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Insani WN, Whittlesea C, Ju C, Man KK, Adesuyan M, Chapman S, Wei L. Impact of ACEIs and ARBs-related adverse drug reaction on patients' clinical outcomes: a cohort study in UK primary care. Br J Gen Pract 2023; 73:e832-e842. [PMID: 37783509 PMCID: PMC10563001 DOI: 10.3399/bjgp.2023.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/26/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Adverse drug reaction (ADR) related to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may negatively affect patients' treatment outcomes. AIM To investigate the impact of ACEIs/ARBs-related ADR consultation on cardiovascular disease (CVD) events and all-cause mortality. DESIGN AND SETTING Propensity score-matched cohort study of ACEIs/ARBs between 2004 and 2019 using UK IQVIA medical research data. METHOD ADR consultations were identified using standardised designated codes. Propensity scores were calculated based on comorbidities, concomitant medications, frailty, and polypharmacy. Cox's proportional hazard regression model was used to compare the outcomes between patients in ADR and non-ADR groups. In the secondary analysis, treatment- pattern changes following the ADR were examined and the subsequent outcomes were compared. RESULTS Among 1 471 906 eligible users of ACEIs/ARBs, 13 652 (0.93%) patients had ACEIs/ARBs- related ADR consultation in primary care. Patients with ACEIs/ARBs-related ADR consultation had an increased risk of subsequent CVD events and all- cause mortality in both primary prevention (CVD events: adjusted hazard ratio [aHR] 1.22, 95% confidence interval [CI] = 1.05 to 1.43; all-cause mortality: aHR 1.14, 95% CI = 1.01 to 1.27) and secondary prevention cohorts (CVD events: aHR 1.13, 95% CI = 1.05 to 1.21; all-cause mortality: aHR 1.15, 95% CI = 1.09 to 1.21). Half (50.19%) of patients with ADR continued to use ACEIs/ARBs, and these patients had a reduced risk of mortality (aHR 0.88, 95% CI = 0.82 to 0.95) compared with those who discontinued using ACEIs/ARBs. CONCLUSION This study provides information on the burden of ADR on patients and the health system. The findings call for additional monitoring and treatment strategies for patients affected by ADR to mitigate the risks of adverse clinical outcomes.
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Affiliation(s)
- Widya N Insani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre of Excellence for Pharmaceutical Care Innovation, Department of Pharmacology and Clinical Pharmacy, Padjadjaran University, Bandung, Indonesia
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Kenneth Kc Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Speical Administrative Region, China
| | - Matthew Adesuyan
- Research Department of Practice and Policy, School of Pharmacy, University College London; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sarah Chapman
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Speical Administrative Region, China
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Brownstein DJ, Salagre E, Köhler C, Stubbs B, Vian J, Pereira C, Chavarria V, Karmakar C, Turner A, Quevedo J, Carvalho AF, Berk M, Fernandes BS. Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials. Aust N Z J Psychiatry 2018; 52:24-38. [PMID: 28754072 DOI: 10.1177/0004867417721654] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE It is unclear whether blockade of the angiotensin system has effects on mental health. Our objective was to determine the impact of angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor (AT1R) blockers on mental health domain of quality of life. STUDY DESIGN Meta-analysis of published literature. DATA SOURCES PubMed and clinicaltrials.gov databases. The last search was conducted in January 2017. STUDY SELECTION Randomized controlled trials comparing any angiotensin converting enzyme inhibitor or AT1R blocker versus placebo or non-angiotensin converting enzyme inhibitor or non-AT1R blocker were selected. Study participants were adults without any major physical symptoms. We adhered to meta-analysis reporting methods as per PRISMA and the Cochrane Collaboration. DATA SYNTHESIS Eleven studies were included in the analysis. When compared with placebo or other antihypertensive medications, AT1R blockers and angiotensin converting enzyme inhibitors were associated with improved overall quality of life (standard mean difference = 0.11, 95% confidence interval = [0.08, 0.14], p < 0.0001), positive wellbeing (standard mean difference = 0.11, 95% confidence interval = [0.05, 0.17], p < 0.0001), mental (standard mean difference = 0.15, 95% confidence interval = [0.06, 0.25], p < 0.0001), and anxiety (standard mean difference = 0.08, 95% confidence interval = [0.01, 0.16], p < 0.0001) domains of QoL. No significant difference was found for the depression domain (standard mean difference = 0.05, 95% confidence interval = [0.02, 0.12], p = 0.15). CONCLUSIONS Use of angiotensin blockers and inhibitors for the treatment of hypertension in otherwise healthy adults is associated with improved mental health domains of quality of life. Mental health quality of life was a secondary outcome in the included studies. Research specifically designed to analyse the usefulness of drugs that block the angiotensin system is necessary to properly evaluate this novel psychiatric target.
