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Brewster LM, van Montfrans GA, Oehlers GP, Seedat YK. Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity. Intern Emerg Med 2016; 11:355-74. [PMID: 27026378 PMCID: PMC4820501 DOI: 10.1007/s11739-016-1422-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/22/2016] [Indexed: 02/06/2023]
Abstract
Despite the large differences in the epidemiology of hypertension across Europe, treatment strategies are similar for national populations of white European descent. However, hypertensive patients of African or South Asian ethnicity may require ethnic-specific approaches, as these population subgroups tend to have higher blood pressure at an earlier age that is more difficult to control, a higher occurrence of diabetes, and more target organ damage with earlier cardiovascular mortality. Therefore, we systematically reviewed the evidence on antihypertensive drug treatment in South Asian and African ethnicity patients. We used the Cochrane systematic review methodology to retrieve trials in electronic databases including CENTRAL, PubMed, and Embase from their inception through November 2015; and with handsearch. We retrieved 4596 reports that yielded 35 trials with 7 classes of antihypertensive drugs in 25,540 African ethnicity patients. Aside from the well-known blood pressure efficacy of calcium channel blockers and diuretics, with lesser effect of ACE inhibitors and beta-blockers, nebivolol was not more effective than placebo in reducing systolic blood pressure levels. Trials with morbidity and mortality outcomes indicated that lisinopril and losartan-based therapy were associated with a greater incidence of stroke and sudden death. Furthermore, 1581 reports yielded 16 randomized controlled trials with blood pressure outcomes in 1719 South Asian hypertensive patients. In contrast with the studies in African ethnicity patients, there were no significant differences in blood pressure lowering efficacy between drugs, and no trials available with mortality outcomes. In conclusion, in patients of African ethnicity, treatment initiated with ACE inhibitor or angiotensin II receptor blocker monotherapy was associated with adverse cardiovascular outcomes. We found no evidence of different efficacy of antihypertensive drugs in South Asians, but there is a need for trials with morbidity and mortality outcomes. Screening for cardiovascular risk at a younger age, treating hypertension at lower thresholds, and new delivery models to find, treat and follow hypertensives in the community may help reduce the excess cardiovascular mortality in these high-risk groups.
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Affiliation(s)
- Lizzy M Brewster
- Department of Vascular Medicine, F4-222, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gert A van Montfrans
- Department of Vascular Medicine, F4-222, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Glenn P Oehlers
- Department of Cardiology, Academic Hospital of Paramaribo, Paramaribo, Suriname
| | - Yackoob K Seedat
- Nelson R Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu Natal, Private Bag. 7, Congella, 4013, Durban, South Africa
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El Hassar C, Merzouk H, Merzouk SA, Malti N, Meziane A, Narce M. Long-term use of angiotensin II receptor antagonists and calcium-channel antagonists in Algerian hypertensive patients: effects on metabolic and oxidative parameters. Free Radic Biol Med 2015; 79:147-53. [PMID: 25499852 DOI: 10.1016/j.freeradbiomed.2014.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/28/2014] [Accepted: 12/02/2014] [Indexed: 11/22/2022]
Abstract
The effects of calcium antagonists (amlodipine) and angiotensin II receptor antagonists (telmisartan) on lipid profile and oxidative markers were investigated in Algerian hypertensive patients. At the beginning and after 1 year of antihypertensive therapy, blood samples are collected for determination of biochemical parameters (glucose, cholesterol, triglycerides, urea, creatinine) and oxidative markers (malondialdehyde, carbonyl proteins, nitric oxide, superoxide anion, vitamin C, glutathione, catalase, superoxide dismutase). The results of this study indicate that telmisartan and amlodipine are effective antihypertensive agents in the treatment of hypertension because a significant reduction in systolic and diastolic blood pressure was observed in all hypertensive patients after 1 year of treatment. Our results show also that telmisartan and amlodipine treatments counteracted hypertension-dependent lipid abnormalities and oxidative stress. Telmisartan treatment appears to be more efficient than amlodipine treatment. In addition, telmisartan, which reversed all lipid and redox changes associated with hypertension, should be prescribed, especially in hypertensive patients with hypertriglyceridemia and with severe oxidative stress.
