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Preeti, Sambhakar S, Malik R, Bhatia S, Harrasi AA, Saharan R, Aggarwal G, Kumar S, Sehrawat R, Rani C. Lipid Horizons: Recent Advances and Future Prospects in LBDDS for Oral Administration of Antihypertensive Agents. Int J Hypertens 2024; 2024:2430147. [PMID: 38410720 PMCID: PMC10896658 DOI: 10.1155/2024/2430147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 12/20/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
The lipid-based drug delivery system (LBDDS) is a well-established technique that is anticipated to bring about comprehensive transformations in the pharmaceutical field, impacting the management and administration of drugs, as well as treatment and diagnosis. Various LBDDSs verified to be an efficacious mechanism for monitoring hypertension systems are SEDDS (self-nano emulsifying drug delivery), nanoemulsion, microemulsions, vesicular systems (transferosomes and liposomes), and solid lipid nanoparticles. LBDDSs overcome the shortcomings that are associated with antihypertensive agents because around fifty percent of the antihypertensive agents experience a few drawbacks including short half-life because of hepatic first-pass metabolism, poor aqueous solubility, low permeation rate, and undesirable side effects. This review emphasizes antihypertensive agents that were encapsulated into the lipid carrier to improve their poor oral bioavailability. Incorporating cutting-edge technologies such as nanotechnology and targeted drug delivery, LBDDS holds promise in addressing the multifactorial nature of hypertension. By fine-tuning drug release profiles and enhancing drug uptake at specific sites, LBDDS can potentially target renin-angiotensin-aldosterone system components, sympathetic nervous system pathways, and endothelial dysfunction, all of which play crucial roles in hypertension pathophysiology. The future of hypertension management using LBDDS is promising, with ongoing reviews focusing on precision medicine approaches, improved biocompatibility, and reduced toxicity. As we delve deeper into understanding the intricate mechanisms underlying hypertension, LBDDS offers a pathway to develop next-generation antihypertensive therapies that are safer, more effective, and tailored to individual patient needs.
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Affiliation(s)
- Preeti
- Banasthali Vidyapith, Vanasthali Road, Aliyabad 304022, Rajasthan, India
- Gurugram Global College of Pharmacy, Haily Mandi Rd, Farukh Nagar 122506, Haryana, India
| | - Sharda Sambhakar
- Banasthali Vidyapith, Vanasthali Road, Aliyabad 304022, Rajasthan, India
| | - Rohit Malik
- Gurugram Global College of Pharmacy, Haily Mandi Rd, Farukh Nagar 122506, Haryana, India
- SRM Modinagar College of Pharmacy, SRMIST, Delhi-NCR Campus, Ghaziabad, India
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mouz, Nizwa, Oman
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun, Uttarakhand, India
| | - Ahmed Al Harrasi
- Natural & Medical Sciences Research Centre, University of Nizwa, Birkat Al Mouz, Nizwa, Oman
| | - Renu Saharan
- Banasthali Vidyapith, Vanasthali Road, Aliyabad 304022, Rajasthan, India
- Maharishi Markandeshwar Deemed to be University, Mullana, Ambala 133203, Haryana, India
| | - Geeta Aggarwal
- Banasthali Vidyapith, Vanasthali Road, Aliyabad 304022, Rajasthan, India
| | - Suresh Kumar
- Bharat Institute of Pharmacy, Pehladpur, Babain, Kurukshetra 136132, Haryana, India
| | - Renu Sehrawat
- School of Medical & Allied Sciences, K. R. Mangalam University, Gurugram, Haryana 122103, India
| | - Chanchal Rani
- Gurugram Global College of Pharmacy, Haily Mandi Rd, Farukh Nagar 122506, Haryana, India
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Rossi FV, Gentili D, Marcantoni E. Metal-Promoted Heterocyclization: A Heterosynthetic Approach to Face a Pandemic Crisis. Molecules 2021; 26:2620. [PMID: 33947170 PMCID: PMC8124705 DOI: 10.3390/molecules26092620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
The outbreak of SARS-CoV-2 has drastically changed our everyday life and the life of scientists from all over the world. In the last year, the scientific community has faced this worldwide threat using any tool available in order to find an effective response. The recent formulation, production, and ongoing administration of vaccines represent a starting point in the battle against SARS-CoV-2, but they cannot be the only aid available. In this regard, the use of drugs capable to mitigate and fight the virus is a crucial aspect of the pharmacological strategy. Among the plethora of approved drugs, a consistent element is a heterocyclic framework inside its skeleton. Heterocycles have played a pivotal role for decades in the pharmaceutical industry due to their high bioactivity derived from anticancer, antiviral, and anti-inflammatory capabilities. In this context, the development of new performing and sustainable synthetic strategies to obtain heterocyclic molecules has become a key focus of scientists. In this review, we present the recent trends in metal-promoted heterocyclization, and we focus our attention on the construction of heterocycles associated with the skeleton of drugs targeting SARS-CoV-2 coronavirus.
