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Samoszuk M, Morgentaler A, de Groot M, van Solinge W, Li Y, Adair F, Hoefer I, Haitjema S. Association of low testosterone with changes in non-cardiovascular biomarkers in adult men. Int J Impot Res 2020; 32:167-175. [PMID: 30670838 PMCID: PMC7066050 DOI: 10.1038/s41443-019-0112-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/04/2018] [Accepted: 12/17/2018] [Indexed: 11/19/2022]
Abstract
Testosterone has effects on many organs and systems. The purpose of this study was to test the hypothesis that low testosterone is associated with changes in various non-cardiovascular biomarkers in men older than 40 who were tested for possible hypogonadism. We extracted data from 9939 outpatient men who were over 40 years old (median age 56) and who also had concurrent laboratory measurements of total testosterone and one or more biomarkers of interest: estradiol, uric acid, prostate-specific antigen (PSA), sex-hormone binding globulin (SHBG), luteinizing hormone, creatinine, bone alkaline phosphatase (BAP), creatine kinase, hemoglobin A1c, and 25-hydroxy-vitamin D, and body mass index (BMI). In a smaller exploratory study of 19 otherwise healthy men presenting for evaluation of possible hypogonadism, pre-albumin (a.k.a.transthyretin, a marker of anabolism) and testosterone were measured. Men with lower levels of testosterone had significantly (p < 0.001) lower mean levels of PSA, SHBG, luteinizing hormone, and estradiol. Overall, men with low levels of testosterone also had significantly (p < 0.001) higher mean levels of LDH and BAP, but these associations varied between men who were younger or older than 56 years. There was a moderate but statistically significant positive correlation (r = 0.63, p < 0.05) between testosterone levels and pre-albumin. These results confirm our hypothesis that testosterone deficiency is associated with a broad range of systemic changes demonstrable in hormonal and non-hormonal serum assays in men over 40 years old being tested for possible hypogonadism.
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Affiliation(s)
| | - Abraham Morgentaler
- Men's Health Boston, Beth Israel Deaconess Medical Center, Harvard Medical School, 1200 Boylston St, Chestnut Hill, MA, 02467, USA
| | - Mark de Groot
- UMC Utrecht, Laboratory of Clinical Chemistry and Hematology, G03.550, Heidelberglaan 100, 3584CX, Utrecht, Netherlands
| | - Wouter van Solinge
- UMC Utrecht, Laboratory of Clinical Chemistry and Hematology, G03.550, Heidelberglaan 100, 3584CX, Utrecht, Netherlands
| | - Yu Li
- Beckman Coulter, Inc., 250S. Kraemer Blvd, Brea, CA, 92821, USA
| | - Fiona Adair
- Beckman Coulter, Inc., 250S. Kraemer Blvd, Brea, CA, 92821, USA
| | - Imo Hoefer
- UMC Utrecht, Laboratory of Clinical Chemistry and Hematology, G03.550, Heidelberglaan 100, 3584CX, Utrecht, Netherlands
| | - Saskia Haitjema
- UMC Utrecht, Laboratory of Clinical Chemistry and Hematology, G03.550, Heidelberglaan 100, 3584CX, Utrecht, Netherlands
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Groenhof TKJ, Koers LR, Blasse E, de Groot M, Grobbee DE, Bots ML, Asselbergs FW, Lely AT, Haitjema S, van Solinge W, Hoefer I, Haitjema S, de Groot M, Blasse E, Asselbergs FW, Nathoe HM, de Borst GJ, Bots ML, Geerlings MI, Emmelot MH, de Jong PA, Leiner T, Lely AT, van der Kaaij NP, Kappelle LJ, Ruigrok YM, Verhaar MC, Visseren FL, Westerink J. Data mining information from electronic health records produced high yield and accuracy for current smoking status. J Clin Epidemiol 2020; 118:100-106. [DOI: 10.1016/j.jclinepi.2019.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 09/06/2019] [Accepted: 11/06/2019] [Indexed: 12/19/2022]
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Gijsberts CM, den Ruijter HM, de Kleijn DPV, Huisman A, ten Berg M, de Groot M, van Wijk RHA, Asselbergs FW, Voskuil M, Pasterkamp G, van Solinge WW, Hoefer IE. Hematological Parameters Outperform Plasma Markers in Predicting Long-Term Mortality After Coronary Angiography. Angiology 2017; 69:600-608. [DOI: 10.1177/0003319717743679] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
