Drug Targets 2019; 21:18-33. [DOI: 10.2174/1389450120666190808101356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023]
Abstract
Background::
Hypertension is a prevalent cardiovascular complication caused by genetic
and nongenetic factors. Blood pressure (BP) management is difficult because most patients become
resistant to monotherapy soon after treatment initiation. Although many antihypertensive drugs are
available, some patients do not respond to multiple drugs. Identification of personalized antihypertensive
treatments is a key for better BP management.
Objective::
This review aimed to elucidate aspects of rational drug design and other methods to develop
better hypertension management.
Results::
Among hypertension-related signaling mechanisms, the renin-angiotensin-aldosterone system
is the leading genetic target for hypertension treatment. Identifying a single drug that acts on multiple
targets is an emerging strategy for hypertension treatment, and could be achieved by discovering new
drug targets with less mutated and highly conserved regions. Extending pharmacogenomics research
to include patients with hypertension receiving multiple antihypertensive drugs could help identify the
genetic markers of hypertension. However, available evidence on the role of pharmacogenomics in
hypertension is limited and primarily focused on candidate genes. Studies on hypertension pharmacogenomics
aim to identify the genetic causes of response variations to antihypertensive drugs. Genetic
association studies have identified single nucleotide polymorphisms affecting drug responses. To understand
how genetic traits alter drug responses, computational screening of mutagenesis can be utilized
to observe drug response variations at the protein level, which can help identify new inhibitors
and drug targets to manage hypertension.
Conclusions::
Rational drug design facilitates the discovery and design of potent inhibitors. However,
further research and clinical validation are required before novel inhibitors can be clinically used as
antihypertensive therapies.
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Affiliation(s)
| | - Krishnasamy Gopinath
- Department of Chemical Engineering, Konkuk University, 1 Hwayang-Dong, Gwangjin-Gu, Seoul, Korea
| | | | - Ritushree Kukreti
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, New Delhi, India
| | - Kannan Rajendran
- Department of General Medicine, Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Jung-Kul Lee
- Department of Chemical Engineering, Konkuk University, 1 Hwayang-Dong, Gwangjin-Gu, Seoul, Korea
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Yin J, Wagner DJ, Prasad B, Isoherranen N, Thummel KE, Wang J. Renal secretion of hydrochlorothiazide involves organic anion transporter 1/3, organic cation transporter 2, and multidrug and toxin extrusion protein 2-K. Am J Physiol Renal Physiol 2019; 317:F805-F814. [PMID: 31322418 DOI: 10.1152/ajprenal.00141.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Hydrochlorothiazide (HCTZ) is the most widely used thiazide diuretic for the treatment of hypertension either alone or in combination with other antihypertensives. HCTZ is mainly cleared by the kidney via tubular secretion, but the underlying molecular mechanisms are unclear. Using cells stably expressing major renal organic anion and cation transporters [human organic anion transporter 1 (hOAT1), human organic anion transporter 3 (hOAT3), human organic cation transporter 2 (hOCT2), human multidrug and toxin extrusion 1 (hMATE1), and human multidrug and toxin extrusion 2-K (hMATE2-K)], we found that HCTZ interacted with both organic cation and anion transporters. Uptake experiments further showed that HCTZ is transported by hOAT1, hOAT3, hOCT2, and hMATE2-K but not by hMATE1. Detailed kinetic analysis coupled with quantification of membrane transporter proteins by targeted proteomics revealed that HCTZ is an excellent substrate for hOAT1 and hOAT3. The apparent affinities (Km) for hOAT1 and hOAT3 were 112 ± 8 and 134 ± 13 μM, respectively, and the calculated turnover numbers (kcat) were 2.48 and 0.79 s-1, respectively. On the other hand, hOCT2 and hMATE2-K showed much lower affinity for HCTZ. The calculated transport efficiency (kcat/Km) at the single transporter level followed the rank order of hOAT1> hOAT3 > hOCT2 and hMATE2-K, suggesting a major role of organic anion transporters in tubular secretion of HCTZ. In vitro inhibition experiments further suggested that HCTZ is not a clinically relevant inhibitor for hOAT1 or hOAT3. However, strong in vivo inhibitors of hOAT1/3 may alter renal secretion of HCTZ. Together, our study elucidated the molecular mechanisms underlying renal handling of HCTZ and revealed potential pathways involved in the disposition and drug-drug interactions for this important antihypertensive drug in the kidney.
