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Lin SY, Lin CL, Lin CC, Hsu WH, Hsu CY, Kao CH. Chronic Kidney Disease Progression Risk in Patients With Diabetes Mellitus Using Dihydropyridine Calcium Channel Blockers: A Nationwide, Population-Based, Propensity Score Matching Cohort Study. Front Pharmacol 2022; 13:786203. [PMID: 35355728 PMCID: PMC8959929 DOI: 10.3389/fphar.2022.786203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Whether diabetes mellitus (DM) patients with chronic kidney disease (CKD) can glean individual renal benefit from dihydropyridine calcium channel blockers (DCCBs) remains to be determined. We conducted a nationwide, population-based, propensity score matching cohort study to examine the effect of DCCBs on CKD progression in DM patients with CKD. Methods: One million individuals were randomly sampled from Taiwan’s National Health Insurance Research Database. The study cohort consisted of DM patients with CKD who used DCCBs. The comparison cohort was propensity-matched for demographic characteristics and comorbidities. The endpoint was advanced CKD or end-stage renal disease (ESRD). The Cox proportional hazards model was used to calculate the risks. Results: In total, 9,761 DCCB users were compared with DCCB nonusers at a ratio of 1:1. DCCB users had lower risk of advanced CKD and ESRD than nonusers—with adjusted hazard ratio [aHR; 95% confidence interval (CI)] of 0.64 (0.53–0.78) and 0.59 (95% CI, 0.50–0.71) for advanced CKD and ESRD, respectively. DCCB users aged ≥65 years had the lowest incidence rates of advanced CKD and ESRD—with aHR (95% CI) of 0.47 (0.34–0.65) and 0.48 (0.35–0.65) for advanced CKD and ESRD, respectively. Finally, cumulative DCCB use for >1,100 days was associated with the lowest advanced CKD and ESRD risks [(aHR, 0.29 (95% CI, 0.19–0.44)]. Conclusion: DM patients with CKD who used DCCBs had lower risk of progression to advanced CKD and ESRD than nonusers did.
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Affiliation(s)
- Shih-Yi Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Chest Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine, PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.,Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung, Taiwan
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Cativo EH, Lopez PD, Cativo DP, Atlas SA, Rosendorff C. The Effect of Calcium Channel Blockers on Moderate or Severe Albuminuria in Diabetic, Hypertensive Patients. Am J Med 2021; 134:104-113.e3. [PMID: 32645341 DOI: 10.1016/j.amjmed.2020.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Inhibitors of the renin-angiotensin system are recommended for the management of albuminuria in patients with hypertension and diabetes mellitus, but there is little consensus about alternative therapies. Calcium channel blockers are recommended for the management of hypertension, but the data are controversial regarding their role in patients with albuminuria. This review was designed to assess the efficacy of calcium channel blockers compared with inhibitors of the renin-angiotensin system in decreasing albuminuria in diabetic, hypertensive patients with nephropathy. METHODS We searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov for records that compared calcium channel blockers to inhibitors of the renin-angiotensin system and reported pre- and postintervention albuminuria measurements. Two reviewers independently screened abstracts for randomized, controlled trials in adults. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to select 29 trials from 855 records. We synthesized the data through a random-effects model. RESULTS We analyzed data from 2113 trial participants with hypertension and diabetes mellitus who had the equivalent of ≥30 mg/day of urinary albumin excretion. Inhibitors of the renin-angiotensin system were more effective than calcium channel blockers in decreasing albuminuria (standardized difference in means -0.442; confidence interval, -0.660 to -0.225; P < .001). This finding was independent of the blood pressure response to treatment. There was no difference between the 2 drug classes regarding markers of renal function. CONCLUSIONS Inhibitors of the renin-angiotensin system are superior to calcium channel blockers for the reduction of albuminuria in nephropathy due to hypertension and diabetes mellitus. The net clinical benefit, however, is small.
