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Liu J, Han J, Izawa K, Sato T, White S, Meanwell NA, Soloshonok VA. Cyclic tailor-made amino acids in the design of modern pharmaceuticals. Eur J Med Chem 2020; 208:112736. [PMID: 32966895 DOI: 10.1016/j.ejmech.2020.112736] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
Tailor-made AAs are indispensable components of modern medicinal chemistry and are becoming increasingly prominent in new drugs. In fact, about 30% of small-molecule pharmaceuticals contain residues of tailor-made AAs or structurally related diamines and amino-alcohols. Cyclic tailor-made AAs present a particular value to rational structural design by virtue of their local conformational constraints and are widely used in lead optimization programs. The present review article highlights 34 compounds, all of which are derived from cyclic AAs, representing recently-approved, small-molecule pharmaceuticals as well as promising drug candidates currently in various phases of clinical study. For each compound, the discussion includes the discovery, therapeutic profile and optimized synthesis, with a focus on the preparation of cyclic tailor-made AA as the principal structural feature. The present review article is intended to serve as a reference source for organic, medicinal and process chemists along with other professionals working in the fields of drug design and pharmaceutical discovery.
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Affiliation(s)
- Jiang Liu
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing, 210037, Jiangsu, China
| | - Jianlin Han
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, College of Chemical Engineering, Nanjing Forestry University, Nanjing, 210037, Jiangsu, China
| | - Kunisuke Izawa
- Hamari Chemicals Ltd., 1-4-29 Kunijima, Higashi-Yodogawa-ku, Osaka, 533-0024, Japan.
| | - Tatsunori Sato
- Hamari Chemicals Ltd., 1-4-29 Kunijima, Higashi-Yodogawa-ku, Osaka, 533-0024, Japan
| | - Sarah White
- Oakwood Chemical, Inc, 730 Columbia Hwy. N, Estill, SC, 29918, USA
| | - Nicholas A Meanwell
- Department of Small Molecule Drug Discovery, Bristol Myers Squibb Research and Early Development, PO Box, 4000, Princeton, NJ, 08543 4000, United States
| | - Vadim A Soloshonok
- Department of Organic Chemistry I, Faculty of Chemistry, University of the Basque Country UPV/EHU, Paseo Manuel Lardizábal 3, 20018, San Sebastián, Spain; IKERBASQUE, Basque Foundation for Science, María Díaz de Haro 3, Plaza Bizkaia, 48013, Bilbao, Spain.
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Abdou MM. Synopsis of recent synthetic methods and biological applications of phosphinic acid derivatives. Tetrahedron 2020. [DOI: 10.1016/j.tet.2020.131251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Si-Miao-Yong-An decoction ameliorates cardiac function through restoring the equilibrium of SOD and NOX2 in heart failure mice. Pharmacol Res 2019; 146:104318. [DOI: 10.1016/j.phrs.2019.104318] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/29/2019] [Accepted: 06/16/2019] [Indexed: 11/19/2022]
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Abdou MM, O'Neill PM, Amigues E, Matziari M. Phosphinic acids: current status and potential for drug discovery. Drug Discov Today 2019; 24:916-929. [PMID: 30481556 DOI: 10.1016/j.drudis.2018.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 01/17/2023]
Abstract
Phosphinic acid derivatives exhibit diverse biological activities and a high degree of structural diversity, rendering them a versatile tool in the development of new medicinal agents. Pronounced recent progress, coupled with previous research findings, highlights the impact of this moiety in medicinal chemistry. Here, we highlight the most important breakthroughs made with phosphinates with a range of pharmacological activities against many diseases, including anti-inflammatory, anti-Alzheimer, antiparasitic, antihepatitis, antiproliferative, anti-influenza, anti-HIV, antimalarial, and antimicrobial agents. We also provide the current status of the corresponding prodrugs, drug-delivery systems, and drug applications of phosphinic acids in the clinical stage.
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Affiliation(s)
- Moaz M Abdou
- Egyptian Petroleum Research Institute, Nasr City, PO 11727, Cairo, Egypt; Department of Chemistry, Xi'an Jiaotong Liverpool University, Suzhou, Jiangsu 215123, PR China; Department of Chemistry, University of Liverpool, Liverpool, L69 7ZD, UK
| | - Paul M O'Neill
- Department of Chemistry, University of Liverpool, Liverpool, L69 7ZD, UK; Department of Pharmacology, School of Biomedical Sciences, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, L69 3GE, UK
| | - Eric Amigues
- Department of Chemistry, Xi'an Jiaotong Liverpool University, Suzhou, Jiangsu 215123, PR China
| | - Magdalini Matziari
- Department of Chemistry, Xi'an Jiaotong Liverpool University, Suzhou, Jiangsu 215123, PR China.