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Affiliation(s)
- Jia Yin
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - David J Wagner
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Bhagwat Prasad
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Nina Isoherranen
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Kenneth E Thummel
- Department of Pharmaceutics, University of Washington, Seattle, Washington
| | - Joanne Wang
- Department of Pharmaceutics, University of Washington, Seattle, Washington
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Comparative Efficacy of Angiotensin II Antagonists in Essential Hypertension: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. Heart Lung Circ 2017; 27:666-682. [PMID: 28807582 DOI: 10.1016/j.hlc.2017.06.721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/24/2017] [Accepted: 06/23/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Evidence on the long-term clinical benefits of individual members of angiotensin II receptor blockers is limited given the lack of head-to-head studies. We conducted a network meta-analysis to determine the comparative efficacy of different members within this drug class with respect to outcomes of (i) blood pressure reduction (at 24 and 52 weeks) and (ii) prevention of cardiovascular disease (>104 weeks). METHODS A systematic literature review was conducted - Protocol registration: (PROSPERO - CRD42014007067) - to identify relevant literature from the following databases: Cochrane Library, PubMed, Medline and EMBASE; searched from inception to July 2016. Randomised controlled trials (RCTs) were included if they reported long-term effectiveness relating to blood pressure, mortality, myocardial infarction or stroke. Eligible studies included those with placebo or specific active-treatment comparators (either another angiotensin II receptor blockers or hydrochlorothiazide). A Bayesian random-effects network model was used to combine direct within-trial comparisons between treatment groups with indirect evidence from other trials. RESULTS Thirty-six studies were identified, representing 28 unique trials. Blood pressure reduction, based on 12 studies (n=807) with fixed dosing regimen, was found to be similar amongst members of the angiotensin receptor blocker drug class at both 24 and 52 weeks. A network meta-analysis of five studies (n=16,716) with a treat-to-target approach found that prevention of all-cause mortality, stroke and myocardial infarction was similar across the angiotensin-receptor blockers therapies initiated. CONCLUSIONS Current evidence is insufficient to show differences in any members within the angiotensin II receptor blocker drug class with respect to blood pressuring lowering effects or a reduction in cardiovascular diseases.
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9
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Imbrici P, Tricarico D, Mangiatordi GF, Nicolotti O, Lograno MD, Conte D, Liantonio A. Pharmacovigilance database search discloses ClC-K channels as a novel target of the AT 1 receptor blockers valsartan and olmesartan. Br J Pharmacol 2017; 174:1972-1983. [PMID: 28334417 DOI: 10.1111/bph.13794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Human ClC-K chloride channels are highly attractive targets for drug discovery as they have a variety of important physiological functions and are associated with genetic disorders. These channels are crucial in the kidney as they control chloride reabsorption and water diuresis. In addition, loss-of-function mutations of CLCNKB and BSND genes cause Bartter's syndrome (BS), whereas CLCNKA and CLCNKB gain-of-function polymorphisms predispose to a rare form of salt sensitive hypertension. Both disorders lack a personalized therapy that is in most cases only symptomatic. The aim of this study was to identify novel ClC-K ligands from drugs already on the market, by exploiting the pharmacological side activity of drug molecules available from the FDA Adverse Effects Reporting System database. EXPERIMENTAL APPROACH We searched for drugs having a Bartter-like syndrome as a reported side effect, with the assumption that BS could be causatively related to the block of ClC-K channels. The ability of the selected BS-causing drugs to bind and block ClC-K channels was then validated through an integrated experimental and computational approach based on patch clamp electrophysiology in HEK293 cells and molecular docking simulations. KEY RESULTS Valsartan and olmesartan were able to block ClC-Ka channels and the molecular requirements for effective inhibition of these channels have been identified. CONCLUSION AND IMPLICATIONS These results suggest additional mechanisms of action for these sartans further to their primary AT1 receptor antagonism and propose these compounds as leads for designing new potent ClC-K ligands.
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Affiliation(s)
- Paola Imbrici
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - Domenico Tricarico
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Orazio Nicolotti
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Diana Conte
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
| | - Antonella Liantonio
- Department of Pharmacy - Drug Sciences, University of Bari 'Aldo Moro', Bari, Italy
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10
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Nelveg-Kristensen KE, Bie P, Ferrero L, Bjerre D, Bruun NE, Egfjord M, Rasmussen HB, Hansen PR. Pharmacodynamic Impact of Carboxylesterase 1 Gene Variants in Patients with Congestive Heart Failure Treated with Angiotensin-Converting Enzyme Inhibitors. PLoS One 2016; 11:e0163341. [PMID: 27662362 PMCID: PMC5035013 DOI: 10.1371/journal.pone.0163341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/07/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Variation in the carboxylesterase 1 gene (CES1) may contribute to the efficacy of ACEIs. Accordingly, we examined the impact of CES1 variants on plasma angiotensin II (ATII)/angiotensin I (ATI) ratio in patients with congestive heart failure (CHF) that underwent ACEI dose titrations. Five of these variants have previously been associated with drug response or increased CES1 expression, i.e., CES1 copy number variation, the variant of the duplicated CES1 gene with high transcriptional activity, rs71647871, rs2244613, and rs3815583. Additionally, nine variants, representatives of CES1Var, and three other CES1 variants were examined. METHODS Patients with CHF, and clinical indication for ACEIs were categorized according to their CES1 genotype. Differences in mean plasma ATII/ATI ratios between genotype groups after ACEI dose titration, expressed as the least square mean (LSM) with 95% confidence intervals (CIs), were assessed by analysis of variance. RESULTS A total of 200 patients were recruited and 127 patients (63.5%) completed the study. The mean duration of the CHF drug dose titration was 6.2 (SD 3.6) months. After ACEI dose titration, there was no difference in mean plasma ATII/ATI ratios between subjects with the investigated CES1 variants, and only one previously unexplored variation (rs2302722) qualified for further assessment. In the fully adjusted analysis of effects of rs2302722 on plasma ATII/ATI ratios, the difference in mean ATII/ATI ratio between the GG genotype and the minor allele carriers (GT and TT) was not significant, with a relative difference in LSMs of 0.67 (95% CI 0.43-1.07; P = 0.10). Results of analyses that only included enalapril-treated patients remained non-significant after Bonferroni correction for multiple parallel comparisons (difference in LSM 0.60 [95% CI 0.37-0.98], P = 0.045). CONCLUSION These findings indicate that the included single variants of CES1 do not significantly influence plasma ATII/ATI ratios in CHF patients treated with ACEIs and are unlikely to be primary determinants of ACEI efficacy.