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Affiliation(s)
- Daniel J Brownstein
- 1 Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Estela Salagre
- 2 Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Cristiano Köhler
- 3 Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Brendon Stubbs
- 4 Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.,5 Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK.,6 Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - João Vian
- 7 Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,8 Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ciria Pereira
- 7 Psychiatry and Mental Health Department, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.,8 Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Victor Chavarria
- 9 Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar (PSM), Barcelona, Spain
| | - Chandan Karmakar
- 10 Center for Pattern Recognition and Data Analytics, School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Alyna Turner
- 11 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,12 Barwon Health, Geelong, VIC, Australia
| | - João Quevedo
- 13 Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,14 Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,15 Neuroscience Graduate Program, Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, USA.,16 Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, Brazil
| | - André F Carvalho
- 3 Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Michael Berk
- 11 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,12 Barwon Health, Geelong, VIC, Australia.,17 Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,18 Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,19 The Florey Institute for Neuroscience Mental Health, Parkville, VIC, Australia
| | - Brisa S Fernandes
- 11 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,12 Barwon Health, Geelong, VIC, Australia.,20 Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Teng R, Hansson AC, Börjesson I. Oral Bioavailability of Candesartan Cilexetil Suspension. J Pharm Technol 2016. [DOI: 10.1177/875512250702300503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background:Candesartan cilexetil is a prodrug that is converted to candesartan during absorption from the gastrointestinal tract. Candesartan is a potent, orally active, specific angiotensin II type 1 receptor antagonist that has become a well-accepted treatment for hypertension. Pediatric patients often require alternative dosage forms, as candesartan cilexetil is not yet commercially available as a liquid formulation.Objective:To determine the relative bioavailability of candesartan by comparing a candesartan cilexetil tablet (reference formulation) with an oral candesartan cilexetil suspension (test formulation).Methods:In an open-label, randomized, 2 period, 2 treatment crossover study, 24 healthy volunteers were given a 32 mg candesartan cilexetil tablet and a 32 mg candesartan cilexetil suspension with a 7 day washout period between treatments.Results:Pharmacokinetic analyses showed that the mean relative bioavailability of the candesartan cilexetil commercial 32 mg tablet compared with the suspension of 32 mg candesartan cilexetil was 93%. The 90% CIs of the plasma AUC for the tablet versus suspension (0.861 and 0.998, respectively) were well within the bioequivalence criteria of 80–125%. Administration of candesartan cilexetil suspension was associated with a 17% increase in the maximum plasma concentration (Cmax) relative to the tablet administration (643 vs 523 nM/L, respectively). The 90% CIs on the ratio of mean Cmaxfor the tablet and suspension were 0.738 and 0.914, respectively. Mean time to peak plasma concentrations (tmax) after suspension administration was 3.1 hours, whereas the tablet resulted in a mean tmaxof 3.9 hours. No significant differences in elimination half-life were observed between the 2 formulations. Both formulations were well tolerated, and no serious adverse events were reported.Conclusions:These results demonstrate that administration of candesartan cilexetil suspension achieves an extent of absorption and tolerability that is comparable with those of orally administered candesartan cilexetil tablets.
