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Inotai A, Kaló Z, Petykó Z, Gyöngyösi K, O’Keeffe DT, Czech M, Ágh T. Facilitators and Barriers of Incremental Innovation by Fixed Dose Combinations in Cardiovascular Diseases. J Cardiovasc Dev Dis 2024; 11:186. [PMID: 39057609 PMCID: PMC11277553 DOI: 10.3390/jcdd11070186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Despite the availability of affordable pharmaceuticals treating cardiovascular diseases (CVDs), many of the risk factors remain poorly controlled. Fixed-dose combinations (FDCs), a form of incremental innovation, have already demonstrated improvements over combinations of single medicines in adherence and hard clinical endpoints. Nevertheless, there are many barriers related to the wider use of FDCs in CVDs. Our aim was to identify these barriers and explore system-level facilitators from a multi-stakeholder perspective. Identified barriers include (i) hurdles in evidence generation for manufacturers, (ii) limited acceptance of adherence as an endpoint by clinical guideline developers and policymakers, (iii) limited options for a price premium for incremental innovation for healthcare payers, (iv) limited availability of real-world evidence, and (v) methodological issues to measure improved adherence. Initiatives to standardize and link healthcare databases in European countries, movements towards improved patient centricity in healthcare, and extended value assessment provide opportunities to capture the benefits of FDCs. Still, there is an emerging need to facilitate the generalizability of sporadic clinical evidence across different FDCs and to improve adherence measures. Finally, healthcare payers need to be convinced to pay a fair premium price for the added value of FDCs to incentivize incremental innovation in CVD treatment.
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Affiliation(s)
- András Inotai
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Zsuzsanna Petykó
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | - Kristóf Gyöngyösi
- Center for Health Technology Assessment, Semmelweis University, 1091 Budapest, Hungary; (A.I.); (Z.P.); (K.G.)
- Syreon Research Institute, 1142 Budapest, Hungary;
| | | | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Tamás Ágh
- Syreon Research Institute, 1142 Budapest, Hungary;
- Medication Adherence Research Group, Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, 7623 Pécs, Hungary
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Machowiec P, Ręka G, Maksymowicz M, Piecewicz-Szczęsna H, Smoleń A. Effect of Spirulina Supplementation on Systolic and Diastolic Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:nu13093054. [PMID: 34578932 PMCID: PMC8468496 DOI: 10.3390/nu13093054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 12/25/2022] Open
Abstract
Spirulina is a microalga that presents various important pro-health properties, for instance lowering blood pressure in the research. The study aims to appraise the efficacy of Spirulina administration on systolic (SBP) and diastolic blood pressure (DBP). Randomized controlled trials (RCTs) were retrieved by a systematic search of PubMed, Web of Science, and the Cochrane Library databases from inception to June 2021 according to a standardized protocol. The effect size of each study was counted from mean and standard deviation before and after the intervention and shown as Un-standardized mean difference and 95% confidence interval. Sensitivity analyses were performed. Meta-analysis on 5 RCTs with 230 subjects was eligible. The amount of Spirulina ranged from 1 to 8 g per day, and intervention durations ranged from 2 to 12 weeks. Data analysis indicated that Spirulina supplementation led to a significant lowering of SBP (Mean Difference (MD): -4.59 mmHg, 95% Confidence Interval (CI): -8.20 to -0.99, I square statistic (I2) = 65%) and significant lowering of DBP (MD: -7.02 mmHg, CI: -8.86 to -5.18, I2 = 11%), particularly in a subgroup of hypertensive patients. Spirulina administration might have a supportive effect on the prevention and treatment of hypertension. More exact randomized controlled trials are needed to clarify the effect of Spirulina supplementation on blood pressure.
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Wang X, Chen H, Essien EJ, Wu J, Serna O, Paranjpe R, Abughosh S. Risk of Cardiovascular Outcomes and Antihypertensive Triple Combination Therapy Among Elderly Patients with Hypertension Enrolled in a Medicare Advantage Plan (MAP). Am J Cardiovasc Drugs 2020; 20:591-602. [PMID: 32043245 DOI: 10.1007/s40256-020-00395-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The aim was to evaluate the risk of cardiovascular-specific hospitalizations with different types of antihypertensive triple combination therapy among patients enrolled in a Medicare Advantage Plan (MAP). METHODS A retrospective cohort study was conducted among patients with hypertension enrolled in a Texas MAP between January 2014 and December 2016. Antihypertensive combination therapy users were classified into three treatment groups: single-pill triple combination, fixed-dose dual combination plus a third agent, and free triple combination. Group differences were assessed using Chi-square tests for binary variables and Student's t tests for continuous variables. Cox proportional hazards model was performed to assess the association between type of combination therapy and risk of cardiovascular-specific hospitalization adjusting for potential confounders. RESULTS A total of 10,836 triple combination users were identified. The risk of cardiovascular disease (CVD) hospitalization for the fixed-dose dual combination plus a third agent group [hazard ratio (HR) 3.82, 95% confidence interval (CI) 1.80-8.12] and for the free triple combination therapy group (HR 3.65, 95% CI 1.43-9.31) was significantly higher than for the single-pill triple combination group. CONCLUSION Single-pill triple combination therapy was significantly associated with a lower risk of CVD hospitalizations in comparison to other types of triple combination therapy.
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Affiliation(s)
- Xin Wang
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun Road, Houston, TX, 77204-5047, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun Road, Houston, TX, 77204-5047, USA
| | - E J Essien
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun Road, Houston, TX, 77204-5047, USA
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | | | - Rutugandha Paranjpe
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun Road, Houston, TX, 77204-5047, USA
| | - Susan Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun Road, Houston, TX, 77204-5047, USA.
