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Choi WJ, Kim GA, Park J, Jang S, Jung WJ, Shim JJ, Park Y, Choi GH, Kim JW, Jeong SH, Jang ES. Incidence and Pattern of Aminotransferase Elevation During Anti-Hypertensive Therapy With Angiotensin-II Receptor Blockers. J Korean Med Sci 2022; 37:e255. [PMID: 35996932 PMCID: PMC9424746 DOI: 10.3346/jkms.2022.37.e255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Angiotensin type II receptor blockers (ARBs) are the most widely used anti-hypertensive drugs. This study aimed to elucidate the likelihood and pattern of ARB-induced liver injury in a hospital-based cohort. METHODS Data of patients receiving fimasartan (n = 5,543), candesartan (n = 6,406), valsartan (n = 6,040), and losartan (n = 9,126) were retrieved from the clinical data warehouse of two tertiary hospitals. Patients with alanine aminotransferase (ALT) levels > 5 times the upper normal limit were assessed according to the Roussel Uclaf Causality Assessment Method (RUCAM). RESULTS A total of 27,115 patients were enrolled, including 14,630 (54.0%) men, with a mean age of 64.6 years (standard deviation, 13.6). During 31,717 person-years of ARB therapy, serum ALT levels > 120 IU/L were found in 558 (2.1%) person-years, and levels > 200 IU/L were found in 155 (0.6%) person-years. The incidence of ALT elevation > 120 IU/L per 106 cumulative defined daily doses was 6.6, 3.6, 3.9, and 4.0 in the fimasartan, candesartan, valsartan, and losartan groups, respectively (P = 0.002). An ALT level > 200 IU/L with RUCAM score ≥ 6 was found in 20 patients, suggesting probable drug-induced liver injury for 11 (0.2%) patients receiving fimasartan, five (0.1%) receiving candesartan, four (0.1%) receiving valsartan, and none receiving losartan (P < 0.001). CONCLUSION Approximately 2% of patients receiving ARB therapy had significant ALT elevation (4.24/106 cumulative defined daily doses [cDDDs]), which was associated with probable ARB-related liver injury in 0.07% of patients (0.15/106 cDDDs). Elevation of ALT was more commonly associated with fimasartan than the other ARBs. Clinicians should be aware of the possibility of ARB-related ALT elevation in patients with unexplained chronic abnormal ALT.
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Affiliation(s)
- Won Joon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gi-Ae Kim
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jaewon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangmi Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Jin Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Yewan Park
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Gwang Hyeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Golubovsky JL, Karnuta JM, Lee M, Enders J, Banerjee A, Grits D, Nowacki A, Ilyas H, Steinmetz MP. A Retrospective Cohort Study of Effects of Antihypertensive and Anticholinergic Medications on Outcomes Following Elective Posterior Lumbar Spine Surgery. Clin Spine Surg 2021; 34:E295-E302. [PMID: 33290327 DOI: 10.1097/bsd.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective consecutive cohort analysis. OBJECTIVE This study aimed to examine the association between commonly prescribed medications and outcomes following posterior lumbar spine surgery. SUMMARY OF BACKGROUND DATA Postoperative complications and prolonged length of stay significantly increase costs following posterior lumbar spine surgery and worsen patient outcomes. To control costs and complications, providers should focus on modifiable risk factors, such as preoperative medications. Antihypertensive and anticholinergic drugs are among the most commonly prescribed medications but can carry significant risks in the perioperative period. MATERIALS AND METHODS This study was a retrospective cohort analysis of patients undergoing posterior lumbar spine surgery from January 2014 through December 2015 at a large tertiary care center. The variable selection followed by multivariable logistic and negative binomial regressions were performed. An α threshold of 0.0056 was used for significance after correction for multiple comparisons. A secondary analysis was performed to evaluate confounding or effect modifying variables. RESULTS This study included 1577 patients. Postoperative urinary retention risk was increased in patients taking loop diuretics. Acute kidney injury risk was increased for patients on nondihydropyridine calcium-channel blockers. Surgical site infection risk was increased for patients on aldosterone receptor blockers. Urinary tract infection risk was increased for patients on anticholinergics for urinary incontinence. Length of stay was decreased for patients on angiotensin II antagonists and angiotensin-converting enzyme inhibitors. CONCLUSION A care path should be established in the perioperative period for patients who are deemed to be at higher risk due to medication status to either modify medications or improve postoperative monitoring. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Joshua L Golubovsky