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Affiliation(s)
- Renli Teng
- RENLI TENG PhD, Senior Director, Clinical Pharmacology, AstraZeneca LP, Wilmington, DE
| | - Anna-Carin Hansson
- ANNA-CARIN HANSSON PhD, Team Manager PARD, Clinical Pharmacology, AstraZeneca LP
| | - Inger Börjesson
- INGER BÖRJESSON MSc, Associate Director, Pharmaceutical and Analytical Research and Development, Clinical Pharmacology, AstraZeneca LP
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Sjølie AK, Porta M, Parving HH, Bilous R, Klein R. The DIabetic REtinopathy Candesartan Trials (DIRECT) Programme: baseline characteristics. J Renin Angiotensin Aldosterone Syst 2016; 6:25-32. [PMID: 16088848 DOI: 10.3317/jraas.2005.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Renin-angiotensin system blockade has been shown to be superior to other antihypertensive therapy in slowing progression of renal disease in diabetic patients, but questions remain regarding diabetic retinopathy. The primary objective of the DIabetic REtinopathy Candesartan Trials (DIRECT) Programme is to examine primary (incidence) and secondary (progression) prevention of diabetic retinopathy when blocking angiotensin II type 1-receptors with candesartan in normoalbuminuric, normotensive Type 1 diabetic patients, and secondary prevention only in normoalbuminuric, normotensive or treated hypertensive Type 2 diabetic patients. The secondary objectives include examining the effect of candesartan treatment on urinary albumin excretion rate (UAER) in each of the three studies and to examine the incidence of proliferative retinopathy in all three populations combined. Standardised investigations for patients at enrolment include blood pressure measurement analysis of HbA1C and serum lipids, and a detailed ophthalmological examination. Retinopathy and UAER outcomes are assessed yearly. Retinopathy is graded centrally, based on seven-field stereo photographs using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Randomisation was performed when the results of retinal gradings were available, and treatment with 16 mg candesartan cilexetil or matching placebo was initiated; the dose was increased to 32 mg after one month. Calculations of UAER are based on two timed overnight urine collections. A sample size re-assessment was carried out when approximately 70% of the patients had been randomised in the DIRECT Programme to ensure the results to be conclusive. In total, 5,231 patients were randomised in the DIRECT Programme in 30 countries. One thousand, four hundred and twenty one and 1,905 patients are evaluated in the primary and secondary prevention studies in Type 1 diabetes, respectively and 1,905 patients in the secondary prevention study in Type 2 diabetes. HbA1C showed mean values of 8.1, 8.5 and 8.2% for the Type 1 primary, Type 1 secondary and Type 2 secondary prevention studies, respectively. In the Type 1 secondary prevention study, 49% of the patients had mild nonproliferative retinopathy (level 20) in at least one eye, and 9% had moderate-moderately severe non-proliferative retinopathy (level 43—47). In Type 2 patients, 17% had level 43—47 and the remainder less severe retinopathy.
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Di Daniele N. Therapeutic approaches of uncomplicated arterial hypertension in patients with COPD. Pulm Pharmacol Ther 2015; 35:1-7. [PMID: 26363278 DOI: 10.1016/j.pupt.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/03/2015] [Accepted: 09/06/2015] [Indexed: 12/23/2022]
Abstract
The concomitant presence of systemic arterial hypertension and chronic obstructive pulmonary disease (COPD) is frequent. Indeed, arterial hypertension is the most common comorbid disease in COPD patients. Since many antihypertensive drugs can act on airway function the treatment of arterial hypertension in COPD patients appears complex. Moreover, in these patients, a combined therapy is required for the adequate control of blood pressure. Currently, available data are inconsistent and not always comparable. Therefore the aim of this review is to analyze how antihypertensive drugs can affect airway function in order to improve the clinical management of hypertensive patients with COPD. Thiazide diuretics and calcium channel blockers appear the first-choice pharmacological treatment for these patients.
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Affiliation(s)
- Nicola Di Daniele
- Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome "Tor Vergata", via Montpellier 1, 00133, Rome, Italy.
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Information for physicians and pharmacists about drugs that might cause dry mouth: a study of monographs and published literature. Drugs Aging 2014; 31:55-65. [PMID: 24293180 DOI: 10.1007/s40266-013-0141-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over three-quarters of the older population take medications that can potentially cause dry mouth. Physicians or pharmacists rarely inform patients about this adverse effect and its potentially severe damage to the teeth, mouth and general health. OBJECTIVES The objectives of this study were to (1) identify warnings in the literature about dry mouth associated with the most frequently prescribed pharmaceutical products in Canada; and (2) consider how this information might be obtained by physicians, pharmacists and patients. METHODS Monographs on the 72 most frequently prescribed medications during 2010 were retrieved from the Compendium of Pharmaceuticals and Specialties (CPS, a standard drug information reference for physicians and pharmacists), the National Library of Medicine's 'DailyMed' database, directly from the manufacturers, and from a systematic search of biomedical journals. RESULTS The CPS provided monographs for 43% of the medications, and requests to manufacturers produced the remaining monographs. Mentions of dry mouth were identified in 61% of the products (43% amongst CPS monographs; an additional 43% amongst manufacturers' monographs; 7% in the DailyMed database and 7% from biomedical journals); five medications had contradictory reports in different monographs. CONCLUSION Nearly two-thirds (61%) of the most commonly prescribed medications can cause dry mouth, yet warnings about this adverse effect and its potentially serious consequences are not readily available to physicians, pharmacists, dentists or patients.