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Combining angiotensin receptor blockers with chlorthalidone or hydrochlorothiazide - which is the better alternative? A meta-analysis. Syst Rev 2020; 9:195. [PMID: 32838806 PMCID: PMC7445912 DOI: 10.1186/s13643-020-01457-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension is a disease with significant clinical and socio-economic consequences. The reduction in cardiovascular mortality and morbidity in patients treated for hypertension is directly related to the magnitude of blood pressure reduction. Diuretics have proven useful for the prevention of cardiovascular complications in addition to a long history of safety and efficacy. The main aim for this meta-analysis is to compare the efficacy of the combination of angiotensin receptor blocker (ARB) and chlorthalidone (CTLD) to the combination of ARB and hydrochlorothiazide (HCTZ) in patients with hypertension. METHODS A comprehensive literature search was conducted through electronic databases PubMed, MEDLINE, Scopus, PsyInfo, Cochrane, eLIBRARY.ru, http://ClinicalTrials.gov and http://www.clinicaltrialsregister.eu in July 2020 to identify studies that investigate the effect of the combination of angiotensin receptor blocker with chlorthalidone or hydrochlorothiazide on the systolic and diastolic blood pressure in patients with hypertension. Changes in systolic and diastolic blood pressure (BP) expressed as a weighted mean difference (WMD) were our primary outcomes. The random-effects method was chosen as the primary analysis and results were presented with a 95% confidence interval (CI). Sensitivity analysis was performed and bias was assessed. RESULTS Our search returned 2745 titles. Of them, 51 full-text articles remained to be subjected to assessment. Comparisons of ARB/HCTZ versus ARB showed changes in BP of -6.89 (-8.09, -5.69) mmHg for systolic BP and - 3.67 (-4.15, -3.19) mmHg for diastolic BP. For the ARB/CTLD versus ARB/HCTZ comparison changes were - 6.30 (-7.30, -5.29) mmHg for systolic BP and - 3.57 (-4.17, 2.98) mmHg for diastolic BP. CONCLUSION Our analysis suggests a small but significant favor for CTLD in blood pressure control when compared to HCTZ. We believe it should be considered as a valuable alternative for HCTZ and an option for fixed dose combinations with an ARB although further research is required.
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Wang X, Chen H, E E, Wu J, Serna O, Paranjpe R, Abughosh S. Cost-effectiveness analysis of antihypertensive triple combination therapy among patients enrolled in a Medicare advantage plan. Expert Rev Pharmacoecon Outcomes Res 2020; 21:829-836. [PMID: 32703040 DOI: 10.1080/14737167.2020.1800457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of single pill fixed dose triple combination therapy vs. free triple combination therapy for the prevention of cardiovascular events among patients with hypertension. METHODS A Markov model with a five year cycle was constructed. Two decision models incorporating strict and more relaxed adherence definitions estimated quality adjusted life years (QALYs) and health-care costs for single pill fixed triple combination therapy vs. free-drug combination therapy. RESULTS When the strict adherence measurement criteria were applied, the total QALYs loss and cost/patient were 6.38 QALYs, $486,026.20 for the single pill triple combination therapy and 8.64 QALYs, $406,405.26 for the free combination therapy. ICER for single pill combination therapy compared to free combination therapy was 33,826.46/QALY. When the relaxed adherence measurement criteria were applied, the total QALYs loss and cost/patient were 8.09 QALYs, $493,404.26 for the single pill triple combination therapy and 8.76 QALYs, $436,415.14 for the free combination therapy. ICER for single pill combination compared with free combination therapy was 84,932.26. CONCLUSION This study suggested that single pill triple combination therapy was cost-effective in comparison with free combination therapy under a willingness to pay threshold of 50,000 when the strict adherence measurement criteria was applied.
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Affiliation(s)
- Xin Wang
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
| | - Essien E
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | | | - Rutugandha Paranjpe
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
| | - Susan Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA
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Garjón J, Saiz LC, Azparren A, Gaminde I, Ariz MJ, Erviti J. First-line combination therapy versus first-line monotherapy for primary hypertension. Cochrane Database Syst Rev 2020; 2:CD010316. [PMID: 32026465 PMCID: PMC7002970 DOI: 10.1002/14651858.cd010316.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND This is the first update of a review originally published in 2017. Starting with one drug and starting with a combination of two drugs are strategies suggested in clinical guidelines as initial treatment of hypertension. The recommendations are not based on evidence about clinically relevant outcomes. Some antihypertensive combinations have been shown to be harmful. The actual harm-to-benefit balance of each strategy is unknown. OBJECTIVES To determine if there are differences in clinical outcomes between monotherapy and combination therapy as initial treatment for primary hypertension. SEARCH METHODS The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to April 2019: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 2005), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We used no language restrictions. We also searched clinical studies repositories of pharmaceutical companies, reviews of combination drugs on the US Food and Drug Administration and European Medicines Agency websites, and lists of references in reviews and clinical practice guidelines. SELECTION CRITERIA We included randomised, double-blind trials with at least 12 months' follow-up in adults with primary hypertension (systolic blood pressure/diastolic blood pressure 140/90 mmHg or higher, or 130/80 mmHg or higher if participants had diabetes), which compared combination of two first-line antihypertensive drugs with monotherapy as initial treatment. Trials had to include at least 50 participants per group and report mortality, cardiovascular mortality, cardiovascular events, or serious adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, evaluated the risk of bias, and performed data entry. The primary outcomes were mortality, serious adverse events, cardiovascular events, and cardiovascular mortality. Secondary outcomes were withdrawals due to drug-related adverse effects, reaching blood pressure control (as defined in each trial), and blood pressure change from baseline. Analyses were based on the intention-to-treat principle. We summarised data on dichotomous outcomes as risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS This update included one new study in which a subgroup of participants met our inclusion criteria. As none of the four included studies focused solely on people initiating antihypertensive treatment, we asked investigators for data for this subgroup. One study (PREVER-treatment 2016) used a combination of thiazide-type diuretic/potassium-sparing diuretic; as the former is not indicated in monotherapy, we analysed this study separately. The three original trials in the main comparison (monotherapy: 335 participants; combination therapy: 233 participants) included outpatients, mostly European and white people. Two trials only included people with type 2 diabetes; the remaining trial excluded people treated with diabetes, hypocholesterolaemia, or cardiovascular drugs. The follow-up was 12 months in two trials and 36 months in one trial. It is very uncertain whether combination therapy versus monotherapy reduces total mortality (RR 1.35, 95% CI 0.08 to 21.72), cardiovascular mortality (zero events reported), cardiovascular events (RR 0.98, 95% CI 0.22 to 4.41), serious adverse events (RR 0.77, 95% CI 0.31 to 1.92), or withdrawals due to adverse effects (RR 0.85, 95% CI 0.53 to 1.35); all outcomes had 568 participants, and the evidence was rated as of very low certainty due to serious imprecision and for using a subgroup that was not defined in advance. The confidence intervals were extremely wide for all important outcomes and included both appreciable harm and benefit. The PREVER-treatment 2016 trial, which used a combination therapy with potassium-sparing diuretic (monotherapy: 84 participants; combination therapy: 116 participants), included outpatients. This trial was conducted in Brazil and had a follow-up of 18 months. The number of events was very low and confidence intervals very wide, with zero events reported for cardiovascular mortality and withdrawals due to adverse events. It is very uncertain if there are differences in clinical outcomes between monotherapy and combination therapy in this trial. AUTHORS' CONCLUSIONS The numbers of included participants, and hence the number of events, were too small to draw any conclusion about the relative efficacy of monotherapy versus combination therapy as initial treatment for primary hypertension. There is a need for large clinical trials that address the review question and report clinically relevant endpoints.
