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Servi H, Korkmaz TB, Ayaz F. Anti-inflammatory activity of benidipine hydrochloride in LPS-activated mammalian macrophages. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:5757-5763. [PMID: 38315186 PMCID: PMC11329695 DOI: 10.1007/s00210-024-02989-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Benidipine hydrochloride (BH), a medication frequently used by the hypertension patients, acts as a calcium channel blocker. However, its effects on the macrophages have not been investigated thus far. Our goal was investigating the effect of the benidipine hydrochloride to modulate the J774.2 murine macrophage cells inflammatory activity. Our results suggest that in the absence of a standard stimulating agent (LPS) BH did not stimulate the macrophages to produce pro-inflammatory IL-12p40, TNF-α, GM-CSF and IL-6 cytokines. However, when BH was administrated to the cells in the presence of LPS as stimulating agent, it reduced the production of these pro-inflammatory cytokines. Therefore, it had anti-inflammatory activity. At the clinical setting this study suggests that BH can be utilized as hypertension drug that can suppress the inflammation associated with it.
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Affiliation(s)
- Hülya Servi
- Faculty of Science, Department of Biotechnology, Mersin University, Mersin, Turkey
| | - Tanya Beril Korkmaz
- Faculty of Science, Department of Biotechnology, Mersin University, Mersin, Turkey
| | - Furkan Ayaz
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Biruni University, Istanbul, 34010, Turkey.
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Reeve E, Gnjidic D, Langford AV, Hilmer SN. Deprescribing antihypertensive drugs in frail older adults. Aust Prescr 2024; 47:85-90. [PMID: 38962389 PMCID: PMC11216913 DOI: 10.18773/austprescr.2024.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Antihypertensive drugs are commonly used by older adults because of the high prevalence of cardiovascular disease and its risk factors, and the increased absolute benefit of blood pressure reduction with increasing age. Clinical trials of blood pressure reduction in older adults have generally excluded older adults with multimorbidity, frailty and limited life expectancy. In this population, the benefit-harm ratio of aggressive blood pressure lowering may become unfavourable; a more relaxed blood pressure target may be appropriate; and deprescribing (cessation or dose reduction) of one or more antihypertensive drugs can be considered. Before deprescribing an antihypertensive drug, it is important to consider other indications for which it may have been prescribed (e.g. heart failure with reduced ejection fraction, diabetic nephropathy, atrial fibrillation). Evidence from randomised controlled deprescribing trials indicates that it is possible to deprescribe antihypertensives in frail older people. However, some patients may experience an increase in blood pressure that warrants restarting the drug. There are limited data on long-term outcomes (follow-up in deprescribing trials ranged from 4 to 56 weeks). The risk of adverse outcomes associated with deprescribing, such as withdrawal effects, can be minimised through appropriate planning, patient engagement, dose tapering and monitoring.
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Affiliation(s)
- Emily Reeve
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne
- Clinical and Health Sciences, University of South Australia, Adelaide
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney
- Royal North Shore Hospital, Sydney
- Geriatric Pharmacology, Faculty of Medicine and Health, The University of Sydney and Kolling Institute, Sydney
| | - Danijela Gnjidic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne
- Clinical and Health Sciences, University of South Australia, Adelaide
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney
- Royal North Shore Hospital, Sydney
- Geriatric Pharmacology, Faculty of Medicine and Health, The University of Sydney and Kolling Institute, Sydney
| | - Aili V Langford
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne
- Clinical and Health Sciences, University of South Australia, Adelaide
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney
- Royal North Shore Hospital, Sydney
- Geriatric Pharmacology, Faculty of Medicine and Health, The University of Sydney and Kolling Institute, Sydney
| | - Sarah N Hilmer
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne
- Clinical and Health Sciences, University of South Australia, Adelaide
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney
- Royal North Shore Hospital, Sydney
- Geriatric Pharmacology, Faculty of Medicine and Health, The University of Sydney and Kolling Institute, Sydney