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute
| | - Jaret M Karnuta
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute
- Department of Quantitative Health Sciences
| | - Maxwell Lee
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute
| | - Jacob Enders
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute
| | - Aditya Banerjee
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute
| | - Daniel Grits
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute
| | | | - Haariss Ilyas
- Department of Orthopaedics, Orthopaedic and Rheumatologic Institute
| | - Michael P Steinmetz
- Department of Neurosurgery, Center for Spine Health, Neurologic Institute, Cleveland Clinic, Cleveland, OH
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Ma R, Zhao Y, Yu X, Li N, Wang Q, Liang W, Zhao X, Yu J. Protective effects of irbesartan and benazepril against vaginal vascular remodeling and fibrosis in female spontaneously hypertensive rats. J Int Med Res 2020; 48:300060520943453. [PMID: 32790534 PMCID: PMC7427039 DOI: 10.1177/0300060520943453] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To compare the potential beneficial effects of the angiotensin converting enzyme inhibitor (ACEI) benazepril and the angiotensin II receptor 1 blocker (ARB) irbesartan on vaginal vascular remodeling and fibrosis in female spontaneously hypertensive rats (SHRs). Methods Twelve-week-old female SHRs were treated with irbesartan or benazepril for 12 weeks. Vaginal renin angiotensin system (RAS) components were detected by polymerase chain reaction and western blot and vaginal α-smooth muscle actin (α-SMA), endothelial nitric oxide synthase (eNOS), and collagen III (Col III) were analyzed by western blot. Vaginal tissue sections were examined by hematoxylin and eosin staining, Masson trichrome staining, and immunohistochemical analysis of α-SMA and Col III. Results Irbesartan and benazepril had different impacts on vaginal RAS components. Both agents decreased vaginal α-SMA and Col III and increased eNOS expression in SHR. The wall/lumen thickness ratio of vaginal arterioles was similarly decreased following irbesartan and benazepril treatment. Both drugs also decreased collagen deposition in SHRs. There was no difference in vaginal vascular remodeling or fibrosis between the two groups. Conclusions Irbesartan and benazepril have different effects on vaginal RAS expression but similar positive effects against vaginal vascular remodeling and fibrosis.
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Affiliation(s)
- Ruixin Ma
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
| | - Yang Zhao
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaorong Yu
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
| | - Ningyin Li
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
| | - Qiongying Wang
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
| | - Wei Liang
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
| | - Xu Zhao
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
| | - Jing Yu
- Department of Hypertension, Lanzhou University Second Hospital, Lanzhou, China
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Frieden TR, Varghese CV, Kishore SP, Campbell NRC, Moran AE, Padwal R, Jaffe MG. Scaling up effective treatment of hypertension-A pathfinder for universal health coverage. J Clin Hypertens (Greenwich) 2019; 21:1442-1449. [PMID: 31544349 DOI: 10.1111/jch.13655] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/21/2023]
Abstract
High blood pressure is the world's leading cause of death, but despite treatment for hypertension being safe, effective, and low cost, most people with hypertension worldwide do not have it controlled. This article summarizes lessons learned in the first 2 years of the Resolve to Save Lives (RTSL) hypertension management program, operated in coordination with the World Health Organization (WHO) and other partners. Better diagnosis, treatment, and continuity of care are all needed to improve control rates, and five necessary components have been recommended by RTSL, WHO and other partners as being essential for a successful hypertension control program. Several hurdles to hypertension control have been identified, with most related to limitations in the health care system rather than to patient behavior. Treatment according to standardized protocols should be started as soon as hypertension is diagnosed, and medical practices and health systems must closely monitor patient progress and system performance. Improvement in hypertension management and control, along with elimination of artificial trans fat and reduction of dietary sodium consumption, will improve many aspects of primary care, contribute to goals for universal health coverage, and could save 100 million lives worldwide over the next 30 years.