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Mohamed IN, Helms PJ, Simpson CR, McLay JS. Using Routinely Collected Prescribing Data to Determine Drug Persistence for the Purpose of Pharmacovigilance. J Clin Pharmacol 2013; 51:279-84. [DOI: 10.1177/0091270010366444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Pruijm M, Hofmann L, Zanchi A, Maillard M, Forni V, Muller ME, Wuerzner G, Vogt B, Stuber M, Burnier M. Blockade of the renin-angiotensin system and renal tissue oxygenation as measured with BOLD-MRI in patients with type 2 diabetes. Diabetes Res Clin Pract 2013; 99:136-44. [PMID: 23245807 DOI: 10.1016/j.diabres.2012.11.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 10/23/2012] [Accepted: 11/08/2012] [Indexed: 12/20/2022]
Abstract
AIM To assess whether blockade of the renin-angiotensin system (RAS), a recognized strategy to prevent the progression of diabetic nephropathy, affects renal tissue oxygenation in type 2 diabetes mellitus (T2DM) patients. METHODS Prospective randomized 2-way cross over study; T2DM patients with (micro)albuminuria and/or hypertension underwent blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) at baseline, after one month of enalapril (20 mgqd), and after one month of candesartan (16 mgqd). Each BOLD-MRI was performed before and after the administration of furosemide. The mean R₂* (=1/T₂*) values in the medulla and cortex were calculated, a low R₂* indicating high tissue oxygenation. RESULTS Twelve patients (mean age: 60 ± 11 years, eGFR: 62 ± 22 ml/min/1.73 m(2)) completed the study. Neither chronic enalapril nor candesartan intake modified renal cortical or medullary R₂* levels. Furosemide significantly decreased cortical and medullary R₂* levels suggesting a transient increase in renal oxygenation. Medullary R₂* levels correlated positively with urinary sodium excretion and systemic blood pressure, suggesting lower renal oxygenation at higher dietary sodium intake and blood pressure; cortical R₂* levels correlated positively with glycemia and HbA1c. CONCLUSION RAS blockade does not seem to increase renal tissue oxygenation in T2DM hypertensive patients. The response to furosemide and the association with 24 h urinary sodium excretion emphasize the crucial role of renal sodium handling as one of the main determinants of renal tissue oxygenation.
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Affiliation(s)
- Menno Pruijm
- Service of Nephrology, University Hospital, Lausanne, Switzerland
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Caldeira D, David C, Sampaio C. Tolerability of angiotensin-receptor blockers in patients with intolerance to angiotensin-converting enzyme inhibitors: a systematic review and meta-analysis. Am J Cardiovasc Drugs 2012; 12:263-77. [PMID: 22587776 DOI: 10.1007/bf03261835] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Between 5% and 20% of patients treated with angiotensin-converting enzyme inhibitors (ACE inhibitors) develop intolerance. Angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) can be used as an alternative treatment. OBJECTIVE In this study we aimed to evaluate the tolerability of ARBs in patients with intolerance to ACE inhibitors. DATA SOURCES The electronic databases PubMed, MEDLINE/EMBASE via Dialog, CENTRAL, and ISI Web of Knowledge were searched. STUDY SELECTION Randomized controlled trials (RCTs) evaluating ARBs in patients with intolerance to ACE inhibitors were selected. DATA SYNTHESIS Risk ratio (RR) and 95% confidence intervals (CIs) were estimated assuming the random effects method. We found 11 RCTs comparing ARBs with ACE inhibitors, diuretics, or placebo, and one RCT comparing high-dose versus low-dose ARB. RESULTS ARBs had fewer cough events versus ACE inhibitors (RR 0.37; 95% CI 0.28, 0.48). ARBs had drug discontinuation (RR 0.99; 95% CI 0.84, 1.17) and cough risk (RR 1.01; 95% CI 0.74, 1.39) rates similar to placebo. Angioedema risk with ARBs was also similar to placebo (RR 1.62; 95% CI 0.17, 15.79). Compared with placebo, hypotension (RR 2.63; 95% CI 1.77, 3.92), renal dysfunction (RR 2.07; 95% CI 1.45, 2.95) and hyperkalemia (RR 3.37; 95% CI 1.60, 7.11) were more frequent with ARBs. CONCLUSIONS ACE inhibitor rechallenge should be discouraged in patients with previous intolerance to ACE inhibitors due to a higher risk of cough. ARBs had cough and angioedema incidences similar to placebo. Despite a significantly higher incidence of hypotension, renal dysfunction and hyperkalemia, discontinuation of ARBs was similar to placebo.
