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Wira CR, Kearns T, Fleming-Nouri A, Tyrrell JD, Wira CM, Aydin A. Considering Adverse Effects of Common Antihypertensive Medications in the ED. Curr Hypertens Rep 2024; 26:355-368. [PMID: 38687403 DOI: 10.1007/s11906-024-01304-5] [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] [Accepted: 02/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW To evaluate the adverse effects of common antihypertensive agents utilized or encountered in the Emergency Department. RECENT FINDINGS All categories of antihypertensive agents may manifest adverse effects, inclusive of adverse drug reactions (ADRs), drug-to-drug interactions, or accidental overdose. Adverse effects, and specifically ADRs, may be stratified into the organ systems affected, might require specific time-sensitive interventions, could pose particular risks to vulnerable populations, and may result in significant morbidity, and potential mortality. Adverse effects of common antihypertensive agents may be encountered in the ED, necessitating that ED systems of care are poised to prevent, recognize, and intervene when adverse effects arise.
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Affiliation(s)
- Charles R Wira
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA.
- Yale Acute Stroke Program, Section of Vascular Neurology, Department of Neurology, New Haven, CT, USA.
| | - Thomas Kearns
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - Alex Fleming-Nouri
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - John D Tyrrell
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Ani Aydin
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Section of Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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2
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Pham NYT, Owen JG, Singh N, Shaffi SK. The Use of Thiazide Diuretics for the Treatment of Hypertension in Patients With Advanced Chronic Kidney Disease. Cardiol Rev 2023; 31:99-107. [PMID: 34224450 DOI: 10.1097/crd.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of thiazide diuretics for the treatment of hypertension in patients with advance chronic kidney disease. Thiazides have been recommended as the first-line for the treatment of hypertension, yet their use has been discouraged in advanced chronic kidney disease (CKD), as they are suggested to be ineffective in advanced CKD. Recent data suggest that thiazide diuretics may be beneficial blood pressure control in addition to natriuresis in existing CKD. This review discusses the commercially available thiazides with a focus on thiazide pharmacology, most common adverse effects, clinical uses of thiazide diuretic, and the evidence for efficacy of thiazide use in advanced CKD.
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Affiliation(s)
- Ngoc-Yen T Pham
- From the University of New Mexico Hospitals, Albuquerque, NM
| | - Jonathan G Owen
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Namita Singh
- University of New Mexico Health Sciences Center, Albuquerque, NM
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Zhang X, Luo S, Wang M, Cao Q, Zhang Z, Huang Q, Li J, Deng Z, Liu T, Liu CL, Meppen M, Vromman A, Flavell RA, Hotamışlıgil GS, Liu J, Libby P, Liu Z, Shi GP. Differential IL18 signaling via IL18 receptor and Na-Cl co-transporter discriminating thermogenesis and glucose metabolism regulation. Nat Commun 2022; 13:7582. [PMID: 36482059 PMCID: PMC9732325 DOI: 10.1038/s41467-022-35256-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
White adipose tissue (WAT) plays a role in storing energy, while brown adipose tissue (BAT) is instrumental in the re-distribution of stored energy when dietary sources are unavailable. Interleukin-18 (IL18) is a cytokine playing a role in T-cell polarization, but also for regulating energy homeostasis via the dimeric IL18 receptor (IL18r) and Na-Cl co-transporter (NCC) on adipocytes. Here we show that IL18 signaling in metabolism is regulated at the level of receptor utilization, with preferential role for NCC in brown adipose tissue (BAT) and dominantly via IL18r in WAT. In Il18r-/-Ncc-/- mice, high-fat diet (HFD) causes more prominent body weight gain and insulin resistance than in wild-type mice. The WAT insulin resistance phenotype of the double-knockout mice is recapitulated in HFD-fed Il18r-/- mice, whereas decreased thermogenesis in BAT upon HFD is dependent on NCC deletion. BAT-selective depletion of either NCC or IL18 reduces thermogenesis and increases BAT and WAT inflammation. IL18r deletion in WAT reduces insulin signaling and increases WAT inflammation. In summary, our study contributes to the mechanistic understanding of IL18 regulation of energy metabolism and shows clearly discernible roles for its two receptors in brown and white adipose tissues.
