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Korshunov VA, Quinn B, Faiyaz A, Ahmed R, Sowden MP, Doyley MM, Berk BC. Strain-selective efficacy of sacubitril/valsartan on carotid fibrosis in response to injury in two inbred mouse strains. Br J Pharmacol 2019; 176:2795-2807. [PMID: 31077344 DOI: 10.1111/bph.14708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Sacubitril/valsartan (Sac/val) is more effective than valsartan in lowering BP and mortality in patients with heart failure. Here, we proposed that Sac/val treatment would be more effective in preventing pathological vascular remodelling in 129X1/SvJ (129X1), than in C57BL/6J (B6) inbred mice. EXPERIMENTAL APPROACH Sac/val (60 mg·kg-1 ·day-1 ) and valsartan (27 mg·kg-1 ·day-1 ) were given as prophylactic or therapeutic treatments, to 129X1 or B6 mice with carotid artery ligation for 14 days. Blood flow was measured by ultrasound. Ex vivo, carotid tissue was analysed with histological and morphometric techniques, together with RNA sequencing and gene ontology. KEY RESULTS Sac/val was more effective than valsartan in lowering BP in 129X1 compared with B6 mice. Liver expression of CYP2C9 and plasma cGMP levels were similar across treatments. A reduction in carotid thickening after prophylactic treatment with valsartan or Sac/val also resulted in significant arterial shrinkage in B6 mice. In 129X1 mice, Sac/val and prophylactic treatment with valsartan had no effect on carotid thickening but preserved carotid size. BP lowering significantly correlated with a decline in carotid stiffness (R2 = .37, P = .0096) in 129X1 but not in B6 mice. The gene expression signature associated with hyalurononglucosaminidase activity was down-regulated in injured arteries after both regimens of Sac/val only in 129X1 mice. Administration of Sac/val but not valsartan significantly reduced deposition of hyaluronic acid and carotid fibrosis in 129X1 mice. CONCLUSION AND IMPLICATIONS These results underscore the importance of the genetic background in the efficacy of the Sac/val on vascular fibrosis.
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Affiliation(s)
- Vyacheslav A Korshunov
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester, Rochester, New York
| | - Breandan Quinn
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester, Rochester, New York
| | - Abrar Faiyaz
- Department of Electrical and Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York
| | - Rifat Ahmed
- Department of Electrical and Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York
| | - Mark P Sowden
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester, Rochester, New York
| | - Marvin M Doyley
- Department of Electrical and Computer Engineering, Hajim School of Engineering and Applied Sciences, University of Rochester, Rochester, New York
| | - Bradford C Berk
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester, Rochester, New York.,Neurorestoration Institute, University of Rochester, Rochester, New York
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Ohtori S, Yamashita M, Murata Y, Eguchi Y, Aoki Y, Ataka H, Hirayama J, Ozawa T, Morinaga T, Arai H, Mimura M, Kamoda H, Orita S, Miyagi M, Miyashita T, Okamoto Y, Ishikawa T, Sameda H, Kinoshita T, Hanaoka E, Suzuki M, Suzuki M, Aihara T, Ito T, Inoue G, Yamagata M, Toyone T, Kubota G, Sakuma Y, Oikawa Y, Inage K, Sainoh T, Yamauchi K, Takahashi K. Conservative and surgical treatment improves pain and ankle-brachial index in patients with lumbar spinal stenosis. Yonsei Med J 2013; 54:999-1005. [PMID: 23709437 PMCID: PMC3663234 DOI: 10.3349/ymj.2013.54.4.999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI. MATERIALS AND METHODS One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment. RESULTS Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05). CONCLUSION This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.
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Affiliation(s)
- Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Bokuda K, Ichihara A, Sakoda M, Mito A, Kinouchi K, Itoh H. Blood pressure-independent effect of candesartan on cardio-ankle vascular index in hypertensive patients with metabolic syndrome. Vasc Health Risk Manag 2010; 6:571-8. [PMID: 20730073 PMCID: PMC2922318 DOI: 10.2147/vhrm.s11958] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Indexed: 01/15/2023] Open
Abstract
Angiotensin receptor blockers (ARBs) are known to reduce the cardiovascular risk in hypertensive patients. This study was designed to examine the effect of an ARB candesartan on subclinical atherosclerosis assessed by cardio-ankle vascular index (CAVI) in comparison with calcium channel blockers (CCBs) alone in hypertensive patients with metabolic syndrome (MetS). A total of 53 consecutive hypertensive patients with MetS were randomly assigned to the candesartan group, in which candesartan was added on, or the CCBs group, in which CCBs were added on. Clinical and biological parameters were obtained before and after the 12-month treatment period. The primary measure of efficacy was the %change in CAVI. When treated with candesartan, but not CCBs, CAVI significantly decreased from 8.7 to 7.7 by 11%. Blood pressure (BP) significantly decreased with both treatments, but the differences between groups were not significant. The changes in other parameters remained unchanged in both the groups. Analysis of covariance found that both the BP reduction and the therapy difference contributed to the decrease in CAVI, but the BP reduction was not involved in the decrease in CAVI caused by the difference in the therapy. Candesartan may be a better antihypertensive drug than CCBs to improve subclinical atherosclerosis of patients with MetS.