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Affiliation(s)
- Federico Vittorio Rossi
- Chemistry Division, School of Science and Technology, University of Camerino, 62032 Camerino, Italy; (D.G.); (E.M.)
- Laboratori Alchemia Srl, Via San Faustino, 20134 Milano, Italy
| | - Dario Gentili
- Chemistry Division, School of Science and Technology, University of Camerino, 62032 Camerino, Italy; (D.G.); (E.M.)
| | - Enrico Marcantoni
- Chemistry Division, School of Science and Technology, University of Camerino, 62032 Camerino, Italy; (D.G.); (E.M.)
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Peglow TJ, Bartz RH, Martins CC, Belladona AL, Luchese C, Wilhelm EA, Schumacher RF, Perin G. Synthesis of 2-Organylchalcogenopheno[2,3-b]pyridines from Elemental Chalcogen and NaBH 4 /PEG-400 as a Reducing System: Antioxidant and Antinociceptive Properties. ChemMedChem 2020; 15:1741-1751. [PMID: 32667720 DOI: 10.1002/cmdc.202000358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/13/2020] [Indexed: 12/29/2022]
Abstract
An alternative method to prepare 2-organylchalcogenopheno[2,3-b]pyridines was developed by the insertion of chalcogen species (selenium, sulfur or tellurium), generated in situ, into 2-chloro-3-(organylethynyl)pyridines by using the NaBH4 /PEG-400 reducing system, followed by an intramolecular cyclization. It was possible to obtain a series of compounds with up to 93 % yield in short reaction times. Among the synthesized products, 2-organyltelluropheno[2,3-b]pyridines have not been described in the literature so far. Moreover, the compounds 2-phenylthieno[2,3-b]pyridine (3 b) and 2-phenyltelluropheno[2,3-b]pyridine (3 c) exhibited significant antioxidant potential in different in vitro assays. Further studies demonstrated that compound 3 b exerted an antinociceptive effect in acute inflammatory and non-inflammatory pain models, thus indicating the involvement of the central and peripheral nervous systems on its pharmacological action. More specifically, our results suggest that the intrinsic antioxidant property of compound 3 b might contribute to attenuating the nociception and inflammatory process on local injury induced by complete Freund's adjuvant (CFA).
