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Pharmacokinetic and pharmacodynamic evaluation of nano-fixed dose combination for hypertension. J Hypertens 2020; 38:1593-1602. [DOI: 10.1097/hjh.0000000000002429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soto-Pina AE, Franklin C, Rani CSS, Gottlieb H, Hinojosa-Laborde C, Strong R. A Novel Model of Dexamethasone-Induced Hypertension: Use in Investigating the Role of Tyrosine Hydroxylase. ACTA ACUST UNITED AC 2016; 358:528-36. [DOI: 10.1124/jpet.116.234005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 07/08/2016] [Indexed: 01/15/2023]
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Kjeldsen SE, Fadl Elmula FEM, Os I, Persu A, Jin Y, Staessen JA. Renal sympathetic denervation after Symplicity HTN-3 and therapeutic drug monitoring in patients with resistant hypertension to improve patients' adherence. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:48-56. [DOI: 10.1093/ehjcvp/pvu009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/27/2014] [Indexed: 12/26/2022]
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Persu A, Fadl Elmula FEM, Jin Y, Os I, Kjeldsen SE, Staessen JA. Renal Denervation After Symplicity HTN-3 - Back to Basics. Review of the Evidence. Eur Cardiol 2014; 9:110-114. [PMID: 30310496 PMCID: PMC6159409 DOI: 10.15420/ecr.2014.9.2.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/09/2014] [Indexed: 12/31/2022] Open
Abstract
Renal sympathetic denervation (RDN) has been proposed as a new treatment modality in patients with apparent treatment resistant hypertension, a condition defined as office blood pressure elevation despite prescription of at least three antihypertensive drugs including a diuretic. However, the impressive fall in blood pressure reported after RDN in Symplicity HTN-2, the first randomised study, and multiple observational studies has not been confirmed in the US sham-controlled trial Symplicity HTN-3 and four subsequent prospective randomised studies, all published or presented in 2014. The blood pressure reduction documented in earlier studies may be largely due to non-specific effects such as improvement of drug adherence in initially poorly adherent patients (Hawthorne effect), placebo effect and regression to the mean. The overall blood pressure lowering effect of RDN seems rather limited and the characteristics of true responders remain largely unknown. Accordingly, RDN is not ready for clinical practice. In most patients with apparent drug-resistant hypertension, drug monitoring and subsequent improvement of drug adherence may prove more effective and cost-beneficial to achieve blood pressure control. In the meantime, research should aim at identifying characteristics of those few patients adherent to drug treatment and with true resistant hypertension who may respond to RDN.
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Affiliation(s)
- Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Fadl Elmula M Fadl Elmula
- Departments of General Internal Medicine, Cardiology and Nephrology, Ullevaal University Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yu Jin
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Ingrid Os
- Departments of General Internal Medicine, Cardiology and Nephrology, Ullevaal University Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sverre E Kjeldsen
- Departments of General Internal Medicine, Cardiology and Nephrology, Ullevaal University Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Vitak Development and Research, Maastricht University, Maastricht, The Netherlands
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Kjeldsen SE, Fadl Elmula FEM, Persu A, Jin Y, Staessen JA. Renal sympathetic denervation in the aftermath of Symplicity HTN-3. Blood Press 2014; 23:256-61. [DOI: 10.3109/08037051.2014.953861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Eisenhofer G. Sympathetic nerve function--assessment by radioisotope dilution analysis. Clin Auton Res 2005; 15:264-83. [PMID: 16032382 DOI: 10.1007/s10286-005-0292-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 04/28/2005] [Indexed: 12/26/2022]
Abstract
Radioisotope dilution measurements of norepinephrine spillover (rate of entry of the transmitter into plasma) provide more accurate assessments of sympathoneural transmitter release than allowed by measurements of plasma catecholamine concentrations alone. Measurements of total body norepinephrine spillover, as an index of global sympathetic outflow, allow effects on plasma clearance to be distinguished from effects on release of catecholamines into plasma, while spillovers from specific tissues enable examination of regionalized sympathetic responses. However, spillovers of norepinephrine represent only a fraction of the transmitter that escapes neuronal and extraneuronal uptake after release by nerves. Numerous factors may influence this fraction and measures spillovers independently of transmitter release by nerves. Modified radioisotope dilution methods for assessment of rate processes operating within and between intracellular and extracellular compartments have further improved our understanding of the relationships of norepinephrine release, uptake, spillover, turnover, and metabolism. This article reviews the breadth of information about sympathetic nerve function attainable using catecholamine radioisotope dilution analyses against a backdrop of the relative advantages and methodological limitations associated with the methodology.
