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Bermúdez-Oria A, Rubio-Senent F, Rodríguez-Gutiérrez G, Fernández-Bolaños J. Antioxidant activity and inhibitory effects on angiotensin I-converting enzyme and α-glucosidase of trans-p-coumaroyl-secologanoside (comselogoside) and its inclusion complex with β-cyclodextrin. Bioaccessibility during simulated in vitro gastrointestinal digestion. Food Chem 2024; 460:140724. [PMID: 39121769 DOI: 10.1016/j.foodchem.2024.140724] [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: 05/29/2024] [Revised: 07/16/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
This study explored the impact of complexing comselogoside (COM) with β-cyclodextrin (β-CD) on antioxidant capacity and investigated its in vitro inhibitory effects against α-glucosidase and angiotensin I-converting enzyme (ACE). The COM: β-CD complex in three molar ratios (1:2, 1:1, and 2:1) showed significantly higher antioxidant activity compared to free COM, assessed by DPPH and ferric reducing power assays. COM exhibited weak to moderate α-glucosidase inhibition (IC50 1221 μM) and notable ACE inhibition (IC50 119.4 μM). Encapsulation improved ACE inhibition notably for the 1:2 and 2:1 M ratios. The cleavage of secoiridoid moiety of COM by β-glucosidase further enhanced ACE inhibition from IC50 of 63.91 to 41.75 μg/mL in the hydrolysed mixture. In vitro gastrointestinal digestion revealed 34-40% bioaccessibility of COM and its β-CD complex. This study demonstrates the potential of encapsulated COM as a functional food or supplement for preventing and treating diabetes, hypertension, and oxidative stress-related diseases.
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Affiliation(s)
- Alejandra Bermúdez-Oria
- Department of Food Phytochemistry, Instituto de la Grasa (Spanish National Research Council, CSIC), Ctra. de Utrera km. 1, Pablo de Olavide University Campus, Building 46, 41013 Seville, Spain
| | - Fátima Rubio-Senent
- Department of Food Phytochemistry, Instituto de la Grasa (Spanish National Research Council, CSIC), Ctra. de Utrera km. 1, Pablo de Olavide University Campus, Building 46, 41013 Seville, Spain
| | - Guillermo Rodríguez-Gutiérrez
- Department of Food Phytochemistry, Instituto de la Grasa (Spanish National Research Council, CSIC), Ctra. de Utrera km. 1, Pablo de Olavide University Campus, Building 46, 41013 Seville, Spain
| | - Juan Fernández-Bolaños
- Department of Food Phytochemistry, Instituto de la Grasa (Spanish National Research Council, CSIC), Ctra. de Utrera km. 1, Pablo de Olavide University Campus, Building 46, 41013 Seville, Spain.
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Bansal S, Boucher R, Shen J, Wei G, Chertow GM, Whelton PK, Cushman WC, Cheung AK, Beddhu S. Role of Diuretics in Cardiovascular Events and Mortality in Systolic Blood Pressure Intervention Trial: A Post Hoc Analysis. Clin J Am Soc Nephrol 2024; 19:620-627. [PMID: 38262377 PMCID: PMC11108241 DOI: 10.2215/cjn.0000000000000406] [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: 06/17/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND In a post hoc analysis, we examined whether postrandomization diuretics use can explain and/or mediate the beneficial effects of intensive systolic BP lowering on cardiovascular disease and all-cause mortality in the Systolic Blood Pressure Intervention Trial (SPRINT). METHODS SPRINT was a randomized, controlled trial of 9361 participants comparing the effects of intensive (systolic BP target <120 mm Hg) versus standard (systolic BP target <140 mm Hg) BP control on a primary composite cardiovascular end point in participants aged 50 years or older with systolic BP of 130-180 mm Hg. In time-varying multivariable Cox analyses, we assessed hazard ratios (HRs) of cardiovascular end points and all-cause mortality in participants on thiazide type, loop and/or potassium (K) sparing, or no diuretics. We also conducted mediation analysis to formally assess the role of diuretics in the effects of intensive systolic BP lowering. RESULTS At baseline, diuretics were prescribed in 46% and 48% of participants in standard and intensive systolic BP-lowering groups, respectively, and in 46% and 74% in the corresponding groups during the