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Zhou KL, Pan DQ, Lou YY, Shi JH. Intermolecular interaction of fosinopril with bovine serum albumin (BSA): The multi-spectroscopic and computational investigation. J Mol Recognit 2018; 31:e2716. [DOI: 10.1002/jmr.2716] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/17/2018] [Accepted: 03/07/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Kai-Li Zhou
- College of Pharmaceutical Science; Zhejiang University of Technology; Hangzhou 310032 China
| | - Dong-Qi Pan
- College of Pharmaceutical Science; Zhejiang University of Technology; Hangzhou 310032 China
| | - Yan-Yue Lou
- College of Pharmaceutical Science; Zhejiang University of Technology; Hangzhou 310032 China
| | - Jie-Hua Shi
- College of Pharmaceutical Science; Zhejiang University of Technology; Hangzhou 310032 China
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Araiza-Saldaña CI, Pedraza-Priego EF, Torres-López JE, Rocha-González HI, Castañeda-Corral G, Hong-Chong E, Granados-Soto V. Fosinopril Prevents the Development of Tactile Allodynia in a Streptozotocin-Induced Diabetic Rat Model. Drug Dev Res 2015; 76:442-9. [DOI: 10.1002/ddr.21280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/22/2015] [Indexed: 01/01/2023]
Affiliation(s)
| | - Erick Fabián Pedraza-Priego
- División Académica de Ciencias de la Salud; Universidad Juárez Autónoma de Tabasco; Villahermosa Tabasco Mexico
| | - Jorge Elías Torres-López
- División Académica de Ciencias de la Salud; Universidad Juárez Autónoma de Tabasco; Villahermosa Tabasco Mexico
| | - Héctor Isaac Rocha-González
- Sección de Estudios de Posgrado e Investigación; Escuela Superior de Medicina, Instituto Politécnico Nacional; México D.F. Mexico
| | | | - Enrique Hong-Chong
- Departamento de Farmacobiología; Centro de Investigación y de Estudios Avanzados (Cinvestav), Sede Sur.; México D.F. Mexico
| | - Vinicio Granados-Soto
- Departamento de Farmacobiología; Centro de Investigación y de Estudios Avanzados (Cinvestav), Sede Sur.; México D.F. Mexico
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Cesari M, Pedone C, Incalzi RA, Pahor M. ACE-inhibition and physical function: results from the Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. J Am Med Dir Assoc 2009; 11:26-32. [PMID: 20129212 DOI: 10.1016/j.jamda.2009.09.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 09/21/2009] [Accepted: 09/23/2009] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Aim of the present study was to evaluate whether an ACE inhibitor intervention is able to significantly improve physical performance and muscle strength in a sample of older persons. DESIGN Double-blind, cross-over, randomized, placebo-controlled trial. SETTING The Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. PARTICIPANTS Participants were 257 subjects aged 55 years and older with high cardiovascular risk profile. INTERVENTION Six months of fosinopril use versus placebo. MEASUREMENTS The Short Physical Performance Battery score (rescaled to obtain a continuous variable ranging from 0 to 3 points), and the hand grip strength were measured at the baseline visit, and after 6 and 12 months of follow-up. Paired t test analyses were performed to compare results of physical function measures after ACE inhibition and placebo interventions. RESULTS Mean age of the sample population was 65.97 (standard deviation 7.41) years old. No statistically significant difference was found at the Short Physical Performance Battery (P=.23) and hand grip strength (P=.57) results after ACE inhibition (2.113, standard deviation [SD] 0.284; and 37.044 kg, SD 12.993 kg, respectively) compared to placebo (2.096, SD 0.298; and 36.898 kg, SD 13.178 kg, respectively). No significant effects from ACE inhibition were also found when the 3 subtests composing the Short Physical Performance Battery (ie, 4-meter walking speed, balance, and chair stand tests) were separately analyzed. Consistent negative results were obtained after analyses were restricted to participants showing the highest compliance to treatment and/or receiving the maximum fosinopril dosage. CONCLUSION No significant modifications in physical performance and muscle strength were reported after 6 months of fosinopril use in older persons with high cardiovascular risk profile. Given these negative findings, it is possible that the beneficial effects of ACE inhibitors on physical function might be attributable to the activation of a virtuous cycle determined by an improved cardiovascular system. Further specifically designed studies are needed to confirm our findings, and expand them to different populations and ACE inhibitors. If our findings will be confirmed, the extracardiovascular properties of ACE inhibitors in older persons might be substantially resized.