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Affiliation(s)
- Xian Zhang
- grid.256896.60000 0001 0395 8562School of Food and Biological Engineering, Hefei University of Technology, Hefei, Anhui 230009 China ,grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Songyuan Luo
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA ,grid.413405.70000 0004 1808 0686Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510000 China
| | - Minjie Wang
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Qiongqiong Cao
- grid.256896.60000 0001 0395 8562School of Food and Biological Engineering, Hefei University of Technology, Hefei, Anhui 230009 China
| | - Zhixin Zhang
- grid.256896.60000 0001 0395 8562School of Food and Biological Engineering, Hefei University of Technology, Hefei, Anhui 230009 China
| | - Qin Huang
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Jie Li
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Zhiyong Deng
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Tianxiao Liu
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Cong-Lin Liu
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA ,grid.207374.50000 0001 2189 3846Department of Nephrology, the First Affiliated Hospital, Research Institute of Nephrology, Zhengzhou University, Henan Province Research Center For Kidney Disease, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, Henan 450052 China
| | - Mathilde Meppen
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Amelie Vromman
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Richard A. Flavell
- grid.47100.320000000419368710Department of Immunobiology, Yale School of Medicine, New Haven, CT 06520 USA
| | - Gökhan S. Hotamışlıgil
- grid.38142.3c000000041936754XDepartment of Molecular Metabolism, Harvard School of Public Health, Boston, MA 02115 USA
| | - Jian Liu
- grid.256896.60000 0001 0395 8562School of Food and Biological Engineering, Hefei University of Technology, Hefei, Anhui 230009 China
| | - Peter Libby
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
| | - Zhangsuo Liu
- grid.207374.50000 0001 2189 3846Department of Nephrology, the First Affiliated Hospital, Research Institute of Nephrology, Zhengzhou University, Henan Province Research Center For Kidney Disease, Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, Henan 450052 China
| | - Guo-Ping Shi
- grid.38142.3c000000041936754XDepartment of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115 USA
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Gao M, Lin W, Ma T, Luo Y, Xie H, Cheng X, Bai Y. The Impact of Different Antihypertensive Drugs on Cardiovascular Risk in Isolated Systolic Hypertension with Type 2 Diabetes Patients. J Clin Med 2022; 11:6486. [PMID: 36362714 PMCID: PMC9655533 DOI: 10.3390/jcm11216486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 09/01/2023] Open
Abstract
BACKGROUNDS Angiotensin receptor blockers (ARB), angiotensin converting enzyme inhibitor (ACEI), calcium channel blocker (CCB) and thiazide diuretics (TD) are common antihypertensive drugs for diabetes patients with hypertension. The purpose of this study was to compare the cardiovascular risks of these drugs in patients with isolated systolic hypertension (ISH) and type 2 diabetes mellitus (T2DM). METHODS We used Action to Control Cardiovascular Risk in Diabetes trial data to explore the relationship between antihypertensive drugs and cardiovascular risks in ISH with T2DM patients by performing propensity score matching, Kaplan-Meier survival analyses and Cox proportional regression. RESULTS The cumulative incidence rates of primary outcomes (PO, including cardiovascular mortality, non-fatal myocardial infarction and non-fatal stroke) in the ARB use group were significantly lower than those without (hazard ratio (HR) 0.53; 95% confidence interval (CI) 0.34-0.83; p = 0.006). However, for ACEI, CCB and TD, they were negligible (ACEI: p = 0.209; CCB: p = 0.245; TD: p = 0.438). ARB decreased cardiovascular mortality (CM) in PO rather than non-fatal myocardial infarction (NMI) and non-fatal stroke (NST) (CM: HR 0.32; 95%CI 0.18-0.90; p = 0.004; NMI: p = 0.692; NST: p = 0.933). CONCLUSION ARB may alleviate the cardiovascular risks in ISH with T2DM patients, but ACEI, CCB, and TD did not.