trial. The lower risk of cardiovascular end points in the intensive group (HR, 0.75; 95% confidence interval [CI], 0.64 to 0.89) persisted after adjustment for postrandomization time-varying diuretics use (HR, 0.74; 95% CI, 0.62 to 0.89). Across the entire study population, time-varying diuretics use was not associated with cardiovascular end points (compared with no diuretics, HR for thiazide type, 0.89; 95% CI, 0.73 to 1.10, and loop/K sparing, 1.29; 95% CI, 0.97 to 1.73). However, thiazide-type diuretics were associated with lower risk of cardiovascular end points in the intensive (HR, 0.62; 95% CI, 0.46 to 0.85) but not in the standard (HR, 1.07; 95% CI, 0.82 to 1.39) group. In mediation analysis, HRs for total effect, direct effect (not mediated through diuretics use), and indirect effect (mediated through diuretics) of the intervention on cardiovascular end points were 0.66 (95% CI, 0.54 to 0.79), 0.67 (95% CI, 0.54 to 0.81), and 0.98 (95% CI, 0.88 to 1.10), respectively. The results were largely similar for all-cause mortality. CONCLUSIONS The favorable effects of intensive systolic BP lowering on cardiovascular end points and all-cause mortality in SPRINT were independent of and not mediated by time-varying diuretics use. However, thiazide-type diuretics use associated with benefit if intensive systolic BP lowering was targeted.
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Affiliation(s)
- Shweta Bansal
- Division of Nephrology, University of Texas Health San Antonio, San Antonio, Texas
| | - Robert Boucher
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Jincheng Shen
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Guo Wei
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - William C. Cushman
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah
- Renal Section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
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Gordon Perue G, Ying H, Bustillo A, Zhou L, Gutierrez CM, Gardener HE, Krigman J, Jameson A, Dong C, Rundek T, Rose DZ, Romano JG, Alkhachroum A, Sacco RL, Asdaghi N, Koch S. Ten-Year Review of Antihypertensive Prescribing Practices After Stroke and the Associated Disparities From the Florida Stroke Registry. J Am Heart Assoc 2023; 12:e030272. [PMID: 37982263 PMCID: PMC10727272 DOI: 10.1161/jaha.123.030272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/29/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Guideline-based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP-guideline adherence). METHODS AND RESULTS The FSR (Florida Stroke Registry) uses statewide data prospectively collected for all acute stroke admissions. Based on established guidelines, we defined optimal BP-guideline adherence using the following hierarchy of rules: (1) use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker as first-line antihypertensive among diabetics; (2) use of thiazide-type diuretics or calcium channel blockers among Black patients; (3) use of beta blockers among patients with compelling cardiac indication; (4) use of thiazide, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, or calcium channel blocker class as first line in all others; (5) beta blockers should be avoided as first line unless there is a compelling cardiac indication. A total of 372 254 cases from January 2010 to March 2020 are in the FSR with a diagnosis of acute ischemic stroke, hemorrhagic stroke, transient ischemic attack, or subarachnoid hemorrhage; 265 409 with complete data were included in the final analysis. Mean age was 70±14 years; 50% were women; and index stroke subtypes were 74% acute ischemic stroke, 11% intracerebral hemorrhage, 11% transient ischemic attack, and 4% subarachnoid hemorrhage. BP-guideline adherence to each specific rule ranged from 48% to 74%, which is below quality standards of 80%, and was lower among Black patients (odds ratio, 0.7 [95% CI, 0.7-0.83]; P<0.001) and those with atrial fibrillation (odds ratio, 0.53 [95% CI, 0.50-0.56]; P<0.001) and diabetes (odds ratio, 0.65 [95% CI, 0.61-0.68]; P<0.001). CONCLUSIONS This large data set demonstrates consistently low rates of BP-guideline adherence over 10 years. There is an opportunity for monitoring hypertensive management after stroke.