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Affiliation(s)
- Matteo Cesari
- Centro per la Salute dell'Anziano-Area di Geriatria, Università Campus Bio-Medico, Via Alvaro del Portillo 5, Rome, Italy.
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Cesari M, Kritchevsky SB, Atkinson HH, Penninx BW, Di Bari M, Tracy RP, Pahor M. Angiotensin-converting enzyme inhibition and novel cardiovascular risk biomarkers: results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study. Am Heart J 2009; 157:334.e1-8. [PMID: 19185642 DOI: 10.1016/j.ahj.2008.10.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 10/23/2008] [Indexed: 01/13/2023]
Abstract
BACKGROUND Beneficial effects of angiotensin-converting enzyme (ACE) inhibitors seem to be mediated by mechanisms that are partly independent of blood pressure lowering. The present study evaluates effects of an ACE inhibitor (ie, fosinopril) intervention on novel cardiovascular risk factors. METHODS Data are from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study, a double-blind, crossover, randomized, placebo-controlled trial enrolling subjects > or =55 years old with high cardiovascular disease risk profile. Biomarkers of hemostasis (ie, plasminogen activator inhibitor 1, D-dimer), inflammation (ie, C-reactive protein, interleukin-6), and endothelial function (ie, endothelin 1, vascular cell adhesion molecule 1) were measured at the baseline, at the midterm, and at end of follow-up (after 1 year) clinic visits. Paired t test analyses (after Sidak's adjustment, P < .009) were performed to compare biomarkers modifications after fosinopril/placebo interventions. RESULTS Mean age of the sample (n = 290, women 43.4%) was 66.0 years old. No significant differences were reported for C-reactive protein, interleukin 6, plasminogen activator inhibitor 1, vascular cell adhesion molecule 1, and endothelin 1 levels in the comparisons between fosinopril and placebo interventions. D-dimer was the only biomarker showing a significant difference between fosinopril intervention (median 0.32 microg/mL, interquartile range 0.22-0.52 microg/mL) and placebo (median 0.29 microg/mL, interquartile range 0.20-0.47 microg/mL, P = .007) when analyses were restricted to participants with higher compliance to treatment and receiving the maximum ACE inhibitor dosage. CONCLUSIONS Angiotensin-converting enzyme inhibition does not significantly modify major biomarkers of inflammation, hemostasis, and endothelial function. Further studies should confirm the possible effect of ACE inhibitors on the fibrinolysis pathway.
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Affiliation(s)
- Matteo Cesari
- Department of Aging and Geriatric Research, University of Florida-Institute on Aging, Gainesville, 32611, USA.
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Saini R, Romanini M, Veglio F. A comparison of fosinopril and hydrochlorothiazide with hydrochlorothiazide in non-insulin-dependent diabetes mellitus patients with mild to moderate hypertension. Clin Drug Investig 2008; 15:21-8. [PMID: 18370462 DOI: 10.2165/00044011-199815010-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A multicentre, randomised, double-blind, parallel-group study of the tolerability and antihypertensive efficacy of once-daily fosinopril 20 mg/hydrochlorothiazide 12.5mg (FOS/HCTZ) compared with once-daily hydrochlorothiazide 25mg (HCTZ) was conducted in 142 patients with non-insulin-dependent diabetes mellitus (NIDDM) and mild to moderate essential hypertension. After 12 weeks of treatment, both groups had statistically significant mean changes from baseline in seated diastolic and systolic blood pressures (FOS/HCTZ, -15.0mm Hg; HCTZ, -11.9mm Hg for seated diastolic blood pressure). The difference between treatment groups was statistically significant (p < 0.001). In addition, normalisation of seated diastolic blood pressure was achieved in 85% of FOS/HCTZ patients compared with 71% of HCTZ patients. A statistically significant difference (p < 0.05) in favour of FOS/HCTZ was observed for the total number of favourable responses (normalisation or >/=10mm Hg reduction in seated diastolic blood pressure) at week 12 and for the end-point analysis. One FOS/HCTZ patient and 5 HCTZ patients discontinued treatment because of adverse events. No clinically significant changes in serum glucose, potassium or cholesterol were observed. A slight but statistically significant increase in fasting triglycerides occurred with FOS/HCTZ compared with HCTZ (+26.1 vs +13.5 mg/dl, respectively; p < 0.05). These results show that the combination of fosinopril and hydrochlorothiazide has considerable potential as an effective antihypertensive regimen that does not significantly alter glucose or lipid metabolism in patients with NIDDM.