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Yun ZY, Lee DW, Jung HS, Park KH, Lee SH, Park JJ, Kim DI, Ki JM, Cho KR, Song JS, Choi S, U CH, Jung TH, Jung SH, Kim SW, Kim I. Change of Selection to Antihypertensive Drugs in Hypertensive Patients with Diabetes Mellitus: In Pohang · Gyeongju Primary Care Research Network. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.3.197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Zu-Young Yun
- Department of Family Medicine, Dongguk University, College of Medicine, Gyeonju, Korea
| | - Dong-Wook Lee
- Department of Family Medicine, Dongguk University, College of Medicine, Gyeonju, Korea
| | - Hee-Su Jung
- Department of Family Medicine, Dongguk University, College of Medicine, Gyeonju, Korea
| | - Ki-Hm Park
- Department of Family Medicine, Dongguk University, College of Medicine, Gyeonju, Korea
| | - Sin-Hyeong Lee
- Department of Family Medicine, Dongguk University, College of Medicine, Gyeonju, Korea
| | - Jung-Jae Park
- Department of Family Medicine, Dongguk University, College of Medicine, Gyeonju, Korea
| | - Dong-Ik Kim
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Jae-Man Ki
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Kyung-Rae Cho
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Joon-Seok Song
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Seok Choi
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Cheang-Ho U
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Tae-Ho Jung
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Sook-Heong Jung
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Sung-Woo Kim
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
| | - Ik Kim
- Pohang · Gyeongju Primary Care Research Network, Pohang, Korea
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Rapposelli S, Cuboni S, Digiacomo M, Lucacchini A, Minutolo F, Letizia Trincavelli M, Balsamo A. Synthesis and Affinity Evaluation for AT1 Receptor of Phenylsalicylaldoxime-Derivatives Structurally Related to Sartans. HETEROCYCLES 2008. [DOI: 10.3987/com-07-11309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Candesartan cilexetil is the prodrug of candesartan, an angiotensin II receptor antagonist. Candesartan binds selectively and non-competitively to the angiotensin II receptor type 1, thus preventing the actions of angiotensin II. Clinical trials have demonstrated its efficacy at a dose range of 2 to 32 mg once daily in hypertension of all grades, heart failure, in reducing urinary albumin excretion in diabetes mellitus and in coexisting hypertension and renal failure. Pharmacokinetic properties of candesartan cilexetil in elderly patients are not significantly different from those in younger individuals. Hepatic impairment does not change pharmacokinetics of candesartan cilexetil at doses up to 12 mg/day. No dose adjustment is necessary in patients with mild or moderate renal impairment. Tolerability of candesartan cilexetil is not much different from that of placebo. All adverse events are usually of mild to moderate severity and not dose-related. The most common adverse events were headache, upper respiratory tract infection, back pain, and dizziness. The incidence of these adverse effects, as well as of cough, was similar in patients treated with candesartan cilexetil or placebo. The incidence of adverse events in long-term trials was not different from that in short-term trials. Tolerability of candesartan cilexetil does not differ with either age or gender.
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Affiliation(s)
- Christoph H Gleiter
- Universitätsklinikum Tübingen, Institut für Pharmakologie und Toxikologie, Abteilung Klinische Pharmakologie, Otfried-Müller-Strasse 45, D-72076 Tübingen, Germany.
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Rosen AB. Indications for and utilization of ACE inhibitors in older individuals with diabetes. Findings from the National Health and Nutrition Examination Survey 1999 to 2002. J Gen Intern Med 2006; 21:315-9. [PMID: 16686805 PMCID: PMC1484715 DOI: 10.1111/j.1525-1497.2006.00351.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Revised: 08/31/2005] [Accepted: 11/03/2005] [Indexed: 01/13/2023]
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) improve cardiovascular outcomes in high-risk individuals with diabetes. Despite the marked benefit, it is unknown what percentage of patients with diabetes would benefit from and what percentage actually receive this preventive therapy. OBJECTIVES To examine the proportion of older diabetic patients with indications for ACE or ARB (ACE/ARB). To generate national estimates of ACE/ARB use. DESIGN AND PARTICIPANTS Survey of 742 individuals> or =55 years (representing 8.02 million U.S. adults) self-reporting diabetes in the 1999 to 2002 National Health and Nutrition Examination Survey. MEASUREMENTS Prevalence of guideline indications (albuminuria, cardiovascular disease, hypertension) and other cardiac risk factors (hyperlipidemia, smoking) with potential benefit from ACE/ARB. Prevalence of ACE/ARB use overall and by clinical indication. RESULTS Ninety-two percent had guideline indications for ACE/ARB. Including additional cardiac risk factors, the entire (100%) U.S. noninstitutionalized older population with diabetes had indications for ACE/ARB. Overall, 43% of the population received ACE/ARB. Hypertension was associated with higher rates of ACE/ARB use, while albuminuria and cardiovascular disease were not. As the number of indications increased, rates of use increased, however, the maximum prevalence of use was only 53% in individuals with 4 or more indications for ACE/ARB. CONCLUSIONS ACE/ARB is indicated in virtually all older individuals with diabetes; yet, national rates of use are disturbingly low and key risk factors (albuminuria and cardiovascular disease) are being missed. To improve quality of diabetes care nationally, use of ACE/ARB therapy by ALL older diabetics may be a desirable addition to diabetes performance measurement sets.