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Affiliation(s)
- Ming Gao
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wenrui Lin
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Luo
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hejian Xie
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
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Zhang X, Luo S, Wang M, Huang Q, Fang W, Li J, Liu T, Zhang Y, Deng Z, Liu CL, Guan S, Ayala JE, Flavell RA, Kulkarni RN, Libby P, Guo J, Liu Z, Shi GP. IL18 signaling causes islet β cell development and insulin secretion via different receptors on acinar and β cells. Dev Cell 2022; 57:1496-1511.e6. [DOI: 10.1016/j.devcel.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 12/31/2021] [Accepted: 05/16/2022] [Indexed: 12/13/2022]
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Abstract
PURPOSE OF REVIEW In patients with prediabetes or type 2 diabetes, the use of thiazides as antihypertensive agents has been challenged because associated metabolic adverse events, including new-onset diabetes. RECENT FINDINGS These metabolic disturbances are less marked with low-dose thiazides and, in most but not all studies, with thiazide-like diuretics (chlorthalidone, indapamide) than with thiazide-type diuretics (hydrochlorothiazide). In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazides resulted in a significant reduction in cardiovascular events, all-cause mortality, and hospitalization for heart failure compared to placebo and generally were shown to be non-inferior to other antihypertensive agents. Benefits attributed to thiazide diuretics in terms of cardiovascular event reduction outweigh the risk of worsening glucose control in type 2 diabetes and of new-onset diabetes in non-diabetic patients. Thiazides still play a key role in the management of patients with type 2 diabetes and hypertension.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, CHU Sart Tilman (B35), B-4000, Liege, Belgium.
- Clinical Pharmacology Unit, CHU Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
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Gentil P, de Lira CAB, Paoli A, Dos Santos JAB, da Silva RDT, Junior JRP, da Silva EP, Magosso RF. Nutrition, Pharmacological and Training Strategies Adopted by Six Bodybuilders: Case Report and Critical Review. Eur J Transl Myol 2017; 27:6247. [PMID: 28458804 PMCID: PMC5391526 DOI: 10.4081/ejtm.2017.6247] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The purpose of this study was to report and analyze the practices adopted by bodybuilders in light of scientific evidence and to propose evidence-based alternatives. Six (four male and two female) bodybuilders and their coaches were directly interviewed. According to the reports, the quantity of anabolic steroids used by the men was 500–750 mg/week during the bulking phase and 720–1160 mg during the cutting phase. The values for women were 400 and 740 mg, respectively. The participants also used ephedrine and hydrochlorothiazide during the cutting phase. Resistance training was designed to train each muscle once per week and all participants performed aerobic exercise in the fasted state in order to reduce body fat. During the bulking phase, bodybuilders ingested ~2.5 g of protein/kg of body weight. During the cutting phase, protein ingestion increased to ~3 g/kg and carbohydrate ingestion decreased by 10–20%. During all phases, fat ingestion corresponded to ~15% of the calories ingested. The supplements used were whey protein, chromium picolinate, omega 3 fatty acids, branched chain amino acids, poly-vitamins, glutamine and caffeine. The men also used creatine in the bulking phase. In general, the participants gained large amounts of fat-free mass during the bulking phase; however, much of that fat-free mass was lost during the cutting phase along with fat mass. Based on our analysis, we recommend an evidence-based approach by people involved in bodybuilding, with the adoption of a more balanced and less artificial diet. One important alert should be given for the combined use of anabolic steroids and stimulants, since both are independently associated with serious cardiovascular events. A special focus should be given to revisiting resistance training and avoiding fasted cardio in order to decrease the reliance on drugs and thus preserve bodybuilders’ health and integrity.
