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Mancia G, Brunström M, Burnier M, Grassi G, Januszewicz A, Kjeldsen SE, Muiesan ML, Thomopoulos C, Tsioufis K, Kreutz R. Rationale for the Inclusion of β-Blockers Among Major Antihypertensive Drugs in the 2023 European Society of Hypertension Guidelines. Hypertension 2024; 81:1021-1030. [PMID: 38477109 PMCID: PMC11025609 DOI: 10.1161/hypertensionaha.124.22821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
We address the reasons why, unlike other guidelines, in the 2023 guidelines of the European Society of Hypertension β-blockers (BBs) have been regarded as major drugs for the treatment of hypertension, at the same level as diuretics, calcium channel blockers, and blockers of the renin-angiotensin system. We argue that BBs, (1) reduce blood pressure (the main factor responsible for treatment-related protection) not less than other drugs, (2) reduce pooled cardiovascular outcomes and mortality in placebo-controlled trials, in which there has also been a sizeable reduction of all major cause-specific cardiovascular outcomes, (3) have been associated with a lower global cardiovascular protection in 2 but not in several other comparison trials, in which the protective effect of BBs versus the other major drugs has been similar or even greater, with a slightly smaller or no difference of global benefit in large trial meta-analyses and a similar protective effect when comparisons extend to BBs in combination versus other drug combinations. We mention the large number of cardiac and other comorbidities for which BBs are elective drugs, and we express criticism against the exclusion of BBs because of their lower protective effect against stroke in comparison trials, because, for still uncertain reasons, differences in protection against cause-specific events (stroke, heart failure, and coronary disease) have been reported for other major drugs. These partial data cannot replace global benefits as the main deciding factor for drug choice, also because in the general hypertensive population whether and which type of event might occur is unknown.
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Affiliation(s)
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umea University, Sweden (Mattias Brunström)
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Switzerland (Michel Burnier)
| | - Guido Grassi
- Clinica Medica, University Milano-Bicocca, Milan, Italy (G.G.)
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland (A.J.)
| | - Sverre E. Kjeldsen
- Institute for Clinical Medicine, University of Oslo, Norway (S.E.K.)
- Departments of Cardiology and Nephrology, Ullevaal Hospital, Oslo, Norway (S.E.K.)
| | - Maria Lorenza Muiesan
- UOC 2 Medicina, ASST Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M.)
| | - Costas Thomopoulos
- Department of Cardiology, General Hospital of Athens “Laiko”, Greece (C.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, University of Athens, Hippokration Hospital, Greece (K.T.)
| | - Reinhold Kreutz
- Charite-Universitaetsmedizin Berlin, Institute of Clinical Pharmacology and Toxicology, Germany (R.K.)
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Lin PID, Rifas-Shiman S, Merriman J, Petimar J, Yu H, Daley MF, Janicke DM, Heerman WJ, Bailey LC, Maeztu C, Young J, Block JP. Trends of Antihypertensive Prescription Among US Adults From 2010 to 2019 and Changes Following Treatment Guidelines: Analysis of Multicenter Electronic Health Records. J Am Heart Assoc 2024:e032197. [PMID: 38639340 DOI: 10.1161/jaha.123.032197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Guidelines for the use of antihypertensives changed in 2014 and 2017. To understand the effect of these guidelines, we examined trends in antihypertensive prescriptions in the United States from 2010 to 2019 using a repeated cross-sectional design. METHODS AND RESULTS Using electronic health records from 15 health care institutions for adults (20-85 years old) who had ≥1 antihypertensive prescription, we assessed whether (1) prescriptions of beta blockers decreased after the 2014 Eighth Joint National Committee (JNC 8) report discouraged use for first-line treatment, (2) prescriptions for calcium channel blockers and thiazide diuretics increased among Black patients after the JNC 8 report encouraged use as first-line therapy, and (3) prescriptions for dual therapy and fixed-dose combination among patients with blood pressure ≥140/90 mm Hg increased after recommendations in the 2017 Hypertension Clinical Practice Guidelines. The study included 1 074 314 patients with 2 133 158 prescription episodes. After publication of the JNC 8 report, prescriptions for beta blockers decreased (3% lower in 2018-2019 compared to 2010-2014), and calcium channel blockers increased among Black patients (20% higher in 2015-2017 and 41% higher in 2018-2019, compared to 2010-2014), in accordance with guideline recommendations. However, contrary to guidelines, dual therapy and fixed-dose combination decreased after publication of the 2017 Hypertension Clinical Practice Guidelines (9% and 11% decrease in 2018-2019 for dual therapy and fixed-dose combination, respectively, compared to 2015-2017), and thiazide diuretics decreased among Black patients after the JNC 8 report (6% lower in 2018-2019 compared to 2010-2014). CONCLUSIONS Adherence to guidelines on prescribing antihypertensive medication was inconsistent, presenting an opportunity for interventions to achieve better blood pressure control in the US population.
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Affiliation(s)
- Pi-I Debby Lin
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
| | - Sheryl Rifas-Shiman
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
| | - John Merriman
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
| | - Joshua Petimar
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
- Department of Epidemiology Harvard TH Chan School of Public Health Boston MA USA
| | - Han Yu
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado Aurora CO USA
| | - David M Janicke
- Department of Clinical and Health Psychology University of Florida Gainesville FL USA
| | - William J Heerman
- Department of Pediatrics Vanderbilt University Medical Center Nashville TN USA
| | - L Charles Bailey
- Applied Clinical Research Center, Children's Hospital of Philadelphia Philadelphia PA USA
| | - Carlos Maeztu
- Department of Health Outcomes and Biomedical Informatics University of Florida Gainesville FL USA
| | - Jessica Young
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
- Department of Epidemiology Harvard TH Chan School of Public Health Boston MA USA
| | - Jason P Block
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
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Fadl Elmula FEM, Mariampillai JE, Heimark S, Kjeldsen SE, Burnier M. Medical Measures in Hypertensives Considered Resistant. Am J Hypertens 2024; 37:307-317. [PMID: 38124494 PMCID: PMC11016838 DOI: 10.1093/ajh/hpad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with resistant hypertension are the group of hypertensive patients with the highest cardiovascular risk. METHODS All rules and guidelines for treatment of hypertension should be followed strictly to obtain blood pressure (BP) control in resistant hypertension. The mainstay of treatment of hypertension, also for resistant hypertension, is pharmacological treatment, which should be tailored to each patient's specific phenotype. Therefore, it is pivotal to assess nonadherence to pharmacological treatment as this remains the most challenging problem to investigate and manage in the setting of resistant hypertension. RESULTS Once adherence has been confirmed, patients must be thoroughly worked-up for secondary causes of hypertension. Until such possible specific causes have been clarified, the diagnosis is apparent treatment-resistant hypertension (TRH). Surprisingly few patients remain with true TRH when the various secondary causes and adherence problems have been detected and resolved. Refractory hypertension is a term used to characterize the treatment resistance in hypertensive patients using ≥5 antihypertensive drugs. All pressor mechanisms may then need blockage before their BPs are reasonably controlled. CONCLUSIONS Patients with resistant hypertension need careful and sustained follow-up and review of their medications and dosages at each term since medication adherence is a very dynamic process.
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Affiliation(s)
- Fadl Elmula M Fadl Elmula
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, KSA
| | | | - Sondre Heimark
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Nephrology, Ullevaal University Hospital, Oslo, Norway
| | - Sverre E Kjeldsen
- Division of Medicine, Ullevaal University Hospital, Cardiorenal Research Centre, Oslo, Norway
- Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
| | - Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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Ivensky V, Zonga P, Dallaire G, Desbiens LC, Nadeau-Fredette AC, Rousseau G, Goupil R. Differences in Antihypertensive Medication Prescription Profiles Between 2009 and 2021: A Retrospective Cohort Study of CARTaGENE. Can J Kidney Health Dis 2024; 11:20543581241234729. [PMID: 38601903 PMCID: PMC11005488 DOI: 10.1177/20543581241234729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/14/2024] [Indexed: 04/12/2024] Open
Abstract
Background Although blood pressure (BP) control is critical to prevent cardiovascular diseases, hypertension control rates in Canada are in decline. Objective To assess this issue, we sought to evaluate the differences in antihypertensive medication prescription profiles in the province of Quebec between 2009 and 2021. Design This is a retrospective cohort study. Setting We used data from the CARTaGENE population-based cohort linked to administrative health databases. Patients Participants with any drug claim in the 6 months prior to the end of follow-up were included. Measurements Guideline-recommended antihypertensive drug prescription profiles were assessed at the time of enrollment (2009-2010) and end of follow-up (March 2021). Methods Prescriptions practices from the 2 time periods were compared using Pearson's chi-square tests. A sensitivity analysis was performed by excluding participants in which antihypertensive drugs may not have been prescribed solely to treat hypertension (presence of atrial fibrillation/flutter, ischemic heart disease, heart failure, chronic kidney disease, or migraines documented prior to or during follow-up). Results Of 8447 participants included in the study, 31.4% and 51.3% filled prescriptions for antihypertensive drugs at the beginning and end of follow-up. In both study periods, guideline-recommended monotherapy was applied in most participants with hypertension (77.9% vs 79.5%, P = .3), whereas optimal 2 and 3-drug combinations were used less frequently (62.0% vs 61.4%, P = .77, 51.9% vs 46.7%, P = .066, respectively). Only the use of long-acting thiazide-like diuretics (9.5% vs 27.7%, P < .001) and spironolactone as a fourth-line agent (8.3% vs 15.9%, P = .054) increased with time but nonetheless remained infrequent. Results were similar in the sensitivity analysis. Limitations Specific indication of the prescribed antihypertensive medications and follow-up BP data was not available. Conclusions Application of hypertension guidelines for the choice of antihypertensive drugs remains suboptimal, highlighting the need for education initiatives. This may be an important step to raise BP control rates in Canada.
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Affiliation(s)
- Victoria Ivensky
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Medicine, Université de Montréal, QC, Canada
| | - Pitchou Zonga
- Department of Pharmacology and Physiology, Université de Montréal, QC, Canada
| | - Gabriel Dallaire
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Pharmacy, Université de Montréal, QC, Canada
| | | | - Annie-Claire Nadeau-Fredette
- Department of Medicine, Université de Montréal, QC, Canada
- Hôpital Maisonneuve-Rosemont, CIUSSS de l’Est-de-l’île-de-Montréal, QC, Canada
| | - Guy Rousseau
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Pharmacology and Physiology, Université de Montréal, QC, Canada
| | - Rémi Goupil
- Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l’île-de-Montréal, QC, Canada
- Department of Medicine, Université de Montréal, QC, Canada
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Lee SR, Lee EG, Cho YH, Park EJ, Lee YI, Choi JI, Kwon RJ, Son SM, Lee SY, Yi YH, Kim GL, Kim YJ, Lee JG, Tak YJ, Lee SH, Ra YJ. Enteropathy and intestinal malabsorption in patients treated with antihypertensive drugs. A retrospective cohort study. Saudi Med J 2024; 45:437-441. [PMID: 38657980 DOI: 10.15537/smj.2024.45.4.20230739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To investigate differences in the incidence of enteropathy or intestinal malabsorption in patients taking angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB), and beta blockers (BBs) at a single center in Korea. METHODS In this retrospective study, we utilized data from the Yangsan electronic medical records to identify 129,169 patients. These individuals were prescribed olmesartan, other ARBs, ACEI, CCB, and BBs between November 2008 and February 2021. RESULTS Of the 44,775 patients, 51 (0.11%) were observed to have enteropathy or intestinal malabsorption. Compared with the ACEI group, the adjusted odds ratios (ORs) for enteropathy and intestinal malabsorption were OR=1.313 (95% confidence interval [CI]: [0.188-6.798], p=0.893) for olmesartan, OR=0.915 (95% CI: [0.525-1.595], p=0.754) for the other ARBs, OR=0.928 (95% CI: [0.200-4.307]; p=0.924) for the CCB, and OR=0.663 (95% CI: [0.151-2.906]; p=0.586) for the BBs group. These findings were adjusted for factors such as age, gender, duration of antihypertensive medication, and comorbidities. CONCLUSION In a retrospective cohort study of patients on antihypertensive medications, no significant difference was found in the incidence of enteropathy or intestinal malabsorption when ACEI was compared to olmesartan, other ARBs, CCB, and BBs.
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Affiliation(s)
- Sae R Lee
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Eun G Lee
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Young H Cho
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Eun J Park
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Young-In Lee
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Jung I Choi
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Ryuk-Jun Kwon
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Soo M Son
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Sang Y Lee
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Yu H Yi
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Gyu L Kim
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Yun J Kim
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Jeong G Lee
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Young Jin Tak
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Seung Hun Lee
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
| | - Young Jin Ra
- From the Department of Family Medicine and Biomedical Research Institute (S. R. Lee, E. G. Lee, Y. H. Cho, E. J. Park, Y. Lee, J. I. Choi, R. Kwon, S. M. Son, S. Y. Lee); from the Department of Family Medicine (G. L. Kim, S. H. Lee, Y. J. Ra), Pusan National University Yangsan Hospital, from the Department of Family Medicine (Y. J. Kim, J. G. Lee, Y. J. Tak, Y. H. Cho, Y. H. Yi, S.H. Lee); Department of Medical Education (S. Y. Lee), Pusan National University School of Medicine, and from the Integrated Research Institute for Natural Ingredients and Functional Foods (S. Y. Lee), Yangsan, South Korea
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Desideri G, Cipelli R, Pegoraro V, Ripellino C, Miroddi M, Meto S, Gori M, Fabrizzi P. Extemporaneous combination therapy with nebivolol/amlodipine for the treatment of hypertension: a real-world evidence study in Europe. Curr Med Res Opin 2024:1-11. [PMID: 38459774 DOI: 10.1080/03007995.2024.2328652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/06/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The investigation of the real-world use of the extemporaneous combination of nebivolol and amlodipine (NA-EXC) in adult patients diagnosed with hypertension in Europe. METHODS Retrospective analysis of data extracted from seven databases of patient medical records and prescriptions from Italy, Germany, France, Hungary, and Poland, to determine the prevalence and incidence of NA-EXC use and to estimate the number of patients potentially eligible for a single-pill combination of the two antihypertensives. Secondary objectives included: the description of the population of NA-EXC users and the assessment of their adherence to treatment based on the proportion of days covered. RESULTS The use of NA-EXC was found to be common in Europe and ranged between 2.9% to 9.9% of all patients identified in the databases with a prescription of nebivolol and/or amlodipine. The estimated numbers of patients potentially eligible in 2019 for a single-pill combination of nebivolol and amlodipine in Italy and Germany were, respectively, 178,133 and 113,240. Users of NA-EXC were mostly aged 70-79 years, had metabolic disorders and other comorbidities; >70% of them had received ≥2 concomitant medications before starting NA-EXC. Adherence to NA-EXC was defined as high only in 15.6% to 35% of patients. CONCLUSIONS The extemporaneous combination of nebivolol and amlodipine is commonly prescribed in Europe, however adherence to the therapy is poor. The development of a single-pill combination of nebivolol and amlodipine may improve adherence by reducing the number of pills administered to patients and thus simplifying treatment regimens.
