Manidipine for hypertension not controlled by dual therapy in patients with diabetes mellitus: a non-comparative, open-label study

Increased Risk of Hypertension in Young Adults in Southwest China: Impact of the 2017 ACC/AHA High Blood Pressure Guideline

PURPOSE OF REVIEW

To examine the impact of the new 2017 ACC/AHA hypertension guideline on the prevalence of hypertension, its constituent ratio, and their associated factors in southwest China.

RECENT FINDINGS

A total of 14,220 permanent residents ≥ 18 years were enrolled in this survey. According to the 2017 ACC/AHA hypertension guideline, the hypertension prevalence was substantially increased (46.9% vs. 24.5%); consistent across different age and gender groups, while the hypertension awareness (23.8% vs. 45.6%); treatment (18.6% vs. 35.5%); control (2.3% vs. 11.2%); and control among treatment (9.6% vs. 24.0%) patients were decreased in southwest of China. In our cohort, 31.1% participants were newly diagnosed as hypertension. Young adults accounted considerable proportion in this newly diagnosed hypertension population. The proportion of young hypertensive individuals substantially increased, whereas those of the older hypertensive subjects decreased. Among the hypertensive subjects aged ≥ 65 years undergoing treatment, 90% of the elderly subjects were not eligible for hypertension control and 32.5% have systolic blood pressure control at 130-149 mmHg, and thus need to intensify antihypertensive treatment according to 2017 ACC/AHA hypertension guideline. Smoking, drinking, body fat percentage, and body mass index were considered the factors associated with hypertension according to the Chinese hypertension guideline but not in the 2017 ACC/AHA hypertension guideline. The adoption of the 2017 ACC/AHA hypertension guideline will substantially increase hypertension prevalence in southwest of China. The new definition of hypertension implies that more young adults will likely suffer from high cardiovascular risks, while additional one third of elder hypertensive subjects will likely need intensified antihypertension treatments.

Dyslipidaemia in type 2 diabetes mellitus: bad for the heart

PURPOSE OF REVIEW

Type 2 diabetes mellitus (T2DM) is associated with increased coronary heart disease (CHD) morbidity and mortality. These patients are also more prone to heart failure, arrhythmias and sudden cardiac death. Furthermore, coronary interventions performed in such high-risk patients have worse outcomes. In this narrative review, we discuss the role of diabetic dyslipidaemia on the risk of CHD in patients with T2DM. The effects of hypolipidaemic, antihypertensive and antidiabetic drugs on lipid and glucose metabolism in T2DM are also considered.

RECENT FINDINGS

Among CHD risk factors, diabetic dyslipidaemia characterized by moderately elevated low-density lipoprotein (LDL) cholesterol, increased triglycerides and small, dense LDL particles as well as decreased high-density lipoprotein cholesterol levels may contribute to the increased CHD risk associated with T2DM. Hypolipidaemic, antihypertensive and antidiabetic drugs can affect lipid and glucose parameters thus potentially influencing CHD risk. Such drugs may improve not only the quantity, but also the quality of LDL as well as postprandial lipaemia.

SUMMARY

Current data highlight the importance of treating diabetic dyslipidaemia in order to minimize CHD risk. Both fasting and postprandial lipids are influenced by drugs in patients with T2DM; physicians should take this into consideration in clinical decision making.

Treatment of hypertensive patients with diabetes: beyond blood pressure control and focus on manidipine

Renin-angiotensin system inhibitors should be considered as the first-line therapy in the treatment of patients with hypertension and diabetes. However, most of the diabetic subjects with hypertension require at least two drugs to achieve blood pressure targets. The ACCOMPLISH trial suggested that the best combination in the treatment of high-risk hypertensive patients should include a renin-angiotensin system inhibitor and a dihydropyridine. However, not all dihydropyridines block the same receptors. Those dihydropyridines that block T-type calcium channel blockers may provide additional advantages. A number of studies suggest that compared with amlodipine, manidipine have the same antihypertensive efficacy, but with a lesser risk of ankle edema. In addition, manidipine, but not amlodipine, significantly reduces urinary albumin excretion rates.

PCL/PHBV microparticles as innovative carriers for oral controlled release of manidipine dihydrochloride

Microparticles of poly(ε-caprolactone) (PCL) and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) containing manidipine dihydrochloride (MAN) were successfully prepared by the simple emulsion/solvent evaporation method. All formulations showed loading efficiency rates greater than 80% and average particle size less than 8 μm. Formulations had spherical shape with smooth and porous surface for PCL and PHBV, respectively. According to Fourier-transform infrared spectroscopy, initial components were not chemically modified during microencapsulation. X-ray diffraction patterns and differential scanning calorimetry demonstrated that this process led to drug amorphization. In vitro dissolution studies showed that all microparticles prolonged MAN release, mainly which one obtained using PCL that contained 5% of drug loaded (PCL-M5). Animal studies demonstrated that formulation PCL-M5 was able to keep the variation of mean arterial pressure after phenylephrine administration up to 24 hours. These data confirmed the sustained antihypertensive effect of the investigated microparticles. Results provided an experimental basis for using formulation PCL-M5 as a feasible carrier for oral controlled release of MAN intended for treating high blood pressure.