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Affiliation(s)
- R Saini
- Cardiovascular Clinical Research, Bristol-Myers Squibb Pharmaceutical Company, Princeton, New Jersey, USA
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Cremonesi G, Cavalieri L, Cikes I, Dobovisek J, Bacchelli S, Degli Esposti D, Costa FV, Borghi C, Ambrosioni E. Fixed combinations of delapril plus indapamide vs fosinopril plus hydrochlorothiazide in mild to moderate essential hypertension. Adv Ther 2002; 19:129-37. [PMID: 12201354 DOI: 10.1007/bf02850269] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This 12-week randomized, parallel-group, multicenter study compared fixed combinations of delapril (D) 30 mg plus indapamide (I) 2.5 mg and fosinopril (F) 20 mg plus hydrochlorothiazide (H) 12.5 mg in 171 adult patients with mild to moderate essential hypertension. After a 2-week placebo run-in, sitting and standing systolic (SBP) and diastolic blood pressure (DBP) was measured by conventional sphygmomanometry. The primary efficacy endpoint was the percentage of normalized (sitting DBP < or =90 mm Hg) and responder (sitting DBP reduction of 10 mm Hg or DBP < or =90 mm Hg) patients. Treatment effects were analyzed in the intention-to-treat (ITT; n = 171) and the per-protocol (PP; n = 167) populations. The percentage of normalized and responder patients did not differ significantly between the D + I (87.4% and 92%) and the F + H (81% and 86.9%) ITT groups. Similar results were seen in the PP population. In ITT and PP patients, sitting and standing SBP and DBP values were comparable at baseline in the two groups and were significantly (P<.01) and similarly reduced at weeks 4, 8, and 12. Neither treatment induced reflex tachycardia, and both regimens were well tolerated. Four patients in the F + H group dropped out because of adverse events. In this study, the efficacy and safety of D + I were comparable to those of F + H in patients with mild to moderate essential hypertension.
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11
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Affiliation(s)
- J Menard
- Faculté de Médecine, Université Paris, 75270 Paris, France
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12
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Bisognano JD, Cody RJ. The renin-angiotensin system antagonism in the treatment of hypertension. Curr Hypertens Rep 1999; 1:275-7. [PMID: 10981078 DOI: 10.1007/s11906-999-0033-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The effective treatment of hypertension is associated with improved mortality and morbidity from diseases such as stroke, congestive heart failure, and renal failure. Use of medications that target the renin-angiotensin system for the treatment of hypertension can often achieve the desired decrease in blood pressure while causing a minimum of unwanted side effects. In this paper, the principles of the renin-angiotensin system antagonism are described. The approach to using these medications is discussed with special attention to specific indications as well as common side effects.
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Affiliation(s)
- J D Bisognano
- Divisions of Hypertension and Cardiology, University of Michigan Medical Center, 3918 Taubman Center, Box 0356, Ann Arbor, Michigan 48109, USA
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Tewari A, Narayan P. Alpha-adrenergic blocking drugs in the management of benign prostatic hyperplasia: interactions with antihypertensive therapy. Urology 1999; 53:14-20; discussion 41-2. [PMID: 10094096 DOI: 10.1016/s0090-4295(98)00534-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Management of benign prostatic hyperplasia (BPH) is often complicated by concomitant hypertension, a life-threatening condition that must be managed optimally. Many of the alpha blockers used to treat BPH also decrease blood pressure, and terazosin and doxazosin have been shown to have significant cardiovascular side effects, such as asthenia/fatigue, postural hypotension, and dizziness when used to treat BPH patients. Furthermore, these drugs are not first-line therapies for hypertension, and the majority of hypertensive BPH patients will be receiving other antihypertensive agents. Therefore, it is possible that the introduction of these drugs will affect blood pressure control, at least temporarily, with possible adverse effects. In contrast, the selective alpha1A blocker tamsulosin does not appear to have significant cardiovascular side effects and produces minimal blood pressure reductions. Therefore, urologists can choose either to use alpha blockers to treat both hypertension and BPH or to treat BPH using alpha blockers that do not interact with antihypertensive therapy. This review focuses on the alpha blockers currently being used to treat BPH, their effects on the cardiovascular system, and their interaction with antihypertensive drugs.