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Affiliation(s)
- Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | | | - Marco Miroddi
- A. Menarini Farmaceutica Internazionale Srl, Florence, Italy
| | - Suada Meto
- A. Menarini Industrie Farmaceutiche Riunite Srl, Florence, Italy
| | | | - Paolo Fabrizzi
- A. Menarini Industrie Farmaceutiche Riunite Srl, Florence, Italy
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Raj R, Garg M, Kaur A. Targeting Hypertension: A Review on Pathophysiological Factors and Treatment Strategies. Curr Hypertens Rev 2024; 20:CHYR-EPUB-139300. [PMID: 38509679 DOI: 10.2174/0115734021293403240309165336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/10/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024]
Abstract
Hypertension is one of the primary causes of cardiovascular diseases and death, with a higher prevalence in low- and middle-income countries. The pathophysiology of hypertension remains complex, with 2% to 5% of patients having underlying renal or adrenal disorders. The rest are referred to as essential hypertension, with derangements in various physiological mechanisms potentially contributing to the development of essential hypertension. Hypertension elevates the risk of cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) and mortality. First-line therapy for hypertension is lifestyle change, which includes weight loss, a balanced diet that includes low salt and high potassium intake, physical exercise, and limitation or elimination of alcohol use. Blood pressure-lowering effects of individual lifestyle components are partially additive, enhancing the efficacy of pharmaceutical treatment. The choice to begin antihypertensive medication should be based on the level of blood pressure and the existence of a high atherosclerotic CVD risk. First-line hypertension treatment includes a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker. Addressing hypertension will require continued efforts to improve access to diagnosis, treatment, and lifestyle interventions.
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Affiliation(s)
- Ruhani Raj
- Department of Biotechnology, UIET, Panjab University, Chandigarh, India
| | - Minakshi Garg
- Department of Biotechnology, UIET, Panjab University, Chandigarh, India
| | - Anupreet Kaur
- Department of Biotechnology, UIET, Panjab University, Chandigarh, India
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8
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Coelho-Junior HJ, Calvani R, Tosato M, Russo A, Landi F, Picca A, Marzetti E. Associations between hypertension and cognitive, mood, and behavioral parameters in very old adults: results from the IlSIRENTE study. Front Public Health 2024; 11:1268983. [PMID: 38533244 PMCID: PMC10964923 DOI: 10.3389/fpubh.2023.1268983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 03/28/2024] Open
Abstract
Introduction Studies on the associations between hypertension-related parameters and cognitive function, mood, and behavioral symptoms in older adults have produced mixed findings. A possible explanation for these divergent results is that investigations have not adequately adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs). Therefore, the present study examined the cross-sectional associations between hypertension-related parameters, ACEI use, and cognitive function, mood, and behavioral symptoms in very old adults. Methods This study was conducted by analyzing the IlSIRENTE database, a prospective cohort study that collected data on all individuals aged 80 years and older residing in the Sirente geographic area (n = 364). Blood pressure (BP) was assessed after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. Cognitive function, mood, and behavioral symptoms were recorded using the Minimum Data Set Home Care instrument. Blood inflammatory markers were measured. Results Hypertension-related parameters were significantly associated with many cognitive, mood, and behavioral parameters after adjustment for covariates. However, only the inverse association between hypertension and lesser problems with short-term memory remained significant. Participants with hypertension had lower blood concentrations of inflammatory markers in comparison to their normotensive peers. Conclusion Findings from the present study indicate that high BP values are associated with fewer complaints about memory problems in very old adults. Furthermore, a lower concentration of inflammatory markers was found in hypertensive participants. ACEI use might affect this scenario.
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Affiliation(s)
- Helio José Coelho-Junior
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Matteo Tosato
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Andrea Russo
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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9
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Zhao S, Xie Y, Ding X, Zheng C, Chen J, Zhao N, Ji Y, Wang Q, Liu Y, Cheng C. Exploring the causal relationship between antihypertensive drugs and glioblastoma by combining drug target Mendelian randomization study, eQTL colocalization, and single-cell RNA sequencing. Environ Toxicol 2024. [PMID: 38450887 DOI: 10.1002/tox.24210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
Recent reports indicate a potential oncogenic role of antihypertensive drugs in common cancers. However, it remains uncertain whether this phenomenon influences the risk of glioblastoma multiforme (GBM). This study aimed to assess the potential causal effects of blood pressure (BP) and antihypertensive drugs on GBM. Genome-wide association study (GWAS) summary statistics for systolic blood pressure (SBP), diastolic blood pressure (DBP), and GBM in Europeans were downloaded. To represent the effects of antihypertensive drugs, we utilized single nucleotide polymorphisms (SNPs) associated with SBP/DBP adjacent to the coding regions of different antihypertensive drugs as instrumental variables to model five antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, β-receptor blockers (BBs), and thiazide diuretics. Positive control studies were performed using GWAS data in chronic heart failure. The primary method for causality estimation was the inverse-variance-weighted method. Mendelian randomization analysis showed that BBs with the β1-adrenergic receptor (ADRB1) as a therapeutic target could significantly reduce the risk of GBM by mediating DBP (OR = 0.431, 95% CI: 0.267-0.697, p < .001) and that they could also significantly reduce the risk of GBM by mediating SBP (OR = 0.595, 95% CI: 0.422-0.837, p = .003). Sensitivity analysis and colocalization analysis reinforced the robustness of these findings. Finally, the low expression of the ADRB1 gene in malignant gliomas was found by GBM data from TCGA and single-cell RNA sequencing, which most likely contributed to the poor prognosis of GBM patients. In summary, our study provides preliminary evidence of some causal relationship between ADRB1-targeted BBs and glioblastoma development. However, more studies are needed to validate these findings and further reveal the complex relationship between BP and GBM.
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Affiliation(s)
- Songyun Zhao
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yi Xie
- Department of Burns and Plastic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xu Ding
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Chuanhua Zheng
- Department of Neurosurgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Jiaxing Chen
- Department of Neurosurgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Ning Zhao
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Yi Ji
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Qi Wang
- Department of Gastroenterology, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuankun Liu
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Chao Cheng
- Department of Neurosurgery, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
- Wuxi Medical Center of Nanjing Medical University, Wuxi, China
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10
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Azizi M, Sharp ASP, Fisher NDL, Weber MA, Lobo MD, Daemen J, Lurz P, Mahfoud F, Schmieder RE, Basile J, Bloch MJ, Saxena M, Wang Y, Sanghvi K, Jenkins JS, Devireddy C, Rader F, Gosse P, Claude L, Augustin DA, McClure CK, Kirtane AJ. Patient-Level Pooled Analysis of Endovascular Ultrasound Renal Denervation or a Sham Procedure 6 Months After Medication Escalation: The RADIANCE Clinical Trial Program. Circulation 2024; 149:747-759. [PMID: 37883784 DOI: 10.1161/circulationaha.123.066941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The randomized, sham-controlled RADIANCE-HTN (A Study of the Recor Medical Paradise System in Clinical Hypertension) SOLO, RADIANCE-HTN TRIO, and RADIANCE II (A Study of the Recor Medical Paradise System in Stage II Hypertension) trials independently met their primary end point of a greater reduction in daytime ambulatory systolic blood pressure (SBP) 2 months after ultrasound renal denervation (uRDN) in patients with hypertension. To characterize the longer-term effectiveness and safety of uRDN versus sham at 6 months, after the blinded addition of antihypertensive treatments (AHTs), we pooled individual patient data across these 3 similarly designed trials. METHODS Patients with mild to moderate hypertension who were not on AHT or with hypertension resistant to a standardized combination triple AHT were randomized to uRDN (n=293) versus sham (n=213); they were to remain off of added AHT throughout 2 months of follow-up unless specified blood pressure (BP) criteria were exceeded. In each trial, if monthly home BP was ≥135/85 mm Hg from 2 to 5 months, standardized AHT was sequentially added to target home BP <135/85 mm Hg under blinding to initial treatment assignment. Six-month outcomes included baseline- and AHT-adjusted change in daytime ambulatory, home, and office SBP; change in AHT; and safety. Linear mixed regression models using all BP measurements and change in AHT from baseline through 6 months were used. RESULTS Patients (70% men) were 54.1±9.3 years of age with a baseline daytime ambulatory/home/office SBP of 150.5±9.8/151.0±12.4/155.5±14.4 mm Hg, respectively. From 2 to 6 months, BP decreased in both groups with AHT titration, but fewer uRDN patients were prescribed AHT (P=0.004), and fewer additional AHT were prescribed to uRDN patients versus sham patients (P=0.001). Whereas the unadjusted between-group difference in daytime ambulatory SBP was similar at 6 months, the baseline and medication-adjusted between-group difference at 6 months was -3.0 mm Hg (95% CI, -5.7, -0.2; P=0.033), in favor of uRDN+AHT. For home and office SBP, the adjusted between-group differences in favor of uRDN+AHT over 6 months were -5.4 mm Hg (-6.8, -4.0; P<0.001) and -5.2 mm Hg (-7.1, -3.3; P<0.001), respectively. There was no heterogeneity between trials. Safety outcomes were few and did not differ between groups. CONCLUSIONS This individual patient-data analysis of 506 patients included in the RADIANCE trials demonstrates the maintenance of BP-lowering efficacy of uRDN versus sham at 6 months, with fewer added AHTs. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02649426 and NCT03614260.
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Affiliation(s)
- Michel Azizi
- Université Paris Cité, France (M.A.)
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department and DMU CARTE, Paris, France (M.A.)
- INSERM, Paris, France (M.A.)
| | - Andrew S P Sharp
- University Hospital of Wales and Cardiff University, Cardiff, UK (A.S.P.S.)
| | | | - Michael A Weber
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Melvin D Lobo
- Barts NIHR Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, UK (M.D.L.)
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands (J.D.)
| | - Philipp Lurz
- Zentrum für Kardiologie, Universitätsmedizin Mainz, Germany (P.L.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Saarland University Hospital, Homburg/Saar, Germany (F.M.)
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge (F.M.)
| | - Roland E Schmieder
- Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University, Erlangen, Germany (R.E.S.)
| | - Jan Basile
- Division of Cardiovascular Medicine, Medical University of South Carolina, Ralph H. Johnson VA Medical Center, Charleston (J.B.)
| | - Michael J Bloch
- Department of Medicine, University of Nevada School of Medicine, Vascular Care, Renown Institute of Heart and Vascular Health, Reno (M.J.B.)
| | - Manish Saxena
- Division of Cardiovascular Medicine, State University of New York, Downstate Medical Center, New York (M.A.W., M.S.)
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (Y.W.)
| | | | | | - Chandan Devireddy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (C.D.)
| | - Florian Rader
- Cedars-Sinai Heart Institute, Los Angeles, CA (F.R.)
| | | | - Lisa Claude
- Recor Medical, Inc., Palo Alto, CA (L.C., D.A.A.)
| | | | | | - Ajay J Kirtane
- Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K.)
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11
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Liu H, Zuo H, Johanna O, Zhao R, Yang P, Chen W, Li Q, Lin X, Zhou Y, Liu J. Genetically determined blood pressure, antihypertensive medications, and risk of intracranial aneurysms and aneurysmal subarachnoid hemorrhage: A Mendelian randomization study. Eur Stroke J 2024; 9:244-250. [PMID: 37800876 PMCID: PMC10916827 DOI: 10.1177/23969873231204420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Observational studies suggest that different classes of antihypertensive drugs may have different effects on the occurrence of intracranial aneurysms (IA) and subarachnoid hemorrhage (SAH). However, the reported results in previous studies are inconsistent, and randomized data are absent. We performed a two-sample Mendelian randomization (MR) analysis to study the causal effects of genetically determined blood pressure (BP) and genetic proxies for antihypertensive drug classes on the risk of IA and SAH. MATERIALS AND METHODS Genetic instruments and outcome data were obtained from independent genome-wide association studies (GWAS) or published data, which were exclusively restricted to European ancestry. Causal relationships were identified using inverse-variance weighted MR analyses and a series of statistical sensitivity analyses. The FinnGen consortium was used for repeated analysis to verify results obtained from the above GWAS. RESULTS Two-sample MR analysis showed that genetically determined Systolic BP, Dystolic BP, and Pulse Pressure were related to a higher risk of IA and SAH. Based on identified single nucleotide polymorphisms (SNPs) that influence the effect of calcium channel blockers (CCB, 42 SNPs), beta-blockers (BB, 8 SNPs), angiotensin-converting enzyme inhibitors (ACEI, 2 SNPs), angiotensin receptor blockers (ARB, 1 SNPs), and thiazides (5 SNPs), genetically determined effect of CCBs was associated with a higher risk of IA (OR, 1.07 [95% CI, 1.03-1.10], p = 5.02 × 10-5) and SAH (OR, 1.06 [95% CI, 1.03-1.09], p = 1.84 × 10-3). No associations were found between other antihypertensive drugs and the risk of IA or SAH. The effect of CCBs on SAH was confirmed in FinnGenconsortium samples (OR, 1.04 [95% CI, 1.00-1.08], p = 0.042). DISCUSSION AND CONCLUSION This MR analysis supports the role of elevated blood pressure in the occurrence of intracranial aneurysms and subarachnoid hemorrhage. However, genetic proxies for calcium channel blockers were associated with an increased risk of intracranial aneurysms and subarachnoid hemorrhage. Further studies are required to confirm these findings and investigate the underlying mechanisms.