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Affiliation(s)
- Kanako Bokuda
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Zankl AR, Ivandic B, Andrassy M, Volz HC, Krumsdorf U, Blessing E, Katus HA, Tiefenbacher CP. Telmisartan improves absolute walking distance and endothelial function in patients with peripheral artery disease. Clin Res Cardiol 2010; 99:787-94. [DOI: 10.1007/s00392-010-0184-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 06/17/2010] [Indexed: 11/27/2022]
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Sengstock D, Sands RL, Gillespie BW, Zhang X, Kiser M, Eisele G, Vaitkevicius P, Kuhlmann M, Levin NW, Hinderliter A, Rajagopalan S, Saran R. Dominance of traditional cardiovascular risk factors over renal function in predicting arterial stiffness in subjects with chronic kidney disease. Nephrol Dial Transplant 2009; 25:853-61. [DOI: 10.1093/ndt/gfp559] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fang W, Yang X, Bargman JM, Oreopoulos DG. Association between Pulse Pressure and Mortality in Patients Undergoing Peritoneal Dialysis. Perit Dial Int 2008. [DOI: 10.1177/089686080902900210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Pulse pressure has been shown to be associated with adverse outcomes in the general population and in patients on hemodialysis (HD). However, the significance of pulse pressure has not been studied in peritoneal dialysis (PD) patients. This study examined the association between pulse pressure and mortality in patients undergoing chronic PD. Methods All patients aged 18 years or older that commenced PD between 1 January 2000 and 31 December 2005 at the University Health Network, Toronto, were included. The association between pulse pressure and mortality was assessed using the Cox proportional hazards model. Results A total of 306 patients were included in the study. Mean pulse pressure of the study cohort was 56.8 ± 17.8 mmHg. Age and diabetes were significant predictors of elevated pulse pressure ( p < 0.001). After adjusting for the level of systolic blood pressure and other demographic and clinical parameters, multivariable Cox proportional hazards modeling showed a direct and consistent association between pulse pressure and death risk. Each increment of 1 mmHg in pulse pressure was associated with a 2.7% increased hazard of all-cause death [95% confidence interval (CI) 1.001 – 1.054, p = 0.039] and a 4.1% increase in risk for cardiovascular mortality (hazard ratio 1.041, 95% CI 1.003 – 1.081; p = 0.035). Conclusion Elevated pulse pressure is associated with an increased risk of all-cause and cardiovascular death in patients on PD. Recognition of this characteristic as an important predictor of mortality suggests that one goal of antihypertensive therapy in PD patients should be to decrease elevated pulse pressure.
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Affiliation(s)
- Wei Fang
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xiao Yang
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Department of Nephrology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Joanne M. Bargman
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Dimitrios G. Oreopoulos
- Peritoneal Dialysis Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
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NTAIOS G, SAVOPOULOS C, HATZITOLIOS A. Telmisartan and Carotid Intima-Media Thickness Regression: A Class Effect of Angiotensin-Receptor Blockers? Hypertens Res 2008; 31:2187-8, author reply 2188. [DOI: 10.1291/hypres.31.2187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Komiya N, Hirose H, Saisho Y, Saito I, Itoh H. Effects of 12-Month Valsartan Therapy on Glycation and Oxidative Stress Markers in Type 2 Diabetic Subjects With Hypertension. Int Heart J 2008; 49:681-9. [DOI: 10.1536/ihj.49.681] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Naoko Komiya
- Department of Internal Medicine, Keio University School of Medicine
| | - Hiroshi Hirose
- Department of Internal Medicine, Keio University School of Medicine
- Health Center, Keio University School of Medicine
| | - Yoshifumi Saisho
- Department of Internal Medicine, Keio University School of Medicine
| | - Ikuo Saito
- Department of Internal Medicine, Keio University School of Medicine
- Health Center, Keio University School of Medicine
| | - Hiroshi Itoh
- Department of Internal Medicine, Keio University School of Medicine
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Kaneshiro Y, Ichihara A, Sakoda M, Kurauchi A, Takemitsu T, Itoh H. Cilnidipine and Telmisartan Similarly Improves Vascular Damage in Hypertensive Patients. Clin Med Cardiol 2007. [DOI: 10.4137/cmc.s353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study was designed to compare the effects of 12-month blood pressure (BP) control using cilnidipine and telmisartan on vascular damage in untreated hypertensive patients. One hundred patients were randomly assigned to either a cilnidipine group or a telmisartan group. The extent of vascular damage was assessed before and after treatment by measuring urinary albumin excretion (UAE), pulse wave velocity (PWV), and intima-media thickness (IMT) of the carotid arteries in each patient. Both drugs similarly decreased BP without altering plasma markers for oxidative stress or inflammation. Both UAE and PWV were significantly improved in both groups, but IMT was significantly reduced only in the cilnidipine group. Multiple regression analyses suggested that the UAE may have decreased as a result of a reduction in intraglomerular pressure caused by telmisartan or by efferent arteriolar dilation caused by cilnidipine. In addition, the PWV may have decreased as a result of the improvement in lipid metabolism caused by telmisartan or the reduction in plasma levels of aldosterone caused by cilnidipine. However, the analyses could not identify any definitive causal relationships or suggest the mechanism responsible for the improvement in IMT caused by cilnidipine. Thus, telmisartan and cilnidipine have unique properties for inhibiting vascular complications.