High-sensitivity troponin I (hsTnI) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) are predictors of coronary artery disease. Recently, routine hematological parameters emerged as mortality predictors. We examined the predictive value of hematological parameters (from the Utrecht Patient Oriented Database) and hsTnI and NT-pro-BNP for mortality in a coronary angiography population (Utrecht Coronary Biobank n = 1913). Using Cox regression, receiver operating characteristics, integrated discrimination improvement (IDI), and continuous net reclassification improvement (cNRI) analysis, we compared the predictive properties of hematological parameters with hsTnI and NT-pro-BNP for mortality. During a median follow-up duration of 1.8 years, 77 deaths occurred. A panel of 7 hematological parameters (leukocyte count, reticulocyte mean corpuscular hemoglobin concentration, red blood cell [RBC] green (FL1) fluorescence, %neutrophils, %large [>120 fL] RBCs, %monocytes, and coefficient of variation of neutrophil complexity) was highly predictive. Added to clinical characteristics, hematological parameters (area under the curve [AUC]: 0.855, P < .001; IDI: 0.04, P = .02; cNRI: 0.41, P < .001) were better predictors than hsTnI (AUC: 0.818) or NT-pro-BNP (AUC: 0.834) alone or combined (AUC: 0.834). Hematological parameters may provide mortality risk information following coronary angiography and may be superior to hsTnI and/or NT-pro-BNP.
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Affiliation(s)
- Crystel M. Gijsberts
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Hester M. den Ruijter
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dominique P. V. de Kleijn
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore, Singapore
| | - Albert Huisman
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten ten Berg
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark de Groot
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Richard H. A. van Wijk
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W. Asselbergs
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
- Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michiel Voskuil
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wouter W. van Solinge
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Imo E. Hoefer
- Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
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Schuerch M, Gasse C, Robinson NJ, Alvarez Y, Walls R, Mors O, Christensen J, Hesse U, de Groot M, Schlienger R, Reynolds R, Klungel O, de Vries F. Impact of varying outcomes and definitions of suicidality on the associations of antiepileptic drugs and suicidality: comparisons from UK Clinical Practice Research Datalink (CPRD) and Danish national registries (DNR). Pharmacoepidemiol Drug Saf 2017; 25 Suppl 1:142-55. [PMID: 27038360 DOI: 10.1002/pds.3928] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 03/27/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study is to quantify the impact of the different outcomes and definitions of suicidality on the association between antiepileptic drugs (AEDs) and suicidality. METHODS Retrospective cohort studies of selected AEDs (carbamazepine, gabapentin, lamotrigine, phenytoin, pregabalin, topiramate and valproate) using data from UK Clinical Practice Research Datalink (CPRD) alone and linked to UK Hospital Episode Statistics (HES) and UK Office of National Statistics (ONS), and from Danish national registries (DNR). Follow-up started at initiation of one of the study AEDs, divided into exposure periods, a maximum 90-day post-exposure period, and the reference period starting the day after the 90-day post-exposure period ended. Primary outcomes were completed suicide (SUI)/suicide attempt (SA) for CPRD and SUI/deliberate self-harm (DSH) for DNR. We applied adjusted Cox regression analyses and sensitivity analyses with varying outcome definitions. RESULTS We analyzed 84,524 AED users from CPRD-HES-ONS (1188 SUI/SA; 96 SUI) and 258,180 users from DNR (7561 SUI/DSH; 781 SUI). The adjusted hazard ratios (HRs) on SUI/SA ranged between 1.3 (95% confidence interval (CI): 0.84-2.00) for lamotrigine and 2.7 (1.24-5.81) for phenytoin in CPRD-HES-ONS, and between 0.9 (0.78-1.00) for valproate and 1.8 (1.10-3.07) for phenytoin on SUI/DSH in DNR. HRs for the primary outcomes varied consistently across exposure periods and data sources. HRs for SUI were in general lower, more stable and similar for periods of exposure and the 90-day post-exposure period. CONCLUSION Applying different outcomes and definitions of suicidality had an impact on the relative risks of suicidality associated with the investigated AEDs with results for SUI being most consistent and reliable.