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Affiliation(s)
- Eder H Cativo
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; Cardiology/Hypertension Research Program, James J. Peters V. A. Medical Center, Bronx, NY
| | - Persio D Lopez
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; Cardiology/Hypertension Research Program, James J. Peters V. A. Medical Center, Bronx, NY
| | - Diana P Cativo
- Health + Hospitals/Metropolitan Hospital, Department of Medicine, New York Medical College, New York, NY
| | - Steven A Atlas
- Cardiology/Hypertension Research Program, James J. Peters V. A. Medical Center, Bronx, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Clive Rosendorff
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY; Cardiology/Hypertension Research Program, James J. Peters V. A. Medical Center, Bronx, NY.
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Burnier M, Lin S, Ruilope L, Bader G, Durg S, Brunel P. Effect of angiotensin receptor blockers on blood pressure and renal function in patients with concomitant hypertension and chronic kidney disease: a systematic review and meta-analysis. Blood Press 2019; 28:358-374. [PMID: 31392910 DOI: 10.1080/08037051.2019.1644155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Angiotensin receptor blockers (ARB) are among the recommended first-line treatment options in patients with hypertension and chronic kidney disease (CKD). This meta-analysis evaluated the effect of ARB on blood pressure (BP) and renal function in patients with concomitant hypertension and CKD with or without diabetes.Methods: Literature search was performed in PubMed/MEDLINE, EMBASE and BIOSIS to identify parallel-group, randomized controlled trials (≥8 weeks) reporting the effects of ARB on office systolic/diastolic BP (SBP/DBP), estimated glomerular filtration rate (eGFR), serum creatinine (SCr), creatinine clearance (CrCl) or proteinuria in adults with hypertension and CKD. Mean difference (MD, generic inverse variance) with 95% confidence intervals (CIs) was used to report an outcome.Results: Among the 24 studies identified, 19 evaluated ARB as monotherapy, 4 evaluated ARB as combination therapy and one evaluated ARB both as monotherapy and combination therapy. Median (range) duration of the studies was 12 (1.84-54.0) months. ARB monotherapy significantly (p < 0.01) reduced BP (treatment ≥1 year: SBP [MD: -14.84 mmHg; 95% CI: -17.82 to -11.85]/DBP [-10.27 mmHg; -12.26 to -8.27]) and proteinuria (≥1 year [-0.90 g/L; -1.22 to -0.59]). Results were consistent for combination therapy. In these studies, non-significant changes were observed for eGFR, CrCl and SCr. The impact of SBP changes on eGFR was not significant; however, studies were of a relatively short duration.Conclusion: ARB had a favorable impact on BP and renal parameters such as proteinuria with monotherapy as well as with combination therapy, highlighting their potential benefits in patients with hypertension and CKD. During the short follow-up of these studies, no significant change in eGFR was observed.
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Affiliation(s)
- Michel Burnier
- Service of Nephrology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Shanyan Lin
- Huashan Hospital, Fudan University, Shanghai, China
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Pongpanich P, Pitakpaiboonkul P, Takkavatakarn K, Praditpornsilpa K, Eiam-Ong S, Susantitaphong P. The benefits of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers combined with calcium channel blockers on metabolic, renal, and cardiovascular outcomes in hypertensive patients: a meta-analysis. Int Urol Nephrol 2018; 50:2261-2278. [DOI: 10.1007/s11255-018-1991-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
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Ghiadoni L, Bruno RM, Cartoni G, Stea F, Magagna A, Virdis A, Grassi D, Ferri C, Taddei S. Combination therapy with lercanidipine and enalapril reduced central blood pressure augmentation in hypertensive patients with metabolic syndrome. Vascul Pharmacol 2017; 92:16-21. [DOI: 10.1016/j.vph.2015.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/29/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
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Ameen, Kashif MA, Sumreen. To compare anti-albumin urea effects of valsartan alone with combination of valsartan and amlodipine in patients of chronic kidney disease. Pak J Med Sci 2016; 32:613-6. [PMID: 27375700 PMCID: PMC4928409 DOI: 10.12669/pjms.323.9541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare anti-albumin urea effects of Valsartan alone with combination of Valsartan and Amlodipine in patients of chronic kidney disease. Methods: This randomized clinical trial was conducted at the Department of Medicine, Combined Military Hospital Bahawalpur, from April 2014 to 30 September 2014. 140 patients of chronic kidney disease with baseline blood pressure more than 140/90mm Hg having raised urinary albumin: creatinine ratio (UACR). UACR more than 3.5 mg/mmol was considered abnormal. Group-A was treated with Valsartan 80mg daily and Group-B was treated with valsartan 80 and amlodipine 10mg once a day. We did not change the dose of drugs and check spot UACR at base line and after six months with therapy and compare improvement in UACR between Group-A and B. Data was analyzed by statistical software packages (SPSS 16.0). Results: In both the groups, BP was significantly lower than the respective value. Mean decrease in spot UACR in Group-A was 3.18±2.64 mg/mmol and UACR in Group-B mean decrease in UACR was 13.01±20.11 mg/mmol. P value was< 0.05. Conclusion: The combination therapy of valsartan with amlodipine significantly lowers the albuminuria in chronic Kidney disease and reduce the progression of disease as compared to Valsartan alone therapy.