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Affiliation(s)
- Thomas R Frieden
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York
| | | | - Sandeep P Kishore
- Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Andrew E Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York.,Columbia University, New York, New York
| | - Raj Padwal
- University of Alberta, Edmonton, Alberta, Canada
| | - Marc G Jaffe
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York
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Braschi A. Potential Protective Role of Blood Pressure-Lowering Drugs on the Balance between Hemostasis and Fibrinolysis in Hypertensive Patients at Rest and During Exercise. Am J Cardiovasc Drugs 2019; 19:133-171. [PMID: 30714087 DOI: 10.1007/s40256-018-00316-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In patients with hypertension, the triad represented by endothelial dysfunction, platelet hyperactivity, and altered fibrinolytic function disturbs the equilibrium between hemostasis and fibrinolysis and translates into a hypercoagulable state, which underlies the risk of thrombotic complications. This article reviews the scientific evidence regarding some biological effects of antihypertensive drugs, which can protect patients from the adverse consequences of hypertensive disease, improving endothelial function, enhancing antioxidant activity, and restoring equilibrium between hemostatic and fibrinolytic factors. These protective effects appear not to be mediated through blood pressure reduction and are not shared by all molecules of the same pharmacological class.
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Affiliation(s)
- Annabella Braschi
- Ambulatory of Cardiovascular Diseases, Via col. Romey n.10, 91100, Trapani, Italy.
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García-Conesa MT, Chambers K, Combet E, Pinto P, Garcia-Aloy M, Andrés-Lacueva C, de Pascual-Teresa S, Mena P, Konic Ristic A, Hollands WJ, Kroon PA, Rodríguez-Mateos A, Istas G, Kontogiorgis CA, Rai DK, Gibney ER, Morand C, Espín JC, González-Sarrías A. Meta-Analysis of the Effects of Foods and Derived Products Containing Ellagitannins and Anthocyanins on Cardiometabolic Biomarkers: Analysis of Factors Influencing Variability of the Individual Responses. Int J Mol Sci 2018; 19:ijms19030694. [PMID: 29495642 PMCID: PMC5877555 DOI: 10.3390/ijms19030694] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [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: 01/22/2018] [Revised: 02/15/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022] Open
Abstract
Understanding interindividual variability in response to dietary polyphenols remains essential to elucidate their effects on cardiometabolic disease development. A meta-analysis of 128 randomized clinical trials was conducted to investigate the effects of berries and red grapes/wine as sources of anthocyanins and of nuts and pomegranate as sources of ellagitannins on a range of cardiometabolic risk biomarkers. The potential influence of various demographic and lifestyle factors on the variability in the response to these products were explored. Both anthocyanin- and ellagitannin-containing products reduced total-cholesterol with nuts and berries yielding more significant effects than pomegranate and grapes. Blood pressure was significantly reduced by the two main sources of anthocyanins, berries and red grapes/wine, whereas waist circumference, LDL-cholesterol, triglycerides, and glucose were most significantly lowered by the ellagitannin-products, particularly nuts. Additionally, we found an indication of a small increase in HDL-cholesterol most significant with nuts and, in flow-mediated dilation by nuts and berries. Most of these effects were detected in obese/overweight people but we found limited or non-evidence in normoweight individuals or of the influence of sex or smoking status. The effects of other factors, i.e., habitual diet, health status or country where the study was conducted, were inconsistent and require further investigation.
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Affiliation(s)
- María-Teresa García-Conesa
- Research Group on Quality, Safety and Bioactivity of Plant Foods, CEBAS-CSIC, P.O. Box 164, Campus de Espinardo, 30100 Murcia, Spain.
| | - Karen Chambers
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UA, UK.
| | - Emilie Combet
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G31 2ER, UK.
| | - Paula Pinto
- Biotechnology and Nutrition, Department of Food Technology, ESA, Polytechnic Institute of Santarem, 2001-904 Santarém, Portugal.
- Molecular Nutrition Health Laboratory, iBET/ITQB, 2780-157 Oeiras, Portugal.
| | - Mar Garcia-Aloy
- Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, XaRTA, INSA, Faculty of Pharmacy and Food Sciencies, University of Barcelona, 08028 Barcelona, Spain.
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 08028 Barcelona, Spain.
| | - Cristina Andrés-Lacueva
- Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, XaRTA, INSA, Faculty of Pharmacy and Food Sciencies, University of Barcelona, 08028 Barcelona, Spain.
