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Qin B, Yu L, Wang R, Tang Y, Chen Y, Wang N, Zhang Y, Tan X, Yang K, Zhang B, He M, Zhang Y, Hu Y. Chemical Synthesis, Safety and Efficacy of Antihypertensive Candidate Drug 221s (2,9). Molecules 2023; 28:4975. [PMID: 37446639 DOI: 10.3390/molecules28134975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Hypertension is the main risk factor of cardiovascular and cerebrovascular diseases. In this paper, a novel compound known as 221s (2,9), which includes tanshinol, borneol and a mother nucleus of ACEI, was synthesized by condensation esterification, deprotection, amidation, deprotection, and amidation, with borneol as the initial raw material, using the strategy of combinatorial molecular chemistry. The structure of the compound was confirmed by 1H NMR, 13C NMR, and high-resolution mass spectrometry, with a purity of more than 99.5%. The compound 221s (2,9) can significantly reduce the systolic and diastolic blood pressure of SHR rats by about 50 mmHg and 35 mmHg after 4 weeks of administration. The antihypertensive effect of 221s (2,9) is equivalent to that of captopril. The use of 221s (2,9) can reduce the content of Ren, Ang II and ACE in the serum of SHR rats, inhibit the RAAS and enhance the vascular endothelial function by upregulating the level of NO. Pathological studies in this area have shown that high dosage of 221s (2,9) can notably protect myocardial fibrosis in rats and reduce the degeneration and necrosis of myocardial fibers, inflammatory cell infiltration, and proliferation of fibrous tissue in the heart of rat. Therefore, the existing work provided a foundation for preclinical research and follow-up clinical research of 221s (2,9) as a new drug.
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Affiliation(s)
- Bei Qin
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Lili Yu
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Rong Wang
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Yimei Tang
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Yunmei Chen
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Nana Wang
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Yixin Zhang
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- School of Pharmacy, Chengdu Medical College, Chengdu 610500, China
| | - Xiong Tan
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- School of Pharmacy, Chengdu Medical College, Chengdu 610500, China
| | - Kuan Yang
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Bo Zhang
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Maofang He
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Yuzhen Zhang
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
| | - Yaqi Hu
- Xi'an Key Laboratory of Multi Synergistic Antihypertensive Innovative Drug Development, Xi'an Medical University, Xi'an 710021, China
- Institute of Drug Research, Xi'an Medical University, Xi'an 710021, China
- College of Pharmacy, Xi'an Medical University, Xi'an 710021, China
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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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Lerma EV. Hydrochlorothiazide versus calcium channel blockers: what is the best add-on to a renin-angiotensin system blocker for treating hypertension in patients with renal disease? Curr Hypertens Rep 2011; 13:386-95. [PMID: 21796332 DOI: 10.1007/s11906-011-0222-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hypertension remains an important problem that increases the risk of cardiovascular disease and is a leading cause of mortality worldwide. Achieving long-term control of arterial hypertension, which has an estimated prevalence of 28% in the US adult population, would translate into a significant reduction in cardiovascular events. Specific causes can be identified and treated for certain forms of secondary hypertension, but often it is multifactorial. Therefore, it makes sense to attain blood pressure control by addressing more than one pressor mechanism. Several clinical studies have demonstrated that combination antihypertensive therapy is more effective than monotherapy, and a review of currently published data suggests that approximately 75% of hypertensive individuals will require some form of combination therapy to achieve target blood pressure (BP) goals. To this end, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of Blood Pressure (JNC 7) has recommended that antihypertensive therapy should start with two drugs when a patient presents with systolic blood pressure (SBP) more than 20 mm Hg above target levels, diastolic blood pressure (DBP) more than 10 mm Hg above target levels, or both. This review attempts to analyze the current evidence in published medical literature to answer the question of whether hydrochlorothiazide or a calcium channel blocker is a better add-on to a renin-angiotensin system blocker for treating hypertension in patients with renal disease.
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Affiliation(s)
- Edgar V Lerma
- Section of Nephrology Department of Medicine, University of Illinois at Chicago College of Medicine/Associates in Nephrology, Berwyn, IL 60402, USA.
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Basile J. Critical appraisal of amlodipine and olmesartan medoxomil fixed-dose combination in achieving blood pressure goals. Integr Blood Press Control 2010; 3:91-104. [PMID: 21949625 PMCID: PMC3172072 DOI: 10.2147/ibpc.s9691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Indexed: 01/13/2023] Open
Abstract
Hypertension remains a significant health burden in the United States, with almost one in three adults affected, and is an independent risk factor for cardiovascular and renal disease. The goal of antihypertensive treatment is to reduce cardiovascular and renal morbidity and mortality by reducing blood pressure (BP). Guidelines recommend a target BP of <140/90 mmHg, with a more stringent goal of <130/80 mmHg for patients with diabetes and chronic renal disease. However, BP goal attainment rates remain low and most patients require therapy with two or more antihypertensive agents. Combination antihypertensive therapy usually employs agents from different classes, thus benefitting from complementary mechanisms of action to achieve greater BP control with fewer side effects. Patient adherence to therapy is enhanced by formulating treatments as fixed-dose (single-pill) combinations. One example is the combination of amlodipine, a dihydropyridine calcium channel blocker (CCB), with olmesartan medoxomil, an angiotensin receptor blocker (ARB). Here, the rationale for the use of CCB/ARB combination therapy is discussed, as well as the pharmacology and tolerability of the amlodipine/olmesartan medoxomil combination and its efficacy in terms of achieving BP goal in patients with hypertension. Advantages of its use from the patient's perspective are also discussed.
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Affiliation(s)
- Jan Basile
- Professor of Medicine, Medical University of South Carolina, Charleston, SC, USA
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