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Affiliation(s)
- Javier Garjón
- Navarre Health Service, Drug Prescribing Service, Plaza de la Paz s/n 4ª, Pamplona, Navarra, Spain, 31002
| | - Luis Carlos Saiz
- Navarre Health Service, Unit of Innovation and Organization, Pamplona, Navarre, Spain
| | - Ana Azparren
- Navarre Health Service, Drug Prescribing Service, Plaza de la Paz s/n 4ª, Pamplona, Navarra, Spain, 31002
| | - Idoia Gaminde
- Department of Health, Continuous Education and Research, Pabellón de Docencia, Recinto Hospital de Navarra, Pamplona, Spain, 31008
| | - Mª José Ariz
- Navarre Health Service, Medical Practice, C/San Martin de Unx 11-, Tafalla, Navarra, Spain, 31300
| | - Juan Erviti
- Navarre Health Service, Unit of Innovation and Organization, Pamplona, Navarre, Spain
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Wang X, Chen H, Essien E, Wu J, Serna O, Paranjpe R, Abughosh S. Medication Adherence to Antihypertensive Triple-Combination Therapy Among Patients Enrolled in a Medicare Advantage Plan. J Manag Care Spec Pharm 2019; 25:678-686. [PMID: 31134857 PMCID: PMC10397987 DOI: 10.18553/jmcp.2019.25.6.678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Approximately 32% (75 million) of adults have hypertension in the United States, leading to 1,100 daily deaths and costing more than $48 billion annually in medical expenditures. Approximately 25% of patients with hypertension require triple combination therapy to reach recommended blood pressure. Currently, only 3 single-pill triple-combination therapies are available in the market for the treatment of hypertension. Medication adherence has become a major concern for the health care system, and nonadherence is associated with higher risks of morbidity and mortality. OBJECTIVE To compare medication adherence rates among single-pill triple-combination therapy, free triple-combination therapy, and fixed-dose dual-combination therapy plus a third agent in hypertensive patients enrolled in a Medicare Advantage prescription drug plan using 2 adherence definitions. METHODS A retrospective cohort study was conducted using Cigna-HealthSpring's medical claims database from January 2014 to December 2016. Antihypertensive combination therapy users were classified into a single-pill triple-combination group, a fixed-dose dual-combination plus a third agent group, and a free triple-combination group. Adherence rates using proportion of days covered (PDC) were calculated for each group within a 1-year follow-up period using 2 definitions: a strict one requiring all antihypertensive agents during follow-up and a more relaxed definition requiring any antihypertensive agent during follow-up. Descriptive statistics were examined, and group differences were assessed using chi-square and analysis of variance. Multivariate logistic regression was conducted to control confounders of adherence using both definitions. RESULTS 10,836 triple-combination users were identified. In the multivariate model using the first definition, fixed-dose dual-combination plus a third agent was significantly associated with lower adherence compared with single-pill triple therapy (OR = 0.177; 95% CI = 0.119-0.263; P < 0.001). No significant difference was detected between single-pill triple-combination therapy in comparison with free-combination therapy. In the multivariate model using the second definition, fixed-dose dual-combination plus a third agent and free-combination therapy were significantly associated with better adherence in comparison with single-pill triple combination therapy (OR = 3.62, 95% CI = 2.59-5.05; OR = 4.31, 95% CI = 2.15-8.64, respectively). Younger age, female gender, language (Spanish), some comorbidities, and previous hospitalization had a negative effect on adherence. CONCLUSIONS Measuring adherence to multiple concurrent regimens is complicated and different adherence definitions can result in significant variations in adherence measures. Future research evaluating clinical outcomes with various definitions is needed. DISCLOSURES No outside funding supported this study. Abughosh reports grants from Sanofi, Regeneron, Valeant Pharmaceuticals, BMS/Pfizer, and PhRMA, not related to this study. Serna reports employement with CareAllies, a Cigna company. The other authors have no conflicts of interest to disclose.