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 08028 Barcelona, Spain.
| | - Sonia de Pascual-Teresa
- Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), Jose Antonio Novais 10, 28040 Madrid, Spain.
| | - Pedro Mena
- Human Nutrition Unit, Department of Food Drug, University of Parma, 43125 Parma, Italy.
| | - Alekxandra Konic Ristic
- Institute for Medical Research, University of Belgrade, 11000 Belgrade, Serbia.
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK.
| | - Wendy J Hollands
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UA, UK.
| | - Paul A Kroon
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UA, UK.
| | - Ana Rodríguez-Mateos
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Science and Medicine, King's College London, London SE1 9NH, UK.
| | - Geoffrey Istas
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Science and Medicine, King's College London, London SE1 9NH, UK.
| | - Christos A Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece.
| | - Dilip K Rai
- Teagasc Food Research Centre Ashtown, D15 KN3K Dublin, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin 4, Ireland.
| | - Christine Morand
- INRA, Human Nutrition Unit, UCA, CRNH Auvergne, F-63000 Clermont-Ferrand, France.
| | - Juan Carlos Espín
- Research Group on Quality, Safety and Bioactivity of Plant Foods, CEBAS-CSIC, P.O. Box 164, Campus de Espinardo, 30100 Murcia, Spain.
| | - Antonio González-Sarrías
- Research Group on Quality, Safety and Bioactivity of Plant Foods, CEBAS-CSIC, P.O. Box 164, Campus de Espinardo, 30100 Murcia, Spain.
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Ramanathan N, Tan E, Loh LJ, Soh BS, Yap WN. Tocotrienol is a cardioprotective agent against ageing-associated cardiovascular disease and its associated morbidities. Nutr Metab (Lond) 2018; 15:6. [PMID: 29387138 PMCID: PMC5775572 DOI: 10.1186/s12986-018-0244-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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: 07/27/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023] Open
Abstract
Ageing is a nonmodifiable risk factor that is linked to increased likelihood of cardiovascular morbidities. Whilst many pharmacological interventions currently exist to treat many of these disorders such as statins for hypercholesterolemia or beta-blockers for hypertension, the elderly appear to present a greater likelihood of suffering non-related side effects such as increased risk of developing new onset type 2 diabetes (NODM). In some cases, lower efficacy in the elderly have also been reported. Alternative forms of treatment have been sought to address these issues, and there has been a growing interest in looking at herbal remedies or plant-based natural compounds. Oxidative stress and inflammation are implicated in the manifestation of ageing-related cardiovascular disease. Thus, it is natural that a compound that possesses both antioxidative and anti-inflammatory bioactivities would be considered. This review article examines the potential of tocotrienols, a class of Vitamin E compounds with proven superior antioxidative and anti-inflammatory activity compared to tocopherols (the other class of Vitamin E compounds), in ameliorating ageing-related cardiovascular diseases and its associated morbidities. In particular, the potential of tocotrienols in improving inflammaging, dyslipidemia and mitochondrial dysfunction in ageing-related cardiovascular diseases are discussed.
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Affiliation(s)
- Nardev Ramanathan
- Department of R&D, Davos Life Science Pte Ltd, 3 Biopolis Drive, #04-19, Davos, 138623 Singapore
- Department of R&D, Level 8, Menara KLK 1,Jalan Pju 7/6,Mutiara Damansara, 47810, 47800 Petaling Jaya, Selangor Malaysia
| | - Esther Tan
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
| | - Li Jun Loh
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
| | - Boon Seng Soh
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, 117543 Singapore
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 China
| | - Wei Ney Yap
- Department of R&D, Davos Life Science Pte Ltd, 3 Biopolis Drive, #04-19, Davos, 138623 Singapore
- Department of R&D, Level 8, Menara KLK 1,Jalan Pju 7/6,Mutiara Damansara, 47810, 47800 Petaling Jaya, Selangor Malaysia
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Šíma M, Vodička M, Marešová V, Šálek T, Čabala R, Slanař O. Adherence with perindopril therapy: a pilot study using therapeutic drug monitoring of perindoprilat and an evaluation of the clearance estimation. Int J Clin Pharm 2017; 39:1095-1100. [DOI: 10.1007/s11096-017-0522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/02/2017] [Indexed: 11/24/2022]
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