Long-term impact of different triple antihypertensive drug treatments on blood pressure control, metabolic pattern and incident events: data from the Brisighella Heart Study

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University of Bologna

Purpose

The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized population cohort.

Methods

We considered data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2008 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with <3 or ≥3 high blood pressure (BP) medications without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and/or thiazide/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with ACE-inhibitors/CCBs/Thiazide, ARBs/CCBs/Thiazide or Perindopril/Amlodipine/Indapamide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive medications. The long term effects of the different antihypertensive medications were compared among the pre-defined groups.

Results

On the long-term, combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with better control of diastolic BP and lipid pattern than other triple combination antihypertensive medication. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow-up they neither developed type 2 diabetes nor had a need for a greater number of antihypertensive drugs to improve BP control.

Conclusion

Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other combination antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/amlodipine/indapamide is associated with better lipids’ profile than any other considered combination antihypertensive medication.

Representativeness of women and racial/ethnic minorities in randomized clinical trials on bempedoic acid

Funding Acknowledgements

Type of funding sources: None.

Background

Women and racial minorities have continued for a long time to be underrepresented in randomized clinical trials testing lipid-lowering therapies (i.e. statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, ezetimibe, bile acid sequestrants, fibrates, niacin, and omega-3 polyunsaturated fatty acids).

Purpose

We sought to investigate presence of disparities in trials testing the new emergent lipid-lowering drug bempedoic acid (BA).

Methods

Several databases were searched with the use of a purposedly developed search strategy. To minimize the chances of missing data, the identified clinical trials were subsequently searched on http://www.clinicaltrials.gov. Original studies were included in the analysis if they met the following inclusion criteria: (i) being a clinical trial with either multicentre or single-centre design and (ii) having an appropriate controlled design for BA.

Results

Considering together, the overall participation rate and the mean participation rate across the clinical studies, men, whites and non-Hispanic/Latinos were sufficiently represented compared with their proportion in the disease population. Non-whites and Asians were underrepresented. Women, blacks and Hispanic/Latinos were from adequately to over-represented across clinical trials, though in the pooled population their portion was lower than their share of the disease population.

Conclusions

Further efforts are needed to enhance the representativeness of clinical trials according to race and sex and ensure complete information about efficacy and safety of treatment with BA.

Non-invasive instrumental evaluation of coenzyme Q10 phytosome on endothelial reactivity in healthy non-smoking young volunteers: a double-blind, placebo-controlled cross-over clinical trial

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): University of Bologna

Background

Coenzyme Q10 (CoQ10) is a natural antioxidant compound that prevents the vascular damage induced by free radicals and the activation of inflammatory signaling pathways.

Supplementation with CoQ10 is safe though its bioavailability is generally low, as far as variable depending on the pharmaceutical form of preparation. Recently, the development of phytosome technology has improved the bioavailability of CoQ10 and definitely facilitated its effective use in clinical.

Purpose and Methods

The present double-blind, randomized, placebo-controlled, cross-over clinical study aimed to investigate the effect on endothelial reactivity and total antioxidant capacity (TAC) of either acute and chronic supplementation with CoQ10 phytosome in a sample of 20 healthy young not smoking subjects.

Results

The immediate acute effect of dietary supplementation with CoQ10 phytosome on pulse volume (PV) was sustained in the actively treated group in comparison with placebo and the baseline (p< 0.05). Chronic supplementation of the tested pharmaceutical formulation of CoQ10 significantly improved mean arterial pressure and TAC compared to placebo and baseline values (p< 0.05 for both comparisons). In the actively treated group, the effect on dietary supplementation with CoQ10 phytosome on PV was also sustained when compared to the baseline (P<0.05).