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Affiliation(s)
- Graeme Eisenhofer
- Clinical Neurocardiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
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Falloon BJ, Heagerty AM. In vitro perfusion studies of human resistance artery function in essential hypertension. Hypertension 1994; 24:16-23. [PMID: 8021003 DOI: 10.1161/01.hyp.24.1.16] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To simulate in vivo conditions as closely as possible to in vitro conditions, we examined the morphological and functional characteristics of isolated human subcutaneous small arteries from 17 essential hypertensive patients and 14 normotensive control subjects using a perfusion myograph. Vessel segments were cannulated and exposed to conditions of constant flow and pressure. The ratio of media thickness to lumen diameter in arteries from hypertensive patients increased significantly. With the endothelium intact, sensitivity to extraluminally applied norepinephrine was not different, and this was not affected by inhibition of neuronal amine uptake with cocaine. After removal of the endothelium, sensitivity to norepinephrine was augmented in normotensive vessels to a greater extent than in hypertensive vessels. Endothelium-dependent relaxation to acetylcholine was significantly reduced in arteries from hypertensive patients, but endothelium-independent relaxation to sodium nitroprusside was not different from that observed in vessels from normotensive control subjects. These data demonstrate that sensitivity to exogenous norepinephrine is not different in essential hypertension but that there is defective endothelium-dependent dilatation, suggesting a contributory role for endothelium dysfunction in human essential hypertension.
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Affiliation(s)
- B J Falloon
- Department of Medicine, University of Manchester, UK
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Frontoni S, Ohman L, Haywood JR, Rossetti L. Increased insulin sensitivity in the high sodium one-kidney, one figure-8 hypertensive rat. Hypertension 1992; 20:192-8. [PMID: 1639460 DOI: 10.1161/01.hyp.20.2.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study examines the relation between sympathetic activity and in vivo insulin-mediated glucose metabolism in a rat model of acquired hypertension. Two groups of conscious, unrestrained rats were studied in the postabsorptive state: sham-operated normotensive rats (n = 10) and renal-wrapped hypertensive rats (n = 10). Mean arterial pressure was increased in the hypertensive compared with the normotensive group in the fed (184 +/- 9 versus 144 +/- 6 mm Hg; p less than 0.01) and in the fasting (147 +/- 8 versus 112 +/- 7 mm Hg; p less than 0.01) state. After a 24-hour fast, hepatic glucose production, plasma glucose, insulin, and norepinephrine concentrations were similar in the two groups. Blood pressure did not change in either group during the 3-milliunits/kg.min euglycemic insulin clamp study; however, plasma norepinephrine concentration rose significantly in hypertensive (207 +/- 24 versus 329 +/- 11 pg/ml; p less than 0.05) but not in normotensive rats (229 +/- 23 versus 267 +/- 27 pg/ml; p = NS). During the insulin clamp study, the hepatic glucose production was similar in the hypertensive (3.8 +/- 0.8 mg/kg.min) compared with the normotensive (4.0 +/- 0.3 mg/kg.min) rats. Insulin-mediated glucose uptake was significantly higher in hypertensive than in normotensive rats (33.0 +/- 0.7 versus 25.8 +/- 0.8; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Frontoni
- Department of Medicine, University of Texas Health Science Center, San Antonio
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Goldstein DS, Horwitz D, Keiser HR, Polinsky RJ, Kopin IJ. Plasma l-[3H]norepinephrine, d-[14C]norepinephrine, and d,l-[3H]isoproterenol kinetics in essential hypertension. J Clin Invest 1983; 72:1748-58. [PMID: 6630523 PMCID: PMC370463 DOI: 10.1172/jci111134] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We infused tracer-labeled l-[3H]-norepinephrine, d-[14C]norepinephrine, and d,l-[3H]-isoproterenol simultaneously into patients with essential hypertension and into normotensive control subjects, in order to determine whether abnormalities in the disappearance kinetics of these substances characterized the hypertensive patients. The mean preinfusion venous plasma norepinephrine concentration was somewhat higher in the hypertensive group (260 vs. 194 pg/ml, P = 0.06), but the groups did not differ in the disappearance kinetics of l- or d-norepinephrine or of isoproterenol. Preinfusion plasma norepinephrine was significantly positively correlated with calculated spillover rates in both the hypertensive and normotensive groups, but not with norepinephrine clearances. The d/l ratio in plasma norepinephrine was the same as in the infusate during and after the infusion, even after pretreatment with the neuronal norepinephrine uptake blocker, desipramine. Because isoproterenol is not taken up by nerve endings, the ratio of [3H]isoproterenol to l-[3H]norepinephrine increased after the infusion ended. This increase was almost completely abolished by pretreatment with desipramine. These results indicate that (a) increased plasma norepinephrine levels seen in some patients with essential hypertension result from increased sympathetic neural activity and not from decreased clearance of norepinephrine, (b) changes in the isoproterenol/norepinephrine ratio after simultaneous infusion of both provide an index of neuronal norepinephrine uptake in man, and (c) neuronal norepinephrine uptake is not stereospecific.