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Affiliation(s)
- Xin Wang
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Ekere Essien
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, South Carolina
| | - Omar Serna
- CareAllies, a Cigna company, Houston, Texas
| | - Rutugandha Paranjpe
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Susan Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
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Neutel JM, Cushman WC, Lloyd E, Barger B, Handley A. Comparison of long-term safety of fixed-dose combinations azilsartan medoxomil/chlorthalidone vs olmesartan medoxomil/hydrochlorothiazide. J Clin Hypertens (Greenwich) 2017; 19:874-883. [PMID: 28681550 DOI: 10.1111/jch.13009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 01/18/2017] [Accepted: 02/12/2017] [Indexed: 12/27/2022]
Abstract
This 52-week, randomized, open-label study evaluated long-term safety/tolerability of fixed-dose combination azilsartan medoxomil/chlorthalidone (AZL-M/CLD) vs fixed-dose combination olmesartan medoxomil/hydrochlorothiazide (OLM/HCTZ) in patients with essential hypertension (stage 2; clinic systolic blood pressure 160-190 mm Hg). Initial AZL-M/CLD 40/12.5 mg/d (n=418) or OLM/HCTZ 20/12.5 mg/d (n=419) could be uptitrated during weeks 4 to 52 (AZL-M/CLD to 80/25 mg; OLM/HCTZ to 40/25 mg [United States] or 20/25 mg [Europe]) to meet blood pressure targets. Treatment-emergent adverse events/serious adverse events occurred in 78.5%/5.7% of patients taking AZL-M/CLD vs 76.4%/6.2% taking OLM/HCTZ. The most frequent adverse events were dizziness (16.3% vs 12.6%), blood creatinine increase (21.5% vs 8.6%), headache (7.4% vs 11.0%), and nasopharyngitis (12.2% vs 11.5%). Hypokalemia was uncommon (1.0% vs 0.7%). Greater blood pressure reductions with AZL-M/CLD by week 2 were maintained throughout the study, despite less uptitration (32.3% vs 48.9% with OLM/HCTZ). Fixed-dose combination AZL-M/CLD showed an encouraging benefit-risk profile when used per standard clinical practice in a titrate-to-target strategy.
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Affiliation(s)
| | | | - Eric Lloyd
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | - Bruce Barger
- Takeda Development Center Americas, Inc., Deerfield, IL, USA
| | - Alison Handley
- Takeda Pharmaceuticals International, Inc., Deerfield, IL, USA
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Garjón J, Saiz LC, Azparren A, Elizondo JJ, Gaminde I, Ariz MJ, Erviti J. First-line combination therapy versus first-line monotherapy for primary hypertension. Cochrane Database Syst Rev 2017; 1:CD010316. [PMID: 28084624 PMCID: PMC6464906 DOI: 10.1002/14651858.cd010316.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Starting with one drug and starting with a combination of two drugs are strategies suggested in clinical guidelines as initial treatment of hypertension. The recommendations are not based on evidence about clinically relevant outcomes. Some antihypertensive combinations have been shown to be harmful. The actual harm-to-benefit balance of each strategy is unknown. OBJECTIVES To determine if there are differences in clinical outcomes between monotherapy and combination therapy as initial treatment for primary hypertension. SEARCH METHODS We searched the Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, 2016, Issue 2), Ovid MEDLINE, Ovid Embase, LILACS, ClinicalTrials.gov, Current Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to February 2016. We searched in clinical studies repositories of pharmaceutical companies, reviews of combination drugs in Food and Drug Administration and European Medicines Agency, and lists of references in reviews and clinical practice guidelines. SELECTION CRITERIA Randomized, double-blind trials with at least 12 months' follow-up in adults with primary hypertension (systolic blood pressure/diastolic blood pressure 140/90 mmHg or higher, or 130/80 mmHg or higher if participants had diabetes), which compared combination of two first-line antihypertensive drug with monotherapy as initial treatment. Trials had to include at least 50 participants per group and report mortality, cardiovascular mortality, cardiovascular events or serious adverse events. DATA COLLECTION AND ANALYSIS Two authors independently selected trials for inclusion, evaluated the risk of bias and entered the data. Primary outcomes were mortality, serious adverse events, cardiovascular events and cardiovascular mortality. Secondary outcomes were withdrawals due to drug-related adverse effects, reaching blood pressure control (as defined in each trial) and blood pressure change from baseline. Analyses were based on the intention-to-treat principle. We summarized data on dichotomous outcomes as risk ratios with 95% confidence intervals. MAIN RESULTS We found three studies in which a subgroup of participants met our inclusion criteria. None of the studies focused solely on people initiating antihypertensive treatment so we asked investigators for data for this subgroup (monotherapy: 335 participants; combination therapy: 233 participants). They included outpatients, and mostly European and white people. Two trials included only people with type 2 diabetes, whereas the other trial excluded people treated with diabetes, hypocholesterolaemia or cardiovascular drugs. The follow-up was 12 months in two trials and 36 months in one trial. Certainty of evidence was very low due to the serious imprecision, and for using a subgroup not defined in advance. Confidence intervals were extremely wide for all important outcomes and included both appreciable harm and benefit. AUTHORS' CONCLUSIONS The numbers of included participants and, hence the number of events, were too small to draw any conclusion about the relative efficacy of monotherapy versus combination therapy as initial treatment for primary hypertension. There is a need for large clinical trials that address the question and report clinically relevant endpoints.