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Affiliation(s)
- Ameen
- Dr. Ameen, FCPS. Department of Medicine, Combine Military Hospital (CMH), Bahawalpur, Pakistan
| | - Muhammad Ali Kashif
- Dr. Muhammad Ali Kashif, FCPS. Department of Medicine, Combine Military Hospital (CMH), Bahawalpur, Pakistan
| | - Sumreen
- Dr. Sumreen, M.Phil. Department of Pathology, SMBBMC, Department of Medicine, Combine Military Hospital (CMH), Bahawalpur, Pakistan
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Cheng Y, Huang R, Kim S, Zhao Y, Li Y, Fu P. Renoprotective effects of renin-angiotensin system inhibitor combined with calcium channel blocker or diuretic in hypertensive patients: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2016; 95:e4167. [PMID: 27428210 PMCID: PMC4956804 DOI: 10.1097/md.0000000000004167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To conduct a meta-analysis of studies comparing the renoprotective effects of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) combined with either calcium channel blocker (CCB) or diuretic, but not both, in hypertensive patients. DATA SOURCES Pubmed, Embase, Medline, and Cochrane databases were searched to identify randomized controlled trials (RCTs) of blood pressure lowering treatments in patients with hypertension. STUDY SELECTION RCTs comparing the renoprotective effects of ACEI/ARB plus CCB with ACEI/ARB plus diuretic in hypertensive patients, with at least one of the following reported outcomes: urinary protein, estimated glomerular filtration rate/creatinine clearance (eGFR/CrCl), or serum creatinine. RESULTS Based on 14 RCTs with 18,125 patients, statistically significant benefits were found in ACEI/ARB plus CCB for maintaining eGFR/CrCl (standardized mean difference [SMD] = 0.36; 95% confidence interval [CI]: 0.20-0.53; P < 0.001), serum creatinine reduction (mean difference [MD] = -0.05 mg/dL; 95% CI: -0.07 to -0.03; P < 0.001). However, no statistical differences were found between the 2 therapeutic strategies in terms of urinary protein (MD = 7.48%; 95% CI: -6.13% to 21.08%; P = 0.28; I = 92%). CONCLUSIONS This meta-analysis concluded that ACEI/ARB plus CCB have a stronger effect on the maintenance of renal function in patients with hypertension than ACEI/ARB plus diuretic.