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Affiliation(s)
- Yuki Kaneshiro
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Atsuhiro Ichihara
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Mariyo Sakoda
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Asako Kurauchi
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tomoko Takemitsu
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Hiroshi Itoh
- Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
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Agarwal R. Antihypertensive agents and arterial stiffness: relevance to reducing cardiovascular risk in the chronic kidney disease patient. Curr Opin Nephrol Hypertens 2007; 16:409-15. [PMID: 17693754 DOI: 10.1097/mnh.0b013e3282063b86] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Arterial stiffness is a sign of diffuse adventitial macrovascular disease. The purpose of the present review is to discuss, in patients with chronic kidney disease, the pathophysiology of increased arterial stiffness, the role of antihypertensive therapy on reduction of arterial stiffness, and the clinical ways by which the prognostication of cardiovascular disease in patients with chronic kidney disease can be refined using arterial stiffness monitoring. RECENT FINDINGS Arterial stiffness is increased with increasing prevalence of traditional cardiovascular risk factors. In patients with chronic kidney disease some unique factors further increase the risk of arterial stiffness, and include volume overload, activation of the renin-angiotensin system, anemia, and dysregulated mineral metabolism. Arterial stiffness is increased even in patients with early-stage chronic kidney disease. Blood pressure reduction when accompanied by a reduction in arterial stiffness is associated with improved prognosis. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can preferentially improve arterial stiffness, which may be an additional mechanism of cardiovascular protection with these agents. SUMMARY The impact of improvement in arterial stiffness with antihypertensive agents on cardiovascular outcomes needs well designed clinical trials.
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Affiliation(s)
- Rajiv Agarwal
- Indiana University School of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA.
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Tinel H. Beneficial Effects of the Combination of Nifedipine and Losartan in Hypertensive Dahl Salt-Sensitive Rats. J Cardiovasc Pharmacol 2007; 50:75-82. [PMID: 17666919 DOI: 10.1097/fjc.0b013e318058820c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The antihypertensive and organ-protective effects of the combination of the angiotensin II type 1 receptor blocker losartan and the calcium channel blocker nifedipine were examined in Dahl salt-sensitive rats. METHODS The rats fed with a high-salt diet developed hypertension accompanied by aorta and heart hypertrophy, and impaired renal function. The animals were treated with losartan (30 mg/kg/day), nifedipine (7.8 mg/kg/day) or with a combination of both drugs for 8 weeks. At the end of the study systolic blood pressure, kidney function, organ weight, and mRNA expression were investigated. RESULTS Losartan reduced significantly the systolic blood pressure as well as the aorta and left ventricular hypertrophy. Nifedipine and its combination with losartan had similar effects on the systolic blood pressure, aorta and left ventricular hypertrophy but only the combination treatment reduced the expression of transforming growth factor-beta1 in aorta and brain natriuretic peptide in left ventricle significantly. Nifedipine and the combination therapy reduced proteinuria and improved urine creatinine excretion. The expression of collagen III and IV in the kidney was significantly reduced by the combination therapy. CONCLUSION These results indicate that although losartan and nifedipine were effective in lowering blood pressure and showed moderate organ protection, additional benefits can be expected by combination therapy with both compounds.
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Affiliation(s)
- Hanna Tinel
- Product Related Research, Pharmacology, Pharma R&D Discovery Research, Bayer HealthCare AG, Wuppertal, Germany.
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