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Affiliation(s)
- Hanchen Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Huiqin Zuo
- Huamu Community Center of Pudong, Shanghai, China
| | - Ospel Johanna
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Rui Zhao
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | | | - Qiang Li
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China
| | - Yu Zhou
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
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12
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Shang L, Cheng Y, Zhou J, Bao Y, Kong D, Huang R, Chen Y, Wang H, Gu N, Ma A. Impacts of national volume-based drug procurement policy on the utilization and costs of antihypertensive drugs in a Chinese medicine hospital: an interrupted time series analysis of 5138 patients. Front Pharmacol 2024; 15:1302154. [PMID: 38389928 PMCID: PMC10881800 DOI: 10.3389/fphar.2024.1302154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Objectives: The study aimed to estimate the effects of National Volume-based Drug Procurement (NVBP) policy on drug utilization and medical expenditures of hypertension patients in public medical institutions in mainland China. Methods: This study used patient-level data based on electronic health records retrieved from the hospital information system of Nanjing Hospital of Chinese Medicine. Data on patients with hypertension who received care at this institution between 2016 and 2021 was used for analysis. Segmented linear regression models incorporating Interrupted Time Series (ITS) analysis were adopted to examine the effects of NVBP policy on drug utilization and health expenditures of eligible patients. Drug utilization volume and health expenditures were the primary outcomes used to assess the policy effects, and were measured using the prescription proportion of each drug class and the overall per-encounter treatment costs. Results: After the implementation of NVBP policy, the volume of non-winning drugs decreased from 54.42% to 36.25% for outpatient care and from 35.62% to 15.65% for inpatient care. The ITS analysis showed that the volume of bid-winning drugs in outpatient and inpatient settings increased by 9.55% (p < 0.001) and 6.31% (p < 0.001), respectively. The volume changes in non-volume based purchased (non-VBP) drugs differed between outpatients and inpatients. The proportion of non-VBP drugs immediately increased by 5.34% (p = 0.002) overall, and showed an upward trend in the outpatient setting specially (p < 0.001) during the post-intervention period. However, no significant differences were observed in the proportion of non-VBP drugs in inpatient setting (p > 0.05) in term of level change (p > 0.05) or trend change (p > 0.05). The average per-visit expenditures of outpatients across all drug groups exhibited an upward trend (p < 0.05) post policy intervention. In addition, a similar increase in the overall costs for chemical drugs were observed in inpatient settings (coefficient = 2,599.54, p = 0.036), with no statistically significant differences in the regression slope and level (p = 0.814). Conclusion: The usage proportion of bid-winning drugs increased significantly post policy intervention, indicating greater use of bid-winning drugs and the corresponding substitution of non-winning hypertensive drugs. Drug expenditures for outpatients and health expenditures per visit for inpatients also exhibited an upward trend, suggesting the importance of enhanced drug use management in Traditional Chinese Medicine hospital settings.
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Affiliation(s)
- Lili Shang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Department of Discipline Construction, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Cheng
- Department of Pharmacy, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Jifang Zhou
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yuqing Bao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Desong Kong
- Chinese Medicine Modernization and Big Data Research Center, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Ruijian Huang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yanfei Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Hao Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ning Gu
- Cardiovascular Department, Nanjing Hospital of Chinese Medicine, Nanjing, China
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
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Rouette J, McDonald EG, Schuster T, Matok I, Brophy JM, Azoulay L. Thiazide Diuretics and Risk of Colorectal Cancer: A Population-Based Cohort Study. Am J Epidemiol 2024; 193:47-57. [PMID: 37579305 DOI: 10.1093/aje/kwad171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 05/05/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023] Open
Abstract
Evidence from clinical trials and observational studies on the association between thiazide diuretics and colorectal cancer risk is conflicting. We aimed to determine whether thiazide diuretics are associated with an increased colorectal cancer risk compared with dihydropyridine calcium channel blockers (dCCBs). A population-based, new-user cohort was assembled using the UK Clinical Practice Research Datalink. Between 1990-2018, we compared thiazide diuretic initiators with dCCB initiators and estimated hazard ratios (HR) with 95% confidence intervals (CIs) of colorectal cancer using Cox proportional hazard models. Models were weighted using standardized morbidity ratio weights generated from calendar time-specific propensity scores. The cohort included 377,760 thiazide diuretic initiators and 364,300 dCCB initiators, generating 3,619,883 person-years of follow-up. Compared with dCCBs, thiazide diuretics were not associated with colorectal cancer (weighted HR = 0.97, 95% CI: 0.90, 1.04). Secondary analyses yielded similar results, although an increased risk was observed among patients with inflammatory bowel disease (weighted HR = 2.45, 95% CI: 1.13, 5.35) and potentially polyps (weighted HR = 1.46, 95% CI: 0.93, 2.30). Compared with dCCBs, thiazide diuretics were not associated with an overall increased colorectal cancer risk. While these findings provide some reassurance, research is needed to corroborate the elevated risks observed among patients with inflammatory bowel disease and history of polyps.
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Peeters LE, Kappers M, Hesselink D, van der Net J, Hartong S, van de Laar R, Ezzahti M, van de Ven P, van der Meer I, de Bruijne E, Kroon A, Indhirajanti-Tomasoa S, van der Linde N, Bahmany S, Boersma E, Massey EK, van Dijk L, van Gelder T, Koch BC, Versmissen J. Antihypertensive drug concentration measurement combined with personalized feedback in resistant hypertension: a randomized controlled trial. J Hypertens 2024; 42:169-178. [PMID: 37796233 PMCID: PMC10713002 DOI: 10.1097/hjh.0000000000003585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Adherence to antihypertensive drugs (AHDs) is crucial for controlling blood pressure (BP). We aimed to determine the effectiveness of measuring AHD concentrations using a dried blood spot (DBS) sampling method to identify nonadherence, combined with personalized feedback, in reducing resistant hypertension. METHODS We conducted a multicenter, randomized, controlled trial (RHYME-RCT, ICTRP NTR6914) in patients with established resistant hypertension. Patients were randomized to receive either an intervention with standard of care (SoC) or SoC alone. SoC consisted of BP measurement and DBS sampling at baseline, 3 months (t3), 6 months (t6), and 12 months (t12); AHD concentrations were measured but not reported in this arm. In the intervention arm, results on AHD concentrations were discussed during a personalized feedback conversation at baseline and t3. Study endpoints included the proportion of patients with RH and AHD adherence at t12. RESULTS Forty-nine patients were randomized to receive the intervention+SoC, and 51 were randomized to receive SoC alone. The proportion of adherent patients improved from 70.0 to 92.5% in the intervention+SoC arm ( P = 0.008, n = 40) and remained the same in the SoC arm (71.4%, n = 42). The difference in adherence between the arms was statistically significant ( P = 0.014). The prevalence of resistant hypertension decreased to 75.0% in the intervention+SoC arm ( P < 0.001, n = 40) and 59.5% in the SoC arm ( P < 0.001, n = 42) at t12; the difference between the arms was statistically nonsignificant ( P = 0.14). CONCLUSION Personalized feedback conversations based on DBS-derived AHD concentrations improved AHD adherence but did not reduce the prevalence of RH.
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Affiliation(s)
- Laura E.J. Peeters
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | | | - D.A. Hesselink
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - J.B. van der Net
- Albert Schweitzer Hospital, Department of Internal Medicine, Dordrecht
| | - S.C.C. Hartong
- Albert Schweitzer Hospital, Department of Internal Medicine, Dordrecht
| | - R. van de Laar
- Ikazia Hospital, Department of Internal Medicine, Rotterdam
| | - M. Ezzahti
- Bravis Hospital, Department of Internal Medicine, Bergen op Zoom
| | | | | | - E.L.E. de Bruijne
- IJsselland Hospital, Department of Internal Medicine, Capelle aan den Ijssel
| | - A.A. Kroon
- Maastricht University Medical Center, Department of Internal Medicine, Maastricht
| | | | | | - S. Bahmany
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
| | - E. Boersma
- Erasmus MC, University Medical Center Rotterdam, Department of Cardiology, Rotterdam
| | - E. K. Massey
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - L. van Dijk
- Nivel, Netherlands Institute for Health Services Research, Department Pharmaceutical Care, Utrecht
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - T. van Gelder
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - Birgit C.P. Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
| | - Jorie Versmissen
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam
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15
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Jafari E, Cooper-DeHoff RM, Effron MB, Hogan WR, McDonough CW. Characteristics and Predictors of Apparent Treatment-Resistant Hypertension in Real-World Populations Using Electronic Health Record-Based Data. Am J Hypertens 2024; 37:60-68. [PMID: 37712350 PMCID: PMC10724527 DOI: 10.1093/ajh/hpad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) despite using ≥3 antihypertensive classes or controlled BP while using ≥4 antihypertensive classes. Patients with aTRH have a higher risk for adverse cardiovascular outcomes compared with patients with controlled hypertension (HTN). Although there have been prior reports on the prevalence, characteristics, and predictors of aTRH, these have been broadly derived from smaller datasets, randomized controlled trials, or closed healthcare systems. METHODS We extracted patients with HTN defined by ICD-9 and ICD-10 codes during 1/1/2015-12/31/2018, from 2 large electronic health record databases: the OneFlorida Data Trust (n = 223,384) and Research Action for Health Network (REACHnet) (n = 175,229). We applied our previously validated aTRH and stable controlled HTN computable phenotype algorithms and performed univariate and multivariate analyses to identify the prevalence, characteristics, and predictors of aTRH in these populations. RESULTS The prevalence of aTRH among patients with HTN in OneFlorida (16.7%) and REACHnet (11.3%) was similar to prior reports. Both populations had a significantly higher proportion of Black patients with aTRH compared with those with stable controlled HTN. aTRH in both populations shared similar significant predictors, including Black race, diabetes, heart failure, chronic kidney disease, cardiomegaly, and higher body mass index. In both populations, aTRH was significantly associated with similar comorbidities, when compared with stable controlled HTN. CONCLUSIONS In 2 large, diverse real-world populations, we observed similar comorbidities and predictors of aTRH as prior studies. In the future, these results may be used to improve healthcare professionals' understanding of aTRH predictors and associated comorbidities.
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Affiliation(s)
- Eissa Jafari
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Department of Pharmacy Practice, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mark B Effron
- John Ochsner Heart and Vascular Institute, The University of Queensland Ochsner Clinical School, New Orleans, Louisiana, USA
| | - William R Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Caitrin W McDonough
- Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA
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Coelho-Junior HJ, Calvani R, Tosato M, Álvarez-Bustos A, Landi F, Picca A, Marzetti E. Associations Between Hypertension, Angiotensin-Converting Enzyme Inhibitors, and Physical Performance in Very Old Adults: Results from the ilSIRENTE Study. J Frailty Aging 2024; 13:74-81. [PMID: 38616362 DOI: 10.14283/jfa.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Results regarding the associations between hypertension-related parameters and physical performance in older adults are conflicting. A possible explanation for these divergent results is that investigations may not have adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs). OBJECTIVES To examine the associations between hypertension-related parameters, ACEI use, and a set of physical performance tests in very old adults. DESIGN Cross-sectional study from the ilSIRENTE database. SETTING Mountain community of the Sirente geographic area (L'Aquila, Abruzzo, Italy). PARTICIPANTS All persons born in the Sirente area (13 municipalities) before 1 January 1924 and living in that region at the time of study were identified and invited to participate. The final sample included 364 older adults (mean age: 85.8 ± standard deviation [SD] 4.8). MEASUREMENTS Physical performance was assessed using isometric handgrip strength (IHG), walking speed (WS) at normal and fast pace, 5-time sit-to-stand test (5STS), and muscle power measures. Blood pressure (BP) was measured after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. ACEIs were categorized in centrally (ACEI-c) and peripherally (ACEI-p) acting. Blood inflammatory markers, free insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3 (IGFBP-3) were assayed. RESULTS Results indicated that 5STS test was significantly and negatively associated with diastolic BP values. However, significance was lost when results were adjusted for ACEI use. Participants on ACEIs were more likely to have greater specific muscle power and higher blood levels of IGFBP-3 than non-ACEI users. When participants were categorized according to ACEI subtypes, those on ACEI-p had higher blood IGF-1 levels compared with ACEI-c users. CONCLUSIONS The main findings of the present study indicate that ACEI use might influence the association between hypertension-related parameters and neuromuscular parameters in very old adults. Such results may possibly be linked to the effects of ACEI-p on the IGF-1 pathway.
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Affiliation(s)
- H J Coelho-Junior
- Helio José Coelho-Junior, PhD, Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy e-mail: ; Emanuele Marzetti, MD, PhD, Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy . Tel: +39 (06) 3015-8885; Fax: +39 (06) 3051-911
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Liu H, Zhang X, Zhou Y, Nguyen TN, Zhang L, Xing P, Li Z, Shen H, Zhang Y, Hua W, Xu H, Zhu X, Chen L, Zuo Q, Zhao R, Li Q, Dai D, Zhang Y, Xu Y, Huang Q, Liu J, Yang P. Association between blood pressure and different antihypertensive drugs with outcome after ischemic stroke: A Mendelian randomization study. Int J Stroke 2023; 18:1247-1254. [PMID: 37337369 DOI: 10.1177/17474930231185695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Observational studies suggest an association between blood pressure (BP) and functional outcomes in ischemic stroke patients but whether this is causal or due to confounding is uncertain. We used Mendelian randomization (MR) to assess causality, and also explore whether particular classes of anti-hypertensives were associated with a better outcome after ischemic stroke. METHODS We selected genetic variants associated with systolic and diastolic BP and BP-lowering variants in genes encoding antihypertensive drugs from genome-wide association studies (GWAS) on 757,601 individuals. The primary outcome was 3-month dependence or death defined as a modified Rankin Scale (mRS) of 3-6. The secondary outcome was disability or death after 90 days defined as mRS 2-6. Cochran's Q statistic in the inverse variance weighted (IVW) model, the weighted median, MR-Egger regression, leave-one-single-nucleotide polymorphism (SNP)-out analysis, MR-Pleiotropy Residual Sum and Outlier methods were adopted as sensitivity analyses. To validate our primary results, we performed independent repeat analyses and Bi-directional MR analyses. RESULTS Genetic predisposition to higher systolic and diastolic BP was associated with disability or death after ischemic stroke in univariable IVW MR analysis (odds ratio (OR) 1.29, 95% confidence interval (CI): 1.05-1.59, p = 0.014; OR 1.27, 95% CI: 1.07-1.51, p = 0.006, respectively). Pulse pressure was associated with both dependence or death and disability or death after ischemic stroke (OR = 1.05, 95% CI: 1.02-1.08, p = 0.002; OR = 1.04, 95% CI = 1.01-1.07, p = 0.009, respectively). Angiotensin-converting enzyme inhibitor (ACEI) and calcium channel blocker (CCB) were significantly associated with improved functional outcomes (dependence or death, OR 0.76, 95% CI: 0.62-0.94, p = 0.009; OR 0.89, 95% CI: 0.83-0.97, p = 0.005). Proxies for β-blockers, angiotensin receptor blockers (ARB), and thiazides failed to show associations with functional outcomes (p > 0.05). CONCLUSION We provide evidence for an association of genetic predisposition to higher BP with a higher risk of 3-month functional dependence after ischemic stroke. Our findings support ACEI and CCB as promising antihypertensive drugs for improving functional outcomes in ischemic stroke.