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Affiliation(s)
- Yiming Cheng
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Sichuan
| | - Rongshuang Huang
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Sichuan
| | - Sehee Kim
- Department of Biostatistics, University of Michigan School of Public Health
| | - Yuliang Zhao
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Sichuan
| | - Yi Li
- Department of Biostatistics, University of Michigan School of Public Health
- Kidney Epidemiology and Cost Center, University of Michigan, MI
| | - Ping Fu
- Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Sichuan
- West China Biostatistics and Cost-Benefit Analysis Center West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Correspondence: Ping Fu, Renal Division, Department of Internal Medicine, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan, China (e-mail: )
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8
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Thamcharoen N, Susantitaphong P, Wongrakpanich S, Chongsathidkiet P, Tantrachoti P, Pitukweerakul S, Avihingsanon Y, Praditpornsilpa K, Jaber BL, Eiam-Ong S. Effect of N- and T-type calcium channel blocker on proteinuria, blood pressure and kidney function in hypertensive patients: a meta-analysis. Hypertens Res 2015; 38:847-55. [PMID: 26134125 DOI: 10.1038/hr.2015.69] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/12/2015] [Accepted: 05/27/2015] [Indexed: 12/28/2022]
Abstract
The combination of a calcium channel blocker (CCB) and a blocker of the renin-angiotensin-aldosterone system (RAAS) is recommended in clinical practice guidelines. L/N- and L/T-type CCBs might provide an additional effect on lowering proteinuria. Therefore, we conducted a meta-analysis to assess the efficacy of L/N- and L/T-type CCBs in hypertensive patients with proteinuria. We searched MEDLINE, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for single-arm studies and randomized controlled trials (RCTs) that examined the effect of L/N- and L/T-type CCBs as add-on therapy compared with standard antihypertensive regimen for proteinuria on hemodynamic and kidney-related parameters in hypertensive patients with proteinuria. Random-effect model meta-analyses were used to compute changes in the outcomes of interest. We identified 17 RCTs, representing 1905 patients. By meta-analysis, L/N- and L/T-type CCB add-on therapy did not yield significant changes in systolic and diastolic blood pressure compared with standard treatment, but there was a significant lowering of the pulse rate. However, L/N- and L/T-type CCBs resulted in a significant standardized net decrease in albuminuria and proteinuria (-1.01; 95% confidence interval (CI), -1.78 to -0.23; P=0.01), and a standardized net improvement in the estimated glomerular filtration rate and serum creatinine (0.23; 95% CI, 0.11 to 0.35, P<0.001; and -0.25; 95% CI, -0.46 to -0.03; P=0.02, respectively). Despite no additional lowering effect on blood pressure, L/N- and L/T-type CCBs combined with a blocker of the RAAS provided a decrease in proteinuria and improvement in kidney function. Further studies are required to establish the long-term kidney benefits of this combination therapy.
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Affiliation(s)
- Natanong Thamcharoen
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Supakanya Wongrakpanich
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pakawat Chongsathidkiet
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pakpoom Tantrachoti
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siwadon Pitukweerakul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bertrand L Jaber
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Department of Medicine, St Elizabeth's Medical Center, Boston, MA, USA
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Tan W, Madhavan K, Hunter KS, Park D, Stenmark KR. Vascular stiffening in pulmonary hypertension: cause or consequence? (2013 Grover Conference series). Pulm Circ 2014; 4:560-80. [PMID: 25610594 PMCID: PMC4278618 DOI: 10.1086/677370] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 05/27/2014] [Indexed: 12/24/2022] Open
Abstract
Recent studies have indicated that systemic arterial stiffening is a precursor to hypertension and that hypertension, in turn, can perpetuate arterial stiffening. Pulmonary artery (PA) stiffening is also well documented to occur in pulmonary hypertension (PH), and there is evidence that pulmonary vascular stiffness (PVS) may be a better predictor of outcome than pulmonary vascular resistance (PVR). We have hypothesized that the decreased flow-damping function of elastic PAs in PH likely initiates and/or perpetuates dysfunction of pulmonary microvasculature. Recent studies have shown that large-vessel stiffening increases flow pulsatility in the distal pulmonary vasculature, leading to endothelial dysfunction within a proinflammatory, vasoconstricting, and profibrogenic environment. The intricate role of stiffening-stimulated high pulsatile flow in endothelial cell dysfunction includes stepwise molecular events underlying PA hypertrophy, inflammation, endothelial-mesenchymal transition, and fibrosis. In addition to contributing to microenvironmental alterations of the distal vasculature, disordered proximal-distal PA coupling likely also plays a role in increasing ventricular afterload, ultimately causing right ventricle (RV) dysfunction and death. Current therapeutic treatments do not provide a realistic approach to destiffening arteries and, thus, to potentially abrogating the effects of high pulsatile flow on the distal pulmonary vasculature or the increased work imposed by stiffening on the RV. Scrutinizing the effect of PA stiffening on high pulsatile flow-induced cellular and molecular changes, and vice versa, might lead to important new therapeutic options that abrogate PA remodeling and PH development. With a clear understanding that PA stiffening may contribute to the progression of PH to an irreversible state by contributing to chronic microvascular damage in lungs, future studies should be aimed first at defining the underlying mechanisms leading to PA stiffening and then at improved treatment approaches based on these findings.