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Affiliation(s)
- Chafika El Hassar
- Laboratory of Physiology, Physiopathology, and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe
| | - Hafida Merzouk
- Laboratory of Physiology, Physiopathology, and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe.
| | - Sid Ahmed Merzouk
- Department of Technical Sciences, Faculty of Engineering, University Abou-Bekr Belkaïd, Tlemcen 13000, Algeria
| | - Nassima Malti
- Laboratory of Physiology, Physiopathology, and Biochemistry of Nutrition, Department of Biology, Faculty of Natural and Life Sciences, Earth and Universe
| | - Abderrahim Meziane
- Cardiology Department, Tlemcen University Hospital Center, Tlemcen 13000, Algeria
| | - Michel Narce
- INSERM UMR 866, "Lipids Nutrition Cancer," Faculty of Life, Earth, and Environment Sciences, University of Burgundy, Dijon 21000, France
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Karnes JH, Gong Y, Arwood MJ, Gums JG, Hall KL, Limacher MC, Johnson JA, Cooper-DeHoff RM. Alteration in fasting glucose after prolonged treatment with a thiazide diuretic. Diabetes Res Clin Pract 2014; 104:363-9. [PMID: 24794890 PMCID: PMC4074403 DOI: 10.1016/j.diabres.2014.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 03/28/2014] [Accepted: 04/02/2014] [Indexed: 12/30/2022]
Abstract
AIMS Thiazide diuretics are recommended as first line antihypertensive treatment, but may contribute to new onset diabetes. We aimed to describe change in fasting glucose (FG) during prolonged thiazide treatment in an observational setting. METHODS We conducted an observational, non-randomized, open label, follow-up study of the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) and PEAR-2 studies. We enrolled previous participants from the PEAR or PEAR-2 studies with at least 6 months of continuous treatment with either hydrochlorothiazide (HCTZ) or chlorthalidone. Linear regression was used to identify associations with changes in FG after prolonged thiazide and thiazide-like diuretic treatment. RESULTS A total of 40 participants were included with a mean 29 (range 8-72) months of thiazide treatment. FG increased 6.5 (SD 13.0) mg/dL during short-term thiazide treatment and 3.6 (SD 15.3) mg/dL FG during prolonged thiazide treatment. Increased FG at follow-up was associated with longer thiazide treatment duration (β=0.34, p=0.008) and lower baseline FG (β=-0.46, p=0.02). β blocker treatment in combination with prolonged thiazide diuretic treatment was also associated with increased FG and increased 2-h glucose obtained from OGTT. CONCLUSIONS Our results indicate that prolonged thiazide treatment duration is associated with increased FG and that overall glycemic status worsens when thiazide/thiazide-like diuretics are combined with β blockers.
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Affiliation(s)
- Jason H Karnes
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Yan Gong
- University of Florida College of Pharmacy, Gainesville, FL, United States
| | - Meghan J Arwood
- University of Florida College of Pharmacy, Gainesville, FL, United States
| | - John G Gums
- University of Florida College of Pharmacy, Gainesville, FL, United States; University of Florida College of Medicine, Gainesville, FL, United States
| | - Karen L Hall
- University of Florida College of Medicine, Gainesville, FL, United States
| | - Marian C Limacher
- University of Florida College of Medicine, Gainesville, FL, United States
| | - Julie A Johnson
- University of Florida College of Pharmacy, Gainesville, FL, United States; University of Florida College of Medicine, Gainesville, FL, United States
| | - Rhonda M Cooper-DeHoff
- University of Florida College of Pharmacy, Gainesville, FL, United States; University of Florida College of Medicine, Gainesville, FL, United States.
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Arslan Z, Ay SA, Karaman M, Cakar M, Celik T, Balta S, Akhan M, Sarlak H, Arslan E, Demirbas S, Demirkol S, Bulucu F, Saglam K. An Additional LDL-Lowering Effect of Amlodipine; Not Only an Antihypertensive? Clin Exp Hypertens 2012. [PMID: 23198737 DOI: 10.3109/10641963.2012.746355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Zekeriya Arslan
- Department of Cardiology, Gelibolu Hospital , Canakkale , Turkey
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Park H, Kim K. Association of alcohol consumption with lipid profile in hypertensive men. Alcohol Alcohol 2012; 47:282-7. [PMID: 22371847 DOI: 10.1093/alcalc/ags019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Alcohol consumption is known to be closely related with alterations in blood lipid levels as well as in blood pressure. The objective of this study was to evaluate the association between alcohol consumption and blood lipid levels in hypertensive men. METHODS A cross-sectional study involving participants (n = 2014) aged 20-69 years from the Korea National Health and Nutrition Examination Survey, 1998-2009. Demographic characteristics, dietary intake and medical history were obtained from the participants by questionnaire, and lipid levels were determined by analysis of blood samples. RESULTS After adjusting for demographic and dietary factors, alcohol consumption was negatively associated with risk of low high-density lipoprotein cholesterol [HDL-C; odds ratio (OR): 0.29, 95% confidence interval (CI): 0.22-0.40 in heavy (≥30 g/day) drinkers; P for trend <0.001], whereas the risk of high triglycerides increased with increasing alcohol consumption (OR: 2.04, 95% CI: 1.53-2.72 in heavy drinkers; P for trend <0.001). However, the OR of high non-HDL-C and the ratio of high triglycerides to HDL-C did not change significantly with an increase in alcohol consumption. CONCLUSION These data suggest that alcohol consumption differentially affected lipid measures according to the amount of alcohol intake in hypertensive men.