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Affiliation(s)
- Hanchen Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Xiaoxi Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Yu Zhou
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Thanh N Nguyen
- Departments of Neurology and Radiology, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lei Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Pengfei Xing
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Zifu Li
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Hongjian Shen
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Yongxin Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Weilong Hua
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Hongye Xu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Xuan Zhu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Lei Chen
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Qiao Zuo
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Rui Zhao
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Qiang Li
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Dongwei Dai
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Yongwei Zhang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Yi Xu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Qinghai Huang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
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Peeters LEJ, van Gelder T, van Dijk L, Koch BCP, Versmissen J. Lessons learned from conducting a randomized controlled trial to improve non-adherence to antihypertensive drug treatment. Blood Press 2023; 32:2281316. [PMID: 38010821 DOI: 10.1080/08037051.2023.2281316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Hypertension significantly contributes to cardiovascular diseases and premature deaths. Effective treatment is crucial to reduce cardiovascular risks, but poor adherence to antihypertensive drugs is a major issue. Numerous studies attempted to investigate interventions for identifying non-adherence, but often failed to address the issue effectively. The RHYME-RCT trial sought to bridge this gap by measuring non-adherence by determining antihypertensive drug concentrations in blood through a dried blood spot (DBS) method in patients with resistant hypertension. This measurement was followed by personalized feedback to improve adherence. During the course of this trial several challenges emerged, including selection bias, the gatekeeper role of physicians, the Hawthorne effect and the role of randomization. AIM This communication aims to inform fellow researchers and clinicians of challenges that can arise when conducting clinical trials to improve adherence and offer insights for refining study designs to avoid these issues in forthcoming adherence studies.
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Affiliation(s)
- L E J Peeters
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, the Netherlands
| | - T van Gelder
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, the Netherlands
| | - L van Dijk
- Nivel, Netherlands Institute for Health Services Research, Department Healthcare from the Perspective of Patients, Clients and Citizens, Utrecht, the Netherlands
- University of Groningen, Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Science and Engineering, University of Groningen, Groningen, the Netherlands
| | - B C P Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, the Netherlands
| | - J Versmissen
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Internal Medicine, the Netherlands
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Du XL, Martinez J, Yamal JM, Simpson LM, Davis BR. The 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drugs: post-trial analyses from ALLHAT-Medicare linked data. Front Cardiovasc Med 2023; 10:1272385. [PMID: 38045916 PMCID: PMC10691487 DOI: 10.3389/fcvm.2023.1272385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose This study aimed to determine the 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drug use. Methods This is a post-trial passive follow-up study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants between 1994 and 1998 that was conducted by linking their follow-up data with Medicare claims data until 2017 of subjects who were free of outcomes at baseline on 1 January 1999. The main outcomes were the occurrence of cancer (among n = 17,332), angioedema (among n = 17,340), insomnia (among n = 17,340), depression (among n = 17,330), and erectile dysfunction (among n = 7,444 men) over 18 years of follow-up. Results The 18-year cumulative incidence rate of cancer other than non-melanoma skin cancer from Medicare inpatient claims was 23.9% for chlorthalidone, 23.4% for amlodipine, and 25.3% for lisinopril. There were no statistically significant differences in the 18-year risk of cancer, depression, and erectile dysfunction among the three drugs based on the adjusted hazard ratios. The adjusted 18-year risk of angioedema was elevated in those receiving lisinopril than in those receiving amlodipine (hazard ratio: 1.63, 95% CI: 1.14-2.33) or in those receiving chlorthalidone (1.33, 1.00-1.79), whereas the adjusted 18-year risk of insomnia was statistically significantly decreased in those receiving lisinopril than in those receiving amlodipine (0.90, 0.81-1.00). Conclusions The 18-year risk of angioedema was significantly higher in patients receiving lisinopril than in those receiving amlodipine or chlorthalidone; the risk of insomnia was significantly lower in patients receiving lisinopril than in those receiving amlodipine; and the risk of cancer, depression, and erectile dysfunction (in men) was not statistically significantly different among the three drug groups.
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Affiliation(s)
- Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Journey Martinez
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose-Miguel Yamal
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Lara M. Simpson
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Barry R. Davis
- Department of Biostatistics and Data Science, Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Laio KM, Shen CW, Huang YH, Lu CH, Lai HL, Chen CY. Prescription pattern and effectiveness of antihypertensive drugs in patients with aortic dissection who underwent surgery. Front Pharmacol 2023; 14:1291900. [PMID: 38026966 PMCID: PMC10667675 DOI: 10.3389/fphar.2023.1291900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Surgical patients with aortic dissection often require multiple antihypertensive drugs to control blood pressure. However, the prescription pattern and effectiveness of antihypertensive drugs for these patients are unclear. We aimed to investigate the prescription pattern and effectiveness of different classes of antihypertensive drugs in surgical patients with aortic dissection. Methods: Newly diagnosed aortic dissection patients who underwent surgery, aged >20 years, from 1 January 2012 to 31 December 2017 were identified. Patients with missing data, in-hospital mortality, aortic aneurysms, or congenital connective tissue disorders, such as Marfan syndrome, were excluded. Prescription patterns of antihypertensive drugs were identified from medical records of outpatient visits within 90 days after discharge. Antihypertensive drugs were classified into four classes: 1) β-blockers, 2) calcium channel blockers (CCBs), 3) renin-angiotensin system, and 4) other antihypertensive drugs. Patients were classified according to the number of classes of antihypertensive drugs as follows: 1) class 0, no exposure to antihypertensive drugs; 2) class 1, antihypertensive drugs of the same class; 3) class 2, antihypertensive drugs of two classes; 4) class 3, antihypertensive drugs of three classes; or 5) class 4, antihypertensive drugs of four classes. The primary composite outcomes included rehospitalization associated with aortic dissection, death due to aortic dissection, and all-cause mortality. Results: Most patients were prescribed two (28.87%) or three classes (28.01%) of antihypertensive drugs. In class 1, β-blockers were most commonly used (8.79%), followed by CCBs (5.95%). In class 2, β-blockers+CCB (10.66%) and CCB+RAS (5.18%) were the most common drug combinations. In class 3, β-blockers + CCB+RAS (14.84%) was the most prescribed combination. Class 0 had a significantly higher hazard of the composite outcome (HR, 2.1; CI, 1.46-3.02; p < 0.001) and all-cause mortality (HR, 2.34; CI, 1.56-3.51; p < 0.001) than class 1. There were no significant differences in hazards for rehospitalization associated with aortic dissection among classes. Conclusion: Among operated patients with type A aortic dissection, no specific type of antihypertensive drug was associated with a better outcome, whereas among those with type B aortic dissection, the use of β-blockers and CCBs was related to a significantly lower risk of the composite outcome.
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Affiliation(s)
| | - Chuan-Wei Shen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yun-Hui Huang
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chun-Hui Lu
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hsuan-Lin Lai
- Division of Pharmacy, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Lou IX, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag 2023; 19:691-705. [PMID: 37941540 PMCID: PMC10629452 DOI: 10.2147/vhrm.s439334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Sexual dysfunction pertains to any issue that hinders an individual from attaining sexual contentment. This health issue can have a significant impact on the quality of life and psychological health of affected individuals. Sexual dysfunction can generate stress, anxiety, depression, and low self-esteem, which can lead to a reduction in overall life satisfaction and the quality of interpersonal relationships. Sexual dysfunction can manifest as erectile dysfunction in men or lack of sexual desire in women. Although both sexes can experience sexual problems, there are some significant differences in the manifestation of sexual dysfunction between men and women. In men, sexual dysfunction is usually physical and associated with problems such as erectile dysfunction, while in women, sexual dysfunction is usually related to psychological factors. Additionally, there was an association between hypertension and sexual dysfunction in both the sexes. In men, hypertension can cause erection problems, whereas in women, it can cause vaginal dryness and a decrease in sexual desire. Furthermore, antihypertensive drugs can negatively impact sexual function, which can decrease adherence to drug treatment. However, nebivolol, an antihypertensive drug, has beneficial effects on erectile dysfunction in men. This is believed to be because nebivolol improves blood flow to the penis by producing nitric oxide, which can help improve erections.
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Affiliation(s)
- Inmaculada Xu Lou
- Department of Cardiology, International Education College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China
- Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310025, People’s Republic of China
| | - Jiayue Chen
- Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310025, People’s Republic of China
- Department of Cardiology, Hangzhou Clinical Medical College Internal Medicine of Traditional Chinese Medicine of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Kamran Ali
- Department of Oncology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, Zhejiang, 322000, People’s Republic of China
| | - Qilan Chen
- Department of Cardiology, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, 310025, People’s Republic of China
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Duo D, Duan Y, Zhu J, Bai X, Yang J, Liu G, Wang Q, Li X. New strategy for rational use of antihypertensive drugs in clinical practice in high-altitude hypoxic environments. Drug Metab Rev 2023; 55:388-404. [PMID: 37606301 DOI: 10.1080/03602532.2023.2250930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
High-altitude hypoxic environments have critical implications on cardiovascular system function as well as blood pressure regulation. Such environments place patients with hypertension at risk by activating the sympathetic nervous system, which leads to an increase in blood pressure. In addition, the high-altitude hypoxic environment alters the in vivo metabolism and antihypertensive effects of antihypertensive drugs, which changes the activity and expression of drug-metabolizing enzymes and drug transporters. The present study reviewed the pharmacodynamics and pharmacokinetics of antihypertensive drugs and its effects on patients with hypertension in a high-altitude hypoxic environment. It also proposes a new strategy for the rational use of antihypertensive drugs in clinical practice in high-altitude hypoxic environments. The increase in blood pressure on exposure to a high-altitude hypoxic environment was mainly dependent on increased sympathetic nervous system activity. Blood pressure also increased proportionally to altitude, whilst ambulatory blood pressure increased more than conventional blood pressure, especially at night. High-altitude hypoxia can reduce the activities and expression of drug-metabolizing enzymes, such as CYP1A1, CYP1A2, CYP3A1, and CYP2E1, while increasing those of CYP2D1, CYP2D6, and CYP3A6. Drug transporter changes were related to tissue type, hypoxic degree, and hypoxic exposure time. Furthermore, the effects of high-altitude hypoxia on drug-metabolism enzymes and transporters altered drug pharmacokinetics, causing changes in pharmacodynamic responses. These findings suggest that high-altitude hypoxic environments affect the blood pressure, pharmacokinetics, and pharmacodynamics of antihypertensive drugs. The optimal hypertension treatment plan and safe and effective medication strategy should be formulated considering high-altitude hypoxic environments.
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Affiliation(s)
- Delong Duo
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
- Qinghai Provincial People's Hospital, Xining, China
| | - Yabin Duan
- Qinghai University Affiliated Hospital, Xining, China
| | - Junbo Zhu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Xue Bai
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Jianxin Yang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Guiqin Liu
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Qian Wang
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
| | - Xiangyang Li
- Research Center for High Altitude Medicine, Qinghai University Medical College, Xining, China
- State Key Laboratory of Plateau Ecology and Agriculture, Qinghai University, Xining, China
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Abstract
Hypertension and osteoporosis are common comorbidities among elderly individuals. Drug therapy has been widely used in clinical practice as the preferred antihypertensive treatment. Therefore, antihypertensive drugs have become some of the most commonly prescribed drugs in healthcare settings. However, antihypertensive drugs have different effects on bone metabolism. The results of animal and clinical studies on the effects of antihypertensive drugs on osteoporosis or fracture risk are controversial and have aroused widespread concern among clinicians. Recent studies found that angiotensin receptor blockers, selective β-adrenergic receptor blockers, and thiazide diuretics might improve bone trabecular number and bone mineral density by stimulating osteoblast differentiation, reducing osteoclast generation, and other mechanism. Furthermore, nonselective β-adrenergic receptor blockers and dihydropyridine calcium channel blockers were found to have no significant relationship with bone mineral density or bone strength, and α-adrenergic receptor blockers and loop diuretics might increase fracture risk by decreasing bone mineral density. This article aimed to review previous animal experiments, clinical studies, and meta-analyses focusing on the effects of different antihypertensive drugs on bone metabolism, and to provide a new approach for the prevention and treatment of osteoporosis.
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Affiliation(s)
- Ruixing Zhang
- The First Clinical Medical College, Lanzhou University, China (R.Z., M.Y.)
- Department of Heart Center (R.Z., Z.Z.), The First Hospital of Lanzhou University, China
| | - Hongtao Yin
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Mengdi Yang
- The First Clinical Medical College, Lanzhou University, China (R.Z., M.Y.)
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Xianqiong Lei
- Department of Geriatrics, The First People's Hospital of Yibin, China (X.L.)
| | - Donghu Zhen
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Zheng Zhang
- Department of Heart Center (R.Z., Z.Z.), The First Hospital of Lanzhou University, China
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Xu RN, Zhang Y, Xu X, Li X, He L, Feng Q, Yang YH, He Y, Ma X, He YM. Serum Copper Concentrations, Effect Modifiers and Blood Pressure: Insights from NHANES 2011-2014. J Cardiovasc Dev Dis 2023; 10:432. [PMID: 37887879 PMCID: PMC10607875 DOI: 10.3390/jcdd10100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Epidemiological studies on the relationship between serum copper and hypertension are contradictory. We assessed the relationship between serum copper and blood pressure among adults in the United States. (2) Methods: We divided hypertension into two categories: treated hypertension and untreated hypertension. Linear or logistic regression analysis was applied to investigate the association between serum copper concentrations and blood pressure levels. (3) Results: As compared to quartile 1, the odds ratios (ORs) for untreated hypertension in quartiles 2, 3, and 4 were 1.02 (0.74-1.42), 1.23 (0.88-1.72), and 1.08 (0.74-1.58), respectively, in multivariable analysis (all p > 0.05). In non-hypertension, as compared with quartile 1, the β (95% CI) of systolic blood pressure for quartiles 2, 3, and 4 was -0.92 (-2.07-0.23), -0.05 (-1.30-1.20), and -0.48 (-1.83-0.88), respectively, in multivariable analysis (all p > 0.05). As compared to quartile 1, the ORs for treated hypertension in quartiles 2, 3, and 4 were 1.36 (0.88-2.10), 1.35 (0.87-2.09), and 1.56 (0.98-2.47), respectively, upon multivariable analysis including antihypertensive medication use as a covariate (all p > 0.05). Furthermore, 1SD increase in serum copper was non-significantly associated with 1.16 (0.97-1.37)-fold increased risk of hypertension in multivariable analysis (p = 0.096). (4) Conclusion: In the present study, we discovered that the serum copper concentration was not related with hypertension or blood pressure levels. Antihypertensive drug use may distort the correlation between copper and blood pressure levels. Information on antihypertensive drug use may be taken into account when identifying new risk factors for hypertension.
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Affiliation(s)
- Ruo-Nan Xu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
| | - Yue Zhang
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
| | - Xin Xu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
| | - Xu Li
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
| | - Lan He
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
- Division of Ultrasound, The Shanghai Municipal No 8 People’s Hospital, 8 Caobao Street, Shanghai 200000, China
| | - Qiang Feng
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
| | - Yong-Hai Yang
- Division of Cardiology, Suzhou Yongding Hospital, 1388 Gaoxin Street, Suzhou 215299, China;
| | - Yang He
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
| | - Xiao Ma
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
| | - Yong-Ming He
- Division of Cardiology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; (R.-N.X.); (Y.Z.); (X.X.); (X.L.); (L.H.); (Q.F.); (Y.H.)