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Affiliation(s)
- Wei Tan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, Colorado, USA
| | - Krishna Madhavan
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kendall S. Hunter
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Daewon Park
- Department of Bioengineering, University of Colorado Denver, Aurora, Colorado, USA
| | - Kurt R. Stenmark
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
- Cardiovascular Pulmonary Research Laboratories, University of Colorado Denver, Aurora, Colorado, USA
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Effects of single pill-based combination therapy of amlodipine and atorvastatin on within-visit blood pressure variability and parameters of renal and vascular function in hypertensive patients with chronic kidney disease. BIOMED RESEARCH INTERNATIONAL 2014; 2014:437087. [PMID: 24809050 PMCID: PMC3997867 DOI: 10.1155/2014/437087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/18/2022]
Abstract
Both strict blood pressure (BP) control and improvements in BP profile such as BP variability are important for suppression of renal deterioration and cardiovascular complication in hypertension and chronic kidney disease (CKD). In the present study, we examined the beneficial effects of the single pill-based combination therapy of amlodipine and atorvastatin on achievement of the target BP and clinic BP profile, as well as markers of vascular and renal damages in twenty hypertensive CKD patients. The combination therapy with amlodipine and atorvastatin for 16 weeks significantly decreased clinic BP, and achievement of target BP control was attained in an average of 45% after the combination therapy in spite of the presence of no achievement at baseline. In addition, the combination therapy significantly decreased the within-visit BP variability. With respect to the effects on renal damage markers, combination therapy with amlodipine and atorvastatin for 16 weeks significantly decreased albuminuria (urine albumin-to-creatinine ratio, 1034 ± 1480 versus 733 ± 1218 mg/g-Cr, P < 0.05) without decline in estimated glomerular filtration rate. Concerning parameters of vascular function, the combination therapy significantly improved both brachial-ankle pulse wave velocity (baPWV) and central systolic BP (cSBP) (baPWV, 1903 ± 353 versus 1786 ± 382 cm/s, P < 0.05; cSBP, 148 ± 19 versus 129 ± 23 mmHg, P < 0.01). Collectively, these results suggest that the combination therapy with amlodipine and atorvastatin may exert additional beneficial effects on renal and vascular damages as well as BP profile in addition to BP lowering in hypertension with CKD.
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Liu M, Li GL, Li Y, Wang JG. Effects of Various Antihypertensive Drugs on Arterial Stiffness and Wave Reflections. ACTA ACUST UNITED AC 2013; 1:97-107. [PMID: 26587429 PMCID: PMC4315340 DOI: 10.1159/000354108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We reviewed trials that tested the efficacy of antihypertensive drugs in reducing arterial stiffness and wave reflections as assessed by pulse wave velocity and augmentation index, respectively. Regardless of cross-over or parallel-group comparison design, placebo-controlled trials demonstrated that antihypertensive drugs were effective in reducing pulse wave velocity. In actively-controlled parallel-group comparison studies, this effect on arterial stiffness was more evident for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers than other classes of antihypertensive drugs, particularly when brachial-ankle pulse wave velocity was measured. Regardless of cross-over or parallel-group comparison or placebo- or actively-controlled design, the reviewed trials showed that β-blockers were inferior to all the other classes of antihypertensive drugs in reducing augmentation index. However, these studies had a small sample size and a short follow-up time and did not link the changes in measurements of arterial function with cardiovascular events. Whether the superiority or inferiority is clinically relevant for cardiovascular protection and prevention remains to be investigated.