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Affiliation(s)
- A Tewari
- Josephine Ford Cancer Center at Henry Ford Hospital, Urology, Detroit, Michigan 98202, USA.
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Cheung BM, Lau CP. Fosinopril reduces left ventricular mass in untreated hypertensive patients: a controlled trial. Br J Clin Pharmacol 1999; 47:179-87. [PMID: 10190653 PMCID: PMC2014174 DOI: 10.1046/j.1365-2125.1999.00873.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/1998] [Accepted: 09/21/1998] [Indexed: 01/20/2023] Open
Abstract
AIMS Left ventricular hypertrophy is a powerful predictor of cardiovascular morbidity and mortality. We tested the hypothesis that fosinopril, an angiotensin-converting enzyme inhibitor, reduces left ventricular mass in hypertensive patients. METHODS Thirty-three patients with untreated mild essential hypertension were randomised to treatment with oral fosinopril (10 mg-20 mg daily) or placebo for 12 weeks. The primary outcome measure was the change in left ventricular mass index determined by echocardiography. RESULTS Diastolic blood pressure changed from 95.5+/-2.1 mmHg at baseline to 96.6+/-2.8 mmHg at the final visit in control patients and changed from 96.6+/-2.3 mmHg to 91.5+/-3.0 mmHg in patients treated with fosinopril (P= 0.04). Systolic blood pressure changed from 147.4+/-3.2 mmHg at baseline to 152.7+/-4.4 mmHg at the final visit in control patients and changed from 157.6+/-5.1 mmHg to 149.1+/-6.1 mmHg in patients treated with fosinopril (P=0.02). Fosinopril reduced diastolic pressure by 6.3 (95%CI 0.3-12.4) mmHg and systolic pressure by 13.3 (95%CI 2.7-23.8) mmHg compared with placebo. The left ventricular mass index changed from 110.0+/-8.3 gm(-2) to 113.1+/-8.7 g m(-2) in the control patients and changed from 120.8+/-5.8 g m(-2) to 109.0+/-7.5 g m(-2) in patients treated with fosinopril (P=0.02). Fosinopril reduced left ventricular mass index by 14.9 (95%CI 2.2-27.6) g m(-2) compared with placebo. There was no significant change in the left ventricular systolic or diastolic function, nor were there any significant changes in plasma electrolytes and renal function. CONCLUSIONS Treatment with fosinopril for 12 weeks reduced left ventricular mass significantly in hypertensive patients.
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Affiliation(s)
- B M Cheung
- Department of Medicine, University of Hong Kong, Hong Kong
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Sica DA, Gehr TWB, Kelleher N, Blumenthal M. Fosinopril: Emerging Considerations and Implications for Angiotensin-Converting Enzyme Inhibitor Therapy. ACTA ACUST UNITED AC 1998. [DOI: 10.1111/j.1527-3466.1998.tb00362.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Verho M, Smith NA, Lorenz H, Beran M. Efficacy of ramipril in therapy-resistant hypertension. Curr Med Res Opin 1998; 14:117-25. [PMID: 9704202 DOI: 10.1185/03007999809113351] [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: 02/08/2023]
Abstract
In an open, 48-week study the antihypertensive efficacy of ramipril when administered as add-on therapy to existing triple antihypertensive treatment (diuretics, beta-blockers, vasodilators) was investigated in 56 patients (24 females, 32 males) with therapy-resistant hypertension. The main variable (sitting diastolic blood pressure) decreased from 112 mmHg at baseline to 91 mmHg at week 8 (p < 0.01) and remained stable thereafter until the end of the trial. The systolic blood pressure in the sitting position decreased from 175 mmHg at baseline to 146 mmHg at week 8 (p < 0.01) and also remained stable thereafter until the end of the trial. Ramipril doses between week 8 and the end of the trial were not changed in 82% of patients. 45% of patients were treated with 5 mg ramipril/day, 33% with 10 mg/day and 22% with 20 mg/day at the end of the study. Addition of ramipril allowed a reduction in the doses of concurrrent therapy, especially in relation to beta-blockers (p < 0.02) and vasodilators (p < 0.01). The safety was good--no serious adverse events were observed. Ramipril is, therefore, a suitable drug for the patients with therapy-resistant hypertension allowing reduction of the doses of concomitant medication.
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Affiliation(s)
- M Verho
- Hoechst Marion Roussel, Inc, Bridgewater, New Jersey 08807-0800, USA
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