- Division of Cardiology, Suzhou Yongding Hospital, 1388 Gaoxin Street, Suzhou 215299, China;
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Cavero-Redondo I, Saz-Lara A, Lugones-Sánchez C, Pozuelo-Carrascosa DP, Gómez-Sánchez L, López-Gil JF, García-Ortiz L, Bruno RM, Gómez-Marcos MÁ. Comparative effect of antihypertensive drugs in improving arterial stiffness in adults with hypertension (RIGIPREV study). A network meta-analysis. Front Pharmacol 2023; 14:1225795. [PMID: 37724181 PMCID: PMC10505405 DOI: 10.3389/fphar.2023.1225795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Aims: To synthesize and evaluate the available scientific evidence on the efficacy of antihypertensive drugs on arterial stiffness in patients with hypertension by using a network meta-analysis approach. Methods: A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different antihypertensive drugs on arterial stiffness parameters (pulse wave velocity [PWV] and augmentation index [AIx]) in adults with hypertension. Comparative evaluation of the effect of antihypertensive drugs was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between antihypertensive drugs and placebo/other antihypertensive drugs. Analyses were performed including studies of any duration and only studies longer than 6 months length. Results: Seventy-six studies were included in the main analysis and considering only studies longer than 6 months length, thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination showed a higher effect on reducing PWV, and ACEIs and ARBs on reducing AIx. Conclusion: Our research provides evidence that antihypertensive medications are an effective way to treat arterial stiffness in adults with hypertension. Based on our findings, patients with hypertension who have greater levels of arterial stiffness may benefit from using thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination. Systematic Review Registration: PROSPERO (CRD42021276360).
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Affiliation(s)
- Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
- Health and Social Research Center, Universidad de Castilla- La Mancha, Cuenca, Spain
| | - Alicia Saz-Lara
- INSERM U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou—APHP, Paris, France
| | | | - Diana P. Pozuelo-Carrascosa
- INSERM U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou—APHP, Paris, France
| | | | - José Francisco López-Gil
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
- INSERM U970, Paris Cardiovascular Research Center (PARCC), Université de Paris, Hopital Europeen Georges Pompidou—APHP, Paris, France
| | - Luis García-Ortiz
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Rosa Maria Bruno
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Rea F, Morabito G, Savaré L, Pathak A, Corrao G, Mancia G. Adherence and related cardiovascular outcomes to single pill vs. separate pill administration of antihypertensive triple-combination therapy. J Hypertens 2023; 41:1466-1473. [PMID: 37432906 PMCID: PMC10399952 DOI: 10.1097/hjh.0000000000003497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/04/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To compare adherence to antihypertensive treatment between patients prescribed a three-drug single-pill combination (SPC) of perindopril/amlodipine/indapamide (P/A/I) vs. the combination of an angiotensin-converting enzyme inhibitor (ACEI), a calcium-channel blocker (CCB), and a diuretic (D) as a two-drug SPC plus a third drug given separately. METHODS Using the healthcare utilization database of the Lombardy Region (Italy), the 28 210 patients, aged at least 40 years, who were prescribed P/A/I SPC during 2015-2018 were identified and the date of the first prescription was defined as the index date. For each patient prescribed the SPC, a comparator who started ACEI/CCB/D treatment as a two-pill combination was considered. Adherence to the triple combination was assessed over the year after the index date as the proportion of the follow-up days covered by prescription (PDC). Patients who had a PDC >75% were defined as highly adherent to drug therapy. Log-binomial regression models were fitted to estimate the risk ratio of treatment adherence in relation to the drug treatment strategy. RESULTS About 59 and 25% of SPC and two-pill combination users showed high adherence, respectively. Compared with patients under a three-drug two-pill combination, those who were treated with the three-drug SPC had a higher propensity to be highly adherent to the triple combination (2.38, 95% confidence interval: 2.32-2.44). This was the case regardless of the sex, age, comorbidities, and number of co-treatments. CONCLUSIONS In a real-life setting, patients under three-drug SPC exhibited more frequently a high adherence to antihypertensive treatment than those prescribed a three-drug two-pill combination.
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Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca
| | - Gabriella Morabito
- National Centre for Healthcare Research and Pharmacoepidemiology
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca
| | - Laura Savaré
- National Centre for Healthcare Research and Pharmacoepidemiology
- MOX – Laboratory for Modeling and Scientific Computing, Department of Mathematics, Politecnico di Milano
- CHDS – Center for Health Data Science, Human Technopole, Milan
| | - Atul Pathak
- Department of Cardiology, and UMR UT3 CNRS 5288 Hypertension and Heart Failure: Molecular and Clinical Investigations, INI-CRCT F-CRIN, GREAT Networks, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca
| | - Giuseppe Mancia
- Emeritus Professor of Medicine, University of Milano-Bicocca, Milan
- Policlinico di Monza, Monza, Italy
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Kollias A, Kyriakoulis KG, Stergiou GS. Chlorthalidone versus hydrochlorothiazide for preventing cardiovascular disease in hypertension: Is the case closed? Hellenic J Cardiol 2023; 73:84-85. [PMID: 37429505 DOI: 10.1016/j.hjc.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
The optimal diuretic choice [hydrochlorothiazide (HCTZ) or chlorthalidone (CTD)] for the management of hypertension has been an ongoing debate for several years. HCTZ is widely used in the form of single-pill combinations, whereas CTD is a more potent drug vs. HCTZ, especially in reducing nighttime blood pressure (BP), with some indirect evidence suggesting a superiority in terms of cardiovascular (CV) risk reduction. In addition, recent data showed that CTD was safe and effective in terms of BP lowering in predialysis patients with stage 4 chronic kidney disease. The Diuretic Comparison Project was the first head-to-head pragmatic, open-label trial that randomly assigned elderly patients with hypertension under HCTZ therapy to continue with HCTZ or to switch to CTD (equivalent doses). Office BP was similar for both groups throughout the study. The trial showed no difference in major CV events or non-cancer-related deaths during a median follow-up of 2.4 years; yet, CTD was associated with a benefit in participants with a previous myocardial infarction or stroke, which might be a chance finding but could also indicate that a high-risk population is more suitable for revealing the impact of slight differences in the 24-hour BP profile in a relatively short-term follow-up. Interestingly CTD vs. HCTZ was associated with higher hypokalemia rates apart from the latter group of patients where there was no difference. Overall, the available data do not confirm the superiority of CTD over HCTZ in general, but this could be questionable in selected patients.
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Affiliation(s)
- Anastasios Kollias
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Shahbazi F, Najafi F, Shojaei L, Farzaei MH, Shokoohinia Y, Pasdar Y, Hamzeh B, Tahvilian R, Rahimi W, Shakiba E, Karim H, Dobson A, Bhatt N, Moradinazar M. Hypertension medication from guidelines to practice: A cohort study in western Iran. Pharmacoepidemiol Drug Saf 2023; 32:951-960. [PMID: 36974582 DOI: 10.1002/pds.5626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Hypertension (HTN) is one of the most common risk factors for non-communicable chronic diseases. The aim of the current study is to evaluate the prescribing patterns of antihypertensive medications in Kermanshah Province, west of Iran. METHODS The Ravansar Non-Communicable Diseases (RaNCD) cohort study is the first Kurdish community-based study; subjects' age ranged from 35 to 65 years. In order to examine the use of medications to control blood pressure, participants were asked to bring all prescribed medications to the study center. Treatments were compared with 2013 European Society of Hypertension (ESH)/European Society of Cardiology (ESC) Guidelines for the management of arterial HTN. RESULTS From a total of 10 040 participants in RaNCD cohort, 1575 (15.7%) individuals were hypertensive, of whom, 1271 (80.7%) people were aware of their condition. From 1153 (73.20%) people under treatment, 840 (72.8%) had their HTN properly controlled. The most common medications used to treat HTN were losartan (27.5%), metoprolol (14.3%), and captopril (11.9%). Regardless of type of treatment, 49.3% of all patients have received the medication for l 6 ≥ years. The most commonly used drugs were β-blockers and angiotension receptor blockers as 620 (31.0%) and 612 (30.6%), respectively. Multivariable analysis showed that female gender, those receive ≥3 antihypertensive agents, and using preferred combinations were associated with a better blood pressure control. In addition, the probability of hypertension control was less likely with increasing duration of treatment (i.e >6 years) and in obese patients with ≥35 kg/m2 . CONCLUSIONS Even though adherence to the international guidelines was acceptable, improvements can be made for better control of HTN. Therefore, it is imperative to educate healthcare professionals on improving their selection of antihypertensive medications and combination therapy for hypertensive patients.
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Affiliation(s)
- Foroud Shahbazi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lida Shojaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yalda Shokoohinia
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Pharmacognosy & Biotechnology, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Nutritional Sciences Department School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behrooz Hamzeh
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Tahvilian
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Werya Rahimi
- Research Center of Oils and fats, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ebrahim Shakiba
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Karim
- Kermanshah Cardiovascular Research Center, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Annette Dobson
- Centre for Longitudinal and Life Course Research (CLLR), School of Population Health, University of Queensland, Queensland, Australia
| | - Neha Bhatt
- Ric Scalzo Institute for Botanical Sciences, Sonoran University of Health Sciences, Tempe, Arizona, USA
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Jiao T, Platt RW, Douros A, Filion KB. Use of a Statistical Adaptive Treatment Strategy Approach for Emulating Randomized Controlled Trials Using Observational Data: The Example of Blood-Pressure Control Strategies for the Prevention of Cardiovascular Events Among Individuals With Hypertension at High Cardiovascular Risk. Am J Epidemiol 2023; 192:1576-1591. [PMID: 37073411 DOI: 10.1093/aje/kwad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 10/12/2022] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
Statistical approaches to adaptive treatment strategies (ATS) can be used to mimic the sequential decision-making inherently found in clinical practice. To illustrate the use of a statistical ATS approach, we emulated a target trial of different blood pressure (BP) control plans for the prevention of cardiovascular events among individuals with hypertension at high cardiovascular risk, inspired by the Systolic Blood Pressure Intervention Trial (SPRINT). We included 103,708 patients with hypertension and a "QRISK3" estimated 10-year risk of cardiovascular disease of ≥20% who initiated an antihypertensive drug between 1998 and 2018. Dynamic marginal structural models estimated the comparative effects of treating patients with intensive (target BP: 130/80 mm Hg), standard (140/90 mm Hg), and conservative (150/90 mm Hg) BP control strategies. The adjusted hazard ratios (HRs) for the intensive versus standard strategy were 0.96 (95% confidence interval (CI): 0.92, 1.00) for major adverse cardiovascular events and 0.93 (95% CI: 0.88, 0.97) for death from cardiovascular causes. For the conservative versus standard strategy, they were 1.06 (95% CI: 1.02, 1.10) and 1.08 (95% CI: 1.03, 1.13), respectively. These results are largely compatible with SPRINT. ATS can be used to emulate randomized controlled trials of complex treatment strategies in an observational setting and represents an alternative approach for situations where randomized controlled trials are not feasible.
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Dybiec J, Krzemińska J, Radzioch E, Szlagor M, Wronka M, Młynarska E, Rysz J, Franczyk B. Advances in the Pathogenesis and Treatment of Resistant Hypertension. Int J Mol Sci 2023; 24:12911. [PMID: 37629095 PMCID: PMC10454510 DOI: 10.3390/ijms241612911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Hypertension is a prevalent chronic disease associated with an increased risk of cardiovascular (CV) premature death, and its severe form manifests as resistant hypertension (RH). The accurate prevalence of resistant hypertension is difficult to determine due to the discrepancy in data from various populations, but according to recent publications, it ranges from 6% to 18% in hypertensive patients. However, a comprehensive understanding of the pathogenesis and treatment of RH is essential. This review emphasizes the importance of identifying the causes of treatment resistance in antihypertensive therapy and highlights the utilization of appropriate diagnostic methods. We discussed innovative therapies such as autonomic neuromodulation techniques like renal denervation (RDN) and carotid baroreceptor stimulation, along with invasive interventions such as arteriovenous anastomosis as potential approaches to support patients with inadequate medical treatment and enhance outcomes in RH.
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Affiliation(s)
- Jill Dybiec
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Łódź, Poland; (J.D.); (J.K.); (E.R.); (M.S.); (M.W.); (B.F.)
| | - Julia Krzemińska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Łódź, Poland; (J.D.); (J.K.); (E.R.); (M.S.); (M.W.); (B.F.)
| | - Ewa Radzioch
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Łódź, Poland; (J.D.); (J.K.); (E.R.); (M.S.); (M.W.); (B.F.)
| | - Magdalena Szlagor
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Łódź, Poland; (J.D.); (J.K.); (E.R.); (M.S.); (M.W.); (B.F.)
| | - Magdalena Wronka
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Łódź, Poland; (J.D.); (J.K.); (E.R.); (M.S.); (M.W.); (B.F.)
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Łódź, Poland; (J.D.); (J.K.); (E.R.); (M.S.); (M.W.); (B.F.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Żeromskiego 113, 90-549 Łódź, Poland;
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Łódź, Poland; (J.D.); (J.K.); (E.R.); (M.S.); (M.W.); (B.F.)
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Quesada-Caballero M, Carmona-García A, Chami-Peña S, Albendín-García L, Membrive-Jiménez C, Romero-Béjar JL, Cañadas-De la Fuente GA. COVID-19 and the Use of Angiotensin II Receptor Blockers in Older Chronic Hypertensive Patients: Systematic Review and Meta-Analysis. Medicina (Kaunas) 2023; 59:1200. [PMID: 37512012 PMCID: PMC10383459 DOI: 10.3390/medicina59071200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Angiotensin II-converting enzyme inhibitors (ACEIs) and selective angiotensin II receptor antagonists (ARAIIs) are widely used antihypertensive agents. Their use has generated controversy due to their possible influence on the health status of chronic patients infected with COVID-19. The objective of this work is to analyze the influence of COVID-19 on chronic hypertensive patients treated with ACEI and ARAII inhibitors. A systematic review and meta-analysis in the databases Pubmed, Pro-Quest and Scopus were carried out. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search equation descriptors were obtained from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "Older AND hypertension AND (COVID-19 OR coronavirus) AND primary care" and its equivalent in Spanish. Nineteen articles were obtained, with n = 10,806,159 subjects. Several studies describe the COVID-19 association with ACEI or ARAII treatment in hypertension patients as a protective factor, some as a risk factor, and others without a risk association. In the case of ACEI vs. ARAII, the risk described for the former has an odds ratio (OR) of 0.55, and for ARAII, an OR of 0.59. Some authors talk about mortality associated with COVID-19 and ACEI with a half ratio (HR) of 0.97, and also associated ARAIIs with an HR of 0.98. It is recommended to maintain the use of the renin-angiotensin-aldosterone axis in the context of the COVID-19 disease.