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Affiliation(s)
- Thiago J Peglow
- LASOL-CCQFA, Universidade Federal de Pelotas - UFPel, P.O. Box 354, 96010-900, Pelotas, RS, Brazil
| | - Ricardo H Bartz
- LASOL-CCQFA, Universidade Federal de Pelotas - UFPel, P.O. Box 354, 96010-900, Pelotas, RS, Brazil
| | - Carolina C Martins
- LaFarBio-CCQFA, Universidade Federal de Pelotas - UFPel, 96010-900, Pelotas, RS, Brazil
| | - Andrei L Belladona
- CCNE, Universidade Federal de Santa Maria - UFSM, 97105-900, Santa Maria, RS, Brazil
| | - Cristiane Luchese
- LaFarBio-CCQFA, Universidade Federal de Pelotas - UFPel, 96010-900, Pelotas, RS, Brazil
| | - Ethel A Wilhelm
- LaFarBio-CCQFA, Universidade Federal de Pelotas - UFPel, 96010-900, Pelotas, RS, Brazil
| | - Ricardo F Schumacher
- CCNE, Universidade Federal de Santa Maria - UFSM, 97105-900, Santa Maria, RS, Brazil
| | - Gelson Perin
- LASOL-CCQFA, Universidade Federal de Pelotas - UFPel, P.O. Box 354, 96010-900, Pelotas, RS, Brazil
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4
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Shekhawat P, Bagul M, Edwankar D, Pokharkar V. Enhanced dissolution/caco-2 permeability, pharmacokinetic and pharmacodynamic performance of re-dispersible eprosartan mesylate nanopowder. Eur J Pharm Sci 2019; 132:72-85. [PMID: 30797937 DOI: 10.1016/j.ejps.2019.02.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
Eprosartan mesylate is an angiotensin receptor blocker which suffers from extremely poor bioavailability owing to its poor solubility and poor permeability. The rationale of the present work was to design the drug delivery system capable of overcoming these constraints. Nanoformulation of eprosartan mesylate was developed using ultrasonic wave-assisted liquid-antisolvent technique. Nanoformulation was further freeze dried with the addition of 1% of mannitol resulting in formation of re-dispersible EPM nanopowder. To prove our proof of principle, the re-dispersed nanopowder with z-average particle size 165.2 ± 1.8 nm was evaluated enormously for in-vitro dissolution behaviour and permeability assay through Caco-2 cell model. In-vitro dissolution study was performed at pH 1.2, pH 4.5 and pH 6.8. Result demonstrates enhanced dissolution from EPM nanopowder with negligible pH dependence. Transport studies accomplished using validated Caco-2 based cell model showed 11-fold enhanced apparent permeability of redispersed nanopowder when compared to pure EPM and corresponding physical mixture (p < 0.0001). In-vivo study reveals, exceptionally strong variations in plasma concentration of EPM through nanopowder (62 mg/kg) formulation when compared with physical mixture and pure EPM (62 mg/kg) group. Moreover, study manifests that 5-fold lower dose (12.4 mg/kg) of developed formulation yields higher exposure (4600 ± 36 ng·mL-1·h) than pure EPM (2349 ± 34 ng·mL-1·h) and corresponding physical mixture (2456 ± 49 ng·mL-1·h) at therapeutic dose (62 mg/kg). Further, L-NAME induced hypertensive model was undertaken to investigate effect of reduced dose of EPM nanopowder on systolic blood pressure, biochemical analysis and histopathology of heart. Results revealed pronounced antihypertensive potential of re-dispersed EPM nanopowder at 5-fold lower dose (12.4 mg/kg). In conclusion, our study indicates that nanopowder delivery might be the promising approach for providing enhanced oral bioavailability at lower dose.
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Affiliation(s)
- Prachi Shekhawat
- Department of Pharmaceutics, Poona College of Pharmacy, Bharati Vidyapeeth University, Erandwane, Pune, India
| | - Milind Bagul
- Raptim Research Limited, Mahape, Navi Mumbai, Maharashtra, India
| | - Diptee Edwankar
- Raptim Research Limited, Mahape, Navi Mumbai, Maharashtra, India
| | - Varsha Pokharkar
- Department of Pharmaceutics, Poona College of Pharmacy, Bharati Vidyapeeth University, Erandwane, Pune, India.
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Perin G, Soares LK, Hellwig PS, Silva MS, Neto JSS, Roehrs JA, Barcellos T, Lenardão EJ. Synthesis of 2,3-bis-organochalcogenyl-benzo[b]chalcogenophenes promoted by Oxone®. NEW J CHEM 2019. [DOI: 10.1039/c9nj00526a] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report here an alternative and tunable metal-free synthesis of benzo[b]chalcogenophenes via the electrophilic cyclization of 2-functionalized chalcogenoalkynes promoted by Oxone®.