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Affiliation(s)
- Hyejin Park
- Department of Epidemiology and Health Promotion, Kyungpook National University, Daegu, Republic of Korea
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de Ciuceis C, Pilu A, Rizzoni D, Porteri E, Muiesan ML, Salvetti M, Paini A, Belotti E, Zani F, Boari GEM, Rosei CA, Rosei EA. Effect of antihypertensive treatment on circulating endothelial progenitor cells in patients with mild essential hypertension. Blood Press 2011; 20:77-83. [PMID: 21114380 DOI: 10.3109/08037051.2010.535973] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It has been reported that the number of circulating endothelial progenitor cells (EPCs) reflects the endogenous vascular repair ability, with the EPCs pool declining in the presence of cardiovascular risk factors. However, their relationship with hypertension and the effects of anti-hypertensive treatment remain unclear. We randomized 29 patients with mild essential hypertension to receive barnidipine up to 20 mg or hydrochlorothiazide (HCT) up to 25 mg. Circulating EPCs were isolated from peripheral blood at baseline and after 3 and 6 months of treatment. Mononuclear cells were cultured with endothelial basal medium supplemented with EGM SingleQuots. EPCs were identified by positive double staining for both FITC-labeled Ulex europaeus agglutinin I and Dil-labeled acethylated low-density lipoprotein. After 3 and 6 months of treatment, systolic and diastolic blood pressure (BP) were significantly reduced. No difference was observed between drugs. An increase in the number of EPCs was observed after 3 and 6 months of anti-hypertensive treatment (p < 0.05). Barnidipine significantly increased EPCs after 3 and 6 months of treatment, whereas no effect was observed with HCT. No statistically significant correlation was observed between EPCs and clinical BP values. Our data suggest that antihypertensive treatment may increase the number of EPCs. However, we observed a different effect of barnidipine and HCT on EPCs, suggesting that, beyond its BP lowering effect, barnidipine may elicit additional beneficial properties, related to a healthier vasculature.
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Affiliation(s)
- Carolina de Ciuceis
- Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Italy
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Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Dyslipidemia induced by drugs used for the prevention and treatment of vascular diseases. Open Cardiovasc Med J 2011; 5:85-9. [PMID: 21769302 PMCID: PMC3137137 DOI: 10.2174/1874192401105010085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/04/2011] [Accepted: 01/06/2011] [Indexed: 12/20/2022] Open
Abstract
Dyslipidemia is a major vascular risk factor. Interestingly, several agents used for the prevention and treatment of vascular diseases have an adverse effect on the lipid profile. In addition, agents belonging to the same class (e.g. beta blockers) can have significantly different actions on lipid levels. We summarize the effects of drugs used for the prevention and treatment of vascular diseases on the lipid profile. These effects should be considered when selecting a specific agent, particularly in high-risk patients.
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Affiliation(s)
- Konstantinos Tziomalos
- Department of Clinical Biochemistry (Vascular Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
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Simolin MA, Pedersen TX, Bro S, Mäyränpää MI, Helske S, Nielsen LB, Kovanen PT. ACE inhibition attenuates uremia-induced aortic valve thickening in a novel mouse model. BMC Cardiovasc Disord 2009; 9:10. [PMID: 19257900 PMCID: PMC2663538 DOI: 10.1186/1471-2261-9-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 03/03/2009] [Indexed: 12/02/2022] Open
Abstract
Background We examined whether impaired renal function causes thickening of the aortic valve leaflets in hyperlipidemic apoE-knockout (apoE-/-) mice, and whether the putative effect on the aortic valves could be prevented by inhibiting the angiotensin-converting enzyme (ACE) with enalapril. Methods Thickening of the aortic valve leaflets in apoE-/- mice was induced by producing mild or moderate chronic renal failure resulting from unilateral nephrectomy (1/2 NX, n = 18) or subtotal nephrectomy (5/6 NX, n = 22), respectively. Additionally, the 5/6 NX mice were randomized to no treatment (n = 8) or enalapril treatment (n = 13). The maximal thickness of each leaflet was measured from histological sections of the aortic roots. Results Leaflet thickness was significantly greater in the 5/6 NX mice than in the 1/2 NX mice (P = 0.030) or the unoperated mice (P = 0.003). The 5/6 NX mice treated with enalapril had significantly thinner leaflets than did the untreated 5/6 NX mice (P = 0.014). Conclusion Moderate uremia causes thickening of the aortic valves in apoE-/- mice, which can be attenuated by ACE inhibition. The nephrectomized apoE-/- mouse constitutes a new model for investigating the mechanisms of uremia-induced aortic valve disease, and also provides an opportunity to study its pharmacologic prevention.
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