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Goldstein DS, McCarty R, Polinsky RJ, Kopin IJ. Relationship between plasma norepinephrine and sympathetic neural activity. Hypertension 1983; 5:552-9. [PMID: 6345364 DOI: 10.1161/01.hyp.5.4.552] [Citation(s) in RCA: 257] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
For circulating norepinephrine (NE) to reflect sympathetic activity validly, plasma NE should show an intensity-dependent increase during sympathetic stimulation and decrease during sympathetic inhibition, and circulating NE should correlate with more directly obtained measures of sympathetic activity. Review of published evidence indicates that NE in peripheral plasma satisfies these criteria. However, models used to explain the relationship between circulating NE and sympathetic activity must take into account processes intervening between the synaptic cleft and free NE in the circulation and, since sympathetic outflow is regionalized, the contributions of specific vascular beds to circulating NE. In this report a model is presented where removal processes for NE are viewed as acting in series to produce a gradient in NE concentrations from synapse to plasma, and where the relative contributions of specific vascular beds are calculated from the arteriovenous difference in plasma NE across those beds and the percentage of cardiac output distributed to them. In general, venous plasma NE provides a useful estimation of average sympathetic outflow.
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Johnson RH. Autonomic dysfunction in clinical disorders with particular reference to catecholamine release. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1983; 7:219-32. [PMID: 6875190 DOI: 10.1016/0165-1838(83)90075-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The role of autonomic dysfunctions in clinical disorders is discussed. Particular attention is paid to catecholamine release, plasma levels and noradrenaline clearance in various disease states and how they are affected by aging. What can be determined from plasma norepinephrine levels requires caution for reasons given. The topics dealt with most specifically are: (1) clinical dysfunctions with raised plasma catecholamine levels and how pathophysiological states may cause or be affected thereby; (2) the abnormalities produced by reduced sympathetic activity; (3) other neurological disorders affecting autonomic functions; and (4) disorders in which abnormal autonomic system function is in doubt, such as orthostatic hypotension in the elderly.
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Abstract
Of 78 comparative studies of plasma catecholamines in patients with essential hypertension and in normotensive controls, most reported higher catecholamine levels in the hypertensives, although only about 40% of the studies were positive (reporting statistically significant hypertensive-normotensive differences). Although there was dramatic variability in catecholamine values within and across studies, virtually all studies of norepinephrine in young, consistently hypertensive patients were positive. The likelihood that a study was positive with respect to norepinephrine was independent of the likelihood with respect to epinephrine, so that total catecholamine values, or else the sum of norepinephrine plus epinephrine, differentiated hypertensives from normotensives to a greater extent than levels of either substance alone. The preponderance of literature on the subject supports the hypothesis that increased plasma catecholamine concentrations occur in some patients with essential hypertension. Elevated plasma norepinephrine in relatively young, established hypertensive patients is consistent with a pathophysiologic role for increased sympathetic neural activity in this subgroup.
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Jackman GP. A simple method for the assay of urinary metanephrines using high performance liquid chromatography with fluorescence detection. Clin Chim Acta 1982; 120:137-42. [PMID: 7067134 DOI: 10.1016/0009-8981(82)90084-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A method is described which extends a high performance liquid chromatographic assay for urinary catecholamines to the assay of urinary metanephrines. The amines are separated from urine after acid hydrolysis of conjugates by ion-exchange chromatography, and then further purified by solvent extraction. The final extracts are suitable for direct HPLC assay using the endogenous fluorescence of the amines for detection. Twenty-four hour excretion of the amines in 35 hospital in-patients was found to be (mean and range: 169 micrograms/24 h normetanephrine (39-423), 102 micrograms/24 h metanephrine (19-290) and 138 micrograms/24 h 3-methoxytyramine (32-234)).
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