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Affiliation(s)
- Gelson Perin
- LASOL-CCQFA
- Universidade Federal de Pelotas – UFPel
- 96010-900, Pelotas
- Brazil
| | - Liane K. Soares
- LASOL-CCQFA
- Universidade Federal de Pelotas – UFPel
- 96010-900, Pelotas
- Brazil
| | - Paola S. Hellwig
- LASOL-CCQFA
- Universidade Federal de Pelotas – UFPel
- 96010-900, Pelotas
- Brazil
| | - Marcio S. Silva
- LASOL-CCQFA
- Universidade Federal de Pelotas – UFPel
- 96010-900, Pelotas
- Brazil
| | - José S. S. Neto
- LASOL-CCQFA
- Universidade Federal de Pelotas – UFPel
- 96010-900, Pelotas
- Brazil
| | - Juliano A. Roehrs
- Instituto Federal Sul-Rio-Grandense
- Campus Pelotas – Praça Vinte de Setembro
- Brazil
| | - Thiago Barcellos
- Laboratory of Biotechnology of Natural and Synthetic Products – Universidade de Caxias do Sul – UCS
- Caxias do Sul
- Brazil
| | - Eder J. Lenardão
- LASOL-CCQFA
- Universidade Federal de Pelotas – UFPel
- 96010-900, Pelotas
- Brazil
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Goyal D, Kaur A, Goyal B. Benzofuran and Indole: Promising Scaffolds for Drug Development in Alzheimer's Disease. ChemMedChem 2018; 13:1275-1299. [DOI: 10.1002/cmdc.201800156] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/27/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Deepti Goyal
- Department of Chemistry, Faculty of Basic and Applied Sciences; Sri Guru Granth Sahib World University; Fatehgarh Sahib 140406 Punjab India
| | - Amandeep Kaur
- Department of Chemistry, Faculty of Basic and Applied Sciences; Sri Guru Granth Sahib World University; Fatehgarh Sahib 140406 Punjab India
| | - Bhupesh Goyal
- School of Chemistry and Biochemistry; Thapar Institute of Engineering & Technology; Patiala 147004 Punjab India
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Chand K, Rajeshwari, Hiremathad A, Singh M, Santos MA, Keri RS. A review on antioxidant potential of bioactive heterocycle benzofuran: Natural and synthetic derivatives. Pharmacol Rep 2016; 69:281-295. [PMID: 28171830 DOI: 10.1016/j.pharep.2016.11.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/10/2016] [Indexed: 12/19/2022]
Abstract
The majority of heterocycle compounds and typically common heterocycle fragments present in most pharmaceuticals currently marketed, alongside with their intrinsic versatility and unique physicochemical properties, have poised them as true cornerstones of medicinal chemistry. In this context, oxygen heterocycles exhibit diverse biological and pharmacological activities due in part to the similarities with many natural and synthetic molecules with known biological activity. Among oxygen containing heterocycles, benzofuran (synthetic and natural isolated) and its derivatives have attracted medicinal chemists and pharmacologists due to their pronounced biological activities and their potential applications as pharmacological agents such as antioxidant, antitumor, antiplatelet, antimalarial, antiinflammatory, antidepressant and anticonvulsant properties. There are also an amazing number of approved benzofuran-containing drugs in the market as well as compounds currently going through different clinical phases or registration statuses. Due to the wide range of biological activities of benzofurans, their structure activity relationships have generated interest among medicinal chemists, and this has culminated in the discovery of several lead molecules in numerous disease conditions. Recently, this scaffold has emerged as a pharmacophore of choice for designing antioxidant drug development as their derivatives have shown excellent results through different mechanism of action. This review focused on the recent development of benzofuran derivatives as antioxidant agents (including natural products) and their antioxidant activities; summarize the structure property, hoping to inspire new and even more creative approaches. Also, this study systematically provides a comprehensive report on current developments in benzofuran-based compounds as antioxidant agents and is also helpful for the researchers working on a substitution pattern around the nucleus, with an aim to help medicinal chemists to develop structure activity relationships (SAR) on these derivatives as antioxidant drugs.