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Affiliation(s)
- Gillian Gordon Perue
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Hao Ying
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Antonio Bustillo
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Lili Zhou
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Carolina M. Gutierrez
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Hannah E. Gardener
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Judith Krigman
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Angus Jameson
- University of South Florida Morsani College of MedicineTampaFL
| | - Chuanhui Dong
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Tatjana Rundek
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - David Z. Rose
- University of South Florida Morsani College of MedicineTampaFL
| | - Jose G. Romano
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Ayham Alkhachroum
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Ralph L. Sacco
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Negar Asdaghi
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
| | - Sebastian Koch
- Department of Neurology, Leonard M. Miller School of MedicineUniversity of MiamiMiamiFL
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Perue GG, Ying H, Bustillo A, Zhou L, Gutierrez CM, Wang K, Gardener HE, Krigman J, Jameson A, Foster D, Dong C, Rundek T, Rose DZ, Romano JG, Alkhachroum A, Sacco RL, Asdaghi N, Koch S. A 10-year review of antihypertensive prescribing practices after stroke and the associated disparities from the Florida Stroke Registry. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.15.23286003. [PMID: 36824806 PMCID: PMC9949203 DOI: 10.1101/2023.02.15.23286003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background Guideline based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescribers' blood pressure medication choice adheres to clinical practice guidelines (Prescribers'-Choice Adherence). Methods The Florida Stroke registry (FSR) utilizes statewide data prospectively collected for all acute stroke admissions. Based on established guidelines we defined optimal Prescribers'-Choice Adherence using the following hierarchy of rules: 1) use of an angiotensin inhibitor (ACEI) or angiotensin receptor blocker (ARB) as first-line antihypertensive among diabetics; 2) use of thiazide-type diuretics or calcium channel blockers (CCB) among African-American patients; 3) use of beta-adrenergic blockers (BB) among patients with compelling cardiac indication (CCI) 4) use of thiazide, ACEI/ARB or CCB class as first-line in all others; 5) BB should be avoided as first line unless CCI. RESULTS A total of 372,254 cases from January 2010 to March 2020 are in FSR with a diagnosis of acute ischemic, hemorrhagic stroke, transient ischemic attack or subarachnoid hemorrhage; 265,409 with complete data were included in the final analysis. Mean age 70 +/-14 years, 50% female, index stroke subtype of 74% acute ischemic stroke and 11% intracerebral hemorrhage. Prescribers'-Choice Adherence to each specific rule ranged from 48-74% which is below quality standards of 85%. There were race-ethnic disparities with only 49% Prescribers choice Adherence for African Americans patients. Conclusion This large dataset demonstrates consistently low rates of Prescribers'-Choice Adherence over 10 years. There is an opportunity for quality improvement in hypertensive management after stroke.
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Affiliation(s)
- Gillian Gordon Perue
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Hao Ying
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Antonio Bustillo
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Lili Zhou
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Carolina M. Gutierrez
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Kefeng Wang
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Hannah E Gardener
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Judith Krigman
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Angus Jameson
- University of South Florida Morsani College of Medicine, Tampa FL
| | | | - Chuanhui Dong
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Tatjana Rundek
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - David Z Rose
- University of South Florida Morsani College of Medicine, Tampa FL
| | - Jose G. Romano
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Ayham Alkhachroum
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Ralph L. Sacco
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Negar Asdaghi
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
| | - Sebastian Koch
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, FL
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Panchawagh S, Karandikar Y, Pujari S. Antihypertensive therapy is associated with improved visuospatial, executive, attention, abstraction, memory, and recall scores on the montreal cognitive assessment in geriatric hypertensive patients. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 4:100165. [PMID: 37131908 PMCID: PMC10149192 DOI: 10.1016/j.cccb.2023.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
Background The prevalence of Mild Cognitive Impairment (MCI) has increased over the past few decades. However, it can potentially be reversed if detected early. Early detection of MCI using the sensitive Montreal Cognitive Assessment (MoCA) might prove to be an important cog in the wheel in identifying and slowing down this morbid pandemic in hypertensive persons. Objectives To study the association of antihypertensive agents on cognitive scores and prevalence of MCI using the MoCA. Materials and methods This is a single-center, controlled, observational, cross-sectional study in a tertiary care teaching hospital in India. Cognitive assessment was done using the Montreal Cognitive Assessment. Data on MoCA scores were comprehensively analyzed. Results A total of N = 210 patients (n = 105 the in study and control groups) were included in the study. The median (IQR) MoCA score (out of 30 points) in patients taking antihypertensives was 26 (25 - 27), while it was 24 (22 - 25) in the control group. There was no difference in MoCA scores between patients taking lipophilic or hydrophilic antihypertensives. Similarly, there was no difference in MoCA scores between patients taking different drug regimens. Conclusion Anti-hypertensive therapy and lower blood pressure had a statistically significant positive association with visuospatial, executive, attention, abstraction, memory, and recall MoCA scores. Patients on antihypertensive therapy also had a lower prevalence of MCI. MoCA scores were similar in patients on either lipophilic or hydrophilic drugs and were similar between patients on different antihypertensive drug classes.