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Affiliation(s)
- Javier Garjón
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaSpain31002
| | - Luis Carlos Saiz
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaSpain31002
| | - Ana Azparren
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaSpain31002
| | - José J Elizondo
- Navarre Health ServicePharmacy B, CHNIrunlarrea 4PamplonaSpain31008
| | - Idoia Gaminde
- Department of HealthContinuous Education and ResearchPabellón de DocenciaRecinto Hospital de NavarraPamplonaSpain31008
| | - Mª José Ariz
- Navarre Health ServiceMedical PracticeC/San Martin de Unx 11‐TafallaSpain31300
| | - Juan Erviti
- Navarre Health ServiceDrug Prescribing ServicePlaza de la Paz s/n 4ªPamplonaSpain31002
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Hampton C, Zhou X, Priest BT, Pai LY, Felix JP, Thomas-Fowlkes B, Liu J, Kohler M, Xiao J, Corona A, Price O, Gill C, Shah K, Rasa C, Tong V, Owens K, Ormes J, Tang H, Roy S, Sullivan KA, Metzger JM, Alonso-Galicia M, Kaczorowski GJ, Pasternak A, Garcia ML. The Renal Outer Medullary Potassium Channel Inhibitor, MK-7145, Lowers Blood Pressure, and Manifests Features of Bartters Syndrome Type II Phenotype. ACTA ACUST UNITED AC 2016; 359:194-206. [DOI: 10.1124/jpet.116.235150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/14/2016] [Indexed: 12/13/2022]
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Mohamed HM, Lamie NT. Application and validation of superior spectrophotometric methods for simultaneous determination of ternary mixture used for hypertension management. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2016; 155:103-110. [PMID: 26590480 DOI: 10.1016/j.saa.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 10/27/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
Telmisartan (TL), Hydrochlorothiazide (HZ) and Amlodipine besylate (AM) are co-formulated together for hypertension management. Three smart, specific and precise spectrophotometric methods were applied and validated for simultaneous determination of the three cited drugs. Method A is the ratio isoabsorptive point and ratio difference in subtracted spectra (RIDSS) which is based on dividing the ternary mixture of the studied drugs by the spectrum of AM to get the division spectrum, from which concentration of AM can be obtained by measuring the amplitude values in the plateau region at 360nm. Then the amplitude value of the plateau region was subtracted from the division spectrum and HZ concentration was obtained by measuring the difference in amplitude values at 278.5 and 306nm (corresponding to zero difference of TL) while the total concentration of HZ and TL in the mixture was measured at their isoabsorptive point in the division spectrum at 278.5nm (Aiso). TL concentration is then obtained by subtraction. Method B; double divisor ratio spectra derivative spectrophotometry (RS-DS) and method C; mean centering of ratio spectra (MCR) spectrophotometric methods. The proposed methods did not require any initial separation steps prior the analysis of the three drugs. A comparative study was done between the three methods regarding their; simplicity, sensitivity and limitations. Specificity was investigated by analyzing the synthetic mixtures containing different ratios of the three studied drugs and their tablets dosage form. Statistical comparison of the obtained results with those found by the official methods was done, differences were non-significant in regard to accuracy and precision. The three methods were validated in accordance with ICH guidelines and can be used for quality control laboratories for TL, HZ and AM.
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Affiliation(s)
- Heba M Mohamed
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr Al-Aini St., 11562 Cairo, Egypt.
| | - Nesrine T Lamie
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Kasr Al-Aini St., 11562 Cairo, Egypt
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12
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Handley A, Lloyd E, Roberts A, Barger B. Safety and tolerability of azilsartan medoxomil in subjects with essential hypertension: a one-year, phase 3, open-label study. Clin Exp Hypertens 2016; 38:180-8. [PMID: 26817604 PMCID: PMC4819839 DOI: 10.3109/10641963.2015.1081213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This 56-week phase 3, open-label, treat-to-target study, involving 2 consecutive, non-randomized cohorts, evaluated the safety and tolerability of azilsartan medoxomil (AZL-M) in essential hypertension (mean baseline blood pressure [BP] 152/100 mmHg). All subjects (n = 669) initiated AZL-M 40 mg QD, force-titrated to 80 mg QD at week 4, if tolerated. From week 8, subjects could receive additional medications, starting with chlorthalidone (CLD) 25 mg QD (Cohort 1) or hydrochlorothiazide (HCTZ) 12.5–25 mg QD (Cohort 2), if required, to reach BP targets. Adverse events (AEs) were reported in 75.9% of subjects overall in the two cohorts (73.8% Cohort 1, 78.5% Cohort 2). The most common AEs were dizziness (14.3%), headache (9.9%) and fatigue (7.2%). Transient serum creatinine elevations were more frequent with add-on CLD. Clinic systolic/diastolic BP (observed cases at week 56) decreased by 25.2/18.4 mmHg (Cohort 1) and 24.2/17.9 mmHg (Cohort 2). These results demonstrate that AZL-M is well tolerated over the long term and provides stable BP improvements when used in a treat-to-target BP approach with thiazide-type diuretics.
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Affiliation(s)
- Alison Handley
- a Takeda Pharmaceuticals International, Inc. , Deerfield , IL , USA and
| | - Eric Lloyd
- b Takeda Development Center Americas, Inc. , Deerfield , IL , USA
| | - Andrew Roberts
- b Takeda Development Center Americas, Inc. , Deerfield , IL , USA
| | - Bruce Barger
- b Takeda Development Center Americas, Inc. , Deerfield , IL , USA
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13
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Mukete BN, Ferdinand KC. Polypharmacy in Older Adults With Hypertension: A Comprehensive Review. J Clin Hypertens (Greenwich) 2015. [DOI: 10.1111/jch.12624] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Bertrand N. Mukete
- Tulane Heart and Vascular Institute/Section of Cardiology at Tulane University School of Medicine; New Orleans LA USA
| | - Keith C. Ferdinand
- Tulane Heart and Vascular Institute/Section of Cardiology at Tulane University School of Medicine; New Orleans LA USA
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14
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Murphy CM, Kearney PM, Shelley EB, Fahey T, Dooley C, Kenny RA. Hypertension prevalence, awareness, treatment and control in the over 50s in Ireland: evidence from The Irish Longitudinal Study on Ageing. J Public Health (Oxf) 2015; 38:450-458. [PMID: 25922371 DOI: 10.1093/pubmed/fdv057] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To assess the prevalence, awareness, treatment and control of hypertension among adults in Ireland and to describe the determinants of awareness, treatment and control in order to inform public health policy. METHODS A cross-sectional study of a nationally representative sample of community living adults aged 50 years and older using data collected from 2009 to 2011 for the first wave of the Irish Longitudinal Study on Ageing (TILDA) (n = 5857). Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or diastolic BP ≥90 mmHg and/or currently taking antihypertensive medications. RESULTS The prevalence of hypertension was 63.7% [95% confidence interval (CI) 62.3-65.1%]. Among those with hypertension, 54.5% (95% CI 52.6-56.2%) were aware of their hypertensive status and 58.9% (95% CI 57.1-60.4%) were on antihypertensive medication. Among those on treatment, 51.6% (95% CI 49.3-53.9%) had their BP controlled to below 140/90 mmHg. Respondents facing financial barriers to primary care and medication were less likely to be on antihypertensive treatment compared with those without financial barriers. CONCLUSIONS A high prevalence of hypertension was identified in this cohort, with low levels of awareness, treatment and control. Population and primary care interventions are required to reduce prevalence and to improve awareness, detection and management of hypertension.