Supplementation with Anti-inflammatory Nutraceutical Products in the Management of Chronic Pelvic Pain: A Narrative Review

Chronic pelvic pain is a chronic syndrome that affects patients’ life quality and expectancy as far as bladder, bowel and sexual functioning are compromised. So far treatment options are limited since pharmaceutical research has not provided any specific drug therapy to manage chronic pelvic pain. Nutraceutical products represent useful tools to supply this lack of medications. The aim of this narrative review is to provide some insight from a neuroscience perspective on the nutraceuticals’ use as adjuvant therapy in chronic pelvic pain. A review of the literature, between 2001 and 2019 on PMC and PubMed was performed in order to identify studies proving safety and efficacy of nutraceuticals in chronic pelvic pain. Inclusion criteria were nutraceutical compounds, namely curcumin, quercetin, bromelain, and diseases known for causing chronic pelvic pain. Nineteen studies were selected. Quercetin demonstrates to inhibit mast-cells, pro-inflammatory cytokines and regulate cell proliferation; curcumin suppresses inflammatory cytokines expression, inhibits invasion, angiogenesis of endometrial lesions. Bromelain resulted in a reduction of painkiller rescue doses required in endometriosis. Pre-clinical studies show promising effects of nutraceutical supplementation with selected enzymes and antioxidant compounds in patients suffering from chronic pelvic pain. Positive weak evidence suggests efficacy of these products in use as antiinflammatory and analgesic medications for chronic pelvic pain treatment.

Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation

Organ shortage is the major limitation to kidney transplantation in the developed world. Conversely, millions of patients in the developing world with end-stage renal disease die because they cannot afford renal replacement therapy-even when willing living kidney donors exist. This juxtaposition between countries with funds but no available kidneys and those with available kidneys but no funds prompts us to propose an exchange program using each nation's unique assets. Our proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers. By making developed-world health care available to impoverished patients in the developing world, we replace unethical transplant tourism with global kidney exchange-a modality equally benefitting rich and poor. We report the 1-year experience of an initial Filipino pair, whose recipient was transplanted in the United states with an American donor's kidney at no cost to him. The Filipino donor donated to an American in the United States through a kidney exchange chain. Follow-up care and medications in the Philippines were supported by funds from the United States. We show that the logistical obstacles in this approach, although considerable, are surmountable.

Red foxes (Vulpes vulpes) bioindicator of lead and copper pollution in Sicily (Italy)

The aim of this study was to evaluate Pb and Cu accumulation in muscle and skin samples of red fox (Vulpes vulpes) from Sicily, for monitoring of environmental metals pollution. Metals determination, carried out by atomic absorption spectrophotometer (AAS), showed the presence of Pb and Cu in all samples analyzed. Pb concentrations were similar in muscle (0.04±0.009 mg/kg) and skin (0.03±0.004 mg/kg) samples, while Cu levels resulted higher in muscle (1.842±0.178 mg/kg) than in skin (1.22±0.151 mg/kg). In addition, a comparative analysis of Pb and Cu concentrations was carried out among samples from different areas of Sicily and between female and male, young and old, immature and mature foxes. Metals content found in all muscle and skin samples demonstrates that V. vulpes could be a valid "sentinel" species of rural and suburban areas to study the environmental metals pollution and the habitat quality.

Pancreas transplantation: experience at University of Texas, Houston

INTRODUCTION

Diabetes mellitus is a spectrum of diseases characterized by the absence of glycemic control and the development of secondary complications. Type 1 diabetes (insulin-dependent) accounts for a minority of cases, but it usually presents in younger age groups. This disease significantly affects quality of life.

METHODS

We retrospectively reviewed the cases of pancreas transplantation performed at University of Texas, Houston, from February 2008 to August 2009. All patients received immunosuppression induction with thymoglobulin (1.5 mg/kg). We used 3 drugs for maintenance: tacrolimus, mycophenolic acid, and prednisone. All patients received cytomegalovirus prophylaxis.

RESULTS

We transplanted 54 organs in 29 patients with type 1 diabetes mellitus. The mean patient age was 42 years. Patients had diabetes mellitus type 1 for an average of 28.82 years and were on dialysis for an average of 2 years. Nineteen patients were male (65%). Complications ensued in 68% of cases (20 patients), 9 of which required surgical exploration (31%). We lost 3 pancreatic allografts.

DISCUSSION

Pancreas transplant recipients constitute a unique population with a high risk of complications in the acute setting. During the first 3 months after simultaneous pancreas-kidney transplantation the relative mortality risk is increased but after a year it has clear advantage over diabetic patients on dialysis waiting for a transplant. To date, 26 patients have functional pancreatic allografts and 29 are dialysis-free. Pancreas transplantation is a challenging procedure. Surgeons must be prepared to aggressively manage the possible complications.