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Affiliation(s)
- Markus Schuerch
- Real World Data Science, F. Hoffmann-La Roche, Basel, Switzerland
| | - Christiane Gasse
- National Center for Register-based Research, Aarhus University, Aarhus V, Denmark
| | | | | | - Robert Walls
- Real World Data Science, F. Hoffmann-La Roche, Basel, Switzerland
| | - Ole Mors
- CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus V, Denmark.,Department P, Research Unit, Aarhus University Hospital Risskov, Aarhus, Denmark
| | - Jakob Christensen
- CIRRAU-Centre for Integrated Register-Based Research, Aarhus University, Aarhus V, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik Hesse
- National Institute for Health Data and Disease Control, Copenhagen, Denmark
| | - Mark de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | | | | | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Frank de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Brauer R, Ruigómez A, Downey G, Bate A, Garcia Rodriguez LA, Huerta C, Gil M, de Abajo F, Requena G, Alvarez Y, Slattery J, de Groot M, Souverein P, Hesse U, Rottenkolber M, Schmiedl S, de Vries F, Tepie MF, Schlienger R, Smeeth L, Douglas I, Reynolds R, Klungel O. Prevalence of antibiotic use: a comparison across various European health care data sources. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:11-20. [PMID: 26152658 PMCID: PMC4918309 DOI: 10.1002/pds.3831] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 09/18/2014] [Revised: 06/04/2015] [Accepted: 06/11/2015] [Indexed: 12/03/2022]
Abstract
Purpose There is widespread concern about increases in antibiotic use, but comparative data from different European countries on rates of use are lacking. This study was designed to measure and understand the variation in antibiotic utilization across five European countries. Methods Seven European healthcare databases with access to primary care data from Denmark, Germany, the Netherlands, Spain and the UK were used to measure and compare the point and 1‐year‐period prevalence of antibiotic use between 2004 and 2009. Descriptive analyses were stratified by gender, age and type of antibiotic. Separate analyses were performed to measure the most common underlying indications leading to the prescription of an antibiotic. Results The average yearly period prevalence of antibiotic use varied from 15 (Netherlands) to 30 (Spain) users per 100 patients. A higher prevalence of antibiotic use by female patients, the very young (0–9 years) and old (80+ years), was observed in all databases. The lowest point prevalence was recorded in June and September and ranged from 0.51 (Netherlands) to 1.47 (UK) per 100 patients per day. Twelve percent (Netherlands) to forty‐nine (Spain) percent of all users were diagnosed with a respiratory tract infection, and the most common type of antibiotic prescribed were penicillin. Conclusion Using identical methodology in seven EU databases to assess antibiotic use allowed us to compare drug usage patterns across Europe. Our results contribute quantitatively to the true understanding of similarities and differences in the use of antibiotic agents in different EU countries. © 2015 The Authors. Pharmacoepidemiology and Drug Safety Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Ruth Brauer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Ruigómez
- Fundación Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain
| | | | | | | | - Consuelo Huerta
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Miguel Gil
- Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Francisco de Abajo
- Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain.,Pharmacology Section, Department of Biomedical Sciences II, University of Alcalá (UAH), Madrid, Spain
| | - Gema Requena
- Pharmacology Section, Department of Biomedical Sciences II, University of Alcalá (UAH), Madrid, Spain
| | | | | | - Mark de Groot
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Patrick Souverein
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Ulrik Hesse
- Laegemiddelstyrelsen (Danish Medicines Agency), National Institute for Health Data and Disease Control, Copenhagen, Denmark
| | - Marietta Rottenkolber
- Institute of Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany
| | - Frank de Vries
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.,School CAPHRI / Maastricht University, Maastricht, The Netherlands
| | | | | | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert Reynolds
- Epidemiology, Pfizer Research & Development, New York, NY, USA
| | - Olaf Klungel
- Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Requena G, Logie J, Martin E, Boudiaf N, González González R, Huerta C, Alvarez A, Webb D, Bate A, García Rodríguez LA, Reynolds R, Schlienger R, Gardarsdottir H, de Groot M, Klungel OH, de Abajo F, Douglas IJ. Do case-only designs yield consistent results across design and different databases? A case study of hip fractures and benzodiazepines. Pharmacoepidemiol Drug Saf 2015; 25 Suppl 1:79-87. [PMID: 26112821 PMCID: PMC4949640 DOI: 10.1002/pds.3822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 09/22/2014] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 01/04/2023]