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Affiliation(s)
- Karam Chand
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal.
| | - Rajeshwari
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Asha Hiremathad
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal; Centre for Nano and Material Sciences, Jain University, Jain Global Campus, Bangalore, Karnataka, India
| | - Mahak Singh
- Gennova Biopharmaceuticals Limited, Vaccine Formulation and Research Centre, Hinjwadi, Pune, India
| | - M Amelia Santos
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Rangappa S Keri
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal; Centre for Nano and Material Sciences, Jain University, Jain Global Campus, Bangalore, Karnataka, India.
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Dangre P, Gilhotra R, Dhole S. Formulation and statistical optimization of self-microemulsifying drug delivery system of eprosartan mesylate for improvement of oral bioavailability. Drug Deliv Transl Res 2016; 6:610-21. [DOI: 10.1007/s13346-016-0318-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sun P, Wang C, Liu Q, Meng Q, Zhang A, Huo X, Sun H, Liu K. OATP and MRP2-mediated hepatic uptake and biliary excretion of eprosartan in rat and human. Pharmacol Rep 2014; 66:311-9. [PMID: 24911086 DOI: 10.1016/j.pharep.2014.02.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 10/03/2013] [Accepted: 10/31/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Eprosartan is an angiotensin II receptor antagonist, used in the treatment of hypertension and heart failure in clinical patients. The objective of this study was to clarify the mechanism underlying hepatic uptake and biliary excretion of eprosartan in rats and humans. METHODS Perfused rat liver in situ, rat liver slices, isolated rat hepatocytes and human organic anion-transporting polypeptide (OATP)-transfected cells in vitro were used in this study. RESULTS Extraction ratio of eprosartan was decreased by rifampicin in perfused rat livers. Uptake of eprosartan in rat liver slices and isolated rat hepatocytes was significantly inhibited by Oatp modulators such as ibuprofen, digoxin, rifampicin and cyclosporine A, but not by tetraethyl ammonium or p-aminohippurate. Uptake of eprosartan in rat hepatocytes indicated a saturable process. Although uptake of eprosartan in OATP1B3-human embryonic kidney cells (HEK) 293 cells was not observed, significant differences in cellular accumulations of eprosartan between vector- and OATP1B1-Madin-Darby canine kidney strain (MDCK) II cells were found in transcellular transport study. Moreover, cumulative biliary excretion rate of eprosartan in the presence of probenecid (Multidrug resistance-associated protein 2 (Mrp2) inhibitor) was significantly decreased in perfused rat livers. Vectorial basal-to-apical transport of eprosartan was also observed in OATP1B1/MRP2 double transfectants. CONCLUSIONS Eprosartan was transported by multiple Oatps (at least Oatp1a1 and Oatp1a4)/Mrp2 in rat and OATP1B1/MRP2, at least, in human.
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Affiliation(s)
- Pengyuan Sun
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China; Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University, China
| | - Changyuan Wang
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China; Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University, China
| | - Qi Liu
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China; Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University, China
| | - Qiang Meng
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China; Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University, China
| | - Aijie Zhang
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China
| | - Xiaokui Huo
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China
| | - Huijun Sun
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China; Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University, China
| | - Kexin Liu
- Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, China; Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University, China; Research Institute of Integrated Traditional and Western Medicine of Dalian Medical University, Liaoning, China.