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Affiliation(s)
- Miguel Quesada-Caballero
- La Caleta Healthcare Unit, Granada-Metropolitan Health District, Andalusian Health Service, 18014 Granada, Spain
| | - Ana Carmona-García
- Primary Care Emergency Service, Granada-Metropolitan Health District, Andalusian Health Service, 18013 Granada, Spain
| | - Sara Chami-Peña
- Serranía de Ronda Hospital, AGS 'Serranía de Málaga', Andalusian Health Service, 29400 Ronda, Spain
| | - Luis Albendín-García
- Casería de Montijo Health Center, Granada Metropolitan District, Andalusian Health Service, 18015 Granada, Spain
| | - Cristina Membrive-Jiménez
- Unidad de Farmacogenetica, Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain
| | - José L Romero-Béjar
- Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs. GRANADA), 18012 Granada, Spain
- Institute of Mathematics, University of Granada (IMAG), 18011 Granada, Spain
| | - Guillermo A Cañadas-De la Fuente
- Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Brain, Mind and Behaviour Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
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Liu Y, Liu S, Zhao J, Wu K, Xu B, Wang W. Increased plasma renin by vasodilators promotes the progression of abdominal aortic aneurysm. Front Pharmacol 2023; 14:1174278. [PMID: 37383707 PMCID: PMC10299739 DOI: 10.3389/fphar.2023.1174278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Background: It is well-accepted that antihypertensive therapy is the cornerstone of treatment for abdominal aortic aneurysm (AAA) patients with hypertension. Direct-acting vasodilators were used in the treatment of hypertension by directly relaxing vascular smooth muscle but may have destructive effects on the aortic wall by activating the renin-angiotensin system axis. Their roles in AAA disease remain to be elucidated. In this study, we used hydralazine and minoxidil, two classical direct-acting vasodilators, to investigate their influence and potential mechanisms on AAA disease. Methods and results: In this study, we investigated the plasma renin level and plasma renin activity in AAA patients. Simultaneously, age and gender ratio-matched patients diagnosed with peripheral artery disease and varicose veins were selected as the control group using a ratio of 1:1:1. Our regression analysis suggested both the plasma renin level and plasma renin activity are positively associated with AAA development. In view of the well-established relationship between direct-acting vasodilators and increased plasma renin concentration, we established a porcine pancreatic elastase-infused AAA mouse model, followed by oral administration of hydralazine (250 mg/L) and minoxidil (120 mg/L) to investigate effects of direct-acting vasodilators on AAA disease. Our results suggested both hydralazine and minoxidil promoted the progression of AAA with increased aortic degeneration. Mechanistically, the vasodilators aggravated aortic inflammation by increased leukocyte infiltration and inflammatory cytokine secretion. Conclusion and relevance: The plasma renin level and plasma renin activity are positively associated with AAA development. Direct vasodilators aggravated experimental AAA progression, which raised cautionary concerns about their applications in AAA disease.
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Affiliation(s)
- Yu Liu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Shuai Liu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jiani Zhao
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Kemin Wu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Baohui Xu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Wei Wang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Zhao C, Feng JL, Deng S, Wang XP, Fu YJ, Wang B, Li HS, Meng FC, Wang JS, Wang X. Genetically predicted hypertension, antihypertensive drugs, and risk of erectile dysfunction: a Mendelian randomization study. Front Cardiovasc Med 2023; 10:1157467. [PMID: 37363097 PMCID: PMC10289031 DOI: 10.3389/fcvm.2023.1157467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Background The causal relationship between hypertension, antihypertensive drugs and the risk of erectile dysfunction is still uncertain. We performed a univariable and multivariable Mendelian randomization study to investigate whether they are causally related to erectile dysfunction. Methods Genetic variants associated with blood pressure were derived from the genome-wide association study meta-analysis of the UK Biobank and International Consortium of Blood Pressure (N = 757,601). Summary association data for hypertension were obtained from the UK Biobank (N = 463,010) and the FinnGen study (N = 356,077). The summary statistics of erectile dysfunction were obtained from the European ancestry with 223,805 subjects. The SNP instruments used to assess the effect of the protein targets of antihypertensive drugs on erectile dysfunction were obtained from previous studys. Causal effects were estimated using the univariate Mendelian randomization method (inverse variance weighted, MR-Egger, weighted median, MR-PRESSO and Wald ratios) and the multivariate Mendelian randomization method. Sensitivity analyses were implemented with the Cochran's Q-test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis. Results Univariate MR found that elevated diastolic blood pressure may increase the occurrence of erectile dysfunction (odds ratio [OR] = 1.012; 95% confidence interval [CI]: 1.000-1.024; P = 0.047). Genetically predicted hypertension is also associated with ED (For the FinnGen, OR = 1.106; 95% CI: 1.027-1.191; P = 0.008. For the UK Biobank, OR = 3.832; 95% CI: 1.410-10.414; P = 0.008). However, after adjusting for systolic blood pressure, diastolic blood pressure and hypertension using multivariate Mendelian randomization, only hypertension was causally associated with ED occurrence (For the FinnGen, OR = 1.103; 95% CI: 1.018-1.195; P = 0.017. For the UK Biobank, OR = 5.037; 95% CI: 1.601-15.846; P = 0.006). We found no evidence that the use of angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers, and thiazide diuretic increased the risk of erectile dysfunction. Conclusions Genetically predicted hypertension increases the risk of erectile dysfunction, but we found no causal relationship between elevated systolic/diastolic blood pressure and erectile dysfunction. We speculate that the relationship between elevated blood pressure and erectile dysfunction risk may be nonlinear. We found little evidence that antihypertensive drugs increase the risk of erectile dysfunction.
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Affiliation(s)
- Cong Zhao
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jun-long Feng
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Sheng Deng
- Department of Andrology, Shunyi Hospital, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Xiang-peng Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-jie Fu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hai-song Li
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fan-chao Meng
- Urology Surgery, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Ji-sheng Wang
- Department of Andrology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xian Wang
- Department of Cardiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Arabi Z, Bawazir AS, Arabi T, Fawzy NA, Baduwaylan RA, Sabbah B. Factors associated with a higher need for antihypertensive medications at 12-months in postkidney transplant recipients: a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:2362-2367. [PMID: 37363589 PMCID: PMC10289748 DOI: 10.1097/ms9.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
There are limited data on why some kidney transplant (KTx) recipients (KTRs) have 'difficult-to-control (DTC) hypertension' requiring greater than or equal to 2 antihypertensive medications while others require less antihypertensive medications post-KTx. Methods The authors reviewed the pre-KTx cardiovascular (CV) imaging, and the changes of CV risk factors during the first-year post-KTx. The authors divided patients according to the number of their blood pressure medications at one year into two groups: requiring less than or equal to 1 and requiring greater than or equal to 2 medications (DTC hypertension). The target blood pressure during the time of this study was less than 140/90 mmHg. Results Two hundred forty-five KTRs were included with an average age of 43.2. 56.3% were male and 79.2% were living donor KTRs. Pre-emptive KTx was 6.5%, previous coronary artery disease was 12.7%, diabetes and smoking 40.8 and 9%, respectively. 38% of the patients had DTC HTN. Risk factors were age (P<0.01), pre-KTx hypertension (P<0.01), and diabetes mellitus (P<0.01). Dialysis vintage, type of dialysis, type of KTx, and smoking were not different between the groups.Patients with abnormal pre-KTx CV imaging, including abnormal ejection fraction less than 55% (P=0.03), abnormal wall motion on echocardiography (P<0.01), abnormal perfusion stress test (P<0.01), higher calcium scoring (P<0.01), abnormal cardiac catheterization (P<0.01), or higher degree of calcifications on CT of pelvic arteries (P<0.01) were at higher risk of DTC hypertension. Post-KTx factors including rejection, change in serum creatinine and weight, A1c, new-onset diabetes post-KTx, and persistent hyperparathyroidism were not different between the groups.Multivariate analysis revealed associations with age (aOR=1.027), male sex (aOR=2.057), baseline diabetes mellitus (aOR=2.065), baseline HTN (aOR=2.82), and use of greater than or equal to 2 antihypertensive medications at 1-month post-KTx (aOR=6.146). Conclusion At one year post transplantation, about a third of the KTRs required had DTC HTN. These patients were more likely to be older, males, diabetics, previously hypertensive, on greater than or equal to 2 HTN medications at 1-month post-KTx, and to have abnormal baseline pretransplant CV imaging.
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Affiliation(s)
- Ziad Arabi
- Department of Medicine, Division of Nephrology, King Abdulaziz Medical City
- College of Medicine, King Saudi bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | - Abdullah S. Bawazir
- Department of Medicine, Division of Nephrology, King Abdulaziz Medical City
- College of Medicine, King Saudi bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | - Tarek Arabi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Nader A. Fawzy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Reem A. Baduwaylan
- Department of Medicine, Division of Nephrology, King Abdulaziz Medical City
- College of Medicine, King Saudi bin Abdulaziz University for Health Sciences
- King Abdullah International Medical Research Center
| | - Belal Sabbah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Mohseni-Alsalhi Z, Vesseur MAM, Wilmes N, Laven SAJS, Meijs DAM, van Luik EM, Vaes EWP, Dikovec CJR, Wiesenberg J, Almutairi MF, Janssen EBNJ, de Haas S, Spaanderman MEA, Ghossein-Doha C. The Representation of Females in Studies on Antihypertensive Medication over the Years: A Scoping Review. Biomedicines 2023; 11:biomedicines11051435. [PMID: 37239106 DOI: 10.3390/biomedicines11051435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The leading global risk factor for cardiovascular-disease-related morbidity and mortality is hypertension. In the past decade, attention has been paid to increase females' representation. The aim of this study is to investigate whether the representation of females and presentation of sex-stratified data in studies investigating the effect of antihypertensive drugs has increased over the past decades. METHODS After systematically searching PubMed and Embase for studies evaluating the effect of the five major antihypertensive medication groups until May 2020, a scoping review was performed. The primary outcome was the proportion of included females. The secondary outcome was whether sex stratification was performed. RESULTS The search resulted in 73,867 articles. After the selection progress, 2046 studies were included for further analysis. These studies included 1,348,172 adults with a mean percentage of females participating of 38.1%. Female participation in antihypertensive studies showed an increase each year by 0.2% (95% CI 0.36-0.52), p < 0.01). Only 75 (3.7%) studies performed sex stratification, and this was the highest between 2011 and 2020 (7.2%). CONCLUSION Female participation showed a slight increase in the past decade but is still underrepresented compared to males. As data are infrequently sex-stratified, more attention is needed to possible sex-related differences in treatment effects to different antihypertensive compounds.
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Affiliation(s)
- Zenab Mohseni-Alsalhi
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Maud A M Vesseur
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Nick Wilmes
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Sophie A J S Laven
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Daniek A M Meijs
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center (MUMC+), Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Eveline M van Luik
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Esmée W P Vaes
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Cédric J R Dikovec
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Jan Wiesenberg
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Mohamad F Almutairi
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Emma B N J Janssen
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Sander de Haas
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Chahinda Ghossein-Doha
- Department of Obstetrics and Gynecology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), 6229 ER Maastricht, The Netherlands
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Seleznev S, Shchulkin A, Mylnikov P, Yakusheva E, Nikulina N. Therapeutic Drug Monitoring in Arterial Hypertension. J Pers Med 2023; 13:jpm13050815. [PMID: 37240985 DOI: 10.3390/jpm13050815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: This study was planned to assess the concentration of antihypertensive drugs (AHD) in the blood serum in patients with controlled and uncontrolled arterial hypertension (AH). (2) Methods: We assessed 46 patients with AH. Based on the results of 24 h blood pressure monitoring (ABPM), the patients were randomized into two groups. The first group consisted of the patients with controlled AH; the second group consisted of the patients with uncontrolled AH. Venous blood was taken in both groups of patients in the morning before and 2 h after taking drugs to assess the concentration of lisinopril, amlodipine, valsartan, and indapamide. (3) Results. The first group included 27 patients, and the second group 19 patients. In patients with uncontrolled AH, the median concentrations of lisinopril, indapamide, amlodipine, and valsartan before and after taking the drugs did not differ from patients who reached the target BP values. (p > 0.05). In some patients with uncontrolled and controlled (shown for the first time) AH the concentration of AHD was below the limit of quantitative determination. (4) Conclusions. The obtained results indicate that the pharmacokinetics of AHD, apparently, does not play a significant role in the development of ineffectiveness of the ongoing therapy for AH. Therapeutic drug monitoring can be used to test adherence to the treatment.
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Affiliation(s)
- Sergey Seleznev
- Department of Hospital Therapy with a Course of Medical and Social Expertise, Ryazan State Medical University, Ryazan 390026, Russia
| | - Alexey Shchulkin
- Department of Pharmacology, Ryazan State Medical University, Ryazan 390026, Russia
| | - Pavel Mylnikov
- Department of Pharmacology, Ryazan State Medical University, Ryazan 390026, Russia
| | - Elena Yakusheva
- Department of Pharmacology, Ryazan State Medical University, Ryazan 390026, Russia
| | - Natalia Nikulina
- Department of Hospital Therapy with a Course of Medical and Social Expertise, Ryazan State Medical University, Ryazan 390026, Russia
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Du XL, Li Z, Schulz PE. Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer. Front Cardiovasc Med 2023; 10:1136475. [PMID: 37215552 PMCID: PMC10196474 DOI: 10.3389/fcvm.2023.1136475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Background Several previous studies showed that patients who received angiotensin II-stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II-inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors. Objectives To determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007-2015 with follow-up from 2007 to 2016. Methods We identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 17 SEER areas in 2007-2015 with follow-up to 2016, who were free of any diagnosed ADRD at the baseline (within 12 months prior to and 12 months after the date of diagnosis for colorectal cancer). All patients who were defined as having hypertension by ICD diagnosis code or received antihypertensive drugs during this baseline 2-year period were classified into 6 groups based on whether they received angiotensin-II stimulating or inhibiting antihypertensive drugs. Results Crude cumulative incidence rates of AD and ADRD were similar between those who received angiotensin II-stimulating antihypertensive medications (4.3% and 21.7%) and those receiving angiotensin II-inhibiting antihypertensive medications (4.2% and 23.5%). As compared to patients who received angiotensin II-stimulating antihypertensive drugs, those who received angiotensin II-inhibiting antihypertensives were significantly more likely to develop AD (adjusted hazard ratio: 1.15, 95% CI: 1.01-1.32), vascular dementias (1.27, 1.06-1.53), and total ADRD (1.21, 1.14-1.28) after adjusting for potential confounders. These results remained similar after adjusting for medication adherence and considering death as a competing risk. Conclusions The risk of AD and ADRD in patients with hypertension who received angiotensin II-inhibiting antihypertensive medications was higher than in those receiving angiotensin II-stimulating antihypertensive drugs in patients with colorectal cancer.