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Rashid I, Tiwari P, Cruz SD, Jaswal S. Rates and determinants of fast chronic kidney disease progression distinguished by nutritional status, and the impact of malnutrition on mortality - evidence from a clinical population. Clin Nutr ESPEN 2023; 57:683-690. [PMID: 37739723 DOI: 10.1016/j.clnesp.2023.08.008] [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: 04/08/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Malnutrition is a serious problem that influences morbidity, mortality, functional activity, and quality of life in patients with chronic kidney disease (CKD). However, there has not been much research done on how nutritional status appears to affect mortality in non-dialysis CKD patients. This study aimed to recognize the rates and predictors of fast CKD progression distinguished by nutritional status, and also sought to determine the impact of malnutrition on mortality in non-dialysis CKD patients. METHODS This prospective cohort study (n = 360) involved non-dialysis CKD patients with index estimated glomerular filtration rate (eGFR) between the range of 15-89 ml/min/1.73 m2. Nutritional status was evaluated by using the "Pt-Global web tool/PG-SGA". A loss of eGFR >4 ml/min/1.73 m2 per year was considered to be a sign of fast CKD progression. Kaplan-Meier plots were used to evaluate the cumulative survival, and Cox-proportional hazard models were used to analyze the renal outcomes. RESULTS Around 244 (67.8%) of patients have experienced a fast decline in kidney function. In the malnourished group, systolic blood pressure and hyperphosphatemia were observed to have increased hazards for fast CKD progression. The overall incidence of mortality and composite endpoints were found to be 13.9% & 37.6%, respectively. Death rates (11.6%) and composite endpoints (29.8%) were higher in the malnourished (severe & moderate) group. Cox regression hazard model reported 4 times increased hazards for death [HR 4.41 (1.99-9.77) 95% CI; P ≤ 0.005] and 3 times increased hazards for composite endpoints [HR 3.29 (2.10-5.16) 95% CI; P ≤ 0.005] for 'severely malnourished' category in reference to 'normal nutrition' category. CONCLUSIONS Fast CKD progression was observed to be more common in malnourished patients. Systolic blood pressure and hyperphosphatemia were recognized as potential predictors of fast CKD progression. Moreover, malnutrition was found to be a significant predictor of mortality among non-dialysis CKD patients. The findings of this study advocate for early nutritional evaluation and timely dietary interventions to halt the progression of CKD.
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Affiliation(s)
- Ishfaq Rashid
- National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India; M.M. College of Pharmacy, M.M. University Ambala, 133203, India.
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar, Punjab, 160062, India.
| | - Sanjay D Cruz
- Department of General Medicine, Government Medical College and Hospital (GMCH), Chandigarh, 160030, India.
| | - Shivani Jaswal
- Department of Biochemistry, Government Medical College and Hospital (GMCH), Chandigarh, 160030, India.
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Siru R, Conradie JH, Gillett MJ, Page MM. Approach to the diagnosis of secondary hypertension in adults. Aust Prescr 2021; 44:165-169. [PMID: 34728882 PMCID: PMC8542481 DOI: 10.18773/austprescr.2021.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Presentations that should raise suspicion of secondary hypertension include early-onset, severe or resistant hypertension. A suggestive family history or clinical clues can point to a specific secondary cause. The most common causes and associations are renal disease, primary aldosteronism and obstructive sleep apnoea. Medicines, illicit substances and alcohol may also be responsible. The assessment of patients begins with history taking and examination, to look for clinical clues. Laboratory tests include electrolytes, urea, creatinine and the aldosterone:renin ratio, urinalysis and the urine albumin:creatinine ratio. Abnormal results should prompt further investigation. Initial testing for primary aldosteronism is best done before starting potentially interfering antihypertensive drugs. If the patient is already taking interfering antihypertensive drugs that cannot be stopped, the interpretation of the aldosterone:renin ratio must consider the presence of those drugs. Specialist advice can be sought if needed.
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Affiliation(s)
- Ranita Siru
- Department of Biochemistry, Western Diagnostic Pathology.,Department of Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital.,Perth
| | - Johan H Conradie
- Department of Biochemistry, Western Diagnostic Pathology.,Department of Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital.,Perth
| | - Melissa J Gillett
- Department of Biochemistry, Western Diagnostic Pathology.,Department of Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital.,Perth
| | - Michael M Page
- Department of Biochemistry, Western Diagnostic Pathology.,Department of Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital.,Perth
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