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Affiliation(s)
- Suhrud Panchawagh
- Department of Medicine, Smt. Kashibai Navale Medical College & General Hospital, Pune, India
| | - Yogita Karandikar
- Department of Pharmacology, Smt. Kashibai Navale Medical College & General Hospital, Pune, India
| | - Shripad Pujari
- Department of Neurology, Deenanath Mangeshkar Hospital, Pune, India
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Lauder L, Mahfoud F, Azizi M, Bhatt DL, Ewen S, Kario K, Parati G, Rossignol P, Schlaich MP, Teo KK, Townsend RR, Tsioufis C, Weber MA, Weber T, Böhm M. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J 2022:6808663. [DOI: 10.1093/eurheartj/ehac395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 diabetes, obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing hypertension with CV comorbidities.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Michel Azizi
- Université Paris Cité, INSERM CIC1418 , F-75015 Paris , France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, DMU CARTE , F-75015 Paris , France
- FCRIN INI-CRCT , Nancy , France
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School , Boston, MA , USA
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Tochigi , Japan
| | - Gianfranco Parati
- Department of Medicine and Surgery, Cardiology Unit, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS , Milan , Italy
| | - Patrick Rossignol
- FCRIN INI-CRCT , Nancy , France
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques - Plurithématique 14-33 and INSERM U1116 , Nancy , France
- CHRU de Nancy , Nancy , France
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School—Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia , Perth, WA , Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital , Perth, WA , Australia
| | - Koon K Teo
- Population Health Research Institute, McMaster University , Hamilton, ON , Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Costas Tsioufis
- National and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital , Athens , Greece
| | | | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen , Wels , Austria
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
- Cape Heart Institute (CHI), Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa
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Ernst ME, Fravel MA. Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. Am J Hypertens 2022; 35:573-586. [PMID: 35404993 DOI: 10.1093/ajh/hpac048] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/27/2023] Open
Abstract
The term thiazide is universally understood to refer to diuretics that exert their principal action in the distal tubule. The thiazide class is heterogenous and can be further subdivided into compounds containing the benzothiadiazine ring structure-the thiazide-type (e.g., hydrochlorothiazide)-and those lacking the benzothiadiazine ring-the thiazide-like (e.g., chlorthalidone and indapamide) drugs. Thiazide-like agents are longer acting and constitute the diuretics used in most of the cardiovascular outcome trials that established benefits of treatment with diuretics, but pragmatic aspects, such as lack of availability in convenient formulations, limit their use. Regardless of class heterogeneity, thiazides have retained importance in the management of hypertension for over 60 years. They are reliably effective as monotherapy in a majority of hypertensive patients, and augment the efficacy of other classes of antihypertensives when used in combination. Importantly, a thiazide-based treatment regimen lowers cardiovascular events, and their sturdy effect reinforces their place among the recommended first-line agents to treat hypertension in major domestic and international hypertension guidelines. There are few head-to-head comparisons within the class, but potential differences have been explored indirectly as well as in non-blood pressure mechanisms and potential pleiotropic properties. Until proven otherwise, the importance of these differences remains speculative, and clinicians should assume that cardiovascular events will be lowered similarly across agents when equivalent blood pressure reduction occurs. Thiazides remain underutilized, with only about one-third of hypertensive patients receiving them. For many patients, however, a thiazide is an indispensable component of their regimen to achieve adequate blood pressure control.
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Affiliation(s)
- Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA.,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
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