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Affiliation(s)
- Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Zhuoyun Li
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Paul E. Schulz
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Zhao W, Liu L, Chen L. Comparison of antihypertensive drugs amlodipine and perindopril on blood pressure variability after long-term treatment of hypertension induced by apatinib and bevacizumab. CHINESE J PHYSIOL 2023; 66:137-143. [PMID: 37322624 DOI: 10.4103/cjop.cjop-d-22-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
The purpose of this study was to elucidate the therapeutic effect of different antihypertensive drugs (amlodipine and perindopril) on hypertension induced by apatinib and bevacizumab. Sixty patients with hypertension treated with apatinib or bevacizumab were selected and divided into two groups: one group was treated with amlodipine and the other group was treated with perindopril. Before and after treatment, the dynamic blood pressure (BP) measurement (systolic BP [SBP] and diastolic BP [DBP]), echocardiography (left ventricular end-diastolic diameter, interventricular septal thickness [IVST], left ventricular posterior wall thickness [LVPWT], and left atrial diameter [LAD]), and detection of nitric oxide (NO) content in venous blood were performed. In the amlodipine group, the 24hSBP, 24hSSD, 24hSCV, daytime mean SBP (dSBP), daytime mean SSD (dSSD), daytime mean SBP CV, night mean SBP (nSBP), night mean SSD, 24hDBP, 24hDSD, 24 h DBP CV, daytime mean DBP (dDBP), daytime mean DSD (dDSD), daytime mean DBP CV, night mean DBP (nDBP), LAD, and LAD index (LADi) after treatment were all lower than before treatment, while NO was higher than before treatment (all P < 0.05). In the perindopril group, the 24hSBP, dSBP, nSBP, 24hDBP, dDBP, nDBP, LAD, LADi, IVST, LVPWT, and left ventricular mass index (LVMI) after treatment were lower than before treatment, and NO level after treatment was higher than before treatment (all P < 0.05). After treatment, the 24hSBP, 24hSSD, dSBP, dSSD, nSBP, 24hDBP, 24hDSD, dDBP, dDSD, nDBP, night mean DSD, and NO were all lower while the LAD, LADi, IVST, LVPWT, and LVMI were higher in the amlodipine group than those in the perindopril group (all P < 0.05). Our study suggests that the SBP and DBP variability of amlodipine in the treatment of hypertension induced by apatinib and bevacizumab is slightly better than that of perindopril, but the effect of perindopril in improving endothelial function indices NO and echocardiographic data is better than that of amlodipine.
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Affiliation(s)
- Weichao Zhao
- Department of Cardiovascular Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lanbo Liu
- Department of Cardiovascular Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liqiang Chen
- Department of Cardiovascular Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Schreiber K, Frishman M, Russell MD, Dey M, Flint J, Allen A, Crossley A, Gayed M, Hodson K, Khamashta M, Moore L, Panchal S, Piper M, Reid C, Saxby K, Senvar N, Tosounidou S, van de Venne M, Warburton L, Williams D, Yee CS, Gordon C, Giles I. Executive Summary: British Society for Rheumatology guideline on prescribing drugs in pregnancy and breastfeeding: comorbidity medications used in rheumatology practice. Rheumatology (Oxford) 2023; 62:1388-1397. [PMID: 36318970 PMCID: PMC10070061 DOI: 10.1093/rheumatology/keac559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 04/05/2023] Open
Affiliation(s)
- Karen Schreiber
- Thrombosis & Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sonderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Margreta Frishman
- Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
| | - Mark D Russell
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Julia Flint
- Department of Rheumatology, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Shropshire, UK
| | - Alexander Allen
- Clinical Affairs, British Society for Rheumatology, London, UK
| | | | - Mary Gayed
- Rheumatology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kenneth Hodson
- UK Teratology Information Service, Newcastle upon Tyne, UK
| | - Munther Khamashta
- Division of Women's Health, Lupus Research Unit, King's College London, London, UK
| | - Louise Moore
- Rheumatic and Musculoskeletal Disease Unit, Our Lady's Hospice and Care Service, Dublin, Ireland
| | - Sonia Panchal
- Rheumatology, South Warwickshire NHS Foundation Trust, Warwickshire, UK
| | - Madeleine Piper
- Royal National Hospital for Rheumatic Diseases, Royal United Hospital, Bath, UK
| | | | - Katherine Saxby
- Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Naz Senvar
- Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sofia Tosounidou
- Lupus UK Centre of Excellence, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | | | - Louise Warburton
- Shropshire Community NHS Trust, Shropshire, UK
- Primary Care and Health Sciences, Keele University, Keele, UK
| | - David Williams
- Obstetrics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chee-Seng Yee
- Department of Rheumatology, Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Department of Inflammation, Division of Medicine, University College London, London, UK
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Wang Z, Lu J, Hu J. Association between antihypertensive drugs and hepatocellular carcinoma: a trans-ancestry and drug-target Mendelian randomization study. Liver Int 2023; 43:1320-1331. [PMID: 37005366 DOI: 10.1111/liv.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND & AIMS Antihypertensive drugs were recently reported to have an oncogenic role in common cancer, however, whether these drugs would affect the risk of hepatocellular carcinoma (HCC) remains unclear. METHODS A drug-target Mendelian randomization method was adopted to examine the long-term effect of 12 antihypertensive drugs classes on the risk of HCC in Europeans and East Asians. To proxy antihypertensive drugs, we leveraged genetic variants located near or within drug target genes that were associated with systolic blood pressure (SBP). Genetically proxied drugs associated with reduced risk of coronary artery disease were included in primary analysis. Genetic summary statistics of SBP and HCC were derived from publicly available large-scale genome-wide association studies in Europeans and East Asians, respectively. Expression quantitative trait loci (eQTLs) of drugs target genes were used to proxy drugs in a sensitivity analysis. RESULTS Genetically proxied thiazides and related diuretics were associated with decreased risk of HCC in both Europeans (OR [95% CI]:0.79 [0.73,0.86] per 1mmHg reduction in SBP; P<0.001) and East Asians (0.60 [0.45,0.82]; P=0.001). Genetically proxied beta-adrenoceptor blockers (BBs) were strongly associated with increased risk of HCC in Europeans (1.46 [1.12,1.91]; P=0.004). These findings were replicated in deCODE genetics study and remained consistent when using eQTLs to proxy antihypertensive drugs. CONCLUSIONS Our findings suggested that thiazides diuretics may lower the risk of HCC in both Europeans and East Asians, while BBs may increase the risk of HCC specifically in Europeans. Further studies are warranted to explore the potential of repurposing or retargeting antihypertensive drugs for HCC prevention.
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Affiliation(s)
- Zhenqian Wang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jiawen Lu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jingyi Hu
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Cicco S, D Abbondanza M, Proietti M, Zaccone V, Pes C, Caradio F, Mattioli M, Piano S, Marra AM, Nobili A, Mannucci PM, Pietrangelo A, Sesti G, Buzzetti E, Salzano A, Cimellaro A. Antihypertensive treatment changes and related clinical outcomes in older hospitalized patients. Eur J Clin Invest 2023; 53:e13931. [PMID: 36453932 DOI: 10.1111/eci.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/20/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Hypertension management in older patients represents a challenge, particularly when hospitalized. OBJECTIVE The objective of this study is to investigate the determinants and related outcomes of antihypertensive drug prescription in a cohort of older hospitalized patients. METHODS A total of 5671 patients from REPOSI (a prospective multicentre observational register of older Italian in-patients from internal medicine or geriatric wards) were considered; 4377 (77.2%) were hypertensive. Minimum treatment (MT) for hypertension was defined according to the 2018 ESC guidelines [an angiotensin-converting-enzyme-inhibitor (ACE-I) or an angiotensin-receptor-blocker (ARB) with a calcium-channel-blocker (CCB) and/or a thiazide diuretic; if >80 years old, an ACE-I or ARB or CCB or thiazide diuretic]. Determinants of MT discontinuation at discharge were assessed. Study outcomes were any cause rehospitalization/all cause death, all-cause death, cardiovascular (CV) hospitalization/death, CV death, non-CV death, evaluated according to the presence of MT at discharge. RESULTS Hypertensive patients were older than normotensives, with a more impaired functional status, higher burden of comorbidity and polypharmacy. A total of 2233 patients were on MT at admission, 1766 were on MT at discharge. Discontinuation of MT was associated with the presence of comorbidities (lower odds for diabetes, higher odds for chronic kidney disease and dementia). An adjusted multivariable logistic regression analysis showed that MT for hypertension at discharge was associated with lower risk of all-cause death, all-cause death/hospitalization, CV death, CV death/hospitalization and non-CV death. CONCLUSIONS Guidelines-suggested MT for hypertension at discharge is associated with a lower risk of adverse clinical outcomes. Nevertheless, changes in antihypertensive treatment still occur in a significant proportion of older hospitalized patients.
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Affiliation(s)
- Sebastiano Cicco
- Department of Biomedical Sciences and Human Oncology (DIMO), Internal Medicine Unit "Guido Baccelli" and Unit of Arterial Hypertension "Anna Maria Pirrelli", University of Bari Aldo Moro, Azienda Ospedaliero-Universitaria Policlinico, Bari, Italy
| | - Marco D Abbondanza
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, 'Santa Maria' Terni University Hospital, Terni, Italy
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Vincenzo Zaccone
- Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - Chiara Pes
- Internal Medicine Unit, Internal Medicine Department, University Hospital of Sassari, Sassari, Italy
| | - Federica Caradio
- Emergency Department, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Massimo Mattioli
- Department of Emergency Medicine, Azienda Ospedaliera 'Ospedali Riuniti Marche Nord', Pesaro, Italy
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Alberto Maria Marra
- Department of Translational Medical Sciences, Interdisciplinary Research Centre in Biomedical Materials (C.R.I.B.), University Federico II of Naples, Naples, Italy
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - Antonello Pietrangelo
- Department of Medical and Surgical Sciences for Children and Adults, Internal Medicine and Centre for Hemochromatosis and Heredometabolic Liver disease, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Buzzetti
- Department of Medical and Surgical Sciences for Children and Adults, Internal Medicine and Centre for Hemochromatosis and Heredometabolic Liver disease, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | | | - Antonio Cimellaro
- Department of Medical Specialties, Internal Medicine Unit, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
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Huang X, Zhang T, Guo P, Gong W, Zhu H, Zhao M, Yuan Z. Association of antihypertensive drugs with fracture and bone mineral density: A comprehensive drug-target Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1164387. [PMID: 37056679 PMCID: PMC10086430 DOI: 10.3389/fendo.2023.1164387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Background Observational studies have investigated the associations between antihypertensive drugs and fracture risk as well as bone mineral density (BMD), but yielding controversial results. Methods In this study, a comprehensive drug-target Mendelian randomization (MR) analysis was conducted to systematically examine the associations between genetic proxies for eight common antihypertensive drugs and three bone health-related traits (fracture, total body BMD [TB-BMD], and estimated heel BMD [eBMD]). The main analysis used the inverse-variance weighted (IVW) method to estimate the causal effect. Multiple MR methods were also employed to test the robustness of the results. Results The genetic proxies for angiotensin receptor blockers (ARBs) were associated with a reduced risk of fracture (odds ratio [OR] = 0.67, 95% confidence interval [CI]: 0.54 to 0.84; P = 4.42 × 10-4; P-adjusted = 0.004), higher TB-BMD (β = 0.36, 95% CI: 0.11 to 0.61; P = 0.005; P-adjusted = 0.022), and higher eBMD (β = 0.30, 95% CI: 0.21 to 0.38; P = 3.59 × 10-12; P-adjusted = 6.55 × 10-11). Meanwhile, genetic proxies for calcium channel blockers (CCBs) were associated with an increased risk of fracture (OR = 1.07, 95% CI: 1.03 to 1.12; P = 0.002; P-adjusted = 0.013). Genetic proxies for potassium sparing diuretics (PSDs) showed negative associations with TB-BMD (β = -0.61, 95% CI: -0.88 to -0.33; P = 1.55 × 10-5; P-adjusted = 1.86 × 10-4). Genetic proxies for thiazide diuretics had positive associations with eBMD (β = 0.11, 95% CI: 0.03 to 0.18; P = 0.006; P-adjusted = 0.022). No significant heterogeneity or pleiotropy was identified. The results were consistent across different MR methods. Conclusions These findings suggest that genetic proxies for ARBs and thiazide diuretics may have a protective effect on bone health, while genetic proxies for CCBs and PSDs may have a negative effect.
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Affiliation(s)
- Xin Huang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Tianxin Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Ping Guo
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Weiming Gong
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Hengchao Zhu
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, United States
| | - Meng Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhongshang Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
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Tamargo J, Caballero R, Mosquera ED. Sex and gender differences in the treatment of arterial hypertension. Expert Rev Clin Pharmacol 2023; 16:329-347. [PMID: 36891888 DOI: 10.1080/17512433.2023.2189585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Arterial hypertension represents the leading modifiable risk factor for all-cause death and early development of cardiovascular disease in women. Current clinical guidelines for the treatment of hypertension noted that women respond to antihypertensive drugs similarly to men and, therefore, treatment recommendations remain the same for both sexes. However, clinical evidence suggests the existence of sex- and gender-related differences (SGRD) in the prevalence, pathophysiology, pharmacodynamics (efficacy and safety) and pharmacokinetics of antihypertensive drugs. AREAS COVERED This review summarizes SGRD in the prevalence of hypertension, hypertension-mediated organ damage and blood pressure control, prescription patterns, and pharmacokinetics/ pharmacodynamics and doses of antihypertensive drugs. EXPERT OPINION There is limited information on SGRD in antihypertensive drug efficacy because of the underrepresentation of women in randomized clinical trials and, more important, because few trials reported results stratified by sex or performed sex-specific analyses. However, there are SGRD in hypertension-mediated organ damage, drug pharmacokinetics and, particularly, in drug safety. Prospective trials specifically designed to better understand the basis for SGRD in the pathophysiology of hypertension and in the efficacy and safety of antihypertensive drugs are needed to achieve a more personalized treatment of hypertension and hypertension-mediated organ damage in women.
