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Nagy A, Májer R, Boczán J, Sipka S, Szabó A, Enyedi EE, Tatai O, Fagyas M, Papp Z, Csiba L, Tóth A. Enalapril Is Superior to Lisinopril in Improving Endothelial Function without a Difference in Blood-Pressure-Lowering Effects in Newly Diagnosed Hypertensives. Biomedicines 2023; 11:3323. [PMID: 38137544 PMCID: PMC10742010 DOI: 10.3390/biomedicines11123323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Angiotensin-converting enzyme (ACE) inhibitors are the primarily chosen drugs to treat various cardiovascular diseases, such as hypertension. Although the most recent guidelines do not differentiate among the various ACE inhibitory drugs, there are substantial pharmacological differences. GOAL Here, we tested if lipophilicity affects the efficacy of ACE inhibitory drugs when used as the first therapy in newly identified hypertensives in a prospective study. METHODS We tested the differences in the cardiovascular efficacy of the hydrophilic lisinopril (8.3 ± 3.0 mg/day) and the lipophilic enalapril (5.5 ± 2.3 mg/day) (n = 59 patients). The cardiovascular parameters were determined using sonography (flow-mediated dilation (FMD) in the brachial artery, intima-media thickness of the carotid artery), 24 h ambulatory blood pressure monitoring (peripheral arterial blood pressure), and arteriography (aortic blood pressure, augmentation index, and pulse wave velocity) before and after the initiation of ACE inhibitor therapy. RESULTS Both enalapril and lisinopril decreased blood pressure. However, lisinopril failed to improve arterial endothelial function (lack of effects on FMD) when compared to enalapril. Enalapril-mediated improved arterial endothelial function (FMD) positively correlated with its blood-pressure-lowering effect. In contrast, there was no correlation between the decrease in systolic blood pressure and FMD in the case of lisinopril treatment. CONCLUSION The blood-pressure-lowering effects of ACE inhibitor drugs are independent of their lipophilicity. In contrast, the effects of ACE inhibition on arterial endothelial function are associated with lipophilicity: the hydrophilic lisinopril was unable to improve, while the lipophilic enalapril significantly improved endothelial function. Moreover, the effects on blood pressure and endothelial function did not correlate in lisinopril-treated patients, suggesting divergent mechanisms in the regulation of blood pressure and endothelial function upon ACE inhibitory treatment.
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Affiliation(s)
- Attila Nagy
- Department of Health Informatics, Institute of Health Sciences, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary;
| | - Réka Májer
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.M.); (J.B.); (L.C.)
- MTA–DE Cerebrovascular and Neurodegenerative Research Group, 4032 Debrecen, Hungary
| | - Judit Boczán
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.M.); (J.B.); (L.C.)
| | - Sándor Sipka
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary (M.F.)
| | - Attila Szabó
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Enikő Edit Enyedi
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Ottó Tatai
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Miklós Fagyas
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary (M.F.)
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - Zoltán Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
| | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (R.M.); (J.B.); (L.C.)
- MTA–DE Cerebrovascular and Neurodegenerative Research Group, 4032 Debrecen, Hungary
| | - Attila Tóth
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (A.S.); (E.E.E.); (O.T.); (Z.P.)
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Abstract
Chronic kidney disease (CKD) is estimated to affect almost 10% of individuals worldwide and is one of the leading causes of morbidity and mortality. Renal fibrosis, a central pathway in CKD progression (irrespective of etiology), is associated with shortened or dysfunctional telomeres in animal studies. Telomeres are specialized nucleoprotein structures located at the chromosome end that maintain genomic integrity. The mechanisms of associations between telomere length and CKD have not yet been fully elucidated, however, CKD patients with shorter telomere length may have decreased renal function and a higher mortality rate. A plethora of ongoing research has focused on possible therapeutic applications of telomeres with the overall goal to preserve telomere length as a therapy to treat CKD.
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Affiliation(s)
| | - Michelle C Maier
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Victoria, Australia
| | - James Eales
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.,Manchester Heart Centre and Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University Australia, Ballarat, Victoria, Australia.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Atherosclerosis is a major cause of abdominal aortic aneurysm (AAA) and up to 80% of AAA patients have atherosclerosis. Therefore it is critical to understand the relationship and interactions between atherosclerosis and AAA to treat atherosclerotic aneurysm patients more effectively. In this paper, we develop a mathematical model to mimic the progression of atherosclerotic aneurysms by including both the multi-layer structured arterial wall and the pathophysiology of atherosclerotic aneurysms. The model is given by a system of partial differential equations with free boundaries. Our results reveal a 2D biomarker, the cholesterol ratio and DDR1 level, assessing the risk of atherosclerotic aneurysms. The efficacy of different treatment plans is also explored via our model and suggests that the dosage of anti-cholesterol drugs is significant to slow down the progression of atherosclerotic aneurysms while the additional anti-DDR1 injection can further reduce the risk.
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Affiliation(s)
- Guoyi Ke
- Department of Mathematics and Physical Sciences, Louisiana State University at Alexandria, Alexandria, LA 71302, USA
| | - Chetan Hans
- School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Gunjan Agarwal
- Department of Mechanical Aerospace Engineering, Ohio State University, Columbus, OH 43210-1142, USA
| | - Kristine Orion
- Ohio State Uniersity Wexner Medical Center, Columbus, OH 43210-1142, USA
| | - Michael Go
- Ohio State Uniersity Wexner Medical Center, Columbus, OH 43210-1142, USA
| | - Wenrui Hao
- Department of Mathematics, Pennsylvania State University, PA 16802, USA
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