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Affiliation(s)
- Ming Liu
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ge-Le Li
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Noto H, Goto A, Tsujimoto T, Noda M. Effect of calcium channel blockers on incidence of diabetes: a meta-analysis. Diabetes Metab Syndr Obes 2013; 6:257-61. [PMID: 23935375 PMCID: PMC3735278 DOI: 10.2147/dmso.s49767] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS Insulin resistance and the progressive loss of β-cell function are components of the fundamental pathophysiology of type II diabetes. A recent experimental study suggested that calcium channel blockers (CCBs) might inhibit β-cell apoptosis, enhance β-cell function, and prevent diabetes. The present meta-analysis examined the clinical effect of CCBs on the incidence of diabetes. METHODS MEDLINE, EMBASE, ISI Web of Science, the Cochrane Library, and ClinicalTrials. gov were each searched for relevant articles published up to March 11, 2013. Randomized controlled trials (RCTs) with a follow-up period of at least 1-year were included. Identified articles were systematically reviewed, and those with pertinent data were selected for inclusion in a meta-analysis. RESULTS We included ten RCTs in a meta-analysis. Of the 108,118 people with hypertension and no pre-existing diabetes, 7,073 (6.5%) cases of type II diabetes were reported. CCBs were associated with a higher incidence of diabetes than angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs; pooled risk ratios [95% confidence intervals]: 1.23 [1.01-1.51] and 1.27 [1.14-1.42], respectively) and a lower incidence compared with β blockers or diuretics (0.83 [0.73-0.94] and 0.82 [0.69-0.98], respectively). The overall risk of diabetes among subjects taking CCBs was not significant (0.99 [0.85-1.15]). CONCLUSION THE USE OF CCBS WAS NOT SIGNIFICANTLY ASSOCIATED WITH INCIDENT DIABETES COMPARED TO OTHER ANTIHYPERTENSIVE AGENTS: the association with diabetes was lowest for ACEIs and ARBs, followed by CCBs, β blockers, and diuretics. Although CCBs can be safely used in hypertensive patients, it would be premature to advocate CCBs for the prevention or treatment of diabetes.
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Affiliation(s)
- Hiroshi Noto
- Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
- Correspondence: Hiroshi Noto, Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan, Tel +81 3 3202 7181, Fax +81 3 3207 1038, Email
| | - Atsushi Goto
- Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuro Tsujimoto
- Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
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Martell Claros N, Prieto Díaz M. Cuándo y por qué iniciar el tratamiento farmacológico con doble terapia. Semergen 2012; 38:445-51. [DOI: 10.1016/j.semerg.2012.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/25/2012] [Accepted: 04/01/2012] [Indexed: 01/13/2023]
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Zhu DL, Bays H, Gao P, Mattheus M, Voelker B, Ruilope LM. Efficacy and tolerability of initial therapy with single-pill combination telmisartan/hydrochlorothiazide 80/25 mg in patients with grade 2 or 3 hypertension: a multinational, randomized, double-blind, active-controlled trial. Clin Ther 2012; 34:1613-24. [PMID: 22717420 DOI: 10.1016/j.clinthera.2012.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 05/23/2012] [Accepted: 05/23/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with grade 2 or 3 hypertension may require high-dose combination therapy to achieve blood pressure (BP) targets in a timely manner. OBJECTIVES This study compared the effectiveness and tolerability of a single-pill combination (SPC) of telmisartan/hydrochlorothiazide 80/25 mg (T80/H25) with T80 monotherapy. METHODS In a Phase IV, multinational, randomized, double-blind, double-dummy, active-controlled, parallel-group trial, 894 patients with mean seated trough cuff systolic BP [SBP] ≥160 mm Hg and diastolic BP [DBP] ≥100 mm Hg were randomly assigned in a 2:1 ratio to receive T40/H12.5 SPC or telmisartan 40 mg monotherapy for 1 week before the dose was uptitrated to T80/H25 SPC or T80, respectively, administered for 6 weeks. The primary efficacy measure was the change from baseline in mean seated cuff trough SBP. Adverse events (AEs) were recorded. RESULTS A total of 888 patients received treatment (294 and 594 patients in the T80/H25 and T80 groups, respectively) (mean age, 57.0 years; age ≥65 years, 25.7%; male, 53.8%; white, 68.0%); 61 patients prematurely discontinued. Mean baseline SBP/DBP values were 172.3/104.3 mm Hg (T80/H25) and 173.3/104.5 mm Hg (T80). After 7 weeks, SBP was changed by -37.0 and -28.5 mm Hg in the T80/H25 and T80 groups (P < 0.0001); DBP was changed by -18.6 and -15.4 mm Hg respectively (P < 0.0001). These differences were significant after 2 weeks at the higher dosage (P < 0.0001). BP target (SBP/DBP <140/<90 mm Hg) was achieved in 55.5% and 34.7% of patients in the T80/H25 and T80 groups (P < 0.0001). T80/H25 SPC and T80 had a similar frequency of overall AEs (16.0% vs 17.0%). The prevalences of treatment-related AEs with T80/H25 SPC and T80 were low (4.6% and 2.8%), as were the rates of AEs that led to discontinuation (1.0% and 2.8%). CONCLUSIONS In these patients with grade 2 or 3 hypertension, initial therapy with T80/H25 was associated with a significantly greater reduction in mean seated cuff trough SBP compared with T80 alone, as well as with improved hypertension goal attainment rates. Both treatments appeared to be well tolerated.