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Affiliation(s)
- C M Murphy
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Lincoln Gate, Dublin 2, Ireland
| | - P M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - E B Shelley
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - T Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons Medical School, Dublin, Ireland
| | - C Dooley
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Lincoln Gate, Dublin 2, Ireland
| | - R A Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College, Lincoln Gate, Dublin 2, Ireland
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Kipnes MS, Handley A, Lloyd E, Barger B, Roberts A. Safety, tolerability, and efficacy of azilsartan medoxomil with or without chlorthalidone during and after 8 months of treatment for hypertension. J Clin Hypertens (Greenwich) 2015; 17:183-92. [PMID: 25619410 PMCID: PMC5024056 DOI: 10.1111/jch.12474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 11/14/2014] [Accepted: 11/23/2014] [Indexed: 12/13/2022]
Abstract
A phase 3, 26‐week, open‐label, titrate‐to‐target study (n=418) assessed the safety of azilsartan medoxomil (AZL‐M) alone and with chlorthalidone (CLD), followed by a 6‐week, double‐blind, placebo‐controlled reversal phase with change in clinic diastolic blood pressure (DBP) as the primary endpoint. Target blood pressure (BP) was <140/90 mm Hg (<130/80 mm Hg with diabetes/chronic kidney disease). AZL‐M was initiated at 40 mg once a day (QD), force‐titrated to 80 mg at week 4. CLD 25 mg QD could be added (weeks 8–22), if required, to reach target, followed by additional antihypertensives from week 12. At the end of the open‐label phase, mean change in systolic BP (SBP)/DBP from baseline was −23/−16 mm Hg. The most common adverse events, irrespective of treatment, were dizziness (8.9%) and headache (7.2%). Serious AEs were reported in eight patients (1.9%). Consecutive creatinine elevations ≥50% with values exceeding the upper limit of normal (ULN) were reported in nine (2.2%) patients. All returned to below the 50% threshold; most also returned to below the ULN after drug discontinuation. Mean DBP was maintained through the reversal phase in patients receiving AZL‐M, but increased with placebo (difference: −7.8 mm Hg, 95% confidence interval, −9.8 to −5.8; P<.001). AZL‐M alone or with CLD showed good long‐term safety and stable BP improvements in a titrate‐to‐target approach. BP improvements caused by AZL‐M therapy were safely reversible upon AZL‐M withdrawal.
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16
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McDonald E, Freedman DM, Alexander BH, Doody MM, Tucker MA, Linet MS, Cahoon EK. Prescription diuretic use and risk of basal cell carcinoma in the nationwide U.S. radiologic technologists cohort. Cancer Epidemiol Biomarkers Prev 2014; 23:1539-45. [PMID: 24812037 DOI: 10.1158/1055-9965.epi-14-0251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND UV radiation (UVR) exposure is the primary risk factor for basal cell carcinoma (BCC). Although prescription diuretics have photosensitizing properties, the relationship between diuretic use and BCC remains unclear. METHODS Using data from the United States Radiologic Technologists Study, a large, nationwide prospective cohort, we assessed the relationship between diuretic use and first primary BCC while accounting for sun exposure history, constitutional characteristics, lifestyle factors, and anthropometric measurements for geographically dispersed individuals exposed to a wide range of ambient UVR. RESULTS After adjustment for potential confounders, we found a significantly increased risk of BCC associated with diuretic use [HR, 1.22; 95% confidence interval (CI), 1.07-1.38]. This relationship was modified by body mass index (P = 0.019), such that BCC risk was increased with diuretic use in overweight (HR, 1.43; 95% CI, 1.16-1.76) and obese individuals (HR, 1.43; 95% CI, 1.09-1.88), but not in normal weight individuals (HR, 0.99; 95% CI, 0.81-1.21). CONCLUSIONS Increased risk of BCC associated with diuretic use in overweight and obese participants may be related to higher dosages, longer duration of medication use, reduced drug metabolism, or drug interactions. IMPACT Future cohort studies should obtain more detailed information on medication use, consider factors that affect drug metabolism, and measure intermediate endpoints such as photosensitivity reactions.