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Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
| | - Eva Delpón Mosquera
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV, 28040 Madrid, Spain
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Huang YH, Chiu KL, Shen CW, Bair MJ, Chen CY. Evaluating Prescription Pattern and Effectiveness of Antihypertensive Drugs in Non-Operated Aortic Dissection Patients. J Clin Med 2023; 12. [PMID: 36902749 DOI: 10.3390/jcm12051962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION Aortic dissection (AD) is a life-threatening disease. However, the effectiveness of different strategies of antihypertensive therapies in non-operated AD patients is still unclear. MATERIALS AND METHODS Patients were classified into five groups (groups 0-4) based on the number of classes of antihypertensive drugs, including β-blockers, renin-angiotensin system (RAS) agents (angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and the renin-inhibitors), calcium channel blockers (CCBs), and other antihypertensive drugs, were prescribed within 90 days after discharge. The primary endpoint was a composite outcome of re-hospitalization associated with AD, referral for aortic surgery, and all-cause death. RESULTS A total of 3932 non-operated AD patients were included in our study. The most prescribed antihypertensive drugs were CCBs, followed by β-blockers and ARBs. Within group 1, compared to other antihypertensive drugs, patients using RAS agents (aHR, 0.58; p = 0.005) had a significantly lower risk of occurrence of the outcome. Within group 2, the risk of composite outcomes was lower in patients using β-blockers + CCBs (aHR, 0.60; p = 0.004) or CCBs + RAS agents (aHR, 0.60; p = 0.006) than in those using RAS agents + others. CONCLUSION For non-operated AD patients, RAS agents, β-blockers, or CCBs should be given in a different strategy of combinations to reduce the hazard of AD-related complications compared to other agents.
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Liang X, Chou OHI, Cheung BMY. Intensive blood pressure control in older patients with hypertension-a STEP in the right direction? Postgrad Med J 2023; 99:47-49. [PMID: 36856663 DOI: 10.1093/postmj/qgad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 03/02/2023]
Abstract
In November 2022, the Clinical Practice Guidelines for the Management of Hypertension in China were updated; the definition of hypertension and the target of treatment was changed from 140/90 mm Hg to 130/80 mm Hg. This was prompted by the results of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) study, a large multicenter randomized controlled trial conducted in China. STEP echoed the results of the American Systolic Blood Pressure Intervention Trial (SPRINT), and confirmed that intense lowering of blood pressure is on the whole beneficial. This confirmation is important for the Chinese population, in which strokes outnumber myocardial infarctions. It is also reassuring to know that treating adults aged 60 years or older to achieve a systolic blood pressure of <130 mm Hg is safe, while reducing cardiovascular events, stroke and all-cause mortality. Nevertheless, further studies are needed to delineate the risks and benefits in subgroups, such as the elderly with diabetes or a history of stroke.
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Affiliation(s)
- Xiaopeng Liang
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Oscar H I Chou
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
| | - Bernard M Y Cheung
- Division of Clinical Pharmacology and Therapeutics, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, China.,Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Hong Kong, China
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Jaglińska K, Polak B, Klimek-Turek A, Fornal E, Stachniuk A, Trzpil A, Błaszczyk R, Wysokiński A. Comparison of the Determination of Some Antihypertensive Drugs in Clinical Human Plasma Samples by Solvent Front Position Extraction and Precipitation Modes. Molecules 2023; 28:molecules28052213. [PMID: 36903457 PMCID: PMC10004659 DOI: 10.3390/molecules28052213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
The determination of the selected antihypertensive drugs in human plasma samples with the novel solvent front position extraction (SFPE) technique is presented. The SFPE procedure combined with LC-MS/MS analysis was used for the first time to prepare a clinical sample containing the drugs mentioned above from different therapeutic groups. The effectiveness of our approach was compared with the precipitation method. The latter technique is usually used to prepare biological samples in routine laboratories. During the experiments, the substances of interest and the internal standard were separated from other matrix components using a prototype horizontal chamber for thin-layer chromatography/high-performance thin-layer chromatography (TLC/HPTLC) with a moving pipette powered by a 3D mechanism, which distributed the solvent on the adsorbent layer. Detection of the six antihypertensive drugs was performed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) in multiple reaction monitoring (MRM) mode. Results obtained by SFPE were very satisfactory (linearity R2 ≥ 0.981; %RSD ≤ 6%; LOD and LOQ were in the range of 0.06-9.78 ng/mL and 0.17-29.64 ng/mL, respectively). The recovery was in the range of 79.88-120.36%. Intra-day and inter-day precision had a percentage coefficient of variation (CV) in the range of 1.10-9.74%. The procedure is simple and highly effective. It includes the automation of TLC chromatogram development, which significantly reduced the number of manual operations performed, the time of sample preparation and solvent consumption.
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Affiliation(s)
- Kamila Jaglińska
- Department of Physical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland
| | - Beata Polak
- Department of Physical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland
- Correspondence:
| | - Anna Klimek-Turek
- Department of Physical Chemistry, Medical University of Lublin, Chodźki 4A, 20-093 Lublin, Poland
| | - Emilia Fornal
- Department of Bioanalytics, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland
| | - Anna Stachniuk
- Department of Bioanalytics, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland
| | - Alicja Trzpil
- Department of Bioanalytics, Medical University of Lublin, Jaczewskiego 8b, 20-090 Lublin, Poland
| | - Robert Błaszczyk
- Chair and Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland
| | - Andrzej Wysokiński
- Chair and Department of Cardiology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland
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Jiao XF, Song K, Jiao X, Li H, Zeng L, Zou K, Zhang W, Wang H, Zhang L. Hyperuricaemia, gout and related adverse events associated with antihypertensive drugs: A real-world analysis using the FDA adverse event reporting system. Front Pharmacol 2023; 13:1045561. [PMID: 36699079 PMCID: PMC9868414 DOI: 10.3389/fphar.2022.1045561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Background: The role of antihypertensive drugs in inducing hyperuricaemia and gout has been a long-term concern in clinical practice. However, clinical studies regarding this issue are limited in number and have yielded inconsistent results. We comprehensively evaluated the association between various antihypertensive drugs and the occurrences of hyperuricaemia, gout and related adverse events (AEs) using the FDA Adverse Event Reporting System (FAERS), aiming to guide the selection of antihypertensive drugs with a goal of minimizing the risk of hyperuricaemia, gout and related AEs. Methods: We used OpenVigil 2.1 to query the FAERS database. Hyperuricaemia, gout and related AEs were defined by 5 Preferred Terms: hyperuricaemia, gout, gouty arthritis, gouty tophus and urate nephropathy. Disproportionality analysis was performed, and a positive signal indicated an association between AEs and antihypertensive drugs. Results: The numbers of antihypertensive drugs with positive signals for hyperuricaemia, gout, gouty arthritis, gouty tophus and urate nephropathy were 46, 66, 27, 8 and 6, respectively. These drugs included diuretics, antihypertensive drugs with central action, α blockers, β blockers, α and β blockers, calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, renin inhibitors, vasodilators, and compound preparations. Furthermore, 42 antihypertensive drugs had positive signal for more than one AEs. Conclusion: Our study suggests that some potassium-sparing diuretics, calcium channel blockers and losartan may be associated with increased risk of hyperuricaemia, gout or related AEs, which is inconsistent with most previous studies. Moreover, Our study also suggests that some antihypertensive drugs with central action, α and β blockers, renin inhibitors and vasodilators may be associated with increased risk of hyperuricaemia, gout or related AEs, which has not been reported in previous studies. These findings complement real-world evidence on the potential risks of hyperuricaemia, gout and related AEs associated with antihypertensive drugs.
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Affiliation(s)
- Xue-Feng Jiao
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Kunpeng Song
- Department of Cardiovascular Medicine Ward II, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Xueyan Jiao
- Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Hailong Li
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Linan Zeng
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Kun Zou
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China,Medical Big Data Center, Sichuan University, Chengdu, China
| | - Huiqing Wang
- Medical Simulation Centre, West China Second University Hospital, Sichuan University, Chengdu, China,*Correspondence: Huiqing Wang, ; Lingli Zhang,
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China,Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China,NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China,Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Huiqing Wang, ; Lingli Zhang,
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Muacevic A, Adler JR, Ayoubi HR, Alzoubi H. Evaluation of the Effect of Antihypertensive Drugs on the Values of Dental Pulp Oxygen Saturation in Hypertension Patients: A Case-Control Study. Cureus 2023; 15:e33245. [PMID: 36741671 PMCID: PMC9890402 DOI: 10.7759/cureus.33245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
Purpose This study aimed to know about the positive or negative effect of antihypertensive drugs of different groups on the values of dental pulp oxygen saturation in hypertension patients. Materials and Methods A case-control study to evaluate the impact of the antihypertensive drugs on the values of dental pulp oxygen saturation in hypertension patients. The studied sample consisted of 40 participants, and they were distributed into two groups: Group I (n=20): Hypertension patients treated with antihypertensive drugs, and Group II (n=20): Healthy participants. A finger pulse oximeter was recorded after a rest period of 15 minutes by BCI® Advisor® vital signs monitor. The patient was then asked to use a chlorhexidine digluconate mouth rinse for five minutes, and the two dental pulp pulse oximeters for the central upper incisors were also recorded for all participants. Data were analyzed using the Mann-Whitney U test. Results The results showed that there was no significant difference between the finger pulse oximeters of the two studied groups (P-value = 0.421). The two dental pulp oxygen saturation was higher than the control group with statistically significant (P-value = 0.043, P-value = 0.002). Conclusions Within the limitation of this study, it can be concluded that antihypertensive drugs increase the dental pulp oxygen saturation in patients with hypertension who are treated with antihypertensive drugs, and thus there is a positive effect of these drugs in stimulating the dental pulp.
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Chen Y, Han Y, Wu Y, Hui R, Yang Y, Zhong Y, Zhang S, Zhang W. Pharmacogenetic association of the NR1H3 promoter variant with antihypertensive response among patients with hypertension: A longitudinal study. Front Pharmacol 2023; 14:1083134. [PMID: 36950018 PMCID: PMC10025344 DOI: 10.3389/fphar.2023.1083134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
Background: The genetic factors in assessing therapeutic efficacy and predicting antihypertensive drug response are unclear. Therefore, this study aims to identify the associations between variants and antihypertensive drug response. Methods: A longitudinal study including 1837 hypertensive patients was conducted in Northern China and followed up for a median 2.24 years. The associations of 11 candidate variants with blood pressure changes in response to antihypertensive drugs and with the risk of cardiovascular events during the follow-up were examined. The dual-luciferase assay was carried out to assess the effect of genetic variants on gene transcriptional activity. Results: The variant rs11039149A>G in the promoter of nuclear receptor subfamily 1 group H member 3 (NR1H3) was associated with the change in systolic blood pressure (ΔSBP) in response to calcium channel blockers (CCBs) monotherapy. Patients carrying rs11039149AG genotype showed a significant increase of systolic blood pressure (SBP) at follow-up compared with AA carriers, and the difference of ΔSBP between AG and AA carriers was 5.94 mm Hg (95%CI: 2.09-9.78, p = 0.002). In 1,184 patients with CCBs therapy, SBP levels decreased in AA carriers, but increased in AG carriers, the difference of ΔSBP between AG and AA carriers was 8.04 mm Hg (95%CI: 3.28-12.81, p = 0.001). Further analysis in 359 patients with CCBs monotherapy, the difference of ΔSBP between AG and AA carriers was 15.25 mm Hg (95%CI: 6.48-24.02, p = 0.001). However, there was no significant difference in ΔSBP between AG and AA carriers with CCBs multitherapy. The rs11039149A>G was not associated with the cardiovascular events incidence during the follow-up. Additionally, transcriptional factor forkhead box C1 (FOXC1) bound to the NR1H3 promoter containing rs11039149A and significantly increased the transcriptional activity, while rs11039149 A to G change led to a loss-of-function and disabled FOXC1 binding. For the other 10 variants, associations with blood pressure changes or risk of cardiovascular events were not observed. Conclusion: Hypertensive patients with rs11039149AG genotype in the NR1H3 gene have a significant worse SBP control in response to CCBs monotherapy compared with AA carriers. Our findings suggest that the NR1H3 gene might act as a promising genetic factor to affect individual sensitivity to antihypertensive drugs.
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Affiliation(s)
- Yu Chen
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yuqing Han
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yiyi Wu
- The First Affiliated Hospital of Anhui University of Science and Technology, The First People’s Hospital of Huainan City, Huainan, Anhui, China
| | - Rutai Hui
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Yunyun Yang
- Clinical Laboratory, Xiamen Key Laboratory of Genetic Testing, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yixuan Zhong
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Shuyuan Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Weili Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
- Central-China Branch of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Hospital, Zhengzhou, China
- *Correspondence: Weili Zhang,
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Qian Q, Wang YZ, Kan LD, Chen J, Wang C, Han G, Li LC, Lou WJ. Real-World Prescribing Patterns for Hypertensive Children in China from 2018 to 2021: A Cross-Sectional Multicenter Study. Risk Manag Healthc Policy 2023; 16:287-299. [PMID: 36875172 PMCID: PMC9983439 DOI: 10.2147/rmhp.s392224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/18/2023] [Indexed: 03/03/2023] Open
Abstract
Background Pediatric hypertension become an early marker of cardiovascular diseases, but their antihypertensive drug use patterns are rarely known. Purpose To investigate the epidemiological characteristics of pediatric hypertension and the use of antihypertensive drugs in the real world in China. Methods In this study, the demographic, diagnosis, and medication prescription data including the antihypertensive drug types and comorbidities, were analyzed. The antihypertensive drugs use were evaluated according to the Chinese guidelines for hypertension. Results 1301 prescriptions (number of visits) containing 1880 antihypertensive medical orders were collected. The average number of antihypertensive drugs per prescription was 1.45 (±0.75). The patients aged 16 to 18 (70.18%) accounted for the highest proportion. Kidney diseases (33.28%) were the most common comorbidities. Calcium channel blocker (CCB), angiotensin II receptor blocker (ARB), and β receptor blocker (BB) were the most used antihypertensive drugs. The most frequent monotherapy was CCB, while that of two and three drugs combination were ARB+CCB and ARB+BB+CCB, respectively. Metoprolol (11.44%), nifedipine (10.64%), amlodipine (10.59%), valsartan (6.12%) were the most commonly used antihypertensive drugs. The utilization rate of fixed compound preparations was 7.34%. However, the percentage of recommended antihypertensive drugs was just 14.20%, while the recommended drug combination was 84.93% according to the guidelines. Conclusion For the first time ever we reported the antihypertensive prescription analysis in children in a large area of China. Our data provided new insights into the epidemiological characteristics and drug use in hypertensive children. We found that the guidelines for medication management in hypertensive children were not routinely followed. The wide use of antihypertensive drugs in children and those with weak clinical evidence raised concerns regarding its rational use. The findings could lead to more effective management of hypertension in children.
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Affiliation(s)
- Qin Qian
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
| | - Yu-Zhen Wang
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
| | - Lian-Di Kan
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
| | - Jie Chen
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
| | - Chen Wang
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
| | - Gang Han
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
| | - Liu-Cheng Li
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
| | - Wei-Jian Lou
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, People's Republic of China
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