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Affiliation(s)
- Dingliang L Zhu
- Shanghai Ruijin Hospital, Shanghai Institute of Hypertension, 197 Ruijin 2nd Road, Shanghai, China.
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Maeda A, Tamura K, Kanaoka T, Ohsawa M, Haku S, Azushima K, Dejima T, Wakui H, Yanagi M, Okano Y, Fujikawa T, Toya Y, Mizushima S, Tochikubo O, Umemura S. Combination Therapy of Angiotensin II Receptor Blocker and Calcium Channel Blocker Exerts Pleiotropic Therapeutic Effects in Addition to Blood Pressure Lowering: Amlodipine and Candesartan Trial in Yokohama (ACTY). Clin Exp Hypertens 2012; 34:249-57. [DOI: 10.3109/10641963.2012.681081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2010; 27:2121-58. [PMID: 19838131 DOI: 10.1097/hjh.0b013e328333146d] [Citation(s) in RCA: 999] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Mourad JJ, Le Jeune S, Pirollo A, Mourad C, Gaudouen Y, Lopez-Sublet M. Combinations of inhibitors of the renin-angiotensin system with calcium channel blockers for the treatment of hypertension: focus on perindopril/amlodipine. Curr Med Res Opin 2010; 26:2263-76. [PMID: 20690889 DOI: 10.1185/03007995.2010.510925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Combination antihypertensive therapy with an inhibitor of the renin-angiotensin system (RAS) and a calcium channel blocker (CCB) is a rational approach to achieve blood pressure (BP) goals in patients with hypertension, and may provide additional cardiovascular protection compared to other strategies in special populations. This article reviews the rationale for, and evidence supporting, the use of newer fixed-dose combinations of RAS inhibitors and CCBs, with particular emphasis on perindopril/amlodipine. METHODS A literature search was performed in Medline and EMBASE databases to identify articles published up to May 2010 describing the impact of combination treatment with angiotensin receptor blocker (ARB)/CCB or angiotensin-converting enzyme (ACE) inhibitor/CCB based antihypertensive strategies on BP or clinical outcomes. FINDINGS A substantial body of evidence supports the BP-lowering efficacy of RAS inhibitor/CCB combination therapy in patients with hypertension. RAS inhibitors and CCBs represent two different and complementary mechanisms of actions; their use in combination is associated with effective BP lowering with favourable tolerability and fewer adverse metabolic effects than some other combination therapies. Currently, intervention studies demonstrating the impact of ARB/CCB combinations on cardiovascular mortality and morbidity are lacking. However, evidence from large outcome trials supports the use of ACE inhibitor/CCB combinations for reducing the risk of cardiovascular and renal events, particularly in high-risk patients. There is also evidence that the benefits of ACE inhibitor/CCB combinations may extend beyond those solely associated with brachial BP lowering, by an additional impact on central BP haemodynamics. CONCLUSIONS RAS inhibitor/CCB combination therapy is an effective antihypertensive therapy. Strong evidence supports the antihypertensive efficacy of ACE inhibitor/CCB combinations with cardioprotective and renoprotective properties. In particular, evidence suggests that fixed-dose perindopril/amlodipine effectively decreases BP and currently is the only RAS inhibitor/CCB combination proven to decrease all-cause and cardiovascular mortality as well as major cardiovascular events, and thus is a valuable option for the management of hypertension, especially in high-risk patients.