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Zaiken K, Hudd TR, Cheng JWM. A Review of the Use of Angiotensin Receptor Blockers for the Prevention of Cardiovascular Events in Patients with Essential Hypertension Without Compelling Indications. Ann Pharmacother 2013; 47:686-93. [DOI: 10.1345/aph.1r273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the role of angiotensin receptor blockers (ARBs) for the prevention of cardiovascular events in patients with essential hypertension without other compelling indications. DATA SOURCES Peer-reviewed clinical trials, review articles, and relevant treatment guidelines were identified from MEDLINE and Current Content database (both 1966-November 15, 2012) using the search terms angiotensin receptor blockers (ARBs), azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, hypertension, myocardial infarction, stroke, heart failure, and cardiovascular outcomes. Results were limited to human trials published in English. Citations from articles were also reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION The focus was on clinical trials evaluating cardiovascular end points of ARBs used in patients with essential hypertension without compelling indications. DATA SYNTHESIS Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are inconsistent. To date, only candesartan and losartan have shown a significant reduction in cardiovascular morbidity within this sizable subgroup of patients. In the Study on Cognition and Prognosis in the Elderly (SCOPE) trial, candesartan showed a 27.8% reduction in nonfatal stroke versus placebo (95% CI 1.3–47.2; p = 0.04). Moreover, losartan demonstrated a decrease in all cardiovascular events compared to atenolol in the Cardiovascular Morbidity and Mortality in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study (RR 0.87; 95% CI 0.77–0.98; p = 0.021). CONCLUSIONS Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are limited and inconclusive. More studies are needed before ARBs can be routinely recommended as first-line therapy for hypertension management in patients without other compelling indications.
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Affiliation(s)
- Kathy Zaiken
- Kathy Zaiken PharmD, Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences (MCPHS University); and Clinical Pharmacist, Harvard Vanguard Medical Associates, Boston, MA
| | - Timothy R Hudd
- Timothy R Hudd BS PharmD AE-C, Associate Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences (MCPHS University); and Clinical Pharmacist, Greater Lawrence Family Health Center, Lawrence, MA
| | - Judy WM Cheng
- Judy WM Cheng BS PharmD MPH FCCP BCPS, Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences (MCPHS University); and Clinical Pharmacist, Brigham and Women's Hospital, Boston
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Benge CD, Muldowney JAS. The pharmacokinetics and pharmacodynamics of valsartan in the post-myocardial infarction population. Expert Opin Drug Metab Toxicol 2012; 8:1469-82. [PMID: 22998368 DOI: 10.1517/17425255.2012.725721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The most common risk factors for heart failure are hypertension and myocardial infarction. Angiotensin receptor blockers (ARBs) attenuate the deleterious effects of angiotensin II. Valsartan is a once or twice daily ARB that is FDA-approved for hypertension, LV dysfunction post-myocardial infarction and congestive heart failure as both an adjunct in ACE-inhibitor tolerant, and alternative in ACE-I intolerant patients. AREAS COVERED This article presents a comprehensive review of the literature regarding the pharmacokinetics and pharmacodynamics of valsartan, with particular attention paid to the post-myocardial infarction population. EXPERT OPINION Valsartan is a safe, well-tolerated and readily titratable ARB. In addition to its vasodilatory effects there are pleotropic effects associated with the ARB such as modulation of a number of neurohormonal regulators, cytokines and small molecules. Given the clear evidence-based benefits above and beyond its hypertensive properties, it has the potential, if priced appropriately, to grow in its impact as a pharmacotherapeutic long after its patent expires.
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Affiliation(s)
- Cassandra D Benge
- Nashville Veterans Affairs Medical Center, Cardiology Section, 1310 24th Avenue South, Nashville, TN 37212-263, USA
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De Backer G, Petrella RJ, Goudev AR, Radaideh GA, Rynkiewicz A, Pathak A. Design and methodology of POWER, an open-label observation of the effect of primary care interventions on total cardiovascular risk in patients with hypertension. Fundam Clin Pharmacol 2011; 27:210-5. [PMID: 22049922 DOI: 10.1111/j.1472-8206.2011.01006.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Guy De Backer
- Department of Public Health, Ghent University, Ghent, Belgium.
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