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Affiliation(s)
| | - Peter Bie
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Laura Ferrero
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Ditte Bjerre
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Niels E. Bruun
- Department of Cardiology, Gentofte University Hospital, Gentofte, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Martin Egfjord
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik B. Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Peter R. Hansen
- Department of Cardiology, Gentofte University Hospital, Gentofte, Denmark
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Ling LH, Oh VMS. Nebivolol as a first-line antihypertensive: a justifiable proposal?: Table 1. HEART ASIA 2016. [DOI: 10.1136/heartasia-2016-010728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Is there a preferred diuretic class for patients with renal impairment and hypertension? ACTA ACUST UNITED AC 2016; 10:282-4. [PMID: 26979914 DOI: 10.1016/j.jash.2016.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/13/2016] [Indexed: 11/20/2022]
Abstract
It is widely believed that "high-ceiling" loop diuretics are required in patients with renal impairment and that "low-ceiling" thiazides are not sufficiently potent to cause meaningful natriuresis and diuresis. If this statement is true, at what level of renal function do thiazides lose their punch? Another related issue is the enlightened use of diuretic combinations. Use of diuretics in chronic kidney disease and hypertension has been addressed in the many guidelines, but further insight is provided in this installment of the "Controversies" series by two well-known authorities, William Elliott, M.D. Ph.D. and Rajiv Agarwal, M.D.
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Nelveg-Kristensen KE, Busk Madsen M, Torp-Pedersen C, Køber L, Egfjord M, Berg Rasmussen H, Riis Hansen P. Pharmacogenetic Risk Stratification in Angiotensin-Converting Enzyme Inhibitor-Treated Patients with Congestive Heart Failure: A Retrospective Cohort Study. PLoS One 2015; 10:e0144195. [PMID: 26633885 PMCID: PMC4669156 DOI: 10.1371/journal.pone.0144195] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/13/2015] [Indexed: 12/20/2022] Open
Abstract
Background Evidence for pharmacogenetic risk stratification of angiotensin-converting enzyme inhibitor (ACEI) treatment is limited. Therefore, in a cohort of ACEI-treated patients with congestive heart failure (CHF), we investigated the predictive value of two pharmacogenetic scores that previously were found to predict ACEI efficacy in patients with ischemic heart disease and hypertension, respectively. Score A combined single nucleotide polymorphisms (SNPs) of the angiotensin II receptor type 1 gene (rs275651 and rs5182) and the bradykinin receptor B1 gene (rs12050217). Score B combined SNPs of the angiotensin-converting enzyme gene (rs4343) and ABO blood group genes (rs495828 and rs8176746). Methods Danish patients with CHF enrolled in the previously reported Echocardiography and Heart Outcome Study were included. Subjects were genotyped and categorized according to pharmacogenetic scores A and B of ≤1, 2 and ≥3 each, and followed for up to 10 years. Difference in cumulative incidences of cardiovascular death and all-cause death were assessed by the cumulative incidence estimator. Survival was modeled by Cox proportional hazard analyses. Results We included 667 patients, of whom 80% were treated with ACEIs. Differences in cumulative incidences of cardiovascular death (P = 0.346 and P = 0.486) and all-cause death (P = 0.515 and P = 0.486) were not significant for score A and B, respectively. There was no difference in risk of cardiovascular death or all-cause death between subjects with score A ≤1 vs. 2 (HR 1.03 [95% CI 0.79–1.34] and HR 1.11 [95% CI 0.88–1.42]), score A ≤1 vs. ≥3 (HR 0.80 [95% CI 0.59–1.08] and HR 0.91 [95% CI 0.70–1.20]), score B ≤1 vs. 2 (HR 1.02 [95% CI 0.78–1.32] and HR 0.98 [95% CI 0.77–1.24]), and score B ≤1 vs. ≥3 (HR 1.03 [95% CI 0.75–1.41] and HR 1.05 [95% CI 0.79–1.40]), respectively. Conclusions We found no association between either of the analyzed pharmacogenetic scores and fatal outcomes in ACEI-treated patients with CHF.
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Affiliation(s)
| | - Majbritt Busk Madsen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | | | - Lars Køber
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Egfjord
- Department of Nephrology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Berg Rasmussen
- Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - Peter Riis Hansen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
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