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Affiliation(s)
- Paulo Gentil
- College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | | | - Antonio Paoli
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | | | | | | | | | - Rodrigo Ferro Magosso
- Post Graduation Program in Movement Sciences, UNESP - Universidade Estadual Paulista, Rio Claro, Brazil
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Mende CW, Giles TD, Bharucha DB, Ferguson WG, Mallick M, Patel MD. Efficacy of nebivolol-valsartan single-pill combination in obese and nonobese patients with hypertension. J Clin Hypertens (Greenwich) 2017; 19:632-639. [PMID: 28075064 PMCID: PMC5484387 DOI: 10.1111/jch.12965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/16/2016] [Accepted: 11/19/2016] [Indexed: 11/29/2022]
Abstract
Antihypertensive efficacy of single-pill combinations (SPCs) consisting of a β1 -selective adrenergic blocker with vasodilatory properties via β3 -agonism (nebivolol) and an angiotensin II receptor blocker (valsartan) was demonstrated in an 8-week phase 3 trial (NCT01508026). In this post hoc analysis, seated blood pressure, heart rate, 24-hour ambulatory blood pressure monitoring, plasma aldosterone, estimated glomerular filtration rate, and safety measures were assessed in obese (body mass index >32 kg/m2 ; n=1823) and nonobese (body mass index <27 kg/m2 ; n=847) adults with hypertension (stage I or II) treated with nebivolol-valsartan SPCs, nebivolol or valsartan monotherapy, or placebo. At week 8, reductions from baseline in blood pressure and ambulatory blood pressure monitoring were greater with SPCs and most nebivolol and valsartan monotherapy doses vs placebo regardless of obesity status. Aldosterone declined with all active treatments and estimated glomerular filtration rate remained steady. The nebivolol-valsartan 5/80 mg/d SPC was efficacious regardless of degree of obesity.
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Metabolic approaches to antihypertensive treatment in diabetic patients. Hypertens Res 2015; 38:802-3. [DOI: 10.1038/hr.2015.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jin C, O'Boyle S, Kleven DT, Pollock JS, Pollock DM, White JJ. Antihypertensive and anti-inflammatory actions of combined azilsartan and chlorthalidone in Dahl salt-sensitive rats on a high-fat, high-salt diet. Clin Exp Pharmacol Physiol 2014; 41:579-88. [DOI: 10.1111/1440-1681.12250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/17/2014] [Accepted: 04/21/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Chunhua Jin
- Division of Nephrology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Sean O'Boyle
- Division of Nephrology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - Daniel T. Kleven
- Department of Pathology; Georgia Regents University; Augusta GA USA
| | - Jennifer S. Pollock
- Division of Nephrology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - David M. Pollock
- Division of Nephrology; Department of Medicine; University of Alabama at Birmingham; Birmingham AL USA
| | - John J. White
- Section of Nephrology, Hypertension and Transplantation; Department of Medicine; Georgia Regents University; Augusta GA USA
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Akbar S, Alorainy MS. The current status of beta blockers' use in the management of hypertension. Saudi Med J 2014; 35:1307-17. [PMID: 25399206 PMCID: PMC4362137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The invention of beta (β)-blockers culminated in a new era in the treatment of cardiovascular diseases (CD), and changed the course of pharmacology research for years to come. Since the introduction of propranolol into clinical practice in 1964, β-blockers enjoyed a special place in the clinicians' armamentarium against CDs, especially for patients with ischemic heart diseases, and are still one of the most extensively used therapeutic drugs in both cardiac and non-cardiac ailments. Current uses of β-blockers in CDs include ischemic heart diseases, hypertension, cardiac arrhythmias, and heart failure. Other substantial non-cardiac uses include glaucoma, migraine, situational anxiety, benign essential tremors, and cardiac symptoms of thyrotoxicosis. This review covers some of the evolutionary changes of clinical uses of β-blockers, the rationale for their use, some recent controversies surrounding their use for treatment of hypertension, and advantages of newer additions to the group.
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Affiliation(s)
- Shahid Akbar
- From the Department of Pharmacology and Toxicology (Akbar), College of Pharmacy, and Department of Pharmacology and Therapeutics (Alorainy), College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia.,Address correspondence and reprint request to: Professor Shahid Akbar, Director, Research Center, Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, PO Box 6800, Buraidah 51452, Kingdom of Saudi Arabia. Tel. +966 (16) 3802267 Ext. 2330. E-mail:
| | - Mohammad S. Alorainy
- From the Department of Pharmacology and Toxicology (Akbar), College of Pharmacy, and Department of Pharmacology and Therapeutics (Alorainy), College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia.
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