Abstract
Background The case‐crossover (CXO) and self‐controlled case series (SCCS) designs are increasingly used in pharmacoepidemiology. In both, relative risk estimates are obtained within persons, implicitly controlling for time‐fixed confounding variables. Objectives To examine the consistency of relative risk estimates of hip/femur fractures (HFF) associated with the use of benzodiazepines (BZD) across case‐only designs in two databases (DBs), when a common protocol was applied. Methods CXO and SCCS studies were conducted in BIFAP (Spain) and CPRD (UK). Exposure to BZD was divided into non‐use, current, recent and past use. For CXO, odds ratios (OR; 95%CI) of current use versus non‐use/past were estimated using conditional logistic regression adjusted for co‐medications (AOR). For the SCCS, conditional Poisson regression was used to estimate incidence rate ratios (IRR; 95%CI) of current use versus non/past‐use, adjusted for age. To investigate possible event‐exposure dependence the relative risk in the 30 days prior to first BZD exposure was also evaluated. Results In the CXO current use of BZD was associated with an increased risk of HFF in both DBs, AORBIFAP = 1.47 (1.29–1.67) and AORCPRD = 1.55 (1.41–1.70). In the SCCS, IRRs for current exposure was 0.79 (0.72–0.86) in BIFAP and 1.21 (1.13–1.30) in CPRD. However, when we considered separately the 30‐day pre‐exposure period, the IRR for current period was 1.43 (1.31–1.57) in BIFAP and 1.37 (1.27–1.47) in CPRD. Conclusions CXO designs yielded consistent results across DBs, while initial SCCS analyses did not. Accounting for event‐exposure dependence, estimates derived from SCCS were more consistent across DBs and designs. © 2015 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
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Affiliation(s)
- Gema Requena
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine, University of Alcalá, Madrid, Spain
| | - John Logie
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | - Elisa Martin
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Nada Boudiaf
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | | | - Consuelo Huerta
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - Arturo Alvarez
- BIFAP Research Unit, Spanish Agency of Medicines and Medical Devices, Madrid, Spain
| | - David Webb
- Worldwide Epidemiology, GlaxoSmithKline, Research and Development, Uxbridge, Middlesex, UK
| | | | | | - Robert Reynolds
- Epidemiology, Pfizer Research and Development, New York, USA
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Mark de Groot
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Fancisco de Abajo
- Pharmacology Unit, Department of Biomedical Sciences, School of Medicine, University of Alcalá, Madrid, Spain.,Clinical Pharmacology Unit, University Hospital Príncipe de Asturias, Madrid, Spain
| | - Ian J Douglas
- London School of Hygiene and Tropical Medicine (LSHTM), London, UK
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Taverne K, de Groot M, de Boer A, Klungel O. Genetic polymorphisms related to the renin-angiotensin-aldosterone system and response to antihypertensive drugs. Expert Opin Drug Metab Toxicol 2010; 6:439-60. [PMID: 20102285 DOI: 10.1517/17425250903571670] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE OF THE FIELD Only 23 - 41% of hypertensive patients receiving antihypertensive drugs achieve adequate blood pressure control. Multiple physiological systems regulate blood pressure and variation in genes involved in these systems may account for enhanced or diminished blood pressure lowering response to antihypertensive therapy. AREAS COVERED IN THIS REVIEW We explored explanations for variation in blood pressure response to antihypertensive drugs by linking genetic polymorphisms in renin-angiotensin-aldosterone system (RAAS) genes to antihypertensive drug response on intermediate parameters (e.g., potassium excretion, aldosterone levels). A MEDLINE search (1966 - 2008) was performed to identify publications reporting effects of genetic polymorphisms in the RAAS on antihypertensive drug response with regard to intermediate parameters. WHAT THE READER WILL GAIN With regard to the ACE insertion/deletion and the angiotensinogen -217G/A polymorphism variation in blood pressure response could be explained by effects on intermediate parameters. However, most studies that were identified with our search varied in study design, population and outcome, which complicate adequate comparisons. TAKE HOME MESSAGE Little evidence is available that explains these pharmacogenetic interactions. In the future, a better understanding of these mechanisms should provide a more solid evidence base for the individualized hypertension treatment based on genetic variation.
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Affiliation(s)
- Kim Taverne
- Universiteit Utrecht, Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Pharmacotherapy, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht, The Netherlands
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