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Affiliation(s)
- Jean-Jacques Mourad
- Dept of Internal Medicine & Arterial Hypertension, Avicenne Hospital, Bobigny Cedex, France.
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Gorostidi M, de la Sierra A. Antagonistas de los receptores de la angiotensina II en combinación con antagonistas del calcio. Focus en la asociación de olmesartán con amlodipino. HIPERTENSION Y RIESGO VASCULAR 2010. [DOI: 10.1016/s1889-1837(10)70015-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Comparative effects of benidipine and amlodipine on proteinuria, urinary 8-OHdG, urinary L-FABP, and inflammatory and atherosclerosis markers in early-stage chronic kidney disease. Am J Med Sci 2010; 339:157-63. [PMID: 20145433 DOI: 10.1097/maj.0b013e3181c643df] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION We examined the effects of 2 calcium channel blockers, benidipine (T-, L-, and N-type) and amlodipine (L- and N-type), on renal, inflammatory, oxidative, and atherosclerosis markers in hypertensive patients with mild chronic kidney disease (CKD). METHODS Forty hypertensive patients with CKD were assigned randomly to either of the 2 treatments: 8 mg benidipine once daily (n = 20, group A) or 5 mg amlodipine once daily (n = 20, group B). Treatment was continued for 12 months. Blood pressure, serum creatinine, estimated glomerular filtration rate, urinary protein excretion, urinary liver-type fatty acid-binding protein, interleukin-6, high mobility group box-1 protein, urinary 8-hydroxy-2'-deoxyguanosine, pulse wave velocity, intima-media thickness, and blood asymmetric dimethylarginine were monitored. RESULTS Blood pressure decreased equally in both groups (P < 0.001, at 6 and 12 months versus before treatment). Serum creatinine and estimated glomerular filtration rate changed little during the experimental period in each group. However, urinary protein excretion (P < 0.001), urinary liver-type fatty acid-binding protein (P < 0.001), urinary 8-hydroxy-2'-deoxyguanosine (P < 0.001), blood interleukin-6 (P < 0.001), blood high mobility group box-1 (P < 0.05), and pulse wave velocity (P < 0.01) decreased more in group A than in group B with 12 months of treatment. The percent reductions in intima-media thickness and blood asymmetric dimethylarginine were significantly greater in group A than in group B (P < 0.001). CONCLUSIONS Benidipine is more effective than amlodipine for protecting renal function and potentially for ameliorating atherosclerosis in hypertensive patients with mild CKD. T-type calcium channel blockers may be effective in patients with CKD.
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Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, Cifkova R, Clément D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HAJ, Van Zwieten PA, Viigimaa M, Zanchetti A. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. Blood Press 2010; 18:308-47. [PMID: 20001654 DOI: 10.3109/08037050903450468] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Giuseppe Mancia
- Clinica Medica, University of Milano-Bicocca, Ospedale San Gerardo, 20052 Monza, Milan, Italy.
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Abstract
Elderly patients have medical and psychological problems affecting all major organ systems. These problems may alter the pharmacokinetics and/or pharmacodynamics of medications, or expose previous neurologic deficits simply as a result of sedation. Delayed arousal, therefore, may arise from structural problems that are pre-existent or new, or metabolic or functional disorders such as convulsive or nonconvulsive seizures. Determining the cause of delayed arousal may require clinical, chemical, and structural tests. Structural problems that impair consciousness arise from a small number of focal lesions to specific areas of the central nervous system, or from pathology affecting the cerebrum. In general, focal or multifocal lesions can be identified by computerized tomography, or diffusion-weighted imaging. An algorithm is presented that outlines a workup for an elderly patient with delayed arousal.
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Affiliation(s)
- Zirka H Anastasian
- Division of Neurosurgical Anesthesiology, Department of Anesthesiology, Columbia University, New York, NY 10032, USA.
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