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Epstein BJ, Anderson S. Endothelin receptor antagonists as antihypertensives: the next frontier. Expert Rev Cardiovasc Ther 2009; 7:675-87. [PMID: 19505283 DOI: 10.1586/erc.09.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The endothelin system is a pivotal player along the continuum of cardiovascular disease. There is convincing evidence that the system not only exerts a potent pressor effect but also promotes end-organ damage independent from blood pressure changes. The role of endothelin receptor antagonists (ERAs) in the treatment of hypertension is rapidly evolving. Recent studies demonstrate a formidable antihypertensive effect. Utility of ERAs is likely to be greatest in patients with resistant hypertension. Beyond blood pressure lowering, ERAs exert several properties that may confer additional protection, including effects on endothelial function, atherosclerosis, arterial stiffening, renal function and proteinuria. The full potential of this class will only be realized when the results of ongoing and future studies in hypertension, heart failure and other forms of cardiovascular disease are completed.
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Affiliation(s)
- Benjamin J Epstein
- Department of Pharmacotherapy and Translational Research, 101 S. Newell Drive, HPNP Building. 212, Room 3315, University of Florida, Gainesville, FL 32610-0486, USA.
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Dhaun N, Goddard J, Kohan DE, Pollock DM, Schiffrin EL, Webb DJ. Role of Endothelin-1 in Clinical Hypertension. Hypertension 2008; 52:452-9. [DOI: 10.1161/hypertensionaha.108.117366] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Neeraj Dhaun
- From the Clinical Pharmacology Unit (N.D., J.G., D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Division of Nephrology (D.E.K.), University of Utah, Salt Lake City; Vascular Biology Center (D.M.P.), Medical College of Georgia, Augusta; and Department of Medicine (E.L.S.), Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Jane Goddard
- From the Clinical Pharmacology Unit (N.D., J.G., D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Division of Nephrology (D.E.K.), University of Utah, Salt Lake City; Vascular Biology Center (D.M.P.), Medical College of Georgia, Augusta; and Department of Medicine (E.L.S.), Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Donald E. Kohan
- From the Clinical Pharmacology Unit (N.D., J.G., D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Division of Nephrology (D.E.K.), University of Utah, Salt Lake City; Vascular Biology Center (D.M.P.), Medical College of Georgia, Augusta; and Department of Medicine (E.L.S.), Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David M. Pollock
- From the Clinical Pharmacology Unit (N.D., J.G., D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Division of Nephrology (D.E.K.), University of Utah, Salt Lake City; Vascular Biology Center (D.M.P.), Medical College of Georgia, Augusta; and Department of Medicine (E.L.S.), Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Ernesto L. Schiffrin
- From the Clinical Pharmacology Unit (N.D., J.G., D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Division of Nephrology (D.E.K.), University of Utah, Salt Lake City; Vascular Biology Center (D.M.P.), Medical College of Georgia, Augusta; and Department of Medicine (E.L.S.), Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David J. Webb
- From the Clinical Pharmacology Unit (N.D., J.G., D.J.W.), University of Edinburgh, Queen’s Medical Research Institute, Edinburgh, United Kingdom; Division of Nephrology (D.E.K.), University of Utah, Salt Lake City; Vascular Biology Center (D.M.P.), Medical College of Georgia, Augusta; and Department of Medicine (E.L.S.), Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Dhaun N, Goddard J, Webb DJ. The endothelin system and its antagonism in chronic kidney disease. J Am Soc Nephrol 2006; 17:943-55. [PMID: 16540557 DOI: 10.1681/asn.2005121256] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The incidence of chronic kidney disease (CKD) is increasing worldwide. Cardiovascular disease (CVD) is strongly associated with CKD and constitutes one of its major causes of morbidity and mortality. Treatments that slow the progression of CKD and improve the cardiovascular risk profile of patients with CKD are needed. The endothelins (ET) are a family of related peptides, of which ET-1 is the most powerful endogenous vasoconstrictor and the predominant isoform in the cardiovascular and renal systems. The ET system has been widely implicated in both CVD and CKD. ET-1 contributes to the pathogenesis and maintenance of hypertension and arterial stiffness and more novel cardiovascular risk factors such as oxidative stress and inflammation. Through these, ET also contributes to endothelial dysfunction and atherosclerosis. By reversal of these effects, ET antagonists may reduce cardiovascular risk. In particular relation to the kidney, antagonism of the ET system may be of benefit in improving renal hemodynamics and reducing proteinuria. ET likely also is involved in progression of renal disease, and data are emerging to suggest a synergistic role for ET receptor antagonists with angiotensin-converting enzyme inhibitors in slowing CKD progression.
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Affiliation(s)
- Neeraj Dhaun
- The Queen's Medical Research Institute, 3rd Floor East, Room E3.23, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
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