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Affiliation(s)
- Emily McDonald
- Department of Epidemiology and Biostatistics, Indiana University, School of Public Health, Bloomington, Indiana; Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - D Michal Freedman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Bruce H Alexander
- Division of Environmental Health Sciences, University of Minnesota, School of Public Health, Minneapolis, Minnesota
| | - Michele M Doody
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Martha S Linet
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
| | - Elizabeth K Cahoon
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, NIH, Bethesda, Maryland; and
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Garcia ML, Kaczorowski GJ. Targeting the inward-rectifier potassium channel ROMK in cardiovascular disease. Curr Opin Pharmacol 2014; 15:1-6. [DOI: 10.1016/j.coph.2013.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 12/11/2022]
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Garcia ML, Priest BT, Alonso-Galicia M, Zhou X, Felix JP, Brochu RM, Bailey T, Thomas-Fowlkes B, Liu J, Swensen A, Pai LY, Xiao J, Hernandez M, Hoagland K, Owens K, Tang H, de Jesus RK, Roy S, Kaczorowski GJ, Pasternak A. Pharmacologic inhibition of the renal outer medullary potassium channel causes diuresis and natriuresis in the absence of kaliuresis. J Pharmacol Exp Ther 2013; 348:153-64. [PMID: 24142912 DOI: 10.1124/jpet.113.208603] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The renal outer medullary potassium (ROMK) channel, which is located at the apical membrane of epithelial cells lining the thick ascending loop of Henle and cortical collecting duct, plays an important role in kidney physiology by regulating salt reabsorption. Loss-of-function mutations in the human ROMK channel are associated with antenatal type II Bartter's syndrome, an autosomal recessive life-threatening salt-wasting disorder with mild hypokalemia. Similar observations have been reported from studies with ROMK knockout mice and rats. It is noteworthy that heterozygous carriers of Kir1.1 mutations associated with antenatal Bartter's syndrome have reduced blood pressure and a decreased risk of developing hypertension by age 60. Although selective ROMK inhibitors would be expected to represent a new class of diuretics, this hypothesis has not been pharmacologically tested. Compound A [5-(2-(4-(2-(4-(1H-tetrazol-1-yl)phenyl)acetyl)piperazin-1-yl)ethyl)isobenzofuran-1(3H)-one)], a potent ROMK inhibitor with appropriate selectivity and characteristics for in vivo testing, has been identified. Compound A accesses the channel through the cytoplasmic side and binds to residues lining the pore within the transmembrane region below the selectivity filter. In normotensive rats and dogs, short-term oral administration of compound A caused concentration-dependent diuresis and natriuresis that were comparable to hydrochlorothiazide. Unlike hydrochlorothiazide, however, compound A did not cause any significant urinary potassium losses or changes in plasma electrolyte levels. These data indicate that pharmacologic inhibition of ROMK has the potential for affording diuretic/natriuretic efficacy similar to that of clinically used diuretics but without the dose-limiting hypokalemia associated with the use of loop and thiazide-like diuretics.
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Affiliation(s)
- Maria L Garcia
- Departments of Ion Channels (M.L.G., B.T.P., J.P.F., R.M.B., T.B., B.T.-F., J.L., A.S., G.J.K.), Hypertension (M.A.-G., X.Z., L.-Y.P., J.X., M.H., S.R.), Drug Metabolism (K.O.), and Medicinal Chemistry (H.T., R. K.J., A.P.), Merck Research Laboratories, Rahway, New Jersey; and Safety and Exploratory Pharmacology, Merck Research Laboratories, West Point, Pennsylvania (K.H.)
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Ferdinand KC, Nasser SA. A review of the efficacy and tolerability of combination amlodipine/valsartan in non-white patients with hypertension. Am J Cardiovasc Drugs 2013; 13:301-13. [PMID: 23784267 PMCID: PMC3781303 DOI: 10.1007/s40256-013-0033-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This article discusses racial/ethnic disparities in hypertension, with particular focus on non-white populations including blacks, Hispanics/Latinos, and Asians. Hypertension and its related morbidity and mortality affect a disproportionate number of black patients compared with white patients. Blacks, Hispanics/Latinos, and Asians have poor rates of hypertension awareness, treatment, and control. Given the high prevalence of comorbidities (e.g., obesity, diabetes, and metabolic syndrome) in these populations, renin–angiotensin–aldosterone system blockers are a good choice for foundation therapy. This review also discusses the importance of adherence and persistence with antihypertensive medication, which remain suboptimal in these non-white populations. Evidence suggests improvement with the use of single-pill combination therapy. Lastly, clinical trial data on the antihypertensive efficacy and safety of the combination of a dihydropyridine calcium channel blocker and an angiotensin receptor blocker, a widely utilized combination, in non-white populations are presented. PubMed was searched using the title/abstract key words (amlodipine AND valsartan AND [hypertension OR hypertensive] AND [black(s) OR African American(s) OR Hispanic(s) OR Latino(s) OR Mexican(s) OR Asian(s)]). In total, eight studies in patients with stage 1 or 2 hypertension were identified (n = 1,111 black, n = 389 Hispanic/Latino, and n = 3,094 Asian). Results showed that treatment with the combination of amlodipine plus valsartan is a reasonable choice for initial therapy or in patients who fail to respond to monotherapy. These drug classes have complementary mechanisms of action and, when used concomitantly, the magnitude of blood pressure lowering in these non-white populations is generally comparable with that seen in non-Hispanic white patients.
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Affiliation(s)
- Keith C Ferdinand
- Division of Cardiology, Tulane University School of Medicine, and Association of Black Cardiologists, Inc., 1430 Tulane Ave., SL-48, New Orleans, LA, 70112, USA,
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Pierini D, Anderson KV. Azilsartan Medoxomil/Chlorthalidone: A New Fixed-Dose Combination Antihypertensive. Ann Pharmacother 2013; 47:694-703. [DOI: 10.1345/aph.1r618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy, safety, and clinical utility of the combination product azilsartan medoxomil/chlorthalidone for the treatment of hypertension. DATA SOURCES Articles indexed in PubMed through December 2012 were identified using the MeSH terms azilsartan and chlorthalidone, Edarbyclor, TAK-490, and Edarbi. Additional information was gathered from references cited in the identified publications, the package insert, and from a review of the ClinicalTrials.gov registry. STUDY SELECTION AND DATA EXTRACTION English-language articles, including clinical trials and reviews involving azilsartan medoxomil/chlorthalidone or each component individually for the treatment of hypertension were reviewed. DATA SYNTHESIS The antihypertensive combination tablet azilsartan medoxomil/chlorthalidone is the first to combine an inhibitor of the renin-angiotensin-aldosterone system with chlorthalidone, a thiazide-type diuretic. In 4 randomized controlled trials (3 published to date), azilsartan medoxomil/chlorthalidone 40 mg/12.5 mg and 40 mg/25 mg reduced blood pressure (BP) significantly more than comparators did, including an approximately 5-mm Hg greater BP reduction than olmesartan medoxomil/hydrochlorothiazide 40 mg/25 mg and azilsartan medoxomil/hydrochlorothiazide. Reductions in 24-hour ambulatory BP and clinic BP were observed, and a greater proportion of patients achieved BP targets while receiving azilsartan medoxomil/chlorthalidone. Azilsartan medoxomil/chlorthalidone was generally well tolerated, with minor, transient increases in serum creatinine and without a significant effect on potassium homeostasis. No studies have directly examined cardiovascular morbidity and mortality benefits associated with this combination. CONCLUSIONS The combination of azilsartan medoxomil/chlorthalidone has demonstrated safety and efficacy in lowering BP in hypertensive patients to a greater degree than olmesartan medoxomil/hydrochlorothiazide and azilsartan medoxomil/hydrochlorothiazide. As a fixed-dose combination tablet, it offers several clinical advantages.