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Affiliation(s)
- Allison B Rosen
- Division of General Medicine, University of Michigan Health Systems, Ann Arbor, MI 48109, USA.
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Malacco E, Santonastaso M, Varì NA, Gargiulo A, Spagnuolo V, Bertocchi F, Palatini P. Comparison of valsartan 160 mg with lisinopril 20 mg, given as monotherapy or in combination with a diuretic, for the treatment of hypertension: the Blood Pressure Reduction and Tolerability of Valsartan in Comparison with Lisinopril (PREVAIL) study. Clin Ther 2004; 26:855-65. [PMID: 15262456 DOI: 10.1016/s0149-2918(04)90129-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The goal of antihypertensive therapy is to provide good blood pressure (BP) control without eliciting adverse effects. OBJECTIVE This study compared the risk-benefit profile of the angiotensin II receptor blocker valsartan with that of the angiotensin-converting enzyme inhibitor lisinopril in patients with mild to severe hypertension. The primary objective was to show that the equipotent BP-lowering effect of the valsartan-based treatment is accompanied by a better tolerability profile. METHODS This 16-week, randomized, double-blind, parallel-group study was conducted at 88 outpatient centers across Italy. After a 2-week placebo run-in period, patients aged > or = 18 years with mild to severe hypertension (systolic BP [SBP], 160-220 mm Hg; diastolic BP [DBP], 95-110 mm Hg) were eligible. Patients were randomized to receive once-daily, oral, self-administered treatment with valsartan 160-mg capsules or lisinopril 20-mg capsules under double-blind conditions for 4 weeks. Responders continued monotherapy, whereas nonresponders had hydrochlorothiazide 12.5 mg added for the final 12 weeks of the study. The 2 primary variables used to assess the equivalence of therapeutic efficacy of the 2 regimens were sitting SBP and sitting DBP, which were measured at weeks 0 (baseline), 4, 8, and 16. The rate of drug-related adverse events (AEs) was used to assess whether 1 treatment had a better tolerability profile than the other. Tolerability was assessed by collecting information about AEs by means of questioning the patient or physical examination at each visit. RESULTS A total of 1213 patients were enrolled (635 men, 578 women; mean [SD] age, 54.5 [10.1] years [range, 28-78 years]). The study was completed by 1100 patients (553 receiving valsartan and 547 receiving lisinopril). Fifty-one patients (8.4%) treated with valsartan and 62 (10.2%) [corrected] treated with lisinopril withdrew, mainly because of AEs (9 [1.5%] and 23 patients [3.8%], respectively). The valsartan- and lisinopril-based treatments were similarly effective in reducing sitting BP, with mean SBP/DBP reductions of 31.2/15.9 mm Hg and 31.4/15.9 mm Hg, respectively. At the end of the study, BP was controlled in 82.6% [corrected] of the patients receiving valsartan and 81.6% of those receiving lisinopril. AEs were experienced by 5.1% of the patients treated with valsartan and 10.7% of those treated with lisinopril (P=.0001), with dry cough observed in 1.0% and 7.2% of patients, respectively (P<0.001). CONCLUSIONS Valsartan and lisinopril were both highly effective in controlling BP in these patients with mild to severe hypertension, but valsartan was associated with a significantly reduced risk for AEs, especially cough.
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Affiliation(s)
- Ettore Malacco
- Division of Internal Medicine, L. Sacco Hospital, University of Milan, Milan, Italy
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Breschi MC, Calderone V, Digiacomo M, Martelli A, Martinotti E, Minutolo F, Rapposelli S, Balsamo A. NO-Sartans: A New Class of Pharmacodynamic Hybrids as Cardiovascular Drugs. J Med Chem 2004; 47:5597-600. [PMID: 15509155 DOI: 10.1021/jm049681p] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this work was to develop lead pharmacodynamic hybrids, NO-sartans, possessing the characteristics of a typical AT1-antagonist and of a "slow NO donor", by adding NO-donor side chains to losartan. These new compounds, 2a and 2b, displayed vasorelaxing effects, due to the release of NO, and antagonized the vasocontractile effects of angiotensin II, with potency values similar to that of losartan. In vivo, the antihypertensive effects of 2a were similar to those of losartan and captopril.
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Affiliation(s)
- Maria C Breschi
- Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, Università di Pisa, Via Bonanno 6, 56126 Pisa, Italy
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Rosen AB, Karter AJ, Liu JY, Selby JV, Schneider EC. Use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in high-risk clinical and ethnic groups with diabetes. J Gen Intern Med 2004; 19:669-75. [PMID: 15209606 PMCID: PMC1492381 DOI: 10.1111/j.1525-1497.2004.30264.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Diabetes causes 45% of incident end-stage renal disease (ESRD). Risk of progression is higher in those with clinical risk factors (albuminuria and hypertension), and in ethnic minorities (including blacks, Asians, and Latinos). Angiotensin-converting enzyme inhibitors (ACE) and angiotensin receptor blockers (ARB) slow the progression of diabetic nephropathy, yet little is known about their use among patients at high risk for progression to ESRD. OBJECTIVES To examine the prevalence of ACE or ARB (ACE/ARB) use overall and within patients with high-risk clinical indications, and to assess for ethnic disparities in ACE/ARB use. DESIGN Observational cohort study. SETTING Kaiser Permanente Northern California (KPNC) Diabetes Registry, a longitudinal registry that monitors quality and outcomes of care for all KPNC patients with diabetes. PATIENTS Individuals (N= 38887) with diabetes who were continuously enrolled with pharmacy benefits during the year 2000, and had self-reported ethnicity data on survey. INTERVENTIONS AND MEASUREMENTS Pharmacy dispensing of ACE/ARB. RESULTS Forty-one percent of the cohort had both hypertension and albuminuria, 30% had hypertension alone, and 12% had albuminuria alone. Fourteen percent were black, 11% Latino, 13% Asian, and 63% non-Latino white. Overall, 61% of the cohort received an ACE/ARB. ACE/ARB was dispensed to 74% of patients with both hypertension and albuminuria, 64% of those with hypertension alone, and 54% of those with albuminuria alone. ACE/ARB was dispensed to 61% of whites, 63% of blacks, 59% of Latinos, and 60% of Asians. Among those with albuminuria alone, blacks were significantly (P =.0002) less likely than whites to receive ACE/ARB (47% vs 56%, respectively). No other ethnic disparities were found. CONCLUSIONS In this cohort, the majority of eligible patients received indicated ACE/ARB therapy in 2000. However, up to 45% to 55% of high-risk clinical groups (most notably individuals with isolated albuminuria) were not receiving indicated therapy. Additional targeted efforts to increase use of ACE/ARB could improve quality of care and reduce ESRD incidence, both overall and in high-risk ethnic groups. Policymakers might consider use of ACE/ARB for inclusion in diabetes performance measurement sets.
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Affiliation(s)
- Allison B Rosen
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA.
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Mora-Maciá J, Tovar Méndez J, Baró Salvador E, Raber Bejar A. Efecto del tratamiento antihipertensivo con candesartán sobre la presión de pulso. HIPERTENSION Y RIESGO VASCULAR 2004. [DOI: 10.1016/s1889-1837(04)71455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dart RA, Gollub S, Lazar J, Nair C, Schroeder D, Woolf SH. Treatment of systemic hypertension in patients with pulmonary disease: COPD and asthma. Chest 2003; 123:222-43. [PMID: 12527626 DOI: 10.1378/chest.123.1.222] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We present a two-part review of the English-language literature pertaining to drug therapy for systemic high BP in patients with pulmonary diseases. Part I examines the literature pertaining to the use of antihypertensive drugs in patients with systemic hypertension and coexisting pulmonary conditions, especially COPD and asthma. Part II of the series reviews studies assessing the relationship between sleep-disordered breathing (including the role of the sympathetic nervous system) and systemic hypertension, and presents an approach to the management of these patients. It is the aim of both parts of this review to make qualified conclusions and recommendations applying a methodologic critique to assess the current literature. In the first part of this series, we review the demographics of hypertension in patients with COPD. This is followed by an extensive review of the use of specific classes of antihypertensive drug therapies in patients with pulmonary disease. The antihypertensive agents reviewed include diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists, beta-adrenergic blocking agents, and alpha-beta-blockers and other non-beta-blocker classes. Additionally, the renin angiotensin system is briefly reviewed, with a discussion of how angiotensin-converting enzyme inhibitors induce cough, especially in pulmonary and congestive heart failure patients.