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Affiliation(s)
- Danielle Pierini
- Danielle Pierini PharmD, Postdoctoral Associate/Pharmacy Resident, Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville
| | - Katherine Vogel Anderson
- Katherine Vogel Anderson PharmD BCACP, Clinical Assistant Professor, Department of Pharmacotherapy and Translational Research, Division of General Internal Medicine, Colleges of Pharmacy and Medicine, University of Florida
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Kourlaba G, Fragoulakis V, Theodoratou D, Maniadakis N. Economic evaluation of telmisartan, valsartan and losartan in combination with hydrochlorothiazide for treatment of mild-to-moderate hypertension in Greece: a cost-utility analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2013. [DOI: 10.1111/jphs.12014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Georgia Kourlaba
- Department of Health Services Management; National School of Public Health; Athens Greece
| | - Vassilios Fragoulakis
- Department of Health Services Management; National School of Public Health; Athens Greece
| | | | - Nikos Maniadakis
- Department of Health Services Management; National School of Public Health; Athens Greece
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[Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events]. Med Clin (Barc) 2012; 141:53-61. [PMID: 22766057 DOI: 10.1016/j.medcli.2012.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 04/25/2012] [Accepted: 04/26/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension. PATIENTS AND METHODS An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥ 11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs. RESULTS We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P<.001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P<.001), compliance (71.4 vs. 69.9 and 67.1%, P=.017), persistence (50.1 vs. 45.5 and 46.2%, P=.044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P<.001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P<.001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p<.001). CONCLUSIONS Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs.
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Balti R, Bougatef A, Guillochon D, Dhulster P, Nasri M, Nedjar-Arroume N. Changes in arterial blood pressure after single oral administration of cuttlefish (Sepia officinalis) muscle derived peptides in spontaneously hypertensive rats. J Funct Foods 2012. [DOI: 10.1016/j.jff.2012.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Tang H, Walsh SP, Yan Y, de Jesus RK, Shahripour A, Teumelsan N, Zhu Y, Ha S, Owens KA, Thomas-Fowlkes BS, Felix JP, Liu J, Kohler M, Priest BT, Bailey T, Brochu R, Alonso-Galicia M, Kaczorowski GJ, Roy S, Yang L, Mills SG, Garcia ML, Pasternak A. Discovery of Selective Small Molecule ROMK Inhibitors as Potential New Mechanism Diuretics. ACS Med Chem Lett 2012; 3:367-72. [PMID: 24900480 DOI: 10.1021/ml3000066] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 03/28/2012] [Indexed: 11/28/2022] Open
Abstract
The renal outer medullary potassium channel (ROMK or Kir1.1) is a putative drug target for a novel class of diuretics that could be used for the treatment of hypertension and edematous states such as heart failure. An internal high-throughput screening campaign identified 1,4-bis(4-nitrophenethyl)piperazine (5) as a potent ROMK inhibitor. It is worth noting that this compound was identified as a minor impurity in a screening hit that was responsible for all of the initially observed ROMK activity. Structure-activity studies resulted in analogues with improved rat pharmacokinetic properties and selectivity over the hERG channel, providing tool compounds that can be used for in vivo pharmacological assessment. The featured ROMK inhibitors were also selective against other members of the inward rectifier family of potassium channels.
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Affiliation(s)
- Haifeng Tang
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Shawn P. Walsh
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Yan Yan
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Reynalda K. de Jesus
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Aurash Shahripour
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Nardos Teumelsan
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Yuping Zhu
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Sookhee Ha
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Karen A. Owens
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Brande S. Thomas-Fowlkes
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - John P. Felix
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Jessica Liu
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Martin Kohler
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Birgit T. Priest
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Timothy Bailey
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Richard Brochu
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Magdalena Alonso-Galicia
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Gregory J. Kaczorowski
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Sophie Roy
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Lihu Yang
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Sander G. Mills
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Maria L. Garcia
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
| | - Alexander Pasternak
- Departments of †Medicinal Chemistry, ‡Hypertension, §Ion Channels, ⊥Preclinical DMPK, and ¶Chemistry Modeling, Merck Research Laboratories, Rahway
New Jersey 07065,
United States
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Current World Literature. Curr Opin Nephrol Hypertens 2011; 20:561-7. [DOI: 10.1097/mnh.0b013e32834a3de5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lu J, Sawano Y, Miyakawa T, Xue YL, Cai MY, Egashira Y, Ren DF, Tanokura M. One-week antihypertensive effect of Ile-Gln-Pro in spontaneously hypertensive rats. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2011; 59:559-563. [PMID: 21182294 DOI: 10.1021/jf104126a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The antihypertensive effect of an angiotensin I-converting enzyme (ACE) inhibitory peptide Ile-Gln-Pro (IQP), whose sequence was derived from Spirulina platensis , was investigated in spontaneously hypertensive rats (SHRs) for 1 week. The weighted systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the peptide IQP-treated group were significantly lower than those of the negative control group from the third and fourth days, respectively. Accompanying the blood pressure reduction, a significant regulation of the expression of major components of the renin-angiotensin system (RAS) was found in the treatment group, including downregulation of the mRNA levels of renin, ACE, and the angiotensin II type 1 (AT1) receptor in the kidney, as well as serum angiotensinogen (Ang), ACE, and angiotensin II (Ang II) concentrations. The treatment group also showed upregulation of mRNA expression of the angiotensin II type 2 (AT2) receptor in the kidney. Our findings suggested that IQP might be of potential use in the treatment of hypertension.
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Affiliation(s)
- Jun Lu
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo 113-8657, Japan
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