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Affiliation(s)
- Richard A Dart
- Department of Nephrology and Hypertension, Marshfield Clinic, Marshfield, WI 54449, USA.
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Tanaka H, Teramoto S, Oashi K, Saikai T, Tanaka S, Suzuki K, Hashimoto M, Abe S. Effects of candesartan on cough and bronchial hyperresponsiveness in mildly to moderately hypertensive patients with symptomatic asthma. Circulation 2001; 104:281-5. [PMID: 11457745 DOI: 10.1161/01.cir.104.3.281] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Candesartan, an AT(1) receptor antagonist, has been reported to have no association with persistent cough in subjects with hypertension, but there has been no study on the safety of its administration to hypertensive patients with symptomatic asthma. The aim of this study was to compare the adverse effects of candesartan and calcium antagonists on cough, pulmonary function, and bronchial hyperresponsiveness in these patients. METHODS AND RESULTS Sixty mildly to moderately hypertensive patients with bronchial asthma received either candesartan (n=30) or the calcium antagonists nifedipine or manidipine (n=30) for 6 months. The candesartan group included 5 subjects with a history of ACE inhibitor-induced cough. There were no differences between the 2 groups in patient characteristics, ACE gene polymorphism, pulmonary function, or bronchial hyperresponsiveness to methacholine. Control of hypertension was the primary end point; new cough detected by self-administrated questionnaire and an increase in cough frequency by visual analog scale were the second end point. No patient complained of persistent cough. Neither mean visual analog scale score nor pulmonary functions changed during this study. Bronchial hyperresponsiveness had a tendency to improve in the candesartan group, but there was no difference between the 2 groups. CONCLUSIONS Incidence, frequency, and severity of persistent cough, pulmonary functions, and bronchial hyperresponsiveness did not change in either the candesartan or calcium antagonist group. It is suggested that candesartan is as effective and safe as calcium antagonists in the treatment of hypertension associated with symptomatic asthma.
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Affiliation(s)
- H Tanaka
- Third Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Côté I, Grégoire JP, Moisan J. Health-related quality-of-life measurement in hypertension. A review of randomised controlled drug trials. PHARMACOECONOMICS 2000; 18:435-450. [PMID: 11151397 DOI: 10.2165/00019053-200018050-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In hypertension, tolerability of drug treatment is important because individuals may see the use of antihypertensive medications as more troubling than their seemingly symptomless disease. This may result in noncompliance and ineffectual long term treatment. In the past 15 years, new antihypertensive medications have been marketed on the basis of the advantages they offer with regard to adverse effects and the unavoidable impact of such adverse effects on a person's quality of life. When related to health, quality of life refers to the physical, psychological and social dimensions of health that are influenced by a person's experiences, beliefs, expectations and perceptions. To measure this concept, many instruments, either generic or specific, may be used. The purpose of this study is to describe, by way of a critical review of the literature, the instruments that are most often used in the measurement of health-related quality of life (HR-QOL) in people using antihypertensive drug treatments. We carried out a search of the literature published in English in the period January 1966 to July 2000, looking for randomised controlled trials of antihypertensive drugs. Using the Medline database, we included 77 papers in our review. Our main finding suggests that HR-QOL changes associated with antihypertensive treatment are measured with many different instruments. In almost all studies, at least 1 instrument specific to a health dimension was used, whereas not many used a generic instrument only. The most commonly measured HR-QOL dimensions were cognitive function, symptomatic well-being, sexual function, psychological well-being, sleep dysfunction, social participation and general health perception. Since the choice of dimensions to measure depends not only on the disease but also on the drug, this review adds further evidence that a generic instrument as well as a preference measurement should be added to a specific instrument.
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Affiliation(s)
- I Côté
- Faculty of Pharmacy and Epidemiology Research Group, Université Laval, Quebec City, Canada
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Current Awareness. Pharmacoepidemiol Drug Saf 2000. [DOI: 10.1002/1099-1557(200007/08)9:4<341::